External-Review-Report-of-the-Faculty by hedongchenchen

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									     Report of the Review Committee For the Faculty of
         Dentistry, University of British Columbia,
                       October, 2011



Respectfully submitted by:

                 Paul Allison
                 Dean, Faculty of Dentistry
                 McGill University

                 Bruce R. Donoff
                 Dean, Harvard School of Dental Medicine
                 Harvard University

                 David C. Johnsen
                 Dean, College of Dentistry
                 University of Iowa

                 David Mock
                 Dean & Zwingenberger Chair
                 Faculty of Dentistry
                 University of Toronto
                            Report of the Review Committee
                              For the Faculty of Dentistry
                             University of British Columbia


INTRODUCTION
The University of British Columbia commissioned a review of the Faculty of Dentistry in
conjunction with the end of the first 6-year term for Dean Charles Shuler. Dr. David Johnsen,
Dean of the University of Iowa College of Dentistry, Dr. David Mock, Dean of the University of
Toronto, Faculty of Dentistry, Dr Paul Allison, Dean of the Faculty of Dentistry at McGill
University, and Dr. Bruce Donoff, Dean of the Harvard University School of Dental Medicine
convened for this review. Dr. Herbert Rosengarten was the Review Coordinator for the
University.

The schedule had the team meeting with David Farrar, Provost and Vice President Academic,
Chuck Shuler, Dean of Dentistry, Academic Vice Provosts, Principals and Deans of the
University and Associate Deans in Dentistry, senior Management Staff and Department Heads
on the first day, October 26, 2011.

On Thursday October 27 the reviewers met with Program Directors, Division Chairs, Clinical
faculty representatives, student representatives, and graduate student representatives. On Friday
October 28, meetings were held with additional Faculty members, regulatory authority
representatives and members of the Board of Counselors.

Prior to the visit a self-study was circulated to the panel and additional information was provided
on the panel’s arrival. In addition, written comments were solicited by the University and
reviewed by the committee.

The review closed with meetings with Dean Shuler and Provost David Farrar.

The charge to the review committee was to review the strength and balance of the Faculty’s
teaching, research, academic programs, and community service activities; to evaluate the
Faculty’s leadership and administration; to assess the Faculty’s standing nationally and
internationally; and to advise on the future development of the Faculty.

The report begins with a summary of the relevant and most important issues that emerged from
the review process. The major themes of the strategic plan included enhancing the educational
experience, broadening research and improving community outreach.




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SUMMARY OF MEETINGS
There was a recurring theme from essentially all quarters, that is that the direction of the Faculty
of Dentistry has overwhelming support but with some anxiety on the pace, communication, and
management of individual decisions.

The Faculty of Dentistry has strong support from the central University administration. The
Provost is well informed about the main initiatives of the Faculty of Dentistry. He:
    perceives that the Faculty of Dentistry has a strategic plan in alignment with UBC’s and
       uses it as a guide to decisions on resources,
    perceives the Faculty of Dentistry to be of value to UBC,
    sees the Faculty of Dentistry to be meeting the needs of the province,
    feels that the budget is healthy but not wealthy

The Dean has led a strategic planning process and operationalized the strategic plan, including:
     recruiting and retaining high quality scholars – two of whom are Canada Research
       Chairs
     expanding advanced study programs, including professional specialty and research
       training,
     inculcating a culture of inquiry in the predoctoral program,
     enhancing the research faculty contingent and external support,
     enhancing outreach programs to the province and internationally,
     forming the strategic plan early in the UBC process and seems to be a model,
     maintaining personal visibility in key internal and external constituencies.

The Faculty of Dentistry has a number of commendable strengths, namely:
    Faculty – qualified, committed, with a balance of roles and with a good mix of junior and
      senior
    Students – predoctoral and advanced
    Experienced and dedicated staff
    Strong research activity and support
    An excellent facility with the potential to increase both teaching and research space
      within the Faculty and using shared space, particularly for research collaborations with
      other units
    Excellent relationships with major constituencies, internal and external
    Excellent relationship with its alumni
    Finances healthy but not wealthy
    Excellent outreach programs.




