Charles S. Greene
In this chapter, the background and current status of science transfer in the orofacial pain field will be analyzed, with special emphasis on the temporomandibular disorders (TMDs). A combination of cultural and educational barriers to the acceptance of recent developments in this field will be discussed, and some possible solutions will be proposed. The intention is to impress upon undergraduate and graduate students the need to constantly update their knowledge in this field. It is hoped that they and their teachers will benefit from learning about the problems of the past, which should enable them to face the problems of the future with open but critical minds.
General Problems in Science Transfer
It might be expected by the lay public that all practicing health care providers are ready and waiting for the latest information to arrive, while all biomedical scientists are eager to have their work applied to patients by clinicians. However, the reality is that several barriers on both sides prevent such a smooth science-transfer process. Clinicians often allege that scientists do not appreciate the “real-life” problems facing practitioners, or that they do not care much whether their research findings can be applied to the clinical situation. As a result, many clinicians believe that the scientific community does not communicate very well with them. In addition, there is always the natural reluctance of people to make changes in the way they do things every day.
In addition, there are some special obstacles that keep health care providers from obtaining and utilizing new information. The roots of some of these problems can be traced back to a fundamental tension that exists in many health care programs, including dental schools. During those years of training, the basic science teachers frequently complain that students do not care much about the academic biomedical subjects. Instead, it seems to them that those students just want to get into the clinics, where they will quickly abandon science and replace it with clinical folklore. Unfortunately, some of the clinical faculty members may foster this behavior by downplaying the importance of science in their daily lives as “real doctors.” In the end, it must be understood that many health care providers tend to resist making changes in the environment in which they work; therefore, it is important to appreciate some of the factors that might account for that resistance.
The general term that describes unwillingness or inability to adopt new ideas has been borrowed from the field of psychology: cognitive dissonance. This uncomfortable feeling arises from natural impulses to understand and control the world around us, so any challenge to previous beliefs has to be processed through that filter of comprehension. Of course, dental students are warned that significant scientific discoveries and changes will occur within their professional lifetime, but each major innovation in their discipline still represents another challenge to their previous understanding. The process by which individuals within a community (eg, physicians or dentists) move from their old concepts and practices to new ones has been described by Rogers as “diffusion of innovations.”1 There are four main elements in the diffusion of new ideas: (1) an innovation that is (2) communicated through certain channels (3) over time (4) among the members of a social/professional system. Rogers has studied this process from both ends (ie, the innovator and the recipient), and through extensive research in this field, he has identified the stages of transformation at both ends. Boxes 28-1 and 28-2 summarize these stages, and the implications for health care providers should be obvious.
|Box 28-1 The innovation-decision process1|
|A new idea, practice, or technology is introduced to prospective “adopters”|
|Communication channels spread the message:|
|• Media (journals, lectures, Internet)|
|• Interpersonal contact (most individuals accept or reject an innovation based on peer reviews rather than relying on scientific research)|
|• Opinion leaders (within the social system, they promote the innovation):|
|– Primary change agents are in authoritative positions|
|– Secondary aides (eg, drug representatives, salespeople) try to persuade clients|
|Over time, five steps occur in the adoption of innovations:|
|• Knowledge → persuasion → decision → implementation → confirmation|
|Box 28-2 Categories of innovation adopters1|
|Venturesome people: Sophisticates that are able to understand complexities and are financially secure enough to take risks. They act as leaders and role models of innovation.|
|Early adopters: Persons who are more integrated in the regular culture or system and respected as being leaders. They are sought out by change agents to promote acceptance of innovation because their stamp of approval often triggers critical mass of acceptance.|
|Early majority: One of the largest subgroups that is slightly ahead in accepting innovation. They are very interconnected within the group, so while they do not lead the change, their acceptance tips the scales.|
|Late majority: A large subgroup that is slightly behind in accepting innovation. Regarded as skeptics, these people require a lot of pressure from peers before accepting innovations. They want uncertainty diminished or removed before feeling it is safe to accept.|
|Laggards: Often isolated people who, although they may interact with similar people, tend to be suspicious of change and also of change agents. Their resistance to innovations may be entirely rational to them because of limited resources and the need for complete certainty before giving up the old ways.|
Science Transfer Problems in Orofacial Pain
The field of orofacial pain has a complex history characterized by a great amount of controversy.2,3 This is especially true for TMDs, which are a main concern for dentists. Many dentists simply want to avoid treating TMD patients because they see them as difficult to manage or because they regard the entire fiel/>