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Graduate dental education in Canada Boyd, Marcia Ann 1974

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GRADUATE DENTAL EDUCATION IN CANADA > y MARCIA ANN BOYD D . D . S . , U n i v e r s i t y of A l b e r t a , 1969 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n the Department of Curr icu lum We accept t h i s thes i s as conforming to the requ ired standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1974 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h C olumbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p urposes may be g r a n t e d by the Head o f my Department o r by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Marcia A. Boyd, D.D.S. Department o f CURRICULUM The U n i v e r s i t y o f B r i t i s h Columbia Vancouver 8 , Canada Date A p r i l 25, 1974 i i ABSTRACT Until the mid 1960's British Columbia was dependent upon outside sources for its dental manpower. With a significant increase in population and a similar increase in demand for dental care it became apparent that British Columbia could no longer rely on the goodwill of other universities for the training of the province's dentists. As a result of two detailed studies authored by Dr. John B. Macdonald, a Faculty of Dentistry was established at the University of British Columbia in 1962 and the first undergrad-uate class admitted in September 1964. After ten years in operation it seemed appropriate to examine the question as to whether or not the implementation of a graduate studies program in the Faculty of Dentistry was justified. In order to provide an in-depth perspective as to the present status of graduate dental education programs a survey questionnaire was sent to all ten dental schools in Canada. The questionnaire dealt with three separate aspects of graduate dental education, namely: 1. the preparation for practice of a clinical dental specialty; 2. the preparation for a teaching and/or research career; and i i i 3 . the continued improvement of the existing professional dentist through continuing dental education. Undergraduate dental programs supply manpower to provide for the public's need for regular and routine dental care, while graduate dental education can provide qualified personnel for research, teachers for dental education, as well as dental special-ists requiring the advanced skills to meet the public's need for special dental services. Consequently, the aim of both the under-graduate and.graduate dental education programs is to provide the knowledge, skil l and manpower to meet the dental health care demands of the community. With the advent of prepaid dental care plans, coupled with the public's growing awareness that it is their right to enjoy good dental health, it is clear that the increasing demand for service cannot be met by the undergraduate dental programs alone. Graduate dental education is the beginning of a partial solution to the problem. An analysis of the collected data, taking into consideration the dental care delivery system as it now exists in Canada, has shown that: 1. If undergraduate enrollment in dentistry is to be increased, not only in British Columbia but also in Canada as a whole, it is essential to provide the advanced training needed i v for personnel to staff the dental schools; 2 . more research workers are needed if the answers to the major problems in the field of dentistry are to be found; 3 . more clinical specialists are required i f the public is to be afforded the treatment necessary in special-ty areas; 4 . many Canadian dentists pursue their graduate training at American institutions even though there are Canadian programs and positions available within these programs; 5 . over the past five years dentists in Canada have demonstrated an increasing interest in continuing dental education programs. If the profession of dentistry is to achieve its ultimate goal of effective and economic treatment of dental disease, then it is of paramount importance for both undergraduate and graduate dental education programs to begin to deliver the professionally equipped personnel needed in Canada. V TABLE OF CONTENTS Page Title i Abstract 11 Table of Contents v List of Tables v i i List of Graphs x Acknowledgements . . . . . . . . . . . . . . . xi Chapter I - Introduction General Background . . . . . 1 The Problem 3 I Specialty Training . . . 4 II Teaching and Research Training . . . 6 III Continuing Dental Education . . 6 The Procedure . . . . . . . . . . . . . . . . . . . 8 Limitations 8 Chapter II - Graduate Dental Education Background 9 Subject Areas 20 Enrollment 24 Summary . . . . . 31 Chapter III - Clinical and Nonclinical Specialties Background 34 Summary 48 v i Chapter IV - Cont inuing Dental Educat ion Background 51 P a r t i c i p a t i o n i n Cont inuing Denta l Educat ion . . . 52 Subject Areas 62 Expenditure 64 Summary . . . . . . . . . . . . . . . . 66 Chapter V - Conclusions Supply and Demand 69 S p e c i a l t y T r a i n i n g . . 70 Teachers and Research Workers . . . . . . . . . . . 79 Cont inuing Denta l Educat ion . . . . . 80 Recommendations 81 Reference B i b l i o g r a p h y . . . . . . 83 Appendix I (Quest ionnaire) . . . . . . . . 85 vi i LIST OF TABLES Page Chapter II TABLE I - Undergraduate Enrollment in Canadian Dental Schools 9 II - Distribution of 1972 Dental Graduates in Canada by region; 1972 Dental Graduate to population ratio 10 III - Population of Canada by Province, estimated as of June 1 for Intercensal Years 10 IV - Population of Canada, by Region, 1969-1973 11 V - Present and Projected Capacity per year of Dental Programs offered by Canadian Universities 11 VI - Dentist/Population Ratio in Canada, by Province 12 VII - Dentist/Population Ratio in.Canada, by Region 12 VIII - Existing Graduate Dental Education Programs in Canada (Dec., 1973) 14 IX - Proposed Graduate Programs (Dec., 1973) 16 X - Existing Graduate Dental Education Programs in Canada, by Region (Dec, 1973) 17 XI - Proposed Graduate Dental Education Programs in Canada, by Region (Dec., 1973) 18 XII - Summary of Graduate Dental Education Programs Offered by Universities in Canada (Dec.,1973) 19 XIII - Subject Areas offered in Graduate Dental Education Programs in Canada 1972 20 XIV - Graduate Dental Education Programs Available in Canada, by Region, 1972 22 v i i i TABLE Page XV - Students Enrolled in Graduate Dental Education in Canada (B.Sc.D., M.Sc.D., Ph.D.) Proceeding to Degree, Diploma, or Certificate 24 XVI - Enrollment in Graduate Dental Education Programs in Canada, by Region 25 XVII - Number of Specialists Certified in Canada 26 XVIII - Total Enrollment in Subject Area 27 XIX - Graduate Degree and Certification Enrollment by Subject Area and University (1973-74) 28 XX - Graduate Degree and Certification Programs by Subject Area and Region (1973-74) 29 Chapter III TABLE I - Certifiable Specialties, by Province Dec, 1972 35 II - Percentage of Dentists who are Specialists (Jan., 1973) 36 III - Specialist to Population Ratio (Jan.,1973) 39 IV - Total Number of Certified Specialists in Canada, 1968-1972 41 V - Licensed Specialists Practising in British Columbia (Dec., 1972) 42 VI - Practising Locations of British Columbia Specialists (Jan., 1973) 43 VII - Location of Graduate Dental Training o f Specialists in British Columbia (Jan.,1973) 45 VIII - Location of Undergraduate Dental Training of Specialists in British Columbia (Jan.,1972) 47 Chapter I V i x TABLE Page I - Enrol lment i n Cont inuing Denta l Educat ion Programs i n Canada 52 I I - Enrol lment i n Cont inuing Denta l Educat ion Programs i n Canada by region 53 I I I - Percent of Dent i s t s E n r o l l e d i n Cont inuing Denta l Educat ion i n Canada by Province 56 I V - Percent of Dent i s t s E n r o l l e d i n Cont inuing Dental Educat ion i n Canada by Region 57 V - Cont inuing Dental Educat ion Programs Offered by Canadian U n i v e r s i t i e s : Subject Areas and Enro l lment , 1969-1973 62 I X LIST OF GRAPHS Chapter IV Page Graph I - Number o f Dent i s t s P a r t i c i p a t i n g i n Cont inuing Dental Educat ion Programs i n Canada, 1969-1973 5 4 I I - Number of Dent i s t s P a r t i c i p a t i n g i n Cont inuing Dental Educat ion Programs i n Canada, by Region, 1969-1973 5 5 I I I - Percentage of Dent i s t s E n r o l l e d i n Cont inuing Dental Educat ion Programs i n Canada by P r o v i n c e , 1969-1973 5 9 IV - Percentage of Dent i s t s E n r o l l e d i n Cont inuing Dental Educat ion i n Canada by Region, 1969-1973 60 ACKNOWLEDGEMENTS The author wished to express sincere appreciation to Dr. Joseph Katz, Professor and Chairman of the Department of Curriculum and Library Education and Chairman of the Thesis Committee. His competence in editorial guidance and his generous cooperation and encouragement are appreciated deeply. I would like to express my thanks to the individuals who cooperated by completing the survey questionnaire. The information they made available constitutes the majority of the factual information in this report. Finally I would like to thank Ms. Pauline McClafferty for her painstaking efforts in preparing the manuscript. CHAPTER I - INTRODUCTION GENERAL BACKGROUND U n t i l the mid 1960's the Province of B r i t i s h Columbia was dependent upon the goodwi l l of the denta l f a c u l t i e s i n A l b e r t a , Washington and Oregon f o r the t r a i n i n g of d e n t i s t s . The d e n t a l schools i n these centres not only t r a i n e d B r i t i s h Columbia's na t ive sons but a lso contr ibuted dent i s t s to the Province by way of emigrat ion . As the need for denta l s erv i ce s i n the Province increased i t became c l e a r that the aforementioned arrangement could not cont inue. I t was at t h i s t ime, June 1955, that Dr . John B. Macdonald was i n v i t e d by the Pres ident of the U n i v e r s i t y of B r i t i s h Columbia to be the Consultant i n Dental Educat ion to the Senate Committee i n v e s t i g a t i n g the idea of e s t a b l i s h i n g a Facu l ty of D e n t i s t r y at t h i s U n i v e r s i t y . Dr . Macdonald at the time was D i r e c t o r o f the D i v i s i o n of Dental Research at the U n i v e r s i t y of Toronto . His task was to assess the need for a denta l school i n B r i t i s h Columbia. Dr . Macdonald's r e p o r t , A Prospectus on Dental Education,"'' was prepared and submitted i n 1956. In i t he recommended the immediate establishment of a Dental F a c u l t y at the U n i v e r s i t y of B r i t i s h Columbia. Apart from the undergraduate t r a i n i n g , he d id "^Dr. John B. Macdonald. A Prospectus on Dental Educat ion  for the U n i v e r s i t y of B r i t i s h Columbia, U n i v e r s i t y of B r i t i s h Columbia, Vancouver, 1956. foresee the eventual establ ishment of a graduate program whose primary purpose would be to provide denta l teachers and research s c i e n t i s t s . He s t a t e s , "It i s u n l i k e l y that a new F a c u l t y of D e n t i s t r y would f i n d i t f e a s i b l e to accept graduate students during the f i r s t four years of i t s ex i s tence . A s trong under-2 graduate program w i l l create the demand for a graduate program. 