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There have been major changes since 2005 with overwhelming support for the direction of the
Faculty of Dentistry and with pockets of anxiety and some disagreement on some of the decision
management. The Dean has engaged many groups in the process with some feeling less than
fully involved.

Several specific issues emerged, including:
    Faculty positions from Dentistry were transferred to Medicine: about 6 faculty lines are
       in Medicine with the historic understanding of responsibility to teach dental students.
       That responsibility has become vague. The estimated stake is about $800K in base
       budget per year.
    Curriculum change approval is cumbersome with Senate approval needed.
    The processes of promotion and tenure are separate.
    The establishment of an Oral and Maxillofacial Surgery graduate program is desirable but
       is apparently stalled due largely to factors external to the Faculty.

By any set of indicators, the Dean’s performance is at a very high level (statements from
stakeholders included “visionary,” “not afraid to fail,” “be the best it can be”). His strengths
include:
     Strong leadership
     Management skills
     Administrative abilities
     Leads the process for setting direction
     Recruits and retains faculty
     Manages resources well
     Networks well.

Alternative funding streams have been enhanced, including:
     Clinic revenues
     Clinic fees for students
     Research support
     Private fundraising.

Faculty-student dynamic:
    The Dean is committed to learning and is an advocate for students
    A history of students being afraid and only a recent history of dealing with the issue
    Marked improvement with graduates returning in teaching roles
    The balance is unclear between support for faculty responsible for standards and
       respectful learning environment (without fear) Some feel that the school has gone from



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       faculty centered to student centered but the shift, although in the right direction may have
       gone too far toward students.

Relationship (dynamics) among and between faculty groups:
     Wide agreement on the direction of changes with anxieties in some quarters on the pace,
       management and degree of change
     Bonding within groups is occurring
     The dynamics are unclear between and among groups and the reality doesn’t fit the
       administrative diagram
     Roles of Associate Deans seem clear to the Associate Deans. Lack of clarity on the roles
       and interrelationships between Associate Deans and Department Heads and between
       Department heads and division chairs. For example, it is not clear how teaching
       assignments are made between the Associate Dean for Academic Affairs, the two
       Department heads and the 13 Division Chairs.
     Role of Department Heads is unclear – Leadership? Management? Recruiting?
     Division Chairs and Clinical Faculty feel most isolated from the Dean and Program
       Directors. Communication was frequently cited as a problem.
     Annual contracts create anxiety among clinical faculty. This is aggravated by the
       perceived preference of student evaluations over peer review and other forms of
       performance evaluations.
     It is unclear why longer standing faculty members are being renewed on an annual basis
       while University policy allows up to three years.


RESPONSE TO THE TERMS OF REFERENCE
    1. Academic programs and teaching:
The past five years at the Faculty of Dentistry can be characterized by important strategic
positive changes in education, with recruitment of new faculty in clinical, educational, and
research areas. Emphasizing the hybrid problem-based learning methods, faculty have undergone
faculty development programs to enhance their effectiveness. Overall the direction of change is
widely supported and should continue.

The Predoctoral DMD Program.
Whereas we support the principle of medical and dental students learning together, the challenge
is finding the right balance of the coursework relevant for dental students, particularly given the
pressure on space and other resources apparently being experienced by the Faculty of Medicine.
The growth of the medical school class from 135 to more than 280 students merits further
consideration. Cutbacks in time for dental student involvement need to be tempered by careful
review of relevant and important courses for the dental students. Historically the University’s
granting of 6 basic science positions to the medical school at the time to enhance the dental

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curriculum needs to be reviewed in terms of potential costs of $800,000 per annum to the Faculty
of Dentistry if it must assume responsibility for this instruction.


