Margaret B. Wilson, DDS, MBA
Attending the Medical College of Virginia School of Dentistry was a wonderful experience for me, and in retrospect it was transformative as well. It was challenging academically, but I was blessed to be part of a cohesive class of 110 students (Only 20 of us were women!), many of whom became like family. My brother had completed a 3-year stint in the US Army Dental Corps and had returned as a faculty member at the dental school. While there were some disadvantages to being “Gibby’s little sister,” there were advantages as well. I had strong family support in Richmond, and I was able to get to know some of the faculty and staff on a more personal level. I had the opportunity to serve as a student member of the Admissions Committee, working with Dr. Marshall Brownstein.
As dental school graduation approached, I was considering a number of options, including private practice and the US Army. At that time, in the early 1980s, general dentistry residency programs weren’t as numerous as they are today. In the spring before graduation, one of our dental school faculty members, Dr. John Svirsky, asked me whether I had firm postgraduation plans. I replied that I had not, and he advised that the University of Maryland Hospital had contacted him regarding an available position in their General Practice Residency (GPR) program. I visited the program and was offered a position. Spending a year in the GPR provided rich opportunities to care for medically compromised patients and to work alongside other health professionals in the hospital setting in providing patient care. I gained invaluable experience in managing complex patients, learning from attending faculty and from my co-residents. As residents, we also had the opportunity to do some teaching in the dental school, and we interacted with dental students as they completed their hospital dentistry rotations. Dr. John Hasler, Associate Dean for Clinical and Hospital Affairs, led our resident seminars. As the residency program was drawing to an end, Dr. Hasler asked several of us residents whether we would be interested in a new faculty position in a pilot clinical program at the University of Maryland dental school. I declined this opportunity because my fiancé (now my husband of 34 years) was in Richmond.
Guy and I were married in late July 1982, and I began working in private practice in Fredericksburg Virginia and volunteering as a clinical faculty member at the Medical College of Virginia School of Dentistry. As the practice in Fredericksburg became busier, I transitioned to full time and regretfully had to discontinue my teaching activities. I practiced in Fredericksburg for 4 years, learning valuable lessons about how thriving practices function and the role of the dentist as a leader of the dental team and a leader within the community.
In 1986, I made the transition to a position at the University of Maryland at College Park in the Student Health Center, where I served as Director of Dental Services. We had a four-chair dental clinic and provided comprehensive care and emergency services for university students, with an emphasis on health promotion. Our clinic served as a rotation site for senior dental student externships and clerkships. Because we saw a lot of patients who needed endodontics, we established a program for postgraduate endodontics residents from the University of Maryland School of Dentistry to also rotate through our clinic. By virtue of these student and resident rotations, I had a faculty appointment at the dental school and had opportunities to periodically attend meetings at the dental school in Baltimore.
26.2 Entry into Full-Time Academia
While at the University of Maryland at College Park, I completed a Master of Business Administration at the University of Maryland School of Business in 1990. At the same time, I accepted a full-time position at the University of Maryland School of Dentistry (then called the Baltimore College of Dental Surgery) as one of the General Practice (GP) Managers in the newly established General Practice Program. This program was conceived and developed by Dr. John Hasler, whom I had known from my residency program, and Dean Errol Reese. Seven of us were hired as GP Managers, and we were each responsible for all operational aspects of our assigned group practice of third- and fourth-year dental students. As general dentists, we interfaced closely with the other general dentistry and specialty faculty, to ensure that our students received well-rounded educational experiences while providing comprehensive care for the patients. We provided clinical coverage for the students and served as their mentors and advisors.
Three years later, an administrative position – Assistant Dean for Admissions and Student Affairs – became available at the dental school. Because of the numbers of interested and qualified internal candidates, Dean Richard Ranney determined that the search would be internal. There were a number of highly qualified faculty members who applied for this position, including several who had been engaged in student-related activities and had served as members of the Admissions Committee. Given the caliber and many years of experience of the faculty who had publicly declared their interest in the position, I was reluctant to even apply for the position, given my relative youth and brief tenure at the dental school. However, with strong encouragement from several mentors and from my husband, I did apply and was fortunate enough to be selected for the position. During this time, I also had the opportunity to begin participating in the students’ ethics curriculum, working with Dr. James T. Rule, author of Ethical Questions in Dentistry. When Dr. Rule retired, I was asked to assume responsibility for coordinating this important aspect of the curriculum. For the next 14 years, I served in various administrative capacities, with responsibilities for student affairs, admissions, and for 2 years, academic affairs. I had the opportunity to work with two Deans – Dr. Ranney and Dr. Christian Stohler.
26.3 Time of Transition
In the spring of 2008, I decided to step away from administrative responsibilities and returned to full-time clinical teaching. Collaborating with other key faculty partners, we piloted the General Practice Simulation (GPS) project in one section of the predoctoral clinics. This shift in focus allowed me to get back in touch with my clinical side and reignited my passion for clinical teaching and patient care. After about a year, as the GPS was moving forward, I learned about professional opportunities at the East Carolina University School of Dental Medicine (School of Dentistry at that time). Dr. James Hupp, who had been the chair of Oral and Maxillofacial Surgery for a number of years at University of Maryland, had gone on to be the Dean of the University of Mississippi School of Dental Medicine and had recently been appointed as Dean at East Carolina University (ECU). I applied for the position of Associate Dean for Student Affairs and, after a lengthy search process, was offered the position.
