The ADEA CCI Liaison Ledger talks with Todd Thierer, D.D.S.,
M.P.H., Associate Dean for Clinical
Affairs and Associate
of Primary Dental Care, School of Dentistry, University of Minnesota
School of Dentistry
Liaison Ledger: What
would need to change in advanced dental education programs (such as curriculum,
accreditation, licensure, admissions standards) to produce graduates that are
person-centered care providers?
Todd Thierer: Continuity of care is an
issue, especially in shorter general dentistry programs, because of resident
rotations and other things that take folks away from the comprehensive care of
patients. In advanced dental education, we assign patients to individual residents,
and I think we need to move toward a team approach where residents are part of
a team that’s headed by a faculty member who’s responsible for the patient’s
care. That would create a person-centered approach where that person feels like
they’re not being shifted around at the discretion of the program for
educational purposes, but it’s actually they and their treatment that’s at the
center of things.
curriculum also needs to change so the residents’ prime focus is not on getting
experience doing procedures but on being able to address the needs of the
particular patients they’re seeing that day. That needs to be one of the
outcomes residents are evaluated on.
in the specialty programs, we tend to be very procedure-focused, and we tend to
focus on making sure residents attain technical competence. We spend less time
making sure they provide a patient experience so people feel that they’re
treated well. We don’t collect that data, and that’s not going to change unless
there’s an accreditation requirement to do that.
Liaison Ledger: Where
does a health professions education association begin in trying to transform
the faculty perspective from patient-centered to person-centered?
Todd Thierer: The previous iteration
of CCI put humanistic values in the CODA standards, but it was more on the
school culture side of things. ADEA has a history of working with CODA, and I think
we can do that again to add very specific standards about the patient
experience to the standards for predoctoral and advanced dental education programs,
and detail how those standards need to be used to evaluate students and
residents. I would be fairly specific about the skills they need to demonstrate
in order to graduate.
Liaison Ledger: What does
the advanced dental education program of the future look like to you if the
predominant model of practice is person-centered?
Todd Thierer: Right now, we do patient-satisfaction
surveys, but it’s not so much about the patient experience. We need to find
ways to collect better data on the patient experience, to have staff members for
whom that’s their prime focus.
now have a person who is totally devoted to patient experience, so hospital-based
education programs are getting a taste of that already, but it’s not reflected
in the accreditation requirements. I keep going back to that, because unless person-centered
care is required there, there’s going to be a resistance that won’t be
from our authors
Nadeem Karimbux: Who is going to be the
champion of the patient or the person in terms of advocating for them and
helping them navigate through what are very complex organizations? To have that
humanistic or personal touch, to look at that information and provide holistic,
comprehensive care—even within the medical field—is something that I think
continuity of care, a lot of teaching clinics have moved to what we call a
comprehensive care model, but the advanced education programs still are really
almost islands of their own. The extreme of procedure-driven, discipline-driven
treatment plans takes us even further away from what we are trying to get at
with person-centered care.
Andrew Spielman: Dr. Thierer’s comments
also speak to the major deficiency that we currently face in patient care
delivered in a dental school setting, or even a residency setting. If I were a
patient, I would hate to move from one practitioner to another. I believe that
we will become truly person-centered when a dental student completes patients
and one of the outcome assessments is, “I completed the following patients, and
they were happy with my care.”
could really move into a patient-satisfaction-based outcome. If you had to
achieve 4.5 stars on a Yelp-type survey of patient satisfaction, it would
certainly make the student pay attention.
Nadeem Karimbux: There’s really nothing
in the advanced dental education program standards right now that talks about
person-centered or even patient-centered care. Appropriate standards would go a
very long way to establishing that person-centered care should happen in some
form across all graduate programs.
Muhammad Walji: Let’s be careful with
the standards as well, because some aspects of person-centered care are harder
to measure than technical procedures. It may be challenging.