The clinical curriculum seems very sound with four major dental blocks broken down into
modules directed by clinical educators as well as full time division heads. The inclusion of the
new specialty program students in the teaching programs is a positive step. The program is a
hybrid problem-based learning one and some effort should be directed to promoting critical
thinking in clinical care by this process. The addition of an educational specialist whose role it is
to create a culture of scholarship of learning is an important step. During the past few years ten
new faculty have been recruited with major impact on the predoctoral curriculum. Three new
associate Deans are in place which will improve the management and flow of the curriculum as
well. A module on ethics and professionalism has drawn rave reviews. There is some concern by
the students that there will be insufficient patient material for smooth learning experiences in the
clinical areas.

The student experience has been enhanced by community outreach programs. There is need for a
senior level person to head this activity. The impact of these programs on students’ time should
be evaluated periodically. These programs have enhanced the collaboration with local and
provincial dental societies and practitioners in a very positive manner.

The Dean has developed resources for students to enter into research projects and about 20 have
done so. Greater integration of students into the splendid science of the faculty based at the
dental school and with labs in other parts of the University is to be promoted. This is just another
example of Dean Shuler’s dedication and commitment to enhancing the student experience.

Growth in New Graduate Programs
Several new programs in specialty areas have been started. The existing programs of Oral
Medicine/Oral Pathology and Periodontology have been bolstered by the addition of the new
programs in orthodontics, prosthodontics, endodontics and pediatric dentistry. These have been
created to permit the inclusion of Master’s and PhD level programs which should enhance the
scholarship and research training of the students completing the programs. A PhD program in
craniofacial biology is in place and addition of new programs in science will enhance he
recruitment of students.

The rapid pace of growth is being monitored by faculty and the Dean and the impact of the new
programs on existing programs, especially the DMD program, deserves scrutiny




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Cost of Education.
The rising costs of a dental education are of concern although it must be noted that Dean Schuler
has championed increased matriculation of British Columbia students and the standards for
admission have not been adversely effected. Means of reducing the debt burden should be found.

Continuing Education
The panel heard a description of the continuing education programs which have traditionally
been independent. There was some concern that there is little academic oversight of this
program.

Oral and Maxillofacial Surgery
There is still no formal oral and maxillofacial surgery program at UBC. The panel was told of the
difficulties relative to operating room time allocation and inclusion of local and regional oral
surgeons. The DMD students appear to have sufficient education and training in this area but
more could be done to bring oral surgery into the role of dental educators bridging the gap
between dentistry and medicine. This is an ongoing issue raised by faculty and the Board of
Counselors.

A modestly robust Faculty development and training program exists and there is a peer review
program that requires greater communication and inclusion of the clinical faculty. The addition
of the educational specialist should enhance these activities.

    2. Scholarly and professional activities:
Advancement of the Faculty’s scholarly activities is a major component of its Strategic Plan.
They have approached this objective by increasing the faculty’s complement and cultivating a
research environment.

The Faculty has recruited 12 new tenure track faculty members since 2009, expanding both the
depth and breadth of research fields to include basic sciences, clinical sciences and applied
sciences. The acquisition of an educational specialist who encourages collaborations with the
faculty’s educators opens the door to an additional and valuable field that will incorporate some
faculty members who would otherwise have little involvement with research. The Faculty of
Dentistry has two Tier I Canada Research Chairs that provide salary support for senior scientists.
The growth of the graduate program, particularly in the clinical specialties, has increased the
need for research capacity and may stretch the faculty in the near future concerning supervision
of the graduate students doing high quality research projects.

There is evidence of excellent collaboration between members of the Faculty of Dentistry and
other health sciences. The research facilities are spread out across a number of buildings and
facilities but all are reasonably close. Although this does not seem to present any problems at


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present, with the planned further staff expansions, collaboration may be discouraged and should
be monitored.

The research capability in Community Dentistry and Dental Public Health is presently limited to
a few junior faculty members. The review committee felt that the addition of a more senior
faculty member would greatly facilitate what appears to be an opportune area of scholarly
activity for this Faculty, particularly as there are plans to develop a formal Dental Public Health
program.

