The Complexity of Curricula Development

Although dental therapy has existed around the world since the 1920s, it is a relatively new phenomenon in the United States.1Globally, the curricula for dental therapy is 2 years to 3 years with the awarding of a certificate or diploma.1 In the US, dental therapy education models have been proposed at the undergraduate and graduate levels. Most models start with a graduate of an entry-level dental hygiene program who then goes on to complete a dental therapy educational program.2

Developing a new program like dental therapy is challenging because there are few examples. Minnesota State colleges and universities (MnSCU) and the University of Minnesota are leaders in dental therapy curriculum with outcomes to demonstrate its effectiveness. Typically, programs in health professions are accredited by a professional organization on an ongoing basis to ensure they meet certain agreed upon standards for the profession. However, dental therapy programs began in the US in advance of national accreditation.

In 2009, legislation for dental therapy was passed in Minnesota, and because no national accreditation existed at the time, the law required dental therapy programs be approved by the Minnesota Board of Dentistry.3 In 2012, the Commission on Dental Accreditation (CODA) began developing dental therapy educational standards at the request of the Minnesota Board of Dentistry, MnSCU, and University of Minnesota. CODA adopted Accreditation Standards for Dental Therapy Education Programs on February 6, 2015, and implemented them on August 7, 2015.4 As these standards were released only 2 years ago and the process to seek CODA accreditation is lengthy and time consuming, as of yet, no programs have undergone the CODA national accreditation process.5 The Minnesota programs remain under accreditation by the state’s Board of Dentistry.

THE COMMISSION ON DENTAL ACCREDITATION PROCESS

There are two pathways to CODA accreditation for developing and existing dental therapy programs. Developing programs do not yet have any enrolled students, while existing programs have graduated at least one class of students and are continuing to enroll new cohorts of students. Developing programs cannot enroll students until CODA grants initial accreditation status. The process can be lengthy because a self-study document addressing the standards for dental therapy must be developed and submitted to CODA with a nonrefundable application fee of $15,000. The work required to develop a curriculum and the processes for evaluation before a self-study document can be completed is significant. A program director has to be hired at least 6 months prior to an accreditation site visit and most programs need the position filled much earlier to develop the program and evaluation processes.6 Even for existing allied dental programs, there is a long list of forms to be completed approximately 12 months prior to a site visit, with work on the self-study commencing at about the same time.7

The self-study document is then sent to a dental therapy site visitor(s) for review to determine if the proposed program meets the criteria for granting accreditation. If so, a site visit is scheduled 4 months to 7 months later.6 Following the site visit, the team submits a report to CODA, which goes through draft review and, once finalized, is submitted to CODA for consideration at the next meeting. The commission then awards the accreditation status and the program is informed of the decision within 30 days. If initial accreditation is awarded, the program may enroll students. It may take 12 months to 18 months to reach this point from the time the application is submitted.6

Existing programs, such as those in Minnesota, will also need to complete a self-study to demonstrate how the program is meeting all CODA standards for dental therapy programs. The self-study will be sent to the site visit team and an on-site comprehensive visit will be conducted to evaluate the program based on the standards. The site visit team develops a draft report of the program’s compliance with the standards, which is submitted to CODA. The report is reviewed at the next scheduled meeting and the program is awarded the accreditation status of “approval with reporting requirements” or “approval without reporting requirements” by CODA.8

WHERE ARE WE NOW?

To date, no dental therapy programs in the US have completed the CODA initial accreditation process. As mentioned before, the existing dental therapy programs at Normandale Community College in partnership with Metropolitan State University and the University of Minnesota are accredited by the Minnesota Board of Dentistry until 2020.3 According to Karl Self, DDS, MBA, clinical associate professor in the University of Minnesota School of Dentistry, the CODA self-study preparation and accreditation process is “time and resource consuming” and since the University of Minnesota program is accredited through 2020, a target date has not been set to submit an application to CODA. Metropolitan State University plans to submit a CODA application in 2019. Vermont Technical College (VTC) has chosen to move forward with the CODA initial accreditation process and is working on curriculum development and preparation of the self-study document with the plan to have its CODA application and self-study document ready for submission by the end of 2017, according to Ellen Grimes, RDH, MA, MPA, EdD, VTC’s dental hygiene program director. This would make the VTC program the first to undergo the CODA accreditation process. However, given the timeline for initial accreditation, it may take 12 months to 18 months before the first students can be enrolled.6

CONCLUSION

The movement to adopt the dental therapy model is gaining momentum; although it faces continued opposition from organized dentistry.2 Despite evidence of the effectiveness of dental therapists in Minnesota, Alaska, and globally, the American Dental Association maintains that access to oral health will be better improved with the addition of its community dental health coordinator model as opposed to the dental therapist model.1,9,10 It will be important for the community to come together to determine the best way to improve access to quality oral health care for all citizens.

REFERENCES

  1. Nash DA, Friedman JW, Mathu-Muju KR, et al. A review of the global literature on dental therapists. Community Dent Oral Epidemiol. 2014;42:1–10.
  2. American Dental Education Association. United States interactive Legistlative Tracking Map. 2017; Available at:adea.org/State-Legislative-Tracker. Accessed September 11, 2017.
  3. Minnesota Board of Dentistry. Dental Therapists and Advanced Dental Therapists: Background and Updates on Implementation. Available at: mn.gov/boards/dentistry/licensure/processingandapplications/dental-therapists.jsp. Accessed September 11, 2017.
  4. Lobene RR, Kerr, A. The Forsyth Experiment: An Alternative System for Dental Care. Cambridge, MA.: Harvard University Press; 1979.
  5. American Dental Association. CODA Votes to Establish Accreditation Process for Dental Therapy Education. Available at: ada.org/en/publications/ada-news/2015-archive/august/coda-votes-to-establish-accreditation-process-for-dental-therapy-education. Accessed September 11, 2017.
  6. Commission on Dental Accreditation. Initial Accreditation Application for a Developing Dental Therapy Education Program. Chicago: CODA; 2016:120.
  7. Commission on Dental Accreditation. Before Your Allied Dental Site Visit. Available at: ada.org/en/coda/site-visits/prep-for-allied-dental-site-visit/before-your-allied-dental-site-visit. Accessed September 11, 2017.
  8. Commission on Dental Accreditation. Accreditation Standards for Dental Therapy Programs. Available at:ada.org/~/media/CODA/Files/dt.pdf?la=en. Accessed September 11, 2017.
  9. American Dental Association Statement on Accrediting Dental Therapy Education Programs. Available at: ada.org/en/press-room/news-releases/2015-archive/february/statement-on-coda-therapist-standards. Accessed September 11, 2017.
  10. Self K, Born D, Nagy A. Dental therapy: evolving in Minnesota’s safety net. Am J Public Health. 2014;104:e63–e68.

From Perspectives on the Midlevel Practitioner, a supplement to Dimensions of Dental HygieneOctober 2017;4(10):28-29.

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