Helping Dental Students to Treat Their Patients Using a Patient-Centered Comprehensive Care Model

My name is Nadeem Karimbux. I’m the Associate Dean for Academic Affairs, and a full professor in the Department of Periodontology at Tufts University School of Dental Medicine. I’m also the editor for the Journal of Dental Education.

I am currently working with a lot of faculty and students on curriculum issues. Many of the curriculum issues that we are trying to address have to do with the integration of basic science knowledge and clinical science knowledge. That’s one realm of area that we are working on. The other problem that we are trying to address is trying to make the clinical experience and clinical education for our students a much more patient-centered comprehensive care kind of experience.

This problem is important because we recognize that students from college are starting to learn across many different disciplines and are learning how to integrate their knowledge so they can really apply it. It’s important for us in dental education to try to follow that model where students are not learning information in silos, but really learning information in an integrated way and in a way that they can apply this knowledge in a much more realistic setting.

In the clinical arena, we also want our students to really view their patients as patients. We want them to treat their patients as they would in private practice. So rather than taking a patient and thinking about a patient in terms of a procedure that they’ve learned, we would really like to reward and incentivize our students to be able to think and treat their patients in a very comprehensive way.

There are already two different areas that we’re thinking about. One is in a didactic sense: foundational knowledge that our students get. Our faculty are very used to thinking within their departments, within their areas of expertise. In order to address this problem, you have to work across many different areas and apply a lot of different skill sets. It means communicating with faculty, getting faculty to see the benefits of changing a lot of their behaviors, and making them a part of the thought process and the implementation of any kind of changes that you are thinking about.

In the clinical arena, as well, a lot of clinicians are very highly specialized and tend to think and teach in that one area or one arena. In order to address the issues in the clinical arena, it’s really looking at the work flow, the work patterns, and shifting the focus from discipline-based approaches to making the patient the center of care. Ultimately, it’s really about asking the questions about how, perhaps, the clinicians themselves would like to be treated as an individual, as a human being. By asking the right kinds of questions at the appropriate times, I think it keeps everyone focused on the problem at hand and gets them engaged in thinking about how to collectively solve the issues or problems.

My approach is not a kind of authoritarian, talk-down approach. It really is to try to break down the issues with the faculty and the students that I’m working with, to get them to think about the problems and become problem solvers themselves because I think by getting all of the different constituents involved in the issues and problems that we’re facing in the educational realm or the clinical realm, it really allows people to grapple with the issues and become a part of the solution. My skill set is not to dictate change but to get people to grapple with the issues and problems to be a facilitator in order for the people that are dealing with the issues at the ground level to come up with the solutions and implement the change that is needed.

In terms of describing the path that led me to where I am now, I have to go back to dental school, in terms of the selection of dental school. I really didn’t know what I wanted to do with my career, and one of the things that impressed me about the dental school that I chose to go to was the view that when I left the dental school, I would actually end up with a broader scope than when I entered. While I was in dental school, I was able to get exposed to the breadth of what dentistry has to offer. Not only was it exposure to medicine, but it was also exposure to clinical dentistry and all the specialties that are available within clinical dentistry. And, more importantly, it was other life skills that I got. For example, having to present in front of my classmates—communication skills; being able to think that I could become an educator or a teacher because I enjoyed that opportunity to present to my classmates; being exposed to research and the whole research community within dentistry is something that I would never have gotten exposed to if I hadn’t gone to the school that I went to. So, it was that path or that exposure to medicine, clinical dentistry, teaching, and research that led me down a path to become an academic dentist.

There were several people that inspired me along the path that I took. One was actually being in an environment that had exposed me to a diverse set of experiences. But the second in my graduate education was working with the chair of the department and my mentor, Dean Howell, in terms of being given the responsibility of doing things independently at a young age. For those mentors to allow me to, for example, present at a research meeting and to run a committee at a very young age are all experiences that (because I had to deal with myself) really helped me develop as a young faculty. It’s those kinds of mentors that, I think, are willing to take a risk on you, that are willing to expose you to experiences that allow you to grow. Those are the things that have shaped me and given me the inspiration along the path that I’ve taken.

