In an ever-evolving world where technology continually reshapes how we learn and practice, the realm of dental education is no exception. While the Herman Ostrow School of Dentistry at USC has pioneered a Hybrid Online Competency-Based Residency Training, if accredited other Universities might take up the challenge of educating working professionals to a Master’s degree level. The value of a hybrid online program is that it is specifically tailored the working professional. This innovative approach not only bridges the gap between traditional learning and modern educational needs but also sets a new standard for postgraduate dental training.
Why Hybrid Online Competency-Based Residency Training?
The primary rationale behind hybrid online competency-based residency education is straightforward: conventional dental education in a dental school often falls short in providing comprehensive clinical experience in diagnosing and treating orofacial pain and TM disorders. Dental students typically do not encounter these patients during their standard training, leading to a gap in their practical knowledge. Furthermore, once practicing, general dentists and specialists find it challenging to take extended time off to pursue additional residency programs, yet the need for additional trained and accredited professional in Orofacial Pain is still being unmet.
Enter hybrid online competency-based residency education. This program is a response to the urgent need for a flexible, accessible, and comprehensive educational model. It allows practicing dentists to gain the necessary skills without leaving their practices, making advanced education feasible and practical. The hybrid model combines online didactic content, virtual patient simulations, video case conferences, intensive boot camps, observational practicums. Once the students are certified as competent in various clinical skills, they start to use them in their offices and thus get direct clinical experiences as they treat patient.
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The Components of Hybrid Online
Competency-Based Residency Education
- Courses: The Master degree in Orofacial Pain at USC involves 32.5 units. The Master degree program in Orofacial Pain uses a list of Entrusted Professional Activities (EPA) as the specific aims for all courses (1). There are 19 courses and among these are 14 involve clinically focused topics including: Pharmacology, Temporomandibular Disorders, Oral Pathology, Immunology, Internal Medicine, Radiology, Bony Pathology, Infectious Disease, Psychology, Neuroscience, Headache Disorders, Introduction to Practice, Epidemiology and Geriatrics, Sleep and Motor Disorders and Neurogenic Orofacial Pain. The other 5 courses are a research methods course, a multipart capstone course, a multipart case portfolio course and an onsite two-part bootcamp (or year-end assessment) course. For the last 5 courses the program uses OSCE examinations, live critiqued presentations of patient cases, an 18-case portfolio with a defense and a capstone research project report and presentation with a defense.
- Course Design and Program Hours: Because our students are working dental professionals, who see patients in their offices they can and do immediately implement what they are learning. However, because students are in different time zones across the world, content associated with our 14 clinical course is provided using asynchronous recorded lectures, interactive asynchronous discussion board where students research and report on faculty guided questions and receive faculty feedback. Asynchronous lectures and monitored discussion boards are considered equivalent to face-to-face contact faculty hours. Moreover, almost all courses involve weekly MCQ quizzes to ensure the content is being reviewed and understood. However, all of these 14 clinical content courses use virtual patient cases as the final exam to assess student mastery of the content. Regarding program hours, the Master degree strictly adheres to the US Department of Education standards where each post-graduate 1-unit requires 1 hour of faculty-to-student contact and 2 hours of non-contact “homework” times 15 weeks per trimester (12 for summer trimester courses). Thus, the total hours for this program are at a minimum of 32.5 times 45 hours of student activity or 1462.5 hours. However, for two of our courses the student activity always exceeds US Department of Education minimum guidelines. This is because the two summative courses (Portfolio and Capstone) are projects where the student works mostly independently, creating their report on their thesis project and documenting a set of patient cases they have treated. The portfolio course requires on average 180 hours and it is where students independently work-up, research and heavily document and present 18 cases to a faculty panel for review. The other is the Capstone course typically requires 300 hours and is where students with the guidance of a faculty mentor, identify, conduct and write-up then defend their project to a panel of faculty judges. A best guess total number of hours in the master’s degree program counting 60 hours of observational practicum experiences is closer to a minimum of 2000 hours.