1 With regard to the t r a i n i n g of s p e c i a l i s t s , he f e l t such a program should be developed, but on a smal l s ca l e only a f t e r the undergraduate program was w e l l e s t a b l i s h e d . He recommended that programs for the t r a i n i n g of s p e c i a l i s t s be developed as demand warranted. Dr. Macdonald's report was adopted by the Senate and the Board of Governors. Although a l l groups endorsed i t , no a c t i o n was taken u n t i l 1961, when Dr. Macdonald was i n v i t e d back to the U n i v e r s i t y of B r i t i s h Columbia to update and r e v i s e h i s o r i g i n a l r e p o r t . He made no changes or fur ther recommendations regarding 3 graduate denta l educat ion . Fo l lowing h i s second report i n 1961, i t was decided to e s t a b l i s h a Facu l ty of D e n t i s t r y at the U n i v e r -s i t y of B r i t i s h Columbia. D r . Wah S.Leung was appointed Dean and i n 1964 the f i r s t c la s s of undergraduate students was admitted. 2 Macdonald, Op. c i t . p . 33 3 Dr. John B. Macdonald. Dental Educat ion i n B r i t i s h Columbia, Vancouver, 1961. THE PROBLEM In these two r e p o r t s , D r . Macdonald recommended the establishment of a denta l school i n which he envisaged the eventual i n c l u s i o n of a graduate program. The denta l school has been i n operat ion for ten years and i t now seems the appropriate time to pursue the quest ion of whether or not the implementation of a graduate s tudies program i s j u s t i f i a b l e . There i s , and always has been, a ser ious gap between the p u b l i c ' s demand for general and s p e c i a l i z e d denta l s erv ices and the p r o f e s s i o n ' s a b i l i t y to d e l i v e r these. Part of the problem i s r e l a t e d to a lack of manpower i n both areas . I f t h i s gap i s to be narrowed, p o s i t i v e steps must be taken by the p r o f e s s i o n . Perhaps a p a r t i a l answer l i e s i n p r o v i d i n g advanced s tudies beyond the undergraduate l e v e l . Graduate denta l educat ion i s not n e c e s s a r i l y l i m i t e d to the t r a i n i n g of denta l s p e c i a l i s t s . There are i n fac t three major categories of graduate education i n d e n t i s t r y . These are: 1 . prepara t ion for p r a c t i c e of a denta l s p e c i a l t y ; 2. p r e p a r a t i o n for a teaching or research career ; and 3 . the continuous inprovement of t h e - e x i s t i n g p r o f e s s i o n a l d e n t i s t . Th i s l a t t e r category i s u s u a l l y r e f e r r e d to as "cont inuing denta l educat ion". The s o c i a l i m p l i c a t i o n s of graduate denta l education are c e r t a i n l y f a r - r e a c h i n g . Some of the questions which need to be considered are : W i l l more s p e c i a l i z e d t r a i n i n g meet the needs of the p u b l i c ? Does t h i s type of t r a i n i n g improve the d e l i v e r y of denta l care to the community at large? Have we s a t i s f i e d the need for denta l educators and research workers? Do the cost fac tors warrant the establishment of a graduate denta l education program? What in f luence w i l l p o l i t i c a l dec i s ions have on proposed or e x i s t i n g programs? What r e a l l y are the bas i c c r i t e r i a invo lved i n the r a t i o n a l e of i n s t i t u t i n g graduate s tudies? These are a l l important questions and c e n t r a l to the i s sue under c o n s i d e r a t i o n . Converse ly , what are the p r o f e s s i o n a l i m p l i c a t i o n s ? What i s the p r o f e s s i o n ' s moral and e t h i c a l r e s p o n s i b i l i t y to the p u b l i c ? S i m i l a r l y , what are i t s i n t r a and i n t e r p r o f e s s i o n a l ' r e s p o n s i b i l -i t i e s and expectat ions? What w i l l be the p r o f e s s i o n a l body's r e l a t i o n s h i p to the government? A g a i n , these are questions c e n t r a l to the problem. The problem b e i n g , i s there a demonstrable need for graduate denta l education i n the Province of B r i t i s h Columbia? I f the answer i s "yes", how can i t be j u s t i f i e d ? I S p e c i a l t y T r a i n i n g I t i s evident that the undergraduate programs i n exis tence i n Canada are unable to f u l f i l l a l l of the needs for d e n t a l care d e l i v e r y to the p u b l i c . I t i s genera l ly agreed that the s p e c i a l t y programs should a r i s e i n response to the demands f o r s p e c i a l i z e d d e n t a l s e r v i c e s . North Americans enjoy a p a r t i c u l a r l y h i g h s t a n -dard of d e n t a l treatment and the t r a i n i n g of s p e c i a l i s t s has an important s o c i a l f u n c t i o n i n that i t maintains and c o n s t a n t l y improves t h a t standard. Where s p e c i a l t y t r a i n i n g i s p r o p e r l y u t i l i z e d i t can a l s o decrease the cost of d e l i v e r y of th a t s e r v i c e . On the other hand, i t may be p o s s i b l e to i n s t i t u t e s p e c i a l a d d i t i o n -a l emphasis i n the undergraduate t r a i n i n g program encouraging general p r a c t i t i o n e r s w i t h complementary s k i l l s t o become i n v o l v e d i n group p r a c t i c e s , thereby reducing the o v e r a l l need f o r s p e c i a l -i s t s e r v i c e . The current demand f o r h e a l t h s e r v i c e i s only a f r a c t i o n of the demand which might su r f a c e i f economic b a r r i e r s were removed and e f f e c t i v e h e a l t h s e r v i c e s were r e a d i l y a c c e s s i b l e to everyone. Among the more important f a c t o r s that i n f l u e n c e demand are the p a t t e r n of di s e a s e , the e d u c a t i o n a l , s o c i a l and c u l t u r a l c h a r a c t -e r i s t i c s of the p o p u l a t i o n and the cost of care. I f the major b a r r i e r s to e f f e c t i v e h e a l t h s e r v i c e s demand were removed, i t i s probable t h a t the gap between demand and d e l i v e r y would become even more c r i t i c a l . However, expectations of the p u b l i c r e g a r d i n g the k i n d of h e a l t h s e r v i c e they need and deserve, have produced rumblings i n the community which are now being f e l t and acted upon at the l e g i s l a t i v e l e v e l . H i s t o r i c a l l y , 6 when the pro fe s s ion allows a s i t u a t i o n such as t h i s to continue without e f f e c t i v e l y r e s o l v i n g i t , the government steps i n and becomes the d i r e c t o r of that s e r v i c e , e . g . Great B r i t a i n , New Zealand. II Teaching and Research T r a i n i n g Teachers and research workers comprise the second category of graduate denta l educat ion . They are of fundamental importance to the development and advancement of d e n t i s t r y i n any country. The s t a f f i n g of denta l schools and research i n s t i t u t e s and the development of comprehensive schemes of graduate denta l education c a l l s f or a continuous flow of h igh c a l i b r e candidates i n t o academic careers . Sa lary scales shou ld , whenever p o s s i b l e , be brought at l ea s t to a par with the rewards of general p r a c t i c e . F i n a n c i a l support throughout the preparat ion per iod for an academic career should a lso be prov ided . Concurrent t r a i n i n g as a teacher and researcher i s e f f i c i e n t and economical . A s p e c i a l l y designed program l ead ing to c e r t i f i c a t i o n as a s p e c i a l i s t and to an academic degree with a view to an academic career i n that s p e c i a l t y would shorten the prepara t ion time and enhance i t s outcome. III Cont inuing Dental Educat ion The t h i r d category of graduate denta l education i s cont inuing educat ion. This form i s addressed to most of the members of the p r o f e s s i o n . I t i s h i g h l y f l e x i b l e , l e ss formal and designed to meet the needs of each geographica l area . These programs are designed to serve d i f f e r e n t purposes: 1. to r e f r e s h the knowledge acquired i n the past or review inadequately covered m a t e r i a l from under-graduate educat ion; 2. to update knowledge wi th regard to recent developments i n methods and techniques; 3. to expand the scope of the general p r a c t i t i o n e r s ' work to cover knowledge and s k i l l s not normally inc luded i n the undergraduate program; and 4. to strengthen knowledge of the b a s i c sc iences and the medical foundations of denta l p r a c t i c e . A l l d e n t i s t s need t h i s type of cont inu ing educat ion , no matter whether they are general p r a c t i t i o n e r s , s p e c i a l i s t s , teachers or research workers. Extensive p a r t i c i p a t i o n by a l l members of the p r o f e s s i o n i s necessary to develop a comprehensive system of cont inuing denta l educat ion . Cont inuing education w i l l improve the d e n t i s t ' s p r a c t i c e and develop new a t t i t u d e s towards d e n t i s t r y through courses where prevent ive and r e s t o r a t i v e d e n t i s t r y are c a r e f u l l y combined. He w i l l ensure h i s p r o f e s s i o n a l growth and f e e l happier i n h i s p r a c t i c