The Center for Research and Education in Technology (CRET) is pleased to report its completion of the first Technological Readiness Assessment of US dental schools. The idea for the assessment emerged from our discussions with dental industry leaders. These leaders indicated that orders from dental schools for new digital technologies were sluggish compared to dental practices. The reason for this disparity was unclear. Was cost an issue? Were faculty members not prepared to teach new technology? Were dental schools unaware of technologies? Was the dental industry putting up a barrier? Or was there some other reason altogether?
To obtain more information, we developed a survey on new and emerging technology acquisition by dental schools. Our survey, which was promoted as our 2017 Dental School Technology Audit, was made available to dental school deans earlier this summer. We did not design the survey to be an equipment inventory; the intent was not to count anything. Rather, we were interested in obtaining a 30,000-foot view of the "readiness" of US dental schools to identify, obtain, and integrate new and emerging technologies—especially digital technologies. Moreover, our survey was not intended to rank dental schools. Its purpose was solely to provide baseline information to dental schools, the dental industry, and dental professionals.
Our survey was composed of 10 multiple choice questions with opportunities to offer comments after many of the questions. Questions included:
• how funding was obtained for new/emerging dental technologies;
• how "healthy" or mutually beneficial relationships were between the school and the dental industry;
• whether digital technologies were used as examples while teaching clinical courses;
• whether digital technologies were included in practice management courses; and
• whether schools allocated resources to faculty training on digital technologies.
The survey completion percentage was 11% (seven universities)—a percentage we hoped would be higher, but one we thought promising for an initial assessment.
Given the completion rate and methodology, we issue this disclaimer: This report is not a scientific report. It contains no graphs, charts, or tables, and it should not be judged using the same criteria used to review a research paper. However, we believe that the survey revealed valuable qualitative and quantitative information. We also believe the information can elucidate aspects of the relationship between dental schools and the dental industry, as well as how this relationship might affect dentistry as a whole.
Although this was a pilot study, responses revealed some surprises. We expected responses for some questions to be distributed along a normal curve, but we found this was not always the case.
We will now break down the results into the following areas:
• digital technology in teaching
• funding digital technology purchases
• keeping up with digital technology
• monitoring developments in the digital technology field
• role of the dental industry
• comments and case studies from dental schools
Digital technology in teaching
With the millennial generation of students, using digital technology is not a problem. However, we wondered if this would be different with faculty members. We therefore were interested if dental schools had digital training programs in place for faculty. Fifty-eight percent (58%) of respondents reported they had training programs, while 42% reported they did not.
Digital technologies (especially equipment) can be used for more than treating patients. For example, it is possible to use the morphology feature of CAD to teach dental morphology. To find out if dental schools incorporated digital technology into clinical lectures, we asked if faculty members discussed digital technologies to help students understand clinical dentistry. Eighty-six percent (86%) of schools answered yes.
The results showed that most dental schools teach digital technology in practice management courses. When asked if the school addressed the topic of “how emerging technologies affect practice management,” 57% reported it was.
When asked if the topic of “how to make product and equipment purchases” was included in practice management courses or otherwise, 29% responded yes. If this is a general trend, it would mean about two-thirds of dental school students receive no information on how to make purchases of products or equipment. One can only wonder how recent graduates decide. Of course, they probably ask industry representatives. When we asked if the school's practice management courses encouraged “communication with dental industry representatives,” 43% replied yes.
Funding digital technology purchases
To evaluate funding, we asked schools to indicate if they received funding for emerging technologies from any of these sources:
• university-specific budget requests
• annual requests in the dental school’s operating budget
• grants (including federal, state, or philanthropic)
• alumni donations
Fifty-seven percent (57%) reported that they obtained funding by making specific budget requests to the university, while 42% obtained funding by including a request in the dental school’s annual operating budget. Fourteen percent (14%) received funding through grants and donors. One school reported no funding was available for emerging technologies, and one school reported that corporate gifts were vital.
Keeping up with digital technology
We asked schools to respond to the global question, "Is your school keeping up with the acquisition of new technology?" Eighty-six (86%) of respondents reported yes. This response made us raise our eyebrows, as there is clearly a disconnect between what the dental industry believes about the situation.
Monitoring developments in digital technology
We also wanted to know if schools were monitoring developments in the field of digital dentistry. We asked if the school had a director of digital dentistry, a school-wide committee, or anyone working on developing specific plans for acquiring emerging technologies. Almost all schools (86%) responded yes. This result was interesting, as it implied that digital technology was very much part of the decision-making process.
Role of the dental industry
The dental industry usually has an important role in informing dental faculty about new equipment and products, as well as in providing training programs. (This is our experience in working with both schools and industry members.) We asked schools about their relationships with dental industry representatives. We asked if relationships could be classified as "minimal"; "having little to no communication"; "being limited with some communication"; "good"; or "strong with frequent and proactive communication". No school replied minimal, and most schools were equally divided between good and strong. This result was consistent with expectations, and reinforced the conclusion that the dental industry likely remains an important source of information and advice—even as information channels have diversified and proliferated.
