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Evolving education trends in Graduate Dental Education.

The Army Dental Corps is recognized for its outstanding dental graduate training opportunities. The availability of appealing Graduate Dental Education (GDE) programs serves as a powerful recruiting and retention tool and enhances the quality of our team and the dental care we provide to maintain the force. Congress established the F. Edward Hebert Armed Forces Health Professions Scholarship Program (AFHPSP) for Dentistry which significantly increased the number of obligated new accessions and created tremendous new opportunities for recent dental school graduates eligible for postgraduate dental education. The residency and fellowship programs vary from year to year and are designed to both optimize Dental Corps force management and offer its officers educational and financial incentives. This article describes these recent changes in the GDE application and selection process.

Program Parameters

The selection of specialty programs and number of residents trained are validated annually by the Dental Corps representative of the Army Medical Department (AMEDD) Personnel Proponent Directorate (APPD). In this role, APPD is responsible for building the AMEDD of tomorrow by designing officer career fields that support the Army's mission. Modifications in the selection process for GDE opportunities significantly affect life cycle management and assist the Corps in its recruiting and retention initiatives. A climate of opportunity has been created which matches the individual officer's expectations with the needs of the Army Dental Corps.

Educational standards for dental professionals in the US are maintained by periodic postgraduate program accreditation by the Commission of Dental Accreditation (CODA) in association with the American Dental Association (ADA). Advanced training in general dentistry is available through 1-Year Advanced Education in General Dentistry (AGD-1) Programs at the following sites: Fort Benning, GA; Fort Campbell, KY; Fort Carson, CO; Fort Lewis, WA; Fort Jackson, SC; and Fort Sill, OK. AGD-1 programs provide additional clinical training for dentists in the performance of increasingly complicated clinical procedures. Students are accepted on the basis of their grades in dental schools, class rank, their scores in the National Dental Board Examination Parts I and II, and letters of recommendation.

Postgraduate dental education programs include residency programs in the ADA-recognized specialties of dental public health, endodontics, oral and maxillofacial pathology, oral and maxillofacial surgery, orthodontics, pediatric dentistry, periodontics, and prosthodontics.

Fellowship And PhD Training

Fellowship and PhD training in the Army Dental Corps produces highly qualified dental officers for utilization in specific specialized areas of dentistry. For example, an Oral and Maxillofacial Surgery Fellowship is offered which allows oral and maxillofacial surgeons an opportunity to attend a 1-year course of instruction for the purpose of obtaining advanced clinical skills. In the past 5 years, these fellowships have included advanced training primarily in the fields of trauma and cosmetic surgery. Following training, graduates typically are assigned as Program Directors, Assistant Program Directors, or mentors in one of the Army's six Oral and Maxillofacial Surgery residency programs, thus further propagating their newly acquired special skills.

Fellowships with sister federal services are also available. In 2004, the first Army resident went to the Orofacial Pain Fellowship at the Orofacial Pain Center, Naval Postgraduate Dental School, National Naval Medical Center, Bethesda, MD. This specific area of dentistry is concerned with the diagnosis and management of pain and dysfunction of the motor and sensory components of the trigeminal nerve system. In the past, these types of disorders were referred to as "temporomandibular disorders." However, growing evidence in the field indicates that patients may have signs and symptoms external to the masticatory system that refer pain to the head and neck area. The fellowship affords Army dentists a unique opportunity to obtain the merged set of skills required to manage a patient population that formerly fell outside the realm of traditional medicine and dentistry. Graduates of this program are typically assigned to an Oral and Maxillofacial Surgery Residency Program to better facilitate a team approach for the management of complex issues presented by orofacial pain patients.

Another fellowship program offered through sister federal services is the 1-year Maxillofacial Prosthetics Fellowship. A maxillofacial prosthodontist (AOC 63F) has completed a 1-year fellowship in the field of maxillofacial prosthetics. Maxillofacial prosthetics encompasses the rehabilitation of patients presenting with congenital or acquired head and neck defects. Acquired defects include those defects resulting from surgical treatment, trauma, or pathology. Nonliving tissue substitutes in the form of prostheses may be used in extraoral prostheses involving the ear, nose, eye, or other head and neck structures. Intraoral prostheses are used to reconstruct oral cavity defects of the maxilla and mandible as well as associated structures. The maxillofacial prosthodontic training emphasizes a team approach to rehabilitative services with other medical specialties. Areas of concentration include palatopharyngeal function, radiation therapy, chemotherapy, and oculofacial defects. The Army Dental Corps has approximately five utilization tours for maxillofacial prosthodontists. These assignments are typically located at the Army's major medical centers.

Specialists are also offered PhD and fellowship training opportunities in dental materials. Program graduates participate in a utilization tour at the US Army Dental and Trauma Research Detachment which conducts research and development in military dentistry and the treatment of combat maxillofacial injuries. This includes research to devise new and improved methods of emergency surgical management of maxillofacial wounds on the battlefield and to develop improved methods of treating oral and maxillofacial wound infections. Graduates will also be involved in epidemiological investigations of field dental needs and in the development of dental materials, equipment, devices, methodologies, and materials that enhance combat dental services. Especially significant work is being done to lower the 14% to 19% deployment dental emergency rate.

Neutral Year

DoD Instruction (DODI) 6000.13 (1) specifies key active duty service obligation (ADO) information for Health Professions Scholarship Program (HPSP) recipients. Section E2.1.15 addresses Graduate Professional Education (GPE), of which GDE is a subset, and defines ADOs for internships such as the Army's 1-Year Advanced Education in General Dentistry Program. DODI 6000.13 notes that "while internship (GPE-1) is included in the definition of GPE, it is obligation neutral; i.e., an ADO is neither incurred nor discharged during internship."