e . These p s y c h o l o g i c a l gains are very important both to h imse l f and 8 to h i s p a t i e n t s . THE PROCEDURE In order to examine the c e n t r a l problem i n depth, a survey quest ionnaire was sent to a l l Canadian denta l schools to gather informat ion regarding e x i s t i n g graduate programs (Appendix I ) . The Canadian programs w i l l be compared f i r s t on a province by province b a s i s , then on a r e g i o n a l b a s i s . The a n a l y s i s to t h i s point should then make i t p o s s i b l e to l a y a bas i s for cons ider ing the parameters d e s i r a b l e for graduate denta l educat ion programs. LIMITATIONS The l i m i t a t i o n s of the study and analyses are determined by the questions asked and the answers e l i c i t e d . The ques t ionnaire deals with e x i s t i n g graduate denta l education programs o n l y , t h e i r subject areas and enrollment (Appendix I ) . No informat ion was s o l i c i t e d i n regard to methodology and no attempt w i l l be made to estimate the d o l l a r s and cents component of graduate denta l educat ion . CHAPTER II - GRADUATE DENTAL EDUCATION BACKGROUND Before pursuing the ana lys i s of graduate denta l educat ion an examination of the undergraduate s i t u a t i o n i n Canadian denta l schools i s i n order . The undergraduate denta l programs are b a s i c to the d e l i v e r y of a l l denta l s erv ices to the p u b l i c . TABLE I Undergraduate Enrol lment i n Canadian Denta l Schools 1972-73 Dental School Year T o t a l Reg ion2 1 2 3 4 5 A . . . B . C B r i t i s h Columbia 40 40 37 34 — 151 513 A l b e r t a 49 47 50 39 — 185 Saskatchewan 12 15 9 9 10 55 Manitoba 33 31 32 26 — 122 Toronto 125 124 128 125 — 502 1199 Western Ontar io 55 46 52 35 — 188 M c G i l l 42 39 37 38 156 Montreal 85 76 69 82 — 332 L a v a l 16 15 31 Dalhousie 30 22 29 24 105 105 T o t a l s 487 455 453 412 10 1817 513 1199 105 Source: Dental Educat ion R e g i s t e r , Canadian Dental A s s o c i a t i o n ( C D . A . ) A l l analyses performed on a r e g i o n a l bas i s were grouped as fo l lows: Western (A) — U n i v e r s i t i e s of B r i t i s h Columbia, A l b e r t a , Saskatchewan, and Manitoba. C e n t r a l (B) — U n i v e r s i t i e s of Western O n t a r i o , Toronto , M o n t r e a l , M c G i l l , a n d L a v a l . A t l a n t i c (C) — Dalhousie U n i v e r s i t y . 1 0 TABLE I I D i s t r i b u t i o n of 1972 Dental Graduates i n Canada by r e g i o n ; 1972 Dental Graduates to p o p u l a t i o n r a t i o 1 -Region 1972 Graduates P o p u l a t i o n ('000) Western (A) 115 50,522 C e n t r a l (B) 260 53,400 A t l a n t i c (C) 23 90,478 Source: S t a t i s t i c s Canada, P o p u l a t i o n of Canada by P r o v i n c e s , 1932-1973, estimated as of June 1 f o r I n t e r c e n s a l Years, Ottawa, September, 1973. As shown i n Table I , l a s t year (1972-73) the ten Canadian d e n t a l schools had a t o t a l undergraduate enrollment of 1817 students. This represented one student f o r every 12,014 Canadian r e s i d e n t s . Region-a l l y , i t represented 1/11,325 i n the Western r e g i o n ; 1/11,580 i n C e n t r a l Canada; and 1/19,819 i n the A t l a n t i c r e g i o n . TABLE I I I P o p u l a t i o n of Canada by P r o v i n c e , estimated as of June 1 f o r I n t e r c e n s a l Years ('OOO)1 Province 1969 . 1970 1971 1972 1973 B.C. 2,060 2,128 2,185 2,247 2,315 A l t a . 1,559 1,595 1,628 1,655 1,683 Sask. 958 941 926 916 908 Man. 979 983 988 992 998 Ont. 7,385 7,551 7,703 7,825 7,939 Que. 5,985 6,013 6,028 6,059 6,081 N.3. 628 627 635 642 652 N.S. 775 782 789 794 805 P.E.I. 111 110 112 113 115 N f l d . 514 517 522 532 541 2 Canada 21,001 21,297 21,569 21,830 22,095 ^Source: S t a t i s t i c s Canada 2Canadian T o t a l i n c l u d e s the Yukon and N.W.T. 11 TABLE IV Popula t ion of Canada, by Region, 1969-1973 ('000) Region 1969 1970 1971 1972 1973 Western 5,556 5,647 5,727 5,810 5,904 C e n t r a l 13,370 13,564 13,731 13,884 14,020 A t l a n t i c 2,028 2,036 2,058 2,081 2,113 I S o u r c e : S t a t i s t i c s Canada The Canadian, popu la t ion i s cont inu ing to increase as i l l u s t r a t e d i n Tables I I I and IV. Although the denta l schools hope to be able to increase the capac i ty of t h e i r denta l p r o g -rams as o u t l i n e d i n Table V , i t can be seen that the 1972-73 enrollment per year , the average being 454, i s w e l l below the p r o j e c t i o n for that year of 482 students . TABLE V Present and P r o j e c t e d Capacity per year of Dental Programs of fered by Canadian U n i v e r s i t i e s PROGRAM Capacity 1972-73 1973-74 1974-75 1975-76 1976-77 D e n t i s t r y 482 500 510 540 550 1 S o u r c e : Dental Educat ion R e g i s t e r , C D . A . I t would be v i r t u a l l y impossible to boost enrollment to meet the pro jec ted 500 mark set for the 1973-74 year . Even i f i t were p o s s i b l e , i t would be d i f f i c u l t to reduce or even maintain the 12 Canadian average as i t now stands , cons ider ing the increase i n popula t ion and the n a t u r a l losses w i t h i n the p r o f e s s i o n i t s e l f . TABLE VI D e n t i s t / P o p u l a t i o n Rat io i n Canada, By Province Province 1969 1970 1971 1972 1973 B . C . 2,337* 2,279 2,203 2,093 2,048 A l t a . 2,817 2,730 2,764 2,643 2,562 Sask. 4,211 4,277 4,164 4,079 3,770 Man. 3,314 3,210 3,212 3,136 2,979 Ont. 2,479 2,451 2,373 2,377 2,316 Que. 3,652 3,565 3,518 3,437 3,375 N . B . 4,496 4,831 5,016 4,635 4,367 N. S. 3,209 3,176 3,385 3,315 3,267 P . E . I . 3,793 4,11.1 3,793 3,613 3,229 N f l d . 9,370 8.712 8,339 8,557 8,312 T o t a l 2,986 2,935 2,873 2,814 2,735 Source: Bureau of Dental S t a t i s t i c s , C D . A . ; S t a t i s t i c s Canada Read, one d e n t i s t f o r every 2,337 people . TABLE VII D e n t i s t / P o p u l a t i o n Rat io i n Canada, by Region Region 1969 1970 1971 1972 1973 Western 2,888 2,818 2,760 2,638 2,546 Centra l 2,937 2,891 2,807 2,780 2,710 A t l a n t i c 4,399 4,426 4,604. 4,456 4,321 Tables VI and VII show the dent i s t populat ion r a t i o s by province and by reg ion from 1969 through 1973. C o n s i s t e n t l y , 13 over t h i s f i v e year p e r i o d , the province of B r i t i s h Columbia has had the best r a t i o . The provinces of Ontario and A l b e r t a have a l so enjoyed a b e t t e r r a t i o than the res t of Canada over that time p e r i o d . Each province has been gradua l ly reducing i t s r a t i o over the years . Most have done t h i s v i a a p r o p o r t i o n a t e l y greater increase i n the number of dent i s t s compared to the increase i n the p r o v i n c i a l p o p u l a t i o n . Saskatchewan, however, i s an i n t e r -e s t i n g case, where the increase i n dent i s t s has been low (averaging only three per year) but the populat ion has dec l ined every year (Table I I I ) , thereby lowering t h e i r o v e r a l l d e n t i s t / p o p u l a t i o n r a t i o . Reg ional ly (Table V I I ) , the Western provinces again enjoy the best r a t i o (1 /2 ,546) , fo l lowed by the C e n t r a l Region (1/2,720) and l a s t l y , the A t l a n t i c provinces (1 /4 ,321) . Cons ider ing the p u b l i c need f o r denta l s e r v i c e and the i n a b i l i t y of the p r o f e s s i o n to meet the demand, i t i s extremely d i f f i c u l t to estimate exac t ly what the d e s i r a b l e or c r i t i c a l d e n t i s t / p o p u l a t i o n r a t i o should be. Has t ings , i n 1962, recommended a d e n t i s t / p o p u l a t i o n r a t i o of 1/1500 to 1/1800 i n the p lan for h e a l t h care proposed by labour."'" Even the best d e n t i s t / p o p u l a t i o n r a t i o of 1/2,546 i n the West i s s t i l l w e l l above the suggested c r i t i c a l l e v e l . To reduce the present Canadian r a t i o of 1/2,735 to approximately one dent i s t for every 1800 people , there would have to be h a l f again J . E . F . Has t ings . Labour's P lan for Medica l Care, Programme  for Toronto , Toronto Labour Health Centre Organiz ing Committee, Toronto , 1962, p. 22. (Unpublished paper;) 14 as many d e n t i s t s as there are i n Canada t h i s y ear, 1973. Therefore, we would need approximately 12,500 d e n t i s t s compared to the 7,981 who were l i c e n s e d to p r a c t i s e i n 1973. To reduce the r a t i o f u r t h e r to 1/1500, approximately 15,000 d e n t i s t s would be needed or almost twice as many as are now p r a c t i s i n g i n Canada. I t i s obvious t h a t some other answer to the problem must be sought. GRADUATE STUDIES: TABLE V I I I E x i s t i n g Graduate ^ Dental Education Programs i n Canada (Dec.,1973) YES NO NO ANSWER i ) Graduate Studies Program 7 3 2 i i ) Graduate Degree Program 7 3 3 i i i ) Graduate C e r t i f i c a t i o n Program 4 5. 1 4 i v ) Graduate Residency Program 5 4 1 v) Continuing Dental Education 9 1 n=10 Source: Study q u e s t i o n n a i r e 2 Programs l e a d i n g to a diploma, B.Sc.D., M.Sc. or Ph.D. degree 3 Programs p r o v i d i n g requirements necessary f o r c e r t i f i c a t i o n as a s p e c i a l i s t . ^General d e n t i s t r y i n t e r n s h i p i n a h o s p i t a l environment. In Tables V I I I and IX, f i g u r e s corresponding to " ( i ) graduate s t u d i e s program" encompass a l l the d i v i s i o n s of graduate d e n t a l education - i . e . .graduate degree, graduate c e r t i f i c a t i o n , graduate residency and c o n t i n u i n g education programs. 