I work at the Tufts University School of Dental Medicine, which is one of the oldest dental schools in the United States and is a part of Tufts University. Tufts University itself is located in Medford. Here, on the Health Sciences campus, we have a medical school, dental school, and school of nutrition. Tufts also has a school of veterinary medicine about twenty-five miles from here. The dental school itself has several different programs. The DMD program is a program that has about 190 students per class, and we’re the second largest dental school in the United States. We are located in Downtown Boston, near Chinatown, so we have a very diverse set of patients that can access our clinics. We also have many graduate programs here at Tufts University, and those include specialties such as oral maxillofacial surgery, endodontics, periodontics, prosthetic dentistry, pediatric dentistry, and orthodontics. We also offer our students a master’s degree that they can get.

My work on a day-to-day basis is never the same, and that’s something that’s very attractive for me. For example, today I had a little bit of time to work on some academic matters in terms of preparing for a meeting. I then had a meeting with several students to talk about certain academics things that were going on. We also had meetings with faculty, committee meetings that we were in. There were also opportunities for me to interact with students in terms of attending seminars series. For example, this morning at 7:45, I was with the residents in Periodontology watching a surgical seminar and giving feedback on the surgical seminar series.

Other times, my time will be spent mentoring students. I have several master’s level students and dental students that are working with me on research projects, so time will be spent working one-on-one with them on their projects or writing manuscripts or papers with them. I do spend a lot of time administratively in my current position, working on issues such as curriculum reform; I chair several committees, and that involves working, obviously, with diverse faculties with diverse opinions in terms of trying to move them in certain directions. I also have a day of private practice, which is a Tuesday. I stopped seeing patients once I came to Tufts because as the editor for the Journal of Dental Education, I now spend my “practice time” actually working on the Journal of Dental Education.

I create value for the organization for which I work, number one, by bringing the experiences that I’ve had before from my previous institute. A lot of those things are things that the school is striving to do. I bring value to the school with the accreditation process that we’re undertaking, having been a site visitor for accreditation and having been through a couple. Finally, I bring value to the institution by collaborating and working with my colleagues; that means spending a lot of one-on-one time with them, whether they’re a new course director or a young faculty member or a student. It’s really that time commitment that I make—to make time for people that want to meet with me—that I think brings the greatest value to this institution.

There are several different people and several different levels that I have to work on to solve the problems that I work on. One is certainly working with the dean and the leadership of the school in terms of the visions that they might have for where we need to head, and part of that is working on strategic plans that we have in place. Then, the next level is to work with the faculty that are leading courses and leading the curriculum, and that means spending time with them, whether it be on a retreat or one-on-one, thinking through the kinds of changes that we need to make, thinking through the kinds of issues resource-wise, faculty-wise, and staff-wise that we might need to implement change.

Within my Office of Academic Affairs, probably the biggest investment for me is working with my staff and leading my staff in a way that sometimes involves a lot of different work, a lot of extra effort. It’s also something that requires a team approach and collaboration in order to get things done.

I think the diversity of what I do is something that I really enjoy. My job involves interacting with many different people, whether it’s staff members, faculty members, or student members. It’s that diversity of experience that basically means that no single day is alike. That, I think, keeps me on my toes and keeps things interesting and enjoyable. Since we’re such a large institute, there isn’t a day where I can’t just wander around the building and find something that is of interest—whether it’s visiting the clinical floors, being on a seminar series with students, etc. Certainly, the environment itself is something that lends itself to the diversity of experiences that you could get.

Some of the less enjoyable parts are some of the administrative things that you just have to get done in terms of running committees, reading reports, and writing reports. Those things can take away from some of the other things that you might have enjoyed as a younger or junior faculty member, whether it be seeing and treating patients or actually spending time teaching students.

I think, like any kind of career, people can be presented with certain kinds of second guessing or obstacles. One of the biggest decisions for me, coming out of dental school with the amount of debt I had, was whether I should go into a career in academics. Some of the obstacles that I might have faced in that scenario were obstacles such as, perhaps, putting off certain personal things for the sake of being in academics or thinking that I couldn’t afford certain things in terms of raising my family. But I would say that if anyone has a mindset about wanting to be busy and wanting to engage, there are always ways to solve those issues. For me, it was much more important to be engaged in something that I thought I could sustain and enjoy over a career rather than thinking short-term. So despite the obstacles that might have presented themselves in terms of finances, I can say that by treating patients, being in academics, and looking for diverse kinds of experiences, I’ve been able to overcome those obstacles without too much sacrifice.

