PROPOSED MODIFICATIONS TO THE DENTAL PUBLIC HEALTH (DPH) POSTGRADUATE PROGRAM (February 11, 2021)

1. PROGRAM OVERVIEW AND HISTORY

The UCSF Dental Public Health (DPH) Postgraduate Program is a one-year, full-time certificate program accredited by the Commission on Dental Accreditation (CODA). Established in 1980, it is the only active DPH program on the West Coast. Each year, the program accepts dentists (DDS or equivalent) based on the number of CODA-approved slots, who possess a Master of Public Health (MPH) degree or its equivalent and seek advanced training in dental public health. The program activities are uniquely tailored to each resident’s past experience and interests, with a goal of developing expertise in the ten core competencies for a DPH specialist outlined by the American Board of Dental Public Health (ABDPH).

For twenty-two years, Dr. Steven Silverstein was the DPH Program Director until 2012 when Dr. Howard Pollick became the DPH Program Director. In November 2016, the DPH program obtained approval from the UCSF School of Faculty Council to proceed with offering a joint program with the one-year interdisciplinary MPH program at the University of , Berkeley (UC Berkeley). This program has helped to identify prospective applicants and create a recruitment pipeline for the DPH program. In 2019, Dr. Enihomo Obadan-Udoh became the DPH Program Director and has been working to enhance the program and achieve its stated goals and objectives.

Dental Public Health Postgraduate Program Goals Our goal is to be an internationally acclaimed postgraduate program that prepares residents for leadership in dental public health education, research, and practice.

Objectives i. To attract a competitive pool of applicants interested in advancing dental public health through research, education, and practice ii. To enable residents to develop competency in the following ten areas outlined by the American Board of Dental Public Health (ABDPH) for dental public health specialists1: 1. Manage oral health programs for population health 2. Evaluate systems of care that impact oral health 3. Demonstrate ethical decision-making in the practice of DPH 4. Design surveillance systems to measure oral health status and its determinants 5. Communicate on oral and public health issues 6. Lead collaborations on oral and public health issues 7. Advocate for public health policy, legislation, and regulations to protect and promote the public’s oral health, and overall health 8. Critically appraise evidence to address oral and public health issues for individuals and populations 9. Conduct research to address oral and public health problems

1 10. Integrate the social determinants of health into DPH practice iii. To prepare residents to become eligible for the ABDPH Certification Exams and to encourage them to attain diplomate status within five years of completing their training iv. To produce graduates who will actively contribute to dental public health education, research, and practice in their chosen job positions upon graduation

2. JUSTIFICATION AND REASON FOR PROPOSED CHANGES

Despite receiving a commendation from CODA during its 2019 accreditation site visit, the DPH program has experienced challenges that mirror the perennial challenges faced by the DPH specialty nationwide. For example, there has been a declining interest in DPH postgraduate training resulting in lower application and enrollment rates compared to other primary care dental specialties. The number of applications to the 15 DPH programs across the country has been sub-optimal [195 applications in 2018 compared to 6531 for Advanced Education in General Dentistry (AEGD), 11,538 for General Practice Residency (GPR) and 9766 for pediatric dentistry (PD)].2 There is an urgent need to expand the pipeline of DPH professionals who are trained and equipped to effectively lead oral health programs at the local, state, and national levels to address the burden of oral diseases in the US population.

Furthermore, prospective applicants have regularly expressed a desire to maintain their clinical skills while pursuing DPH training. Since the DPH program has traditionally been offered as a non-clinical residency program, there are currently no opportunities for residents to maintain these clinical skills or learn new skills that are relevant to the practice of dental public health, such as conducting school-based dental screenings and oral health needs assessments, or applying caries-preventive treatments (e.g. fluoride varnish, silver diamine fluoride) in public health settings, such as school-based oral health programs or Federally Qualified Health Centers (FQHCs).