15 Table VIII c l e a r l y demonstrates that Canadian denta l schools are indeed o f f e r i n g a wide v a r i e t y of t r a i n i n g beyond the undergraduate l e v e l . Only one school of a t o t a l of ten does not o f f e r graduate work i n any form, and only three schools do not have- a graduate s tudies program i n exis tence at the time of t h i s r e p o r t . I t i s genera l ly recognized that two b a s i c p r e r e q u i s i t e s are necessary for the func t ion ing of a denta l school before a succes s fu l and worthwhile graduate program can be i n s t i t u t e d . The f i r s t i s that the undergraduate program must be s trong and w e l l e s t a b l i s h e d . There i s no j u s t i f i c a t i o n i n s a c r i f i c i n g the q u a l i t y of an undergraduate program for the sake of graduate denta l educat ion . The second p r e r e q u i s i t e concerns research . I t i s understood that i t i s qu i te f e a s i b l e to have research a c t i v i t y without a graduate program. But , because of the p h i l o -s o p h i c a l r a t i o n a l e under ly ing a l l graduate studies. , i t i s unacceptable to have a graduate program without high q u a l i t y research a c t i v i t y . However, there are circumstances i n which i t would be e n t i r e l y reasonable to begin a program of graduate s tudies on the bas i s of research done elsewhere, and gradua l ly engage an ac t ive research program on s i t e . Although the two p r i n c i p l e s aforementioned, the undergraduate program and research a c t i v i t y , may p a r t i a l l y account for the lack of graduate programs 1 6 at the three denta l schools r e f e r r e d to — the U n i v e r s i t i e s of B r i t i s h Columbia, Saskatchewan, and L a v a l — a l l denta l schools i n Canada might be o f f e r i n g graduate work at the present time i f these schools would be s a t i s f i e d to begin with a l e ss ambitious program and al low i t to expand and grow wi th time. There i s one p a r t i c u l a r c h a r a c t e r i s t i c common to a l l three of these schools i n that they are the youngest denta l schools i n Canada, having been o p e r a t i o n a l only s ince 1 9 6 4 , 1 9 6 8 and 1 9 7 1 r e s p e c t i v e l y . Thus, i t i s understandable that i t takes a great dea l of time to develop and organize a s trong undergraduate program, as i t does to engage substant ive re search . TABLE IX Proposed Graduate Programs (Beyond Table I ) D e c . , 1 9 7 3 YES NO NO ANSWER i ) Graduate Studies Program 7 3 i i ) Graduate Degree Program 4 3 3 i i i ) Graduate C e r t i f i c a t i o n Program 4 3 3 i v ) Graduate Residency Program 1 6 3 v) Cont inuing Dental Educat ion 4 2 4 n=10 """Source: Study Quest ionnaire Table IX i l l u s t r a t e s the number of denta l schools that are proposing graduate work beyond that o f fered at the present t ime. For example, a school may have a comprehensive program i n a l l areas except denta l r a d i o l o g y , but has proposed such a program and hopes to have i t a v a i l a b l e as soon as p o s s i b l e . Th i s i s the case i n many of the denta l schools . However, two denta l s choo l s , the U n i v e r s i t y of Manitoba and L a v a l U n i v e r s i t y , have now proposed graduate c e r t i f i c a t i o n programs for the f i r s t time. S i m i l a r l y , the U n i v e r s i t y of Western Ontario i s proposing a graduate res idency program. TABLE X E x i s t i n g Graduate Dental Educat ion ^ Programs i n : Canada, by Region D e c , 1973: YES A B C NO A B C i ) Graduate Studies Program 3 5 1 1 i i ) Graduate Degree Program 2 4 1 2 1 i i i ) Graduate C e r t i f i c a t i o n Program 1 3 0 3 2 1 iv ) Graduate Residency Program 2 3 0 2 2 1 v) Cont inuing Dental Educat ion 3 5 1 1 Source: Study Quest ionnaire According to the previous d e f i n i t i o n of "i) graduate s tudies program", Table X shows that there i s only one Canadian denta l s c h o o l , i t being i n the Western Region, that o f f er s no t r a i n i n g beyond the undergraduate l e v e l . Graduate degree programs would seem to be the most popular; each reg ion having t h i s a v a i l a b l e i n at l e a s t 50% of the i n s t i t u t i o n s . Graduate c e r t i f i c a t i o n 1 8 and res idency programs are of fered i n a l l but the A t l a n t i c Region. TABLE XI Proposed Graduate Dental Educat ion ^ Programs i n Canada by Region Dec. ,1973 YES A B C NO A B C NO ANSWER A B C i ) Graduate Studies Program 3 2 1 1 3 i i ) Graduate Degree Program 2 1 1 3 1 1 i i i ) Graduate C e r t i f i c a t i o n Program 2 2 1 2 1 1 1 i v ) Graduate Residency Program 1 3 3 1 1 1 v ) Cont inuing Dental Educat ion 3 1 1 2 1 2 Source: Study Quest ionnaire The a d d i t i o n of proposed programs at the U n i v e r s i t y of Manitoba and L a v a l U n i v e r s i t y are shown i n Table X I . The graduate res idency program a n t i c i p a t e d by the U n i v e r s i t y of Western O n t a r i o , combined wi th those o f f e r e d by the U n i v e r s i t i e s of Toronto and M o n t r e a l , and by M c G i l l U n i v e r s i t y , w i l l t o t a l four of the p o s s i b l e f i v e u n i v e r s i t i e s with t h i s type of res idency program a v a i l a b l e , L a v a l U n i v e r s i t y being the except ion . The proposed course a d d i t i o n at the U n i v e r s i t y of Manitoba shows that 50% of the Western Region schools w i l l be o f f e r i n g a graduate c e r t i f i c a t i o n program. L a v a l U n i v e r s i t y ' s new c e r t -i f i c a t i o n program w i l l boost the C e n t r a l Region so that the U n i v e r s i t y o f Western Ontar io w i l l be the only school not o f f e r i n g a c e r t i f i c a t i o n program i n d e n t i s t r y . 1 9 TABLE XII Summary of Graduate Dental Educat ion Programs ^ Offered by U n i v e r s i t i e s i n Canada December, 1 9 7 3 n=10 UNIVERSITY (of) Graduate Degree Graduate C e r t i f i c a t i o n ,Graduate Residency Cont inuing Dental Educat ion B r i t i s h Columbia - - X A l b e r t a X X . . . X X Saskatchewan . - . . - -Manitoba X . (Proposed) X X Toronto X X X X Western Ontario X . . . .- (Proposed) X M c G i l l X X X X Montreal X X X X L a v a l - (Proposed) - X Dalhousie X No Answer No Answer X T o t a l 7 4 5 9 Source: Study Quest ionnaire Table XII provides a summary of the Canadian p i c t u r e showing each denta l school and the form of graduate denta l education each i s present ly o f f e r i n g . I t can be s ta ted that the U n i v e r s i t y of Saskatchewan i s the only U n i v e r s i t y i n Canada that does not o f f e r any program., even cont inuing education for d e n t i s t s , a f t e r g r a d -u a t i o n ; and that only two of the ten Canadian denta l s choo l s , the U n i v e r s i t y of B r i t i s h Columbia and the U n i v e r s i t y of Saskatchewan, are not invo lved i n graduate denta l education programs. 20 SUBJECT AREAS  TABLE XIII Subject Areas o f f ered i n Graduate Dental Educat ion Programs i n Canada (1972)"'" SUBJECT AREAS A l t a . Man. T o r . West. Ont. McG. Mont. D a l . O r a l Bio logy X X X O r a l Pathology X Bac ter io logy & Immunology X Pharmacology X Biochemistry X Dental M a t e r i a l s X X Prosthodont ics X X X Pedodontics X Orthodontics X X X X O r a l Surgery X X X Pe r i odon t i c s X X Dental Science X Ph. D. X X Health Services X A d m i n i s t r a t i o n Occas iona l Studies X S p e c i a l X Dental P u b l i c X Health Anesthes ia X Radiology X Endodontics X Res torat ive X X Source: Regis ter of Graduate and Post-Graduate Dental Programs  i n Canadian U n i v e r s i t i e s , the A s s o c i a t i o n of Canadian F a c u l t i e s of D e n t i s t r y ( A . C . F . D . ) , 1972. 21 O u t l i n e d i n Table X I I I are the subject areas o f f e r e d i n graduate denta l educat ion in'1972 by each Canadian u n i v e r s i t y . C e r t a i n i n t e r e s t i n g observat ions can be made from the t a b l e . The U n i v e r s i t y of Toronto seems to have the greatest number of courses a v a i l a b l e although there would appear to be a c l e a r c l i n i c a l o r i e n t a t i o n . On the other hand, the U n i v e r s i t y of Western Ontario has a heavy b a s i c and denta l sc ience l e a n i n g . The two being i n the same province complement each other w e l l . The most widely o f fered t r a i n i n g i s i n the f i e l d of or thodont i c s , although no program i s a v a i l a b l e i n the A t l a n t i c Region. Th i s i s fol lowed by o r a l surgery and prosthodont ics i n a v a i l a b i l i t y . 22 TABLE XIV Graduate Dental Educat ion Programs A v a i l a b l e i n Canada, by Region, 1972 1  SUBJECT AREAS;: Western c e n t r a l A t l a n t i c O r a l B io logy X X — O r a l Pathology X X — Bacter io logy & Immunology — X — Pharmacology — X — Biochemistry — X — Denta l M a t e r i a l s X X — Prosthodont ics X X — Pedodontics — X — Orthodontics X X — O r a l Surgery — X X Pe r i odon t i c s X X — Dental Science — X — Ph. D. X X — Heal th Services A d m i n i s t r a t i o n X — . — Occas iona l Studies — X — S p e c i a l X — — Dental P u b l i c Heal th — X — Anesthes ia — X — Radiology — X — Endodontics — X — Restorat ive — X — Source: Reg i s ter of Post-Graduate and Graduate Denta l Programs i n Canadian U n i v e r s i t i e s , the A s s o c i a t i o n of Canadian F a c u l t i e s of D e n t i s t r y ( A . C . F . D . ) , 1972. 