My husband Guy was absolutely thrilled (as was I!) with this opportunity and was unquestioningly supportive of our relocating to Greenville, North Carolina, knowing full well that it could prove difficult for him to find employment options in his area of expertise, financial management of manufacturing companies. We were also aware that while the commitment to establish the dental school at ECU was unwavering, there were significant budgetary concerns within the state of North Carolina that could impact the timeline or even the establishment of the school. However, the opportunity to help start a new school – one with such a clear, concise mission – was incredible, and we made the decision to embrace the opportunity. We moved to Greenville in November 2009, and Guy began his job exploration. After 9 months of searching, he ultimately accepted a position as Chief Financial Officer for a newly established manufacturing facility in Oxford, North Carolina. We were now both working with our respective “start-ups.”
26.4 Early History of the East Carolina University School of Dental Medicine
Established as the School of Dentistry at East Carolina University (ECU) by the North Carolina legislature in 2007, the School of Dental Medicine (SoDM), located in Greenville, North Carolina, is the second dental school in the state of North Carolina. In considering the establishment of a second dental school, state policy makers were extremely concerned about the overall shortage of dentists in North Carolina as well as an unequal distribution of dentists across the state. North Carolina currently ranks 47th in the 50 United States, with respect to dentist-to-population ratios, and is the fifth fastest growing state in the county and the tenth most populated.
Geography matters in North Carolina. There is a rural–urban divide within the population. Approximately half of the state’s population lives in the 15 urban counties, while the other half of the population is spread among the 85 rural counties. Of North Carolina’s 100 counties, 79 qualify as federally designated health professional shortage areas, and 3 counties (all in the eastern region of the state) do not have a single dentist.1
In choosing ECU as the parent institution for the new dental school, legislators noted ECU’s demonstrated capacity to meet the health-care needs of the state and region through its medical school and colleges of nursing and allied health. ECU’s Brody School of Medicine was established in 1977, in order “…to increase the supply of primary care physicians to serve the state, to improve health status of citizens in eastern North Carolina, and to enhance the access of minority and disadvantaged students to a medical education.”2
The plan to establish the new dental school at ECU was created under a joint agreement with the University of North Carolina (UNC), Chapel Hill, which also included an increase in enrollment for the existing public dental school at that institution. The plan included the establishment of ECU, with a class size of 50, and a future planned increase in UNC’s class size from 80 to 100, substantially increasing the opportunities for dental training in North Carolina.
Dr. Greg Chadwick was the very first person to join ECU in 2005 to begin to develop the plan for the school and initially served as Associate Vice Chancellor for Oral Health. A practicing endodontist who had initially practiced general dentistry in community dental clinics in underserved areas of North Carolina, Dr. Chadwick’s perspective gained from his roles as President of the North Carolina Dental Society, and the American Dental Association uniquely prepared him to lead in the further development and implementation of the plan for the school.
Dr. Chadwick had hired Dr. Todd Watkins in the spring 2008 and tasked him with developing an innovative curriculum model for the School of Dental Medicine. Dr. Watkins’ background in curriculum and informatics uniquely qualified him for this undertaking. He had served as the primary architect for two other dental schools’ curricula and had consulted with many medical and dental schools and other health profession schools related to curriculum development, assessment, and use of educational technology. Dr. Watkins’ charge was to develop a curriculum that would prepare the students to meet the vision and mission of the school and would culminate in the students spending a large portion of their fourth year providing care in the Community Service Learning Centers (CSLCs).
26.5 The ECU Model
The vision and mission of the ECU School of Dental Medicine are clear and consistent with the school’s founding principles. The school’s vision – “Improving the health and quality of life of all North Carolinians by creating leaders with a passion to care for the underserved and by leading the nation in community-based, service learning oral health education” – encapsulates its commitment to the people of North Carolina. Further amplifying the vision, the school’s mission is to:
Prepare leaders with outstanding clinical skills, an ethical bearing, sound judgment, and a passion to serve.
Provide educational opportunities for academically qualified North Carolinians from historically underrepresented groups, disadvantaged backgrounds, and underserved areas.
Provide and enhance oral health services for underserved North Carolinians through implementation of community-oriented service learning and inter-professional collaborations.
Foster a learning environment where collaboration, creativity, diversity, and professionalism are embraced.
Influence future clinical practice and dental education through research, innovation, and discovery.
This vision and mission fully align with our parent institution, which has a motto of servire, to serve. Consistent with our mission, admission to the ECU School of Dental Medicine is limited to residents of North Carolina.
The ECU School of Dental Medicine was the first public dental school in the United States established in the past 40 years with an emphasis on serving the oral health-care needs of rural America. The ECU model focuses on the education of primary care dentists to provide dental care and leadership within communities of need across the state of North Carolina. Students spend their first three years on the Greenville campus of ECU, participating in a wide range of educational activities, including didactic, small group discussion and preclinical laboratory and simulation activities, and caring for patients in a brand-new, state-of-the-art educational and patient care facility, Ledyard E. Ross Hall. In sharp contrast, fourth-year students spend the majority of their time providing care for patients in the Community Service Learning Centers (CSLCs), constructed using state funds and located in rural and underserved regions in the state.
From 2012 until 2016, ECU has established a network of eight CSLCs, each functioning as a “branch office” of the dental school. The CSLC Directors are full-time dental faculty, hired by the school. Each of the school’s eight CSLCs is an ECU built, owned, and operated 7,700 square foot, 16-operatory dental clinic. A full-time Director and a second part- or full-time dentist, both of whom are School of Dental Medicine faculty, a business manager, two dental hygienists, and a team of dental assistants and administrative support professionals, staff each CSLC. Two Advanced Education in General Dentistry (AEGD) residents complete their residency year at each CSLC, and fourth-year dental students spend more than half of their senior year on three-week CSLC rotations. The AEGD residents and students treat patients alongside the faculty who also provide direct patient care, enabling the students and residents to work in an actual care delivery system. The students’ opportunity to work with all members of the dental team on a daily basis allows them to appreciate the key roles in dental practice, while enabling the students to see six or more patients per day.