By Dan Soine

A sea change is coming to the sea of chairs spanning the Main Clinic at the Arthur A. Dugoni School of Dentistry.

The physical expanse of the operatories looks impressive. New patients, visitors, students and others who visit the Main Clinic for the first time have a nearly unanimous reaction to its sheer size – it sure doesn’t look like any dental clinic they’ve ever seen.

But now the clinic is preparing for a major transformation. While the full expanse of Main Clinic operatories will remain in place, much of the organizational and behind-the-scenes structure of the clinic is changing in the next year.

Ultimately, these updates will ensure that the school continues its legacy of providing an outstanding, clinically based education to students, and comprehensive, patient-centered care to Bay Area residents in need.

“Creating clinically trained dental professionals is at the very heart of our school’s mission,” explains Dr. Richard Fredekind, associate dean for clinical services. “The new changes will keep us at the forefront of dental education and ensure that the clinical experience we provide remains second to none. Our clinics were good before, but with these updates, they’ll only get better.”

The most fundamental shift to come is a reorganization of the Main Clinic from four group practices into eight student private practices, each with its own practice leader (formerly known as group practice administrators or GPAs). The reduction in the average size of each practice will allow practice leaders to work even more closely with students than before.

Other changes are coming as well. The second- and third-year classes will be merged in the clinics. There will no longer be a separate second-year clinic or “second-year experience.” Students now will have two years of clinical practice at their individual learning paces, achieving competency in the various disciplines managed by their student practice leaders, and faculty within the practices.

In addition, first-year students will have an opportunity to gain additional exposure to the clinic. From the start of their first week, first-year students will get introduced to their student private practice and forge an even closer relationship with their practice leaders. They won’t be treating patients directly at this point, but will spend additional time getting familiar with the people, processes and procedures involved in patient care.

The changes to the clinics are the results of a planning process that started several years ago as part of the implementation of the school’s strategic plan, Advancing Greatness. More than 50 people were involved in two task forces to analyze how the Main Clinic can continue to refine and enhance its structure and processes to the benefit of patient care and student education.

A Model Adjustment

What’s driving these changes?

In 2008, the Dugoni School of Dentistry made a major philosophical and practical change to the way it educates its students through the development of the Pacific Dental Helix Curriculum. This new approach places a strong focus on active learning and critical thinking by integrating multiple disciplinary areas. The goal is to move toward small-group, case-based learning as a signature pedagogy. The process of developing the new curriculum also called for a complete review of the clinical practice model to make sure that this important component of the school’s educational program was staying on the leading edge of dental education.

“A major component of the development of the clinical practice strand of the Pacific Dental Helix Curriculum is to serve as the practical laboratory to integrate the practice management curriculum into the student private practices,” said Dr. Nader Nadershahi, executive associate dean and associate dean for academic affairs. “Students are not only learning to manage the diagnosis and delivery of care, but also the management skills to develop and maintain a productive practice.”

In early 2009, a task force was created to look at the existing clinical teaching model and make recommendations on the organization and management of the system. As part of its background work, the task force performed a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis of the clinic system. The group also discussed issues such as faculty coverage, student and faculty attendance, and differences in teaching between the second- and third-year clinics. A separate task force reviewed the resulting recommendations (See Master Plan sidebar) and developed an implementation plan.

The task force teams identified strengths in the current clinic teaching system that the new model retains or improves upon. These current strengths include excellent clinical training; a humanistic approach to education; comprehensive patient-centered care; the school’s generalist model and the use of specialists for difficult cases as in private practice.

Educational and Operational Benefits

The new clinical model is designed to be truly patient centered, stressing the “ownership” of the patient’s care by all treating and supervising team members. The new model will provide some flexibility in teaching and allow all members to capitalize on their personal strengths. It will also tie into the Helix Curriculum through the integration of clinical, biomedical, and behavioral sciences, and ensure careful supervision of patient care, with meticulous safety precautions during all clinical procedures. In addition, the new model will better ensure adequate patient distribution among students.

Delivery of services will also be adjusted. The services offered in the comprehensive care setting will be expanded to include simple procedures in the disciplines of endodontics, oral surgery, periodontics, removable prosthodontics, implants and orthodontics, which will decrease the number of referrals outside of the Main Clinic to other specialists in the school. This change will ensure continuity of care for the patients and also better reflects what happens in private dental practices. Furthermore, it will increase the value of the specialists, which in the new model will supervise only more complex procedures, where their expertise can be best utilized.

[pullquote]The new clinical model is designed to be truly patient centered, stressing the “ownership” of the patient’s care by all treating and supervising team members. [/pullquote]

Under the new model, the screening and emergency care rotation will be absorbed into the normal student workload. This will allow students to treat and follow up with their own emergency patients. As in private practice, emergency patients will be seen when time allows. This means that students who have cancellations or “no show” patients can still have learning experiences. Patients will be screened by teams, which will allow faculty to assign new patients as needed within the team.

Another key benefit of the reorganized clinic model is the strengthening of team spirit, thanks to the inclusion of a strong leader who organizes huddles and monitors each team. A more hands-on approach will increase knowledge about individual students and allow for small problems to be handled before they grow to impact learning and patient care.

Another change will involve patient scheduling. Rather than having students schedule appointments on their own, the school is moving toward staff-managed and technology-assisted appointments. Lightweight laptops will be available for staff to use chairside to make next appointments for patients. Plus, touchscreen monitors have already been installed in the patient reception lobby for use by patients to check in. The electronic check in will be a more convenient and quicker way for patients to check into the clinic, compared to waiting in line at the lobby reception desk.

All of these operational changes are expected to increase chair utilization and decrease complaints from patients about not being seen by their own student dentists. The shift to smaller and more collaborative teams is also expected to lead to a decrease in waiting times for students looking for supervision by faculty. Thanks to these changes, the school expects clinic productivity to increase by 10%.

A Commitment to Delivering the New Model

The changes in the clinic model, and the resulting new policies and protocol, will require significant cross-training among faculty, staff and students.

“Everyone is interested in how the changes will impact them,” said Fredekind.  “We’re keeping the lines of communication open with students, faculty and staff as we move forward. We’re open to feedback and want to make sure that the overall implementation will ultimately enhance the experience of both students and patients.”

The dental school expects to fully implement the new clinic model by July 2012, with minor adjustments as needed subsequently. However, while the clinic will run differently, the changes do not mean an immediate end to the sea of chairs in the clinic. The switch to the new model will not be complete until after the school takes occupancy of new facilities in the future. Then, it will more adequately have physical space that allows for the new distribution of eight teams with physically separate clinic spaces.

While the school incorporates the new model within its existing facilities, there may be some bumps along the way. A sea change does not guarantee smooth sailing! However, the faculty, staff, students and administration are committed to this clinic transformation and excited about what the future holds for education and patient care at the school.

Dan Soine is Director of Marketing & Communications at the Dugoni School of Dentistry.