2 3 On a r e g i o n a l bas i s (Table XIV) Ontario and Quebec are far ahead of the re s t of Canada i n the range of programs made a v a i l -ab le . Note, however, that the major i ty of programs o r i g i n a t e at the U n i v e r s i t y of Toronto and the U n i v e r s i t y of Western O n t a r i o . The Western Region has a mixture of both c l i n i c a l p lus b a s i c and denta l sc ience programs, whi le Dalhousie U n i v e r s i t y o f f ers only o r a l surgery i n i t s graduate denta l education program. The 1972-73 Reg i s t er of Graduate and Post-Graduate Students s tates that 153 students were invo lved i n graduate denta l s t u d i e s . Of these , 110 answered and returned the quest ionnaire of the A s s o c i a t i o n of Canadian F a c u l t i e s of D e n t i s t r y ( A . C . F . D . ) regarding t h e i r graduate work. The r e s u l t s showed that one t h i r d (39) of those who rece ived t h e i r undergraduate t r a i n i n g i n Canada are p a r t i c i p a t i n g i n graduate programs i n the United Sta tes . Of the remaining 61 who are at tending Canadian i n s t i t u t i o n s for graduate work, e ight students rece ived t h e i r undergraduate t r a i n i n g e l s e -where — two i n the United States and s i x among the B r i t i s h Commonwealth c o u n t i r e s . According to the A . C . F . D . survey, t h i s means that only 53 Canadian graduates are e n r o l l e d i n f u r t h e r study i n Canadian i n s t i t u t i o n s whi le 39 have gone to the United States to study. Why do so many leave Canada to pursue t h e i r graduate t r a i n i n g ? Granted some programs are not a v a i l a b l e i n Canada. But , according to the Reg i s ter o f Post-Graduate and Graduate Dental Educat ion Programs i n Canadian U n i v e r s i t i e s , 24 there are p o s i t i o n s a v a i l a b l e i n a l l the areas o f fered by 2 Canadian f a c u l t i e s of d e n t i s t r y . W i l l those students who are s tudying i n the United States r e t u r n to Canada to p r a c t i s e and/or teach? Thi s would be d i f f i c u l t to es t imate . ENROLLMENT  TABLE XV Students E n r o l l e d i n Graduate Denta l Educat ion i n Canada ( B . S c . D . , M . S c . D . , Ph .D. ) Proceeding to Degree, Diploma, or Cert i f icate- ' -Dental School 1968-69 1969-70 1970-71 1971-72 1972-73 1973-74 B r i t i s h Columbia - - - - - -A l b e r t a 2 5 9 8 7 7 Saskatchewan - - - - - -Manitoba 24 19 31 19 29 20 U. of Toronto 67 64 66 57 68 64 Western Ontario 4 6 1 - 2 4 M c G i l l - 1 2 1 2 -U. of Montreal 13 17 18 11 7 14 L a v a l - - - - - -Dalhousie - - 2 3 3 3 T o t a l Canada 110 112 139 99 119 112 Source: Dental Educat ion R e g i s t e r , C D . A . , 1968-73; Study Ques t ionna ire , 1973-74. Reg i s t er of Post-Graduate and Graduate Dental Programs i n  Canadian U n i v e r s i t i e s , A . C . F . D . , 1972, p. 46-47. 25 TABLE XVI Enrollment in Graduate Dental Education Programs in Canada, by Region Region 1968-9 1969-70 1970-71 1971-72 1972-73 1973-74 Western 26 24 40 27 36 27 Central 84 88 87 69 80 82 Atlantic — — 2 3 3 3 The data in Table XV shows by institution the number of students enrolled in graduate dental education proceeding to degree or certification in clinical dentistry over the last six year period. In spite of slight fluctuations, the enroll-ment figures have remained remarkably constant over these years. With extra positions being available and the public's demand as it is, one might have expected that the yearly totals would have increased. Similarly, the regional totals (Table XVI) have remained relatively constant as well. In attempt to determine enrollment by subject area, figures were obtained from the A.C.F.D.'s Register of Graduate and Post-Graduate Students. Since the survey for information is conducted by questionnaire, the data is restricted by the number who reply. Consequently, there is a discrepancy between the totals in Tables XV and XVI. It is assumed, however, that this is a representative sample since approximately 65% of the questionnaires were returned. 26 The heavies t enrol lment i s i n the f i e l d of o r t h o d o n t i c s ; i t i s greater than three times the enrollment i n any other area . Orthodont i c s , i n f a c t , represents at l ea s t 40% of the t o t a l en-rol lment over the f ive years s t u d i e d . A l l other areas are low i n enro l lment , r e l a t i v e l y speaking, and have remained f a i r l y constant , with the except ion of denta l p u b l i c h e a l t h , where enrollment has decreased. Orthodont ics i s the l a r g e s t s p e c i a l t y i n the country . In December, 1972, or thodont i s t s comprised 41.77% of the t o t a l s p e c i a l i s t populat ion (Table X V I I ) . They were fol lowed by the o r a l surgeons, and the other s p e c i a l t i e s then tended to group with s i m i l a r enrollments (Table X V I I I ) . TABLE XVII Number of S p e c i a l i s t s C e r t i f i e d i n Canada"*" S p e c i a l t y Jan . 1968 Jan . 1969 Jan . 1970 Dec. 1970 Dec. 1971 Dec. 1972 Dental P u b l i c Heal th 19 * * 23 32 39 Endodontics 4 4 4 5 6 18 O r a l Surgery 72 87 98 106 110 122 Orthodont ics 176 . 186 201 225 232 259 Pedodontics 33 33 37 44 51 70 Per iodont i c s 51 53 58 72 83 82 Prosthodont ics 9 12 15 20 23 30 •^Source: Bureau of Dental S t a t i s t i c s , Canadian Dental A s s o c i a t i o n Number of s p e c i a l i s t s i n P u b l i c Heal th not a v a i l a b l e . 27 TABLE XVIII T o t a l Enrol lment i n Subject Area Subject Area 1968-69 1969-70 1970-71 1971-72 1972-73 1973-74 Biochemistry - - ... - 1 1 1 Dental P u b l i c Health 14 10 9 3 6 7 O r a l Anatomy - . - . 1 1 1 O r a l B io logy 5 4 2 - — O r a l Pathology . - . . - - 2 2 5 O r a l Surgery & Anesthes ia 6 . 6 8 6 9 11 Orthodontics 35 35 35 26 19 37 Pedodontics 9 7 6 7 5 8 Per iodont i c s 7 8 9 6 7 8 Prosthodont ics Res torat ive J D e n t i s t r y 1 2 2 1 1 1 1 Radiology - 1 2 3 T o t a l 71 73 73 56 53 86 Source: Dental Educat ion R e g i s t e r , Canadian Dental A s s o c i a t i o n . Study Quest ionnaire . Let us look s p e c i f i c a l l y at l a s t year ' s (1972-73) enrollment i n graduate denta l educat ion . Table XIX provides a breakdown of the enrol lment by subject area in to graduate degree and grad-uate c e r t i f i c a t i o n programs. It can be seen that the b a s i c and denta l sc iences proceed to graduate degree, whi le the c l i n i c a l l y based s p e c i a l t i e s can proceed to e i t h e r a graduate degree and/or c e r t i f i c a t i o n . Seventy percent , or 50 o f 71 e n r o l l e d i n c l i n i c a l subjects would l i k e to obta in c e r t i f i c a t i o n ra ther than or i n a d d i t i o n to a b a c h e l o r ' s or master's degree. TABLE XIX Graduate Degree and C e r t i f i c a t i o n Enrol lment by Subject Area and U n i v e r s i t y (1973-74) Subject Area Graduate Degree C e r t i f i c a t e T o t a l A l t a Man Tor West Mont Dal A l t a Tor Mont Biochemistry 1 4 5 C r a n i o - F a c i a l Growth 8 8 Dental P u b l i c Health 7 7 O r a l Anatomy 1 1 O r a l Pathology 1 1 3 5 O r a l Surgery 3 8 11 Orthodontics 1 7 4 6 3 11 6 38 Pedodontics 6 2 8 Pe r i odon t i c s 8 8 Radiology 1 2 3 Other* 18 18 T o t a l 4 20 22 4 6 3 3 42 8 112 Source: Study Quest ionnaire 0*-her — H i s t o l o g y , Phys io logy , Denta l M a t e r i a l s By U n i v e r s i t y , Toronto has the l a r g e s t enrollment — 64 s tudents , or 57% of the t o t a l Canadian enrollment of 112 i n 29 graduate s t u d i e s ; Manitoba i s next with 20, orl8%; fol lowed by the U n i v e r s i t y of Montreal with 1 4 , o r 1 2 . 4 % , A l b e r t a wi th 7, or 6 . 2 5 % , Western Ontario with 4 , or 3 . 5 % , and, f i n a l l y , Dalhous ie , with 3 s tudents , or 2 . 7 % . Regiona l ly (Table X X ) , 7 3 % o f the graduate students are e n r o l l e d i n C e n t r a l Canada, 2 4 % i n the West, and 2% i n the A t l a n t i c reg ion . I n t e r e s t i n g l y , t h i s c l o s e l y resembles the percentage pop-u l a t i o n i n these areas , 6 3 % , 2 6 % and 9% r e s p e c t i v e l y . However, each denta l school r e c r u i t s nat ionwide , so t h i s cannot be taken as a t r u l y representat ive comparison. TABLE XX Graduate Degree and C e r t i f i c a t i o n Programs by Subject Area and Region (1973-74)1 Subject Area Graduate Degree Graduate C e r t i f i c a t i o n Western C e n t r a l A t l a n t i c Western C e n t r a l A t l a n t i c lotax Biochemistry 5 5 C r a n i o - F a c i a l Growth 8 8 Dental P u b l i c Heal th 7 7 O r a l Anatomy 1 1 O r a l Pathology 2 3 5 O r a l Surgery 3 8 11 Orthodontics 8 10 3 17 38 Pedodontics 8 8 Pe r i odont i c s 8 8 Other* 18 18 T o t a l 24 32 3 3 50 . 0 112 Source: Study Quest ionnaire Other — H i s t o l o g y , Phys io logy , Denta l M a t e r i a l s 30 In establishing the tables of enrollment from the Canadian Dental Association's Dental Education Register, it gives a some-what distorted idea of the exact situation, for the pure dental laboratory and basic medical sciences were not taken into account. For example, in 1971-72, students numbering 64 were enrolled in bacteriology/immunology, pharmacology and biochemistry at the 3 University of Western Ontario exclusively. These figures are important to note because the subject areas mentioned are not clinical dental specialties and the probability of such graduates becoming involved in teaching and research within a dental facul-ty is high. In the Association of Canadian Faculties of Dentistry questionnaire in 1972, graduate students were asked if , after graduation, they desired a full or part time appointment at a dental teaching institute. Of the 100 students that responded, 16 desired full time, 44 desired part time and 8 desired full or part time. This gives some indication of the potential for teachers in the dental schools. In total, 68% would consider a faculty position, 23% of whom would consider full time positions at a dental school while 65% would consider a part time position. In summary, it can be said that the Canadian dental schools offer a wide variety of graduate programs in dentistry and have — Register of Graduate and Post-Graduate Dental Programs  In Canadian Universities, the Association of Canadian Faculties of Dentistry, 1972. 31 . m o r e t h a n a m p l e p o s i t i o n s o p e n t o s t u d e n t s . H o w e v e r , t h e - e n r o l l m e n t h a s r e m a i n e d r e l a t i v e l y c o n s t a n t o v e r t h e l a s t f i v e y e a r s , n o t i n c r e a s i n g a s t h e g e n e r a l p o p u l a t i o n a n d d e n t a l p o p u l a t i o n h a v e . B u t i n o r d e r t o d r a w m o r e m e a n i n g f u l c o n c l u s i o n s i t i s n e c e s s a r y t o e x a m i n e t h e s p e c i a l i s t s ' p o s i t i o n i n C a n a d a . SUMMARY T h e u n d e r g r a d u a t e d e n t a l p r o g r a m s p r o v i d e t h e b a s i s f o r m a i n t a i n i n g a s u p p l y o f c o m p e t e n t d e n t i s t s a d e q u a t e t o e n s u r i n g g o o d d e n t a l h e a l t h c a r e d e l i v e r y t o t h e p u b l i c . D e s p i t e e x p e c t -a t i o n s o f a n i n c r e a s e i n s i z e o f c l a s s a t t h i s l e v e l , 1 9 7 2 - 1 9 7 3 f e l l s h o r t o f t h e p r o j e c t e d p e r y e a r e n r o l l m e n t o f 4 8 2 s t u d e n t s by 2 8 s t u d e n t s . W i t h a n e v e r i n c r e a s i n g C a n a d i a n p o p u l a t i o n i t i s d i f f i c u l t t o i m a g i n e t h e d e n t i s t p o p u l a t i o n r a t i o b e c o m i n g s i g n i f i c a n t l y b e t t e r , c o n s i d e r i n g n a t u r a l l o s s e s w i t h i n t h e p r o f e s s i o n t h r o u g h e a r l y r e t i r e m e n t o r d e a t h a n d a r e l a t i v e l y l o w u n d e r g r a d u a t e e n r o l l m e n t . T h e 1 9 7 3 d e n t i s t p o p u l a t i o n r a t i o i n C a n a d a w a s 1 / 2 , 7 3 5 . I n t h e U n i t e d S t a t e s t h r e e y e a r s e a r l i e r ( 1 9 7 0 ) , t h e a v e r a g e d e n t i s t p o p u l a t i o n r a t i o w a s 1 / 1 , 6 8 3 . 