Educator Spotlight: Dr. John D. Rugh, University of Texas Health Science Center at San Antonio Dental School

By Nicole Fauteux 

Rugh for Web

Bring up the topic of teaching evidence-based dentistry (EBD), and it won’t be long before someone mentions CATs, and once the conversation turns to CATs, the name Dr. Rugh is almost sure to follow. 

Dr. John Rugh did not invent Critically Appraised Topics (CATs for short), but he can be credited with seeking out this pedagogical tool, adapting it for dental education, championing its use at his home institution—the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School—and helping to spread the word about EBD from there.

Collectively, CATs is one of several tools currently in use for teaching medical and dental students—and practitioners, for that matter—the skills they need for evidence-based practice. The lessons learned through these single-page evidence summaries include:  

  • Formulating a focused question 
  • Systematically searching the scientific literature 
  • Evaluating the quality of the available evidence 
  • Making clinical judgments about its applicability to the clinical situation at hand 

Dr. Rugh’s interest in CATs grew from his concern about the slow pace at which new scientific knowledge is transferred to the practice community.

“It takes about 14 to 16 years for medical science to make its way into private practice,” he estimates. “It’s not clear how long it takes in dentistry (the research is not as extensive), but it’s probably about the same.” 

Confronted with this problem, it’s no surprise that this former Director of Research for the Dental School and Past President of the American Association for Dental Research turned to the literature. He discovered the use of CATs to teach evidence-based practice in medicine and saw the method as a way to raise awareness of the importance of EBD among dental students and faculty. 

In 2007, Dr. Rugh presented a seminar at UTHSCSA that outlined his vision and rationale for incorporating CATs into the dental school curriculum. By the end of the following year, an implementation plan was in place, a third of the faculty was trained in the use of CATs, students had received their first exposure, and Dr. Rugh had received a four-year National Institutes of Health Education (R25) Research Grant to continue training the faculty and assessing the new EBD program.  

Today EBD skills are taught and employed in all four years of the predoctoral program and in some residency programs as well.   

“There has been a cultural shift within the school,” says Dr. Rugh. “People have bought into the EBD principles. They may be overwhelmed by other stuff, but they see that CATs are workable in different classes, cost effective, and can be implemented at various levels. We’re 85% of the way toward integrating EBD throughout the curriculum.” 

Every UTHSCSA predoctoral student is currently expected to write two to three CATs with a faculty mentor. Eighty-two faculty members serve as mentors and receive academic credit for their CAT publications. These are collected in an online library, which opened to the public in 2011. To date, the library has received more than 50,000 page views worldwide with about 30% coming from patients and 35% coming from the TRIP Database, an international search tool designed to allow health professionals to access clinical evidence. The CATs are reviewed and updated annually, and library visitors are encouraged to post comments.  

The widespread embrace of CATs at UTHSCSA has drawn the attention of other dental schools. Dr. Rugh has spoken at about eight of these. Some are implementing CATs programs of their own. Others are using the CATs library at UTHSCSA as a resource for their own EBD assignments.  

According to Dr. Rugh, bringing CATs to UTHSCSA has been “one of the most fun, exciting, and satisfying things I have done in my educational career.” In his view, people with doctoral degrees (he includes himself) have traditionally focused too heavily on teaching predoctoral students to do science when they really needed the skills, knowledge, and judgment to use science well.   

“With CATs,” he observes, “it’s gratifying to see that students are embracing this, and that they leave here with skills that are of value to them.”