In 2001, the Dental Corps issued the following policy in compliance with DODI 6000.13:
 "All personnel who entered the HPSP on or after
 1 Oct 2002 will not discharge nor incur any
 obligation while participating in AGD-1.
 Personnel who entered the HPSP or have military
 service obligations incurred through subsidized or
 pre-professional education or training (i.e., HPSP,
 ROTC) prior to 1 Oct 2002, will discharge
 obligation while participating in AGD-1. ROTC
 obligors who enter the AGD-1 prior to 1 Oct
 2006 will also discharge obligation while
 participating in AGD-1." (2)


Expanded Dental Graduate Training Opportunities

Traditionally, senior dental students and newly accessed officers could apply only for the AGD-1 program. Selection to attend an Army dental specialty training program was limited to dentists who were currently serving on active duty with the Army. However, dental accessions entering the Army Dental Corps in FY 2002 with an active duty service obligation were allowed to apply for specialty training as well as the AGD-1 program. Thus, FY 2002 accessions competed for training slots with current active duty dental officers. Accelerated opportunities for earlier board certification increases availability of incentive pays to a larger number of officers early in their careers--a critical retention tool. Residents enrolled in 2-year or greater specialty training programs are not eligible to receive Dental Additional Specialty Pay (DASP). However, these officers have the opportunity to become board certified following successful completion of the program and thereby will be eligible for Board Certified Specialty Pay (BCP) very early in their careers. Officers selected for training will also have an accelerated opportunity to execute Dental Multiyear Retention Bonus incentive contracts. The personal financial implications of loss of DASP during the initial entry years, when payment schedules are at a minimum, can quickly be offset by early qualification for BCP. The Dental Corps benefits from early training opportunities by producing an increased number of highly trained dentists providing quality dental care for eligible beneficiaries.

The HPSP and otherwise obligated accessions are eligible to apply for dental specialty training programs in the following specialties: 2-Year Advanced Education in General Dentistry Program (AGD-2), periodontics, endodontics, prosthodontics, pediatric dentistry, orthodontics, oral, and maxillofacial surgery, and oral and maxillofacial pathology. FY 2002 accessions selected for the AGD-2 residency training by the December 2001 board were scheduled to begin training as early as July 2002 in lieu of attending an AGD-1 program. New accessions for all other specialty training were selected 18 months in advance of the residency start dates to enter the July 2003 training programs. These officers were either pre-positioned for duty at the installation where they would train, or they may have attended a planned AGD-1 program in the US and were then reassigned for residency training.

Two annual selection boards are held: (1) The December dental specialty board administered by the GDE administrators and the Army Human Resources Command, and (2) the February AGD-1 board administered by the US Army Recruiting Command (USAREC). The AGD-1 board also accepts applications for any available unfilled FY specialty training positions. Officers not selected for residency training in an ADA-approved dental specialty are not precluded from applying to the February AGD-1 board. Students not selected or who do not desire to compete for 2-year (or greater) GDE programs are still eligible to apply for the traditional AGD-1 training programs.

Dual Training

In 2001, a policy was implemented which provides general dentistry officers (AOC 63B) the opportunity to apply for a second graduate dental specialty training program. Officers must meet the following criteria: (1) successful completion of a primary residency in a dental specialty recognized as such by ADA and/or federal services, (2) achievement of certification by the recognized specialty board in the officer's primary specialty, and (3) service for a period of 5 years in the active component US Army Dental Corps in their primary specialty. While the policy in no way guarantees selection for a second residency, opportunities to compete for secondary training in another specialty will exist as long as the policy is in effect.

Direct Accession Training Opportunities

Despite many requests, prior to 2002 GDE policy prohibited direct accession application to advanced education training opportunities. In FY2002, USAREC allowed direct accessions to apply for both the AGD-1 and AGD-2 programs. The policy does not extend to those under current obligation to another branch of federal service. A direct accession officer incurs a 3-year initial ADO which is not concurrent with residency training. If the officer attends a civilian training program, the remainder of the initial 3-year ADO and the newly incurred training ADO will be consecutive (additive).

Change In Prerequisites Requirements for Residency Programs

Other changes in prerequisite requirements for residency programs have occurred in certain dental specialties. In April 2001, the ADOs for orthodontics and endodontics increased from 2 years to 3 years. Effective May 2004, Dental Corps policy was amended to recognize those qualified applicants with significant active duty service experience. The current criteria for residency selection states that "When sufficient numbers of active duty applicants exist, applicants to endodontics, orthodontics, and pediatric dentistry must have a minimum of 2 years active duty service prior to the first day the residency selection board convenes." (2)

References

(1.) Department of Defense Instruction 6000.13. Medical Manpower and Personnel. 30 June 1997.

(2.) Policy Revision of Obligation--Advanced General Dentistry Program (AGDP-1). US Army Medical Command. 1 October 2002.

COL von Gonten is currently on staff at the United States Army Dental Command, Fort Sam Houston, TX and serves as the Dental Consultant.

COL Malone is the Chief, Graduate Dental Education, Academy of Health Sciences, US Army Medical Department Center and School, Fort Sam Houston, TX.

COL Ann Sue von Gonten, DC, USA COL Kay H Malone, DC, USA
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Author:von Gonten, Ann Sue; Malone, Kay H.
Publication:U.S. Army Medical Department Journal
Date:Jan 1, 2006
Words:1961
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