Research faculty are involved in the graduate teaching but minimally with the undergraduate
students.

There is an obvious need for the addition of metrics to monitor the Faculty’s scholarly activity
and output; however, the available evidence strongly suggests that they compare favorably to
their national and international peers.

    3. Community service/outreach:
In recent years, the Faculty has dramatically increased the community outreach and service
elements of its work, particularly in relation to its DMD and specialty training programs. There
are now multiple learning opportunities for trainees through work with a variety of patient
groups in the community in a variety of settings. These experiences focus on under-privileged
groups such as the institutionalized elderly, those in poverty, aboriginal peoples and young
children, in settings such as the Downtown Eastside, institutions for the elderly, a school, and
remote and rural communities. In addition to providing an increased range of community
learning opportunities, this expanded outreach service has enabled clinical trainees to be exposed
to a high level of volunteerism in the dental profession and so sensitized them to the
accompanying ethical and professional issues.

One area of concern that was highlighted by students with respect to the community outreach
activities was the sometimes large distances they have to travel and, particularly during the
senior years of the DDS program, the lack of new, clinical learning opportunities they sometimes
have when going to these outreach sites.

Finally, in addition to the increased training and service opportunities and experiences for
clinical trainees, the Faculty has a strong applied research group of professors who are also
performing research in the aforementioned under-privileged groups and settings and thereby
providing similar learning opportunities to research trainees.




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    4. Governance, organization, and administration:
Leadership is clear and the direction of the Faculty of Dentistry is widely endorsed with a
spectrum from acceptance to distinct enthusiasm. Administration of individual administrative
units is active in dealing with arising issues and solving problems. Resources are adequate to
fulfill the strategic goals and daily operations. In the opinion of the Review Committee, the
dynamics between and among the different faculty groups are unclear. Identified faculty groups
include Associate Deans, Department Chairs, Program Directors, Division Chairs, Module
Directors and Course Directors. The two groups with which we met that seemed most separated
(and from whom we hear the deepest concerns on the pace and management of specific
decisions) were the Division Chairs and clinical faculty representatives (we later learned that
some of these were Module Directors). All of these groups see the Dean as a “go to” person.
The system seems to function and it may be clear to those inside the system, but the dynamics
between and among these groups remains unclear to the Review Committee. Relationships
between the Faculty of Dentistry and the central administration are active and constructive in
both directions. There is active involvement between the Faculty of Dentistry and several units
and groups within the University – with respect to education, research, and university service and
university governance. Faculty mentoring is ongoing and is effective as evidenced by the
success in the promotions process. Promotion and tenure are separate and this is a problem as
the two processes are interrelated.

    5. Infrastructure and resources:
The physical facility is in a good location with access to the academic health center. Travel time
to community and other offsite settings may be presenting a challenge. The facility was
expanded and renovated with completion since the last review. The facility is quite adequate to
carry out the mission of the Faculty of Dentistry. Considerable institutional energy has been
expended for many years to realize the new facility and the many involved ought to be
commended for the end result. Research space is both in the Faculty and in buildings with
multiple units, thereby enabling strong collaborations. Renovations of Faculty space are ongoing
in accordance with strategic functions. This is true for teaching, research, patient care, and
outreach. The finances are healthy if not wealthy. Financial streams that have been enhanced
are clinic income, research support, student fees, and private fundraising. The External Advisory
Group was enthusiastic and impressive in their eclectic nature, covering many key constituencies
in their support and enthusiasm.

