DENCOM trains EFDAs: the army goes rolling along ...

The United States Army Dental Command (DENCOM) has a chronic shortage of military dentists and efforts at recruiting and retaining civilian contract dentists are not meeting the military dental staff shortfall. Coupled with this staff shortage, soldiers coming into the Army have a high level of dental need. In 1994, 33 percent of all Army recruits entered service with acute, active dental disease (Dental Fitness (DF) class 3-a potential emergent dental patient); in 2000, 42 percent were in DF class 3). As the number of soldiers on active duty increases and federalization of National Guard and activation of Reserve Component soldiers continues, the need now exceeds our capacity.

The war on terrorism will require the DENCOM to continue to provide care for a significant number of mobilizing and demobilizing nonactive duty soldiers. With this increase in demand, the system has been forced to focus primarily on soldier readiness. Routine and specialty dental care for soldiers will face continued curtailment unless the system changes its core business principles to utilize all its personnel to deliver optimal and quality dental care.

The Expanded Function Dental Assistant (EFDA) Program's primary objective is to address this issue. By design, the program provides current dental assistants with advanced training, allowing them to place and contour final restorative materials that increases the dentists' overall efficiency. As efficiency improves, both access to care and costs per procedure simultaneously improve.

Labor Substitution is the mechanism through which an EFDA working under the direct supervision of a licensed provider can optimize the productivity of the primary dental provider. The DENCOM began training EFDAs in March of 2002 and now has 112 EFDAs at different levels of training. The goal is to double this number within the organization over the next three years. Results are preliminary at this junction but the collected data so far point very dramatically to the success of the program. Dentists working with an EFDA provider are 40 percent more productive than their counterparts working without an EFDA. As an EFDA completes a two-year training cycle, the expectation is that a dentist working with two EFDAs and one ancillary (a Dental Care Optimization Team) will be 80 percent more efficient with no compromise in quality.

The Indian Health Service developed a program that the DENCOM used as a template for success. However, the training process and procedures are evolutionary. "Continuous Quality Improvement" is the guiding principle to make sure the program does not stagnate but adapts to new training and end-user's requirements. The selected candidates enter into a multiyear, progressive training program designed to minimize didactic training time and maximize hands-on clinical competencies. The didactic phases consist of a weeklong course at the beginning of the training cycle and a two-week-long course at the eighteen-month mark. Prior to attending each didactic course, the candidate completes distance learning material required to successfully understand and facilitate the didactic portion of the course. The didactic phases focus on dental materials and the reasons for different restorations. Following each didactic phase is an in-depth clinical mentorship at the candidate's home station. The clinical mentorship focuses on the candidate's ability to implement concepts learned in the didactic phases. During the mentorship phase, each EFDA receives direct feedback on all restorations by his/her Designated Trainer (DT).

An EFDA enters the Government Civilian Personnel system at a GS-4 level An EFDA career training program allows for a noncompetitive promotion to GS-5 (after six months) with a target promotion to GS-6 after successful completion of the EFDA program (two years). The selection process is conducted by an impartial selection board convened to select the highest quality applicants based on the applicant's work experience, letters of recommendation and intent, and a chalk carving demonstration given to evaluate the applicant's manual dexterity and attention to detail.

The tangible benefit of this program is its ability to save the government over ten million dollars in purchased dental care by the 36th month of the EFDA program and over $18 million annually thereafter. Since its inception 24 months ago, EFDA's combined workload totals over $12 million in direct patient care. The intangible benefits are the pride and job satisfaction the program instills in our EFDAs. No longer are they just valued team members, they are now directly responsible for the process that makes our soldiers fit and ready for duty. Below are just a few of the feelings our EFDAs have about their training and their ability to provide this valuable service for their patients:

* Margo Pate from Fort Bragg, NC, writes, "After being a CDA for 12 yrs, what I considered a dream, came true and after applying and qualifying, I went to phase 1 EFDA training at Fort Sam Houston, TX ... I think I have the best of both 'dental worlds.' I can do my part in restoring teeth, by placing and finishing restorations, and I can help with hygiene services by performing prophylaxes. EFDAs are greatly appreciated in the clinics ... I love my job of being an EFDA!"

* Connie Montano from Fort Hood, TX, writes, "The EFDA Training program in San Antonio, TX, was exciting and fast paced. After graduation, we were released backed to our Dental Clinics ... and put on teams from the start of our training and were supervised from the clinic's volunteer doctor and DTA to evaluate and grade our restorations in all procedures. As an EFDA student, I was treated with respect by my colleagues. I've learned to do the best possible restorations I can do, and continue to learn daily. Much satisfaction is gained when soldiers are greatly pleased with my treatment and thank me when the work is done."

* Marilyn Mackeprang from Fort Bragg, NC, writes, "... in the EFDA program, it's figuring how and learning why and looking forward and thinking high. It's been about 1 1/2 years since I joined the EFDA program. The greatest feeling is to give a patient their smile back by cleaning or restorative care. By serving and giving and doing your best, that is what I call success EFDA style."

* Harry Rogers from Fort Knox, KY, writes, "EFDA has allowed me to function in all aspects of chairside dental assisting with great pride and accuracy The EFDA Program is a win--win situation. The patient wins--they receive more excellent patient care in an even more timely manner--the EFDA wins by advancing."

* Sandra Gilmore from Fort Knox, KY, writes, "Before I entered into the EFDA program, I debated on returning to school to become a hygienist. Now, no longer have that desire. In fact, being an EFDA has allowed more of a variety in this field of work. I can't think of anything I enjoy doing more. This position as an EFDA has been truly an enhancement to my life."

* Robin L. Williams from Fort Hood, TX, writes, "I value the experience and cherish the opportunity I was given when selected for the EFDA program. I was impressed with the strong support network that I found while attending."

* Allison R. Lascano from Fort Bliss, TX, comments on the quality of training when she writes, "When I returned to my permanent duty station and started to treat patients my doctor (Designated Trainer) was very impressed with my carving abilities and how well the anatomy of the tooth restorations were. That is when I understood why the instructors were so meticulous about my restorations; at that moment I was extremely grateful to the instructors. Being an EFDA has made me more confident in my role as a care provider. I feel as though I am a real asset to the Army Dental Care System."

* Sophia Osorio from Hunter Army Airfield, GA, writes, "The EFDA training experience has opened the door for an opportunity that I could not achieve without further education. This program has made me part of a great team providing service to our soldiers ... and the level of my job satisfaction has increased tremendously."

If you'd like to be part of this expanding program, please read the advertisement for Government Job Opportunities on the preceding page. EFDAs are now a vital part of the Army Dental Care System's business practices for the future.