Guest Perspective(1)

Learning: the Sine Qua Non of Innovation

Dr. N. Karl Haden, Academy of Academic Leadership

As communities devoted to learning, discovery, dissemination, and application of new knowledge, institutions of higher education are ironically slow to change and adopt new ways of doing things. They rightly demand evidence to guide both pedagogical and clinical practice decisions. Not only must academicians understand why change is necessary, they must also be able to envision superior outcomes, know how to implement the innovation, and appreciate how change affects the culture of the institution and the individuals in it. Change is a learning process, and learning is the sine qua non of innovation.

In 2005, ADEA launched a bold initiative, the ADEA Commission on Change and Innovation in Dental Education (ADEA CCI), to build consensus and to lead change. Through white papers, open forums, and engaging Liaison teams at dental schools, ADEA CCI has fostered the learning process needed to bring about change. This learning has focused on the evidence for change in the predoctoral dental curriculum, best practices, and implementation strategies for novel and innovative ways to educate general dentists for the 21st century.

A recent survey of associate deans for academic affairs or their equivalents at U.S. and Canadian dental schools reveals ADEA CCI has succeeded in galvanizing innovation through broad and deep learning. Conducted by the Academy for Academic Leadership and ADEA, the 2009 Dental School Curriculum Format and Innovations Survey updated and expanded data gathered in a similar study conducted approximately seven years earlier. Fifty-five U.S. and Canadian dental schools responded to the survey, an 82% response rate.

According to the 2009 survey, the majority of dental schools are involved in learning processes that will build bridges to new models of dental education. The survey asked in which year the responding schools conducted their most recent broad-based, comprehensive review of the overall predoctoral curriculum. Prior to 2005, the year in which ADEA CCI began, only 14% of respondents indicated their schools had conducted a comprehensive review of the predoctoral curricula. By contrast, 45% of respondents reported completion of a comprehensive review since 2005, and another 42% stated they were engaged in a review during 2009.

The institutional learning that is taking place has the appearance of being more deliberate and informed than previously. In the survey conducted in 2002-03, the three primary catalysts for change were changes in resources, scientific evidence that needed to be incorporated into the curriculum, and alumni feedback. In 2009, survey respondents indicated the top catalysts for change were "findings of a curriculum review conducted by ourselves," student feedback, educational best practices reported in the literature, and scientific evidence. Another notable difference from the earlier survey is the level of faculty dissatisfaction with curricula, with 70% of respondents indicating this factor is an important or highly important catalyst for change, compared to 27% seven years earlier.

What has changed in dental education over the past seven years? The most striking change is an increase in students' community-based clinical learning experiences. In 2002-03, 42% of responding dental schools required community-based clinical experiences in the core curriculum. Today, 91% of respondents indicated community-based patient care requirements for all students as a part of the core curriculum, with 50% indicating this requirement extended to five or more weeks.

Just over half of respondents also stated students' patient care experience is based on a general dentistry concept and students acquire competencies in the dental disciplines in the context of comprehensive patient care. In other areas, change might better be described as incremental. Nearly half of the responding dental schools indicated most of their curricula is still organized around disciplinary boundaries, although many schools have shifted at least one major section of their curricula to a theme of interrelated topics taught by interdisciplinary faculty teams. Compared to the data gathered in 2002-03, there is a slight increase in the use of problem-based learning in the classroom.

Perhaps the reticence to move swiftly in these areas can be ascribed to a preference for stability within the academy. When asked what factors principally influence design of the school's curriculum, the highest ranked answers were: capacity (the curriculum is feasible); success (the curriculum works; our graduates do well); comfort (faculty are comfortable with the curriculum); tradition (curriculum reflects long-standing values); and resources (curriculum reflects the resources available to us).

Each of these influential factors has the potential to become a barrier to change. Some of these barriers, such as resources and capacity, are largely dependent on the external environment. Success may be measured in a variety of ways, but it is typically measured in established ways that may be long outmoded. Comfort may well inhibit the experimentation and appropriate risk-taking required for innovation. While tradition has a valuable place in institutional life, institutions and what they do can be left behind if they remain tied to the past. A disciplinary organizational and curriculum structure is one tradition that presents a significant barrier to many dental schools.

As educators, we know that if we ask a person to do something differently-particularly if that action requires stepping away from an established way or moving outside of one's comfort zone-that person must learn why and how. Our students must learn new ways of thinking and acting and form new attitudes and behaviors appropriate to the evolving needs of the profession in the 21st century. Similarly, dental schools must bridge the knowledge gap between existing pedagogies and envisioned ones.

While some barriers are largely beyond the control of an institution, many others are addressed by learning the "why" and "how" of change. Respondents to the 2009 survey placed high priority on professional development and training for experienced and new faculty related to innovations in curriculum design, teaching strategies, and assessment methods as critical to the implementation of innovative pedagogies. The cultivation of lifelong learning is one of the principles identified by ADEA CCI as fundamental to the educational environment. Lifelong learning is not only a habit we wish to develop in our students, but also a defining trait of faculty and academic dental institutions themselves.