    6. Interactions with the profession outside the Faculty (including the University):
Since Dean Schuler arrived, the relationship with various elements of the dental profession in
British Columbia has improved dramatically. The Dean himself has reached out to the BC Dental
Association, the BC College of Dental Surgeons and a variety of regional and local dental
groups, and they have responded very positively in a number of ways. This partnering of the



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Faculty with the dental community has enabled the creation of some highly innovative programs
of mutual benefit to the trainees and the profession in the community. Examples include:

   a rural placement project in which senior DDS students can do externships over the summer
    with dentists working in communities with low numbers of dentists, thereby helping
    recruitment into these areas, with some success; and
   a mentorship program for senior students in which they are paired with a dentist in the
    community so they can learn about practice management and professional issues from the
    perspective of practitioners working in community dental offices.

In addition, the Dean has set up a “Board of Counselors” that has wide representation from a
variety of external stakeholders, including alumnae, friends of the Faculty, and members of the
dental hygiene community, the dental industry and organized dentistry. This group is very
supportive of the strategic directions of the Faculty and is enabling current and future links
between the Faculty and the community.

With respect to the Faculty’s relationships with other units at UBC, it clearly has strong support
from the University’s central administration and has a well-established relationship with the
Faculty of Medicine concerning the teaching of their MD and DMD students. Beyond this, on an
organizational level, the links with other health professional units are minimal, although there are
a number of examples of teaching and research collaborations organized at an individual level
between members of the Faculty of Dentistry and other units.

While external and internal relationships and collaborations are on the whole strong, two areas of
concern were observed by the review panel:

   The Faculty and its members are very keen to develop a specialty training program in oral
    and maxillofacial surgery and this would be an excellent addition to the range of programs
    the Faculty provides both in terms of teaching and research opportunities but also in terms of
    service to the community. However, relationships with the University Teaching Hospital
    Network and relevant professional groups seem to creating barriers to the development of the
    program and things have not changed in this realm for some time.
   Pressure on the MD program to take on increasing numbers of students and the limited
    resources available to accommodate those increases are putting strain on the partnership
    between the Faculties of Medicine and Dentistry for teaching in the MD and DMD programs.
    This is exacerbated by differences between the two Faculties over the nature of the historical
    agreement that enabled the MD/DMD teaching partnership.




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     7. Equity & Diversity
A new initiative has been introduced at UBC that aims to address issues of equity and diversity
in its faculties. The Committee met with the Senior Advisor on Women’s Issues who explained
that structures and metrics needed to be instituted to facilitate an appropriate evaluation of the
issues that are at play in the various faculties and that she would be meeting with Dean Shuler in
the near future to discuss Dentistry’s role in this process and whether the Faculty of Dentistry’s
Strategic Goals address issues of representation, leadership, diversity, and institutional
environment.

    8. Future Development & Recommendations
First and foremost, the reviewers unanimously agree that the existing academic plan and course
continue.
Our recommendations are:
    1. Consider slowing the implementation of additional clinical graduate programs while
        monitoring their effect on faculty members and the DMD program, both academically
        and clinically,
    2. Review the methods of monitoring DMD students’ clinical experiences to ensure
        adequate coverage of all necessary competencies in light of the concern regarding the
        impact of the new specialty programs and comments made,
    3. Review operation of the Continuing Education Department and its relationship to the
        Faculty’s academic mission and standards,
    4. Initiate appropriate discussions with the Faculty of Medicine and the University
        administration to ensure that the education standards for the undergraduate curriculum do
        not suffer as a result of their expansion, particularly the differences in the understanding
        of the number of faculty lines responsible for teaching dental students,
    5. Initiate discussions with the Faculty of Medicine and the teaching hospitals with a view
        to creating a graduate program in Oral & Maxillofacial Surgery,
    6. Review the organizational structure of the Faculty to ensure appropriate designation of
        responsibilities and indicate lines of communication to ensure adequate dissemination of
        information and allay some of the anxiety with change,
    7. Review the application of the PBL method in the clinical years,
    8. Examine the impact of the cost of dental education (both DMD and specialty programs)
        on the nature of the applicant pool,
    9. Review the system of keeping long-standing non-tenure-track staff on year-to-year
        contracts rather than longer term contracts, and ensure the annual evaluation criteria for
        these staff are clear to them.




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