- Virtual Patient Simulations: As mentioned above, the Master’s degree program at USC uses virtual patient simulations as the final examination for 14 of its 19 courses (2). There are no standards yet established regarding the breadth and depth of training that must be achieved using simulated patient experiences. At USC, we have over 150 different patient simulations to draw from and they cover a wide variety of patient problems. With our virtual patient system, we can assess in detail the clinical decision-making skills of our students. Specifically, we assess their ability to interview a patient, to focus their examination on the elements of importance, to choose the logical diagnostic tests including referrals and consultation from other specialist, and finally to make decision about the logical treatment intervention, and the logical medications to prescribe. In essence these virtual patient simulations provide a controlled environment where residents can practice data collection, differential diagnosis, and treatment planning. In the field of orofacial pain, it is knowing what to do and when to do a procedure that is at least if not more important than the skill itself needed to perform the procedure. At USC, the Master degree in the hybrid online competency based resident program are exposed to over 50 simulated cases that they must solve. Providing students with simulations as a summative exam in their courses ensures that they demonstrate and achieve a minimum level of competency of the content course and that the competency exam mimics a real-life scenario, allowing students to make clinical decisions and see the outcomes immediately, thereby honing their decision-making skills.
- Video Case (Portfolio Preparation) Conferences: There are 40 weekly live two hour zoom based small group sessions, where residents are exposed to digital versions of a wide variety of de-identified OFP cases. During each 2-hour small group session, the students in the hybrid online competency based resident program are exposed to over 200 cases which are discussed in depth on a video conference. Each student writes commentary on each case and over two years, they are individually assigned 20 cases to solve and present live in these live zoom conferences. We have over 1000 cases to draw upon for these conferences and the conferences encourage critical thinking and collaborative learning, as students discuss and dissect each case under the guidance of experienced faculty.
- Boot Camp (Year-End Assessment) Experiences: The two, year-end Boot camps are where students are given a rigorous set of competency tests and hands-on procedural training experiences. Each bootcamp has 8 video and audio recorded OSCE exams. During these OSCEs each procedure is demonstrated, practiced, and are then, when they are ready students are given their exam in our Clinical Skills Examination and Evaluation Center (3). Residents must demonstrate the specific skill and understanding of the skill being assess on either a manikin or on their partner applying their knowledge and skills in a real-world setting. These OSCE demonstration, practice and exams are where face-to-face interaction between student and faculty occurs and is crucial for mastering practical techniques and receiving immediate feedback. In addition to the skill and knowledge based OSCE exams each student is given 5 case-based essay tests with 17 case scenarios they must solve. The boot camp also has a live oral exam (viva voca) with 3 case scenarios that the students must solve and a virtual patient exam where the student must work-up and solve 5 cases. The four key summative competency assessments are our recorded OSCE exams, our viva voca exam, the capstone defense and the portfolio defense.
- Observational Practicums: These practicums occur during the boot camps and individually arranged practicums occur where students visit specialist offices or attend our clinic at USC during the third year of the program. Observational practicums allow residents to observe specialists in their practice, gaining insights into interdisciplinary approaches to patient data analysis and clinical decision-making.
Achieving Competency Through Diverse Clinical Experiences
The goal of hybrid online competency-based residency education is not just to impart knowledge but to ensure that residents achieve a level of clinical competency that prepares them for real-world challenges. The program focuses on ten key learning objectives, including taking medical histories, conducting physical examinations, selecting diagnostic tests, making appropriate referrals, treatment planning, performing procedures such as prescribing medications, performing injections and biopsies and troubleshooting complex cases.
Each component of the program is meticulously designed to meet these objectives. For instance, virtual patient simulations and video case conferences use highly selected cases drawn from our clinical population so that the students are exposed to a remarkable diversity of diseases, disorders and dysfunctions. These simulations, zoom conferences and OSCEs address competencies such as differential diagnosis and treatment planning. Bootcamps focus on physical examinations and procedural skills, while observational practicums and direct clinical experiences offer exposure to real-world clinical decision-making and patient management.