4 I n s p i t e o f t h e f a c t t h a t B r i t i s h C o l u m b i a h a s e n j o y e d t h e b e s t d e n t i s t p o p u l a t i o n r a t i o o v e r t h e _ D i s t r i b u t i o n o f d e n t i s t s i n t h e U n i t e d S t a t e s b y S t a t e ,  R e g i o n , D i s t r i c t , a n d C o u n t y , A m e r i c a n D e n t a l A s s o c i a t i o n , B u r e a u o f E c o n o m i c R e s e a r c h a n d S t a t i s t i c s , 1 9 7 1 . 32 last five years, a ratio of 1/2,048 is clearly, as regards both dentist and patient, an undesirable situation for the efficient delivery of dental health care. Only one Canadian dental school — the University of Saskatchewan — does not.offer graduate dental education in any form, even continuing dental education. The three youngest faculties of dentistry, those of the Universities of British Columbia and Saskatchewan and Laval University, do not offer graduate dental education leading to a diploma, degree or cert-i f i c a t i o n . Graduate degree programs are most widely available, apart from continuing dental education, for they are flexible in permitting a degree in either c l i n i c a l or dental sciences. Certification programs apply only to c l i n i c a l specialty areas. The Central region offers the most comprehensive l i s t of subject areas with the emphasis s p l i t between the University of Toronto in c l i n i c a l sciences and the University of Western Ontario in basic medical and dental sciences. The Universities of Manitoba and Alberta offer more limited subject areas and Dalhousie University in the Atlantic region offers an oral surgery graduate program only. The study questionnaire showed a 1973-1974 graduate enrollment of 112 students, 64 or 57% of whom are attending the University of Toronto. Of these 112 students, 53 are enrolled in certification 3 3 programs and 59 are in degree programs. The heaviest enrollment is in orthodontics and oral surgery. It i s important to note that within the degree programs are to be found individuals doing work in areas that do not lead to private practise, e.g. biochemistry, pharmacology, den-t a l materials, as certification usually does. These people provide the pool for the selection of teachers and research workers for the faculties of dentistry. CHAPTER III - CLINICAL AND NONCLINICAL SPECIALTIES BACKGROUND Section ninety-one, part eleven of the British North America Act legislates to the federal government jurisdiction over "Quarantine in the establishment and maintenance of marine hospitals.""'" Section ninety-two, part six, delineates provincial responsibility for "Establishment, maintenance, and management of hospitals, assylums, charities and eleemosynary 2 institutes in and for the province other than marine hospitals."' Since 1867 this legislation has been inferred and expanded such that the provinces in Canada have assumed responsibility for matters of health and education. Consequently, the licensing bodies of the dental profession in each Canadian province have set their own individual c r i t e r i a for the certification of dental specialties. If a dentist's graduate training meets these c r i t e r i a he i s then el i g i b l e to become certi f i e d as a specialist within that province. He may elect to take the certification examination or he may not, in which case he can practise his specialty without the certification label by merely announcing that he is limiting his practice to that particular specialty. A similar situation would arise i f a person's graduate training did not meet the certification British North America Act, Ottawa, Queen's Printer, 1957, p. 24-25 British North America Act, Op. c i t . , p. 27-28 35 c r i t e r i a s p e c i f i e d . To fur ther complicate the p i c t u r e , a dent i s t without graduate t r a i n i n g , who has a s p e c i a l i n t e r e s t i n one f i e l d and has what he cons iders enough experience , may also l i m i t h i s p r a c t i c e to that s p e c i a l f i e l d , even though he does not have the necessary t r a i n i n g to be e l i g i b l e for c e r t i f -i c a t i o n . There fore , when speaking of the denta l s p e c i a l i s t p o p u l a t i o n , i t must be kept i n mind that t h i s r e f e r s only to those who are a c t u a l l y c e r t i f i e d . I t f o l l o w s , then, that s ince a s p e c i a l - s e r v i c e can be d e l i v e r e d without the dent i s t being c e r t i f i e d , the true o v e r a l l p i c t u r e of the d e l i v e r y of s p e c i a l denta l h e a l t h serv ices to the p u b l i c i s somewhat unc lear . Table I provides a summary of those s p e c i a l t i e s that are recognized and c e r t i f i a b l e according to prov ince . TABLE I C e r t i f i a b l e S p e c i a l t i e s , by P r o v i n c e , Dec. 1972 Province Dental P u b l i c Endo O r a l Ortho Pedo P e r i o Prostho Heal th dont ics Surgery dont ics dont ics dont ics dont ics B . C . X X X X X A l t a . X X X X X X Sask. X X X X X X Man. X X X X X X Ont. X X X X X X Que. X X X X X X X N. B. X X X X X X N. S. X X X X X X P. E . 1. X X X X X N f l d . X X X X X X Source: Bureau of Dental S t a t i s t i c s , Canadian Denta l A s s o c i a t i o n 36 TABLE I I Percentage of Dent i s t s who are S p e c i a l i s t s ( J a n . , 1973) S p e c i a l t y B . C . ALTA SASK MAN ONT QUE N . B . N . S . PEI NFLD TOTAL Dental P u b l i c Health N C 2 NC 1.23 NC .533 .835 — .411 NC 3.13 .489 Endodontics .546 .464 — .601 NC .334 NC .411 NC — .225 O r a l Surgery 1.27 1.08 1.23 1.50 1.78 1.50 — 2.06 — 1.56 1.53 Orthodontics 3.01 2.48 2.47 3.33 4.03 2.61 2.04 2.46 — 1.56 3.25 Pedodontics 1.19 2.12 .412 .601 .769 .556 — 2.06 — — .877 Per iodont i c s .456 .774 1.23 1.80 1.33 .724 — 2.06 — — 1.03 Prosthodontics NC 1.39 .412 .300 NC .835 — 1.65 — — .375 T o t a l 6.47 8.20 6.99 8.10 8.44 7.41 2.04 11.11 6.25 7.77 "Source: Bureau o f Dental S t a t i s t i c s , Canadian Dental A s s o c i a t i o n 'NC - Not C e r t i f i a b l e Dental s p e c i a l i s t s form a smal l e l i t e p o r t i o n of the t o t a l denta l p r o f e s s i o n . Table I I shows a p r o v i n c i a l breakdown of the percent of p r a c t i s i n g d e n t i s t s who are c e r t i f i e d s p e c i a l i s t s . S p e c i a l t y - w i s e , the f i e l d of orthodont ics has the h ighest percent -age i n a l l ten p r o v i n c e s , with a Canadian average of 3.25%. O r a l surgeons comprise 1.53% of a l l s p e c i a l i s t s , which i s the second l a r g e s t p o p u l a t i o n , fol lowed by p e r i o d o n t i s t s (1.03%), pedodontists (0.88%), denta l p u b l i c h e a l t h (0.49%), pros thodont i s t s (0.38%), and l a s t l y , endodontists (0.23%). Thi s p a t t e r n , of or thodont ics fol lowed 37 by oral surgery, seems to be the rule rather than the exception. There are some interesting features to note when examining the percentages on a provincial basis. Amazingly enough Nova Scotia has the largest percentage of specialists in comparison to a l l other provinces (11.11%) Referring back to Table VI, Chapter II, the dentist population ratio for Nova Scotia in 1973 was 1/3,267, the median figure for Canada, while the Canadian average was 1/2,735. The high 11.11 specialist percentage is due to the fact that 27 dentists, of a total dentist population of 243, are specialists. One par t i a l explanation for the high percen tage may be that Dalhousie University, in Nova Scotia, is the only dental school in the Atlantic Region and therefore, training and f a c i l i t i e s are readily available in the province. The other Atlantic provinces are not so fortunate. Prince Edward Island has no specialists at a l l among i t s 35 dentists. New Brunswick has 3 specialists, of a total dentist population of 147, a l l of whom are orthodontists, resulting in a 2.04 percentage figure. Newfoundland has 64 dentists, of which 2 are specialists in dental public health, and one each are specialists in ortho-dontics and oral surgery, for a total of 6.25 percent. Post Graduate Education, Conference Report, London. World Health Organization, April, 1970. 38 The total Canadian percentage of specialists i s 7.77. The provinces of Ontario (8.44%), Manitoba (8.10%), and Alberta (8.20%) have a greater number of specialists than average and Quebec, with 7.41%, is just short of the Canadian average. The provinces with the least number of specialists ranked in order of decreasing percentages below the Canadian average are Quebec, Saskatchewan, British Columbia, Newfoundland, New Brunswick and Prince Edward Island. This means four provinces are above and six provinces are below the 7.77% Canadian total. This shows an imbalance in the distribution of specialists in Canada. Since specialists are unable to treat the population adequately at present, i t is assumed that even the best percentage is probably not great enough to meet the actual needs of the public. If financial barriers were removed for the individual, the manpower shortage in the specialties and general dentistry would result in complete i n a b i l i t y of the profession to meet the demands for service. With prepaid dentistry and insurance plans gaining in popularity every year, i t is obvious that Canada not only needs more general dentists but also more specialists, i f the quality of service is to remain high. TABLE III Specialist to Population Ratio (Jan.,1973) SPECIALTY B.C. ALTA. SASK. MAN. ONT. QUE. N.B. N.S. P.E.I. NFLD. CANADA Dental Public 1971* NC2 — NC NC 453,1243430,555 634,557 — — * 672,347 Health 1973 NC — 302,666 . NC 441,056 135,133 — 805,000 — 270,500 . 