I’ve tried to maintain a fairly healthy mindset outside my career work. I remember in dental school being challenged by some dental students to run a half marathon. Not only did I run the marathon with those two students, but as a younger faculty member, I actually beat their time, which was quite an accomplishment. That really started what has been a lifelong love of running, which resulted in me running three marathons. Even though I’ve caught back now, I can say that some of the runs that I remember when I go on conferences, or on trips, are some of the richest experiences that I’ve had in terms of seeing cities or scenery that I would never have seen. I was just at a meeting in Maryland last week as a part of the American Dental Education Association on an island in Maryland called Kent Island. The run that I had there along Chesapeake Bay is something that I will remember and value.

The other things are spending time with my sons as they were growing up in terms of going to sporting events—just finding the time to be active; as I’ve aged, I’m still able to play squash twice a week during the winter when I play in the league. And, in the last two years, I’ve become very fond of doing yoga on weekends, as well.

I’ve always been one that has used media as an educator to try to make things efficient. As an educator and a publisher of educational research, one of the things that I’ve tried to strive for is not using media just for the sake of using them, but trying to use them to support the central pedagogy or the kind of learning that’s going on. For example, one piece of media that I’ve implemented here at Tufts involves really engaging students students in a large classroom. It’s very difficult for us in this environment to have our students learn in small groups due to the kind of resources it would take.

We came across a program called Learning Catalytics that really engages students in the classroom: like a modern-day clicker where through a smartphone, a tablet, or a laptop, the faculty member can actually make students think about images or problems, and then in real-life time, see the responses of the students and either change the course of the lecture or ask students to rethink their answers based on the use of that media or technology. That allows, rather than just students listening to a lecture, for the lecture to become something that is much more interactive in nature.

Be diverse in the kinds of experiences that you’re having and diverse in terms of the things that you’re doing. I think it’s very easy in our education system to go lockstep through everything that you’re asked to do in order to succeed. Sometimes, those things can get narrower as you move up the ladders. For example, if you’re doing a PhD, focusing on one question—if you want to become a dentist, focusing on one skillset, perhaps your clinical skill set or technical skill set. The broader that you can cast your experiences, the more diverse that you can make your experiences, and the more you can grow as your career advances.

The vision is to get students to think across different disciplines and to question the kind of information that they are looking at. Rather than students going through one course and having to study for that exam and quickly forgetting that information, I would say the best design is for students to continue to be exposed to information, to try to think a little bit deeper about it so that it becomes part and parcel of the deeper understanding of the concept. The only way to do that is to engage students in active learning. That means having them explain certain concepts, having them engage with each other in terms of group projects, and also changing the way that we assess them so that the assessment is not just a summative assessment, but something that allows the students to really think about things and form ideas about the concepts we are trying to introduce to them.

I do think of myself as being conservative and thoughtful about certain things, but one of the things that I value is not shying away from certain challenges because you think that you don’t have the time or it’s going to take away from what you’re doing. In each of those scenarios where I’ve taken on a challenge or leadership position, it’s given me the opportunity to grow and learn from my mistakes.

I came through a British education system, so by the age of eighteen, I was very specialized in terms of studying sciences. My formal education really helped me in terms of having good habits to be successful in a system where you might be rewarded for recall of knowledge and taking tests and writing to a certain extent.

The informal parts of my education, whether it was doing a research project that didn’t count toward grades or putting together a presentation, are the pieces, I think, that really helped me as I matured—grapple with issues, grapple with problems in a way where I have a much better understanding or deeper understanding.

Lastly, being an educator and having to explain things to, first of all, students and now to my colleagues and peers in terms of faculty really allows you to articulate things in a way that truly shows that you can understand concepts and explain them. It’s those informal kinds of experiences and pieces that really have helped me to grow.

My first marathon—it’s a feeling that I’ll never forget. That brought me more joy and happiness, I would say, in terms of what it represented to me than some of the other academic achievements that I had. I mention going for runs and seeing the sunrise, or running through the Arboretum after a snowstorm when nobody else is around. Those are the things, I think, that get you to appreciate your everyday life and nature and beauty that we have around us. Certainly, on a more personal note, seeing the birth of your children is also something I think is amazing to witness and brings you a lot of joy and happiness.