Data-Driven Success
The efficacy of hybrid online education is backed by data. The USC program graduated its first students in 2015 and in the last 9 years has issued over 125 Master’s degrees in Orofacial Pain. At present, prior to 2003, graduates of the USC program were eligible for the American Board of Orofacial Pain diplomat exam. In 2003 the National Commission on Recognition of Dental Specialties and Certifying Boards (NCRDSCB) decided to recognize Orofacial Pain as an Advanced Dental Specialty and the American Board of Orofacial Pain as the board eligible to issue diplomat status to eligible individuals who pass the diplomate examination. Unfortunately, with that ruling the National Commission also issued a ruling that only graduates of onsite OFP programs would be eligible for the Diplomat exam, using the criteria that hybrid online programs were not accredited by CODA. Of course, the USC program is accredited by the Royal College of Surgeons in Edinburgh (4) and by the Western Association of Schools and Colleges (5) and by the USC Provosts, University Committee on Academic Review (6) but since CODA has no written standards for Hybrid Online programs the USC program is not CODA accredited.
The stated mission of the NCRDSCB is: “Protect the public and the profession through objective and transparent review of the recognized and prospective dental specialty sponsoring organizations and certifying boards.” In addition, the stated mission of the Commission on Dental Accreditation is: “The Commission on Dental Accreditation serves the public and dental professions by developing and implementing accreditation standards that promote and monitor the continuous quality and improvement of dental education programs.” It seems that neither is serving the greater good of the public by reducing the ways that dentists can get training in the area of Orofacial Pain. If CODA and the NCRDSCB were true to its mission statement they would consider creating accreditation standards for hybrid online programs and expand the number of trained clinicians available to the public. Especially considering that between 2015 and 2023 48 graduates of the USC OFP program took and passed the ABOP diplomat exam and are now boarded in the specialty. In fact, two of our graduates have become Deans of US dental schools and over 15 other graduates are current faculty in various dental schools around the world. Those of our graduates who are in private practice are providing quality care to their patients and having a positive impact on clinical care of patients with OFP problems in their communities but since 2023 they cannot sit for the ABOP examination.
A Call to Embrace Innovation
As we navigate the complexities of modern healthcare, it is imperative to adopt innovative educational models that prepare practitioners for the realities of clinical practice. The program at USC is a testament to the power of hybrid online competency-based residency education in bridging educational gaps and fostering a new generation of competent, confident dental professionals. We invite educators, practitioners, and accrediting bodies to consider the benefits of hybrid online competency-based residency education. Let us hope CODA and the NCRDSCB moves beyond the limitations of traditional residency programs and embraces a future where education is accessible, flexible, and thoroughly effective in preparing clinicians for the challenges of tomorrow. CODA and the NCRDSCB need to give serious consideration on how to help clinicians have the opportunity to advance their education and still continue working. At USC, we can ensure that our residents not only meet but exceed the standards of clinical competency, ultimately improving patient care and advancing the field of orofacial pain.
Earn an Online Postgraduate Degree in Orofacial Pain and Oral Medicine
Are you interested in a variety of issues focused on orofacial pain, medicine and sleep disorders? Consider enrolling in the Herman Ostrow School of Dentistry of USC’s online, competency-based certificate or master’s program in Orofacial Pain and Oral Medicine.
References
- Hawkins J, Heir G, Okeson J, Shaefer J. Entrustable Professional Activities in Postgraduate Orofacial Pain Programs. J Oral Facial Pain Headache. 2020 Summer;34(3):255-264.
- Padilla M, Nocera L, Abe Y, Clark GT. A modern web-based virtual learning environment for use in dental education. J Dent Educ. 2020 Sep 11.
- Abe Y, Boyer B, Padilla M, Clark GT. Clinical skills evaluation and examination center: From demos to competence validation. J Dent Educ. 2020 Oct 2.
- https://www.rcsed.ac.uk/events-courses/rcsed-course-accreditation/rcsed-accredited-courses
- https://www.acswasc.org/about/acs-wasc-commission/
- https://faculty.usc.edu/apr/ucar/