3. CURRENT PROGRAM OUTLINE Based on the 2018 CODA Accreditation Standards for Advanced Dental Education Programs in Dental Public Health3, the curriculum is designed to “provide special knowledge and skills beyond the D.D.S. or D.M.D. training” as outlined below:

1. Instruction in Ethics and Professionalism (4-1): “Graduates must receive instruction in and be able to apply the principles of ethical reasoning, ethical decision making and professional responsibility as they pertain to the academic environment, research, patient care, practice management, and programs to promote the oral health of individuals and communities.”3

2. Instruction in General Public Health or MPH degree requirement for One-year Programs (4-2; 4-3; 4-4): “The program must provide instruction at the advanced level in the following: a. Epidemiology b. Biostatistics

2 c. Behavioral science d. Environmental health e. Health care policy and management.”3 3. Instruction in Dental Public Health (4-5): “The program must provide instruction in the following competencies: a. Manage oral health programs for population health b. Evaluate systems of care that impact oral health c. Demonstrate ethical decision-making in the practice of dental public health d. Design surveillance systems to measure oral health status and its determinants e. Communicate on oral and public health issues f. Lead collaborations on oral and public health issues g. Advocate for public health policy, legislation, and regulations to protect and promote the public’s oral health, and overall health h. Critically appraise evidence to address oral health issues for individuals and populations i. Conduct research to address oral and public health problems j. Integrate the social determinants of health into dental public health practice.”3

4. Individualized student curriculum plan (4-6): “Each student/resident in a dental public health program must have a written curriculum plan, designed to build upon and augment previous education and experience, and which describes the competencies to be developed during the program, activities necessary to develop the stated competencies, and methods to evaluate the competencies.”3

5. Supervised Field Experience (4-7): “The program must include a supervised field experience at a location determined by the program director which requires the students/residents to gain an understanding of one or more of the competencies listed in Standard 4-5.”3

6. Research Project (4-8): “The program must include a supervised research experience for each student/resident, approved by the program director, that demonstrates application of dental public health principles and sound research methodology and is consistent with the competencies listed is Standard 4-5. Advanced dental education students/residents must engage in scholarly activity.

a. Students/Residents must understand research methodology (6-1). b. Students/Residents must understand biostatistics and epidemiology (6-2). c. Students/Residents must complete one or more residency research projects after a review of the literature and approval of a comprehensive protocol; they must also produce evidence of engagement in scholarly activity based on the research (6-3).”3

These standards are met through a variety of course offerings and program activities that are determined by the program director.

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Table 1: Current Dental Public Health Course Offerings (2020-2021)

Core Courses Course Number Course Title DPH 175 DPH Guest Lecture Series DPH 400 Dental Public Health Research Project DPH 410 Core and Contemporary DPH Topics; Book Review DPH 420 DPH Field Site Experience and Practice DPH 200 Ethical Considerations in Clinical & Public Health Dentistry DPH 210 Introduction to Research Methods and Design

Elective Courses OCS 283 Introduction to Biostatistics for Dentists

Note: Detailed course descriptions and syllabi are available on request.

4. PROPOSED PROGRAM CHANGES

To remain competitive, the UCSF DPH program seeks to enhance its curriculum by developing new courses, modifying existing courses, expanding the available field site experience opportunities, and offering elective courses or clinical rotations in partnership with other UCSF dental postgraduate programs, as approved by the program director. The proposed program changes will attract additional high-quality applicants, promote interdisciplinary learning, improve the capacity of DPH residents to lead and evaluate innovative dental care delivery models, and enhance their ability to work with underserved, rural, or vulnerable populations.