Comments from dental schools
We asked deans who completed the survey if they would be interested in providing further comments on request. Most schools expressed interest, and we subsequently spoke to dental school deans about challenges and successes of acquiring new digital technologies. Their answers were instructive, and we have included two examples here.
A closer look: The University of Michigan School of Dentistry
Lynn Johnson, PhD, an associate dean at the University of Michigan School of Dentistry, talked with us about "rate-limiting factors" for acquiring and incorporating new and emerging technologies. Specifically, Dr. Johnson described the difficulty of taking digital technologies that were designed for single practices and incorporating them on an enterprise scale.
"Our rate-limiting factor is implementing technology, not acquiring it," Dr. Johnson said. "We have to deal with hundreds of student practitioners, as opposed to a few practitioners in a dental office. For example, when dealing with software, we have to invest in significant infrastructure and manpower behind the scenes to ensure that the software is installed in a secure manner and the data is protected."
At the University of Michigan's dental simulation lab, which hosts more than 100 digital workstations, keeping software continually updated and in compliance with university cybersecurity standards can be a problem. For example, Dr. Johnson—whose expertise is in information technology—says software updates for digital dental products are not typically designed to be "pushed out" easily to multiple machines. Therefore, the process is a manual and intensive one to keep 100-plus workstations current.
"That manual process really drives up the cost of us supporting the software and supporting the technology," Dr. Johnson says. "Those costs are the additional people required to do software updates in a secure manner and in keeping with the licensing of the vendor. We're not going to violate any licensing codes, and we're not going to violate any security mechanisms the university puts in place. But the vendors make it difficult to take something designed for a single office to be put into our simulation lab and consequently into our clinics. We get why they do it, but it still creates difficulties for us."
When asked about working with the industry to correct these kinds of problems, Dr. Johnson says there have been difficulties in getting their needs heard by decision-makers at the technical level. This problem was not exclusive to a single vendor, but a pervasive impediment.
How can these problems be overcome, and are things getting better or worse? Dr. Johnson, who has 30 years' experience working at the university level, has observed this: "From a software perspective, if schools work together, we can help move vendors forward. It's hard and expensive to build these technology products. For a while, I don't think vendors were listening to the schools. But now I think they're listening and understanding that we can help them build better products. It's mutually beneficial."
There is also an added incentive for the industry to collaborate with schools. "We at the University of Michigan are able to pull from resources that go beyond dentistry," Dr. Johnson says. "Not every university or dental school can do that. We have strong connections throughout campus—in IT security, medicine, pharmacology, etc. We can bring expertise from many domains. Today, I would say no matter what your technology is, things are getting more complicated, and you're better off working in a community with numerous and various experts rather than working in isolation. We can help bring the latest ideas and great minds to the table."
A closer look: Oregon Health and Sciences University School of Dentistry
We had the chance to interview Philip Marucha, DMD, PhD, dean of the Oregon Health and Sciences University School of Dentistry, about his responses. Talking with Dr. Marucha opened a window into a different view of emerging technology.
Specifically, we asked Dr. Marucha about where the teaching opportunities were for emerging technologies. Dr. Marucha surprised us in his answer. Instead of confining it to the curriculum, he talked about how emerging technology could be used to explore the integration of dentistry into the health-care system. For example, he envisions students learning about how artificial intelligence (AI) algorithms could be used for integrating medical and dental records, or how tracking patient-care outcomes could be used for charting success and processing reimbursements.
Dr. Marucha adds that one of the best uses for teaching about AI is in diagnosis. “AI would be perfect to integrate intraoral images taken with a digital wand with images transmitted by teledentistry to on-call consulting dentists located at geographically distant sites,” he says.
He continues, “Eventually, when DNA on a chip becomes available, there will be an opportunity to evaluate each patient’s susceptibility to a range of diseases both medical and dental. AI will be invaluable in this evaluation allowing integration of all the chip’s data.”
Building on this year's data, we hope to gain more insight when we offer our emerging technology survey to US dental school deans in 2018. In addition, we intend to use the insight gained in this report to help strengthen our existing Technology Center partnerships at Loma Linda University, the University of Missouri Kansas City, and West Virginia University.
We thank those who participated in this year's survey and hope that others will find this information of use to strengthen the relationship between dental schools and the dental industry.
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For more information, please contact:
Edward Rossomando, DDS, PhD, MS
President, Center for Research and Education in Technology (CRET)
Vice President, Equipment Sales, Henry Schein
CEO and Chairman of the Board, Center for Research and Education in Technology (CRET)