566,538 Endodontics 1971 — 542,625 — 494,124 NC 6027764 NC — • NC NC 3,585,852 1973 385,833 561,000 — 499,000 NC 1013500 NC 805,000 NC NC, 1,227,500 Oral Surgery 1971 168,048 232,553 463,121 197,649 148,137 231,837 — . 197,240 — 522,104 195,591 1973 165,357 240,428 302,666 199,600 132,317 225,222 — 161,000 — 541,000 181,107 Orthodontics 1971 72,821 116,277 185,248 89,841 64,732 136,995 211,519 157,792 — 522,104 92,738 1973 70,152 105,188 151,333 90,727 58,301 129,383 217,333 134,166 — 541,000 85,309 Pedodontics 1971 218,462 162,874 — 329,416 320,963 — — 197,240 — — 421,865 1973 178,077 129,462 908,000 499,000 305,346 608,100 — 161,000 — — 315,643 Periodontics 1971 436,924 325,575 463,121 197,649 160,481 463,674 — 157,792 — — 259,218 1973 463,000 336,600 302,666 166,333 176,422 467,769 — 161,000 — — 269,451 Prosthodontics 1971 NC 180,875 — 988,247 NC 602,776 — 262,987 — — 935,440 1973 NC 187,000 908,000 998,000 NC 405,400 — 201,250 736,500 TOTAL 1971 37,672 33,916 102,888 36,592 29,627 55,814 158,750 37,571 — 261,000 40,165 1973 32,153 31,755 53,412 36,963 27,856 45,721 108,333 29,815 — 135,250 35,637 Source: Bureau of Dental S t a t i s t i c s , Canadian Dental Association; Statistics Canada NC - Not Certifiable Read: One specialist for every 453,124 people 1971 - December; 1973 - January 40 Table III compares the specialists to population ratio for a l l the provinces for two years, 1971 and 1973. At quick glance, the majority of the ratios have shown improvement over the two years compared. Only periodontists showed an increased ratio in five of the seven provinces involved, result-ing i n an overall increased ratio for Canada. Once again, the orthodontists enjoy the best specialist to population ratio of 1/85,309. The oral surgeons follow with a 1/181,107 ratio. The others follow the same order as in Table II: periodontics, pedodontics, dental public health, prostho-dontics and endodontics. The provincial ranking, however, has changed from Table I. Ontario, rather than Nova Scotia, has the best specialist to population ratio, 1/27,856. British Columbia has the fourth best ratio of 1/32,606, which i s s t i l l below the Canadian ratio of 1/35,637. Two provinces, New Brunswick and Newfoundland, weight the Canadian total with extremely high ratios of 1/208,333 and 1/135,250 repectively. Although most of the total provincial ratios seem quite reasonable, i t is really a result of the high orthodontic and oral surgery specialist population. Examining the other total Canadian ratios shows nothing below 1/250,000 for any other specialty area. It is apparent that this is a less than ideal 41 situation for the dentist or patient, since dentistry i s a service oriented profession. TABLE IV Total number of Certified Specialists in Canada, 1968-1972 Specialty Jan. 1968 Jan. 1969 Jan. 1970 Dec. 1970 Dec. 1971 Dec. 1972 Dental Public Health 19 * * 23 32 39 Endodontics 4 4 4 5 6 18 Oral Surgery 72 87 98 106 110 122 Orthodontics 176 186 201 225 232 259 Pedodontics 33 33 37 44 51 70 Periodontics 51 53 58 72 83 82 Prosthodontics' 9 12 15 20 23. 30 Total 364 375 413 495 537 620 Source: Bureau of Dental Statistics, Canadian Dental Association * Number of Specialists in Dental Public Health not available. Table IV provides an indication of the rate of increase in the specialist population since 1968, the last year seeing the greatest increase - 83 specialists. Of the additional 83 specialists, 39 or 47%, were from the orthodontic or oral surgery branch of dentistry. Considering the rate of increase in the number of specialists, plus the numbers enrolled in Canadian graduate dental education in fields other than orthodontics and oral surgery, i t seems unlikely that this w i l l result in a 42 significant lowering of the specialist population ratios to compensate for an increasing general population. We can and do absorb specialists from outside Canada, but when there is ample room in the programs for more students, perhaps Canadian recruiting must be done more actively. TABLE V Licensed Specialists Practising in British Columbia (Dec.J1972)1 YEAR TOTAL Dental Public Health Endo-dontics Oral Surgery Ortho-dontics Pedo-dontics Perio-dontics Prostho-dontics 1968(Jan) 37 NC2 — 6 19 8 4 NC 1969(Jan) 43 NC 9 22 8. 4 NC 1970(Jan) 45 NC — 11 22 8 4 NC 1970(Dec) 55 NC — 12 - 31 8 4 NC 1971(Dec) 58 NC — 13. 30 10 5 NC 1972 (Dec) 72 NC 6 14 33 12 7 NC Source: Bureau of Dental Statistics, Canadian Dental Association 2NC - Not Certifiable Specialist /Population Ratio ' 19 73(Jan) 32,1531 NC 385,833 165,35 7 70,152 178,077 463,000 NC Source: Table III, Chapter III To examine the situation in British Columbia in more det a i l , Table V shows the number of c e r t i f i e d specialists practising in British Columbia over the five year period since 1968. It should 43 be kept in mind that dental public health and prosthodontics are not certifiable in this province. There are, of course, dentists within the province who have obtained their graduate degrees or are e l i g i b l e for certification i n these areas and are practising but are not recognized as certificable special-i s t s . The total number of specialists is 72, or 6.56% of the general dentist population. The dentist population ratio in British Columbia in January, 1973, was approximately 1/2,093, while the specialist to population ratio was 1/32,153. Both these ratios are below the Canadian average. British Columbia is very gradually approaching the suggested ideal ratio of 1/1,500-1/1,800, but a l l specialists ratios other than ortho-dontics, which i s 1/70,152, suggest that dental services cannot be delivered to the public on an adequate basis. TABLE VI Practising Locations of B r i t i s h Columbia Specialists (Jan. ,1973)-'-LOCATION Ortho-dontics Endo-dontics Oral Surgery Pedo-dontics Perio-dontics Total Vancouver 24 6 11 12 5 58 Vancouver Island 5 - 2 - 1 8 Interior 3 - 1 - . . . . . . 4 Prince George 1 - - - - 1 Sparwood - - - 1 1 Total 33 6 14 12 7 72 Source: Directory, College of Dental Surgeons of British Columbia.. 4 4 The uneven distribution of specialists within the province further complicates the situation. The majority of population within the province, both general and dental, is centered in the Lower Mainland Vancouver area. However, there are many communit-ies scattered throughout British Columbia that do not enjoy the privilege of a general dentist let alone a specialist. Table VI illustrated this distribution of specialists within Br i t i s h Columbia. The 1973 figures show that 58, or 80.5%, of the special-i s t s are i n the Vancouver area serving a population of 1,028,334. A l l specialties are represented in this area. Practising on Vancouver Island are eight specialists, or 11.11%, of the British Columbia total — seven in Victoria and one orthodontist in Nanaimo. Of these specialists, orthdontics, oral surgery and periodontics are represented, but there are no specialists in either endodontics or pedodontics. They service a population of 381,297. The remainder of British Columbia's population of 774,990 is provided for by six specialists: four in the Interior, one in Central Br i t i s h Columbia (Prince George), and one in Sparwood, A l l of the above figures are based on the 1971 census 4 as s t a t i s t i c s for 1973 were not available. Because these are 1971 population figures used with 1973 specialist s t a t i s t i c s the i l l u s t -ration i s not entirely accurate. It does, however, demonstrate the imbalance of specialist distribution within the province. Population, Census Divisions and Subdivisions (Western  Provinces), Statistics Canada, Ottawa, October, 1972. 45 TABLE VII Location of Graduate Dental Training of Specialists in British Columbia (Jan.,1973)1 SPECIALTY. CANADA Total ** UNITED STATES Total ALTA MAN ONT QUE N.S. WASH ORE CALIF OTHER Orthodontists — 1 5 - 6 3 2 4 1 17 24 Endodontists — - - - — 4 - - - 2 2 Oral Surgeons — - 2 - - 2 3 - - - 9 9 Pedodontists — - - - - — 5 - 1 - 6 7 Periodontists 1 3 - - 4 7 Total — 1 2 5 - 8 16 5 5 1 38 49 Unspecified Total Canada United States Combined 8 49 57 Unspecified !6 Source: College of Dental Surgeons of British Columbia Table VII shows where the specialists practising in British Columbia took their graduate specialty training. In the Canadian United States comparison, the United States western coast states of Washington, Oregon and California were singled out as these three states provided British Columbia with many dentists by way of emigration prior to the establishment of the dental school at the University of British Columbia. 46 The "unspecified" column in Table VII includes those specialists who were permitted to take the British Columbia cert i f i c a t i o n examination at the time of recognition of that specialty. For example, endodontics is a recently recognized and certifiable specialty within the province of British Columbia. Over the years there had been a number of dentists who had limited their practice to endodontics whether or not they had had any graduate training in the f i e l d . Although their qualifications did not meet the established c r i t e r i a , they were allowed under the "grandfather clause" to take the certification examination. Therefore, these individuals would not show a location of graduate training. Of those specified, only eight or 14.04%, received their grad-uate training in Canada. Conversely, 49 or 85.96% of Br i t i s h Columbia specialists received their graduate training in the United States. Are a l l these specialists Canadians or immigrants from the United States? Table VIII offers the explanation. 47 TABLE VIII Location of Undergraduate Dental Training of Specialists in British Columbia (Jan., 1 9 7 2 ) SPECIALTY CANADA UNITED STATES BRITISH COMMON-WEALTH B.C. ALTA MAN ONT QUE N.S. WASH ORE CALIF OTHER Orthodontists - • 8 1 4 1 0 1 2 3 1 2 1 Endodontists - 2 1 2 - - . 1 -Oral Surgeons _ ... 2 2 7 2 - _ - • Pedodontists 1 - - 4 4 1 - - - 1 1 Periodontists - 1 4 1 - - . - - - - 1 Total 1 1 3 8 1 8 1 6 2 3 3 1 3 3 Source: Directory, College of Dental Surgeons of British Columbia Canada United States British Commonwealth Combined Total 5 8 1 0 3 72 Table VIII provides an overview of where the practising specialists in British Columbia received their undergraduate training. It shows that of a total of 72 specialists, 5 8 or 8 1 . 