These program changes (highlighted in red color below) will be supported by a recently awarded five-year Health Resources and Services Administration (HRSA) postdoctoral training grant for the UCSF DPH and Pediatric Dentistry (PD) postgraduate programs. The grant will provide salary support for faculty, tuition support for residents, and travel reimbursement to field site locations. The overall goal of this grant is to improve the oral health of vulnerable, underserved, and rural children in California (CA) by expanding and enhancing the postdoctoral training programs in pediatric dentistry (PD) and dental public health (DPH). The grant objectives are to: 1. Enhance the Didactic Curricula for PD and DPH Trainees by a) Incorporating DPH topics into the PD curriculum, including cultural competency, oral health literacy & promotion, social determinants of health, and advocacy; b) Incorporating clinical PD topics into the DPH curriculum, including behavioral management of children with special healthcare needs, pediatric oral health assessments, anticipatory guidance, and atraumatic restorative techniques. 2. Expand the Experiential Learning of PD and DPH Trainees in Federally Qualified Health Centers (FQHCs) by a) Adding two clinical training sites for 2-4 PD trainees per year at Petaluma Health Center (2021) and La Clinica de la Raza (2022) serving predominantly low-income,

4 underserved children; b) Integrating oral health into primary care pediatrics by conducting caries risk assessments and fluoride varnish applications during well-child visits; c) Developing community-based quality improvement (QI) projects for DPH trainees. 3. Expand Experiential Learning of DPH and PD Trainees in Rural Local Oral Health Programs (LOHPs) by a) Adding field site rotations for 4 DPH trainees in rural LOHPs in partnership with the CA Office of Oral Health (OOH); and b) Piloting the virtual dental home/school-based telehealth model in Tuolumne County. 4. Expand the DPH Recruitment Pipeline by a) Targeted recruitment of UCSF PD, AEGD, and GPR trainees, FQHC dentists from 21 UCSF externship sites, military dentists, veterans, and predoctoral students from all CA dental schools; and b) Offering financial assistance to 1-2 DPH trainees per year from rural, disadvantaged, and/or underrepresented minority backgrounds. 5. Evaluate and Report Program Outcomes 6. Implement a Hybrid In-Person and Virtual Oral Health Program for children with special healthcare needs, such as autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDDs), using virtual consults, pre-visit imagery, desensitization programs, and home oral hygiene coaching in the UCSF Service, Training, Advocacy and Research (STAR) Smiles Clinic, as well as offer behavior management workshops by STAR psychiatry faculty and behavior therapists.

In accordance with the program changes outlined above, we propose the following course offerings for the July 2021-2022 academic session:

Table 2: Proposed Dental Public Health Course Offerings (2021-2022)

Core Courses Course Number Course Title DPH 175 DPH Guest Lecture Series DPH 400 Dental Public Health Research Project (modified) DPH 410 Core and Contemporary DPH Topics; Book Review (modified) TBD Introduction to Dental Public Health (new) DPH 420 DPH Field Site Experience and Practice (modified) DPH 430 Quality Improvement in Dental Care Settings (new) DPH 200 Ethical Considerations in Clinical & Public Health Dentistry DPH 210 Introduction to Research Methods and Design

Elective Courses OCS 283 Introduction to Biostatistics for Dentists TBD Topics in Pediatric Dentistry for the Public Health Dentist (new) Not Applicable Pediatric Telehealth Autism Workshop and Clinic Sessions (new)

5. NEXT STEPS

5 • Obtain signed affiliation agreements for all training sites including rural local oral health programs, FQHCs, school-based programs, and the UC Berkeley MPH program. • Obtain approvals for new courses and existing course modifications.

References

1. Altman D, Mascarenhas AK. New competencies for the 21st century dental public health specialist. Journal of Public Health Dentistry. 2016;76(S1):S18-S28. 2. American Dental Association (ADA), Health Policy Institute (HPI). 2018-19 Survey of Advanced Dental Education. https://www.ada.org/en/coda/find-a-program/program- surveys#. Accessed Jan 24, 2020. 3. Commission on Dental Accreditation (CODA). Accreditation Standards for Advanced Dental Education Programs in Pediatric Dentistry. https://www.ada.org/en/coda/current-accreditation-standards. Published 2019. Accessed Jan 24, 2020.

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