6 9 % took their undergraduate degree at a Canadian dental school. Only 1 0 specialists or 1 4 . 0 8 % did their undergraduate work in the United States, and 7 were from the west coast. A total of three others, or 4 . 2 3 % , had undergraduate training within the British Commonwealth. 4 8 From these two tables, Tables VII and VIII, one can see that the majority of specialists now practising in British Columbia received their undergraduate training at a Canadian dental school, but chose to do their graduate work in the United States. Why? SUMMARY Since each province is able to establish individual c r i t e r i a for the recognition of dental specialties not every specialty is certifiable in a l l ten provinces in Canada. For example, the College of Dental Surgeons of British Columbia does not recognize dental public health and prosthodontics as certifiable specialties. Certified specialists constitute a small portion of the total dentist population. Throughout the world the largest specialties in numbers are orthodontics and oral surgery. This i s the case in Canada, where 3.25% of the dentists are orthodontists and 1.53% are oral surgeons. Of a l l the provinces in Canada, Nova Scotia has the largest total percentage of dentists who are specialists, while the province of British Columbia i s low, being followed only by Newfoundland, New Brunswick and Prince Edward Island, in that order. The specialist population ratios show orthodontists and oral surgeons again with the best ratio while other specialties in Canada on the average have a ratio of no better than one specialist for 49 every quarter of a million people. Although the individual specialty population ratio i s large, the average ratio for British Columbia i s 1/32,153, which i s the fourth best in Canada. However, total figures are distorted by the relatively large numbers of orthodontists and oral surgeons. Of the Canadian total of 620 specialists, 72 or 10.16% are practising i n Br i t i s h Columbia. Fifty-eight practise in the Greater Vancouver area, eight practise on Vancouver Island and six special-ists provide for the remainder of the province. Even though the majority of dentist and general population i s i n Vancouver, this represents an imbalance in distribution in both location and specialty service available. Among the 72 specialists presently practising in British Columbia, 82% received their undergraduate training in Canadian dental schools. However, only 14% remained in Canada for graduate studies, while 86% went to the United States for their graduate work, then returned to Canada to practise. Why does this happen when there are programs available in Canada and there i s ample space within the programs for graduate students? CHAPTER IV - CONTINUING DENTAL EDUCATION BACKGROUND "The rate of obsolescence of people on the f i r i n g line in the application of new medical knowledge i s a function of the rate of change of technology and of research output.""'" This statement of Thomas Hunter's applies equally well to the f i e l d of dentistry. We know that the flow of information and materials capable of effecting change in dental practices w i l l increase rather than subside as federal and corporation dollars are chan-nelled into medical and dental research. In the light of the aforementioned, i t becomes increasingly clear that the organiz-ation and systematic provision for delivery of current knowledge to the members of the profession on a regular basis i s of great importance for post-graduate or continuing dental education programs. An accelerated rate of change in a l l fields has been particul-arly characteristic of this century in North America. Progress in i t s e l f i s usually disruptive in that i t exposes the inadequacies of present methods. If a society or indeed a profession i s to prosper and achieve maximum development, i t must not attempt to impede or diminish that rate of progress. If the profession i s "'"Thomas H. Hunter, M.D., "New Knowledge and Its Application," Paper read before the White House Conference on Health, Washington, D.C, November 3, 1965. 51 to take f u l l advantage of these advances, i t must devise a viable mechanism whereby the changes can be ordered into progress and progress incorporated into application. Post-graduate dental education is concerned with the communication of existing knowledge and techniques and with investigatory procedures that w i l l culminate in new knowledge and application. It is further concerned with the professional s k i l l s of both the future practitioners and practising dentists as they acquire and maintain the competency necessary for effective practise. Practically a l l dental schools in Canada have reached the stage of development where i t has become possible for them to transform this concern into concrete programs of continuing dental education. This provision for post-graduate dental education is basic to the continued excellence of individ-ual dentists and to the quality of health services available to society. The problem of the obsolescence of the practising dentist's expertise, particularly as this fact affects the remotely located practitioners, w i l l grow increasingly acute under the impact of accelerated research in a l l phases of dentistry. These pressures, i f dealt with constructively, w i l l in fact aid in' the i n i t i a t i o n and further development of the educational process for making available the results of research to the practising profession. 52 Continuing dental education should be considered as an integral part of the total dental education curriculum of every dental school. This would mean that dental schools would view graduation as only a start to professional education, because their graduates would remain actively engaged in dental studies throughout their professional lives. The individual dentist would view his institutionalized training as merely a basis for future knowledge, a learning how to learn. In combination, the two would contribute to the dual goal of lifetime learning for dentists and the formal-ization of a total educational continuum, leading to a lessening of the gap between dentistry available and dentistry practised. PARTICIPATION IN CONTINUING DENTAL EDUCATION TABLE I Enrollment in Continuing Dental Education Programs in CanadaA Dental School 1969-70 1970-71 1971-72 1972-73 British Columbia 293 447 530 Alberta 124 103 366 179 Saskatchewan Manitoba 50 36 30 98 Toronto 151 142 231 261 Western Ontario 49 78 184 224 McGill 40 40 8 Montreal 63 10 20 No Answer Laval 15 Dalhousie 22 104 369 264 Total 459 806 1687 1579 Source: Dental Education Register, Canadian Dental Association; Study Questionnaire V 5 3 T A B L E I I E n r o l l m e n t i n C o n t i n u i n g D e n t a l E d u c a t i o n P r o g r a m s i n C a n a d a b y r e g i o n ^ -R e g i o n 1 9 6 9 - 7 0 1 9 7 0 - 7 1 1 9 7 1 - 7 2 1 9 7 2 - 7 3 W e s t e r n ( A ) 1 7 4 4 3 2 8 4 3 8 0 7 C e n t r a l ( B ) 2 6 3 2 7 0 4 7 5 5 0 8 A t l a n t i c ( C ) 2 2 1 0 4 3 6 9 2 6 4 ^ S o u r c e : D e n t a l E d u c a t i o n R e g i s t e r , C a n a d i a n D e n t a l A s s o c i a t i o n ; S t u d y Q u e s t i o n n a i r e I t i s e v i d e n t f r o m t h e d a t a i n T a b l e s I a n d I I t h a t t h e r e h a s b e e n a n i n c r e a s e i n t h e n u m b e r o f d e n t i s t s i n C a n a d a w h o a r e t a k i n g p a r t i n c o n t i n u i n g d e n t a l e d u c a t i o n p r o g r a m s . I n f a c t , t h e y e a r l y f i g u r e s d o u b l e d f r o m 1 9 6 9 - 7 0 t h r o u g h 1 9 7 1 - 7 2 ; 4 5 9 , 8 0 6 a n d 1 6 8 7 r e s p e c t i v e l y . I n 1 9 7 2 - 7 3 t h e n u m b e r s l e v e l l e d o f f . T h e r e g i o n a l p a t t e r n i s s i m i l a r ( T a b l e I I ) , w i t h s o m e i n t e r e s t i n g f e a t u r e s t h a t c a n b e s e e n i n G r a p h I I . 5 4 G r a p h I N u m b e r o f D e n t i s t s P a r t i c i p a t i n g i n C o n t i n u i n g D e n t a l E d u c a t i o n P r o g r a m s i n C a n a d a , 1 9 6 9 - 1 9 7 3 2 0 0 0 1 5 0 0 N u m b e r -o f D e n t i s t s 1 0 0 0 5 0 0 1 9 6 9 1 9 7 0 1 9 7 0 1 9 7 1 1 9 7 1 1 9 7 2 1 9 7 2 1 9 7 3 Y E A R 5 5 G r a p h I I N u m b e r o f D e n t i s t s P a r t i c i p a t i n g i n C o n t i n u i n g D e n t a l E d u c a t i o n P r o g r a m s i n C a n a d a , b y R e g i o n , * 1 9 6 9 - 1 9 7 3 N u m b e r o f D e n t i s t s 9 0 0 8 0 0 7 0 0 6 0 0 5 0 0 4 0 0 3 0 0 2 0 0 1 0 0 1 9 6 9 1 9 7 0 1 9 7 0 1 9 7 1 1 9 7 1 1 9 7 2 1 9 7 2 1 9 7 3 Y E A R R e g i o n : A B 5 6 • G r a p h s I a n d I I c o r r e s p o n d t o T a b l e s I a n d I I a n d a r e a g o o d i l l u s t r a t i o n o f t h e t r e n d s i n p a r t i c i p a t i o n i n c o n t i n u i n g d e n t a l e d u c a t i o n i n C a n a d a . A s f i g u r e s w e r e n o t a v a i l a b l e f o r d a t e s e a r l i e r t h a n 1 9 6 9 t h e g r a p h s r e p r e s e n t t h e n u m b e r o f p a r t i c i p a t i n g d e n t i s t s i n C a n a d a o v e r a f o u r y e a r p e r i o d , b y C a n a d i a n t o t a l s a n d b y r e g i o n . G r a p h I I i s p a r t i c u l a r l y i n t e r e s t i n g . I t s h o w s t h a t t h e W e s t e r n r e g i o n h a s s e t t h e t r e n d f o r t h e C a n a d i a n a v e r a g e . I t i s i m p o r t a n t t o n o t e t h a t t h e C e n t r a l r e g i o n c o n t i n u e d t o i n c r e a s e i t s e n r o l l m e n t d u r i n g 1 9 7 2 - 7 3 w h i l e t h e o t h e r t w o r e g i o n s s h o w e d a s l i g h t d e c r e a s e i n e n r o l l m e n t . I t w i l l b e o f i n t e r e s t t o s e e i f t h e s e t r e n d s c o n t i n u e . T A B L E I I I P e r c e n t o f D e n t i s t s E n r o l l e d i n ^ C o n t i n u i n g D e n t a l E d u c a t i o n i n C a n a d a b y P r o v i n c e P r o v i n c e 1 9 6 9 - 7 0 1 9 7 0 - 7 1 1 9 7 1 - 7 2 1 9 7 2 - 7 3 B r i t i s h C o l u m b i a — 3 0 . 3 3 4 2 . 8 2 4 8 . 3 1 A l b e r t a 2 1 . 7 2 1 7 . 8 5 5 9 . 4 2 2 7 . 7 1 S a s k a t c h e w a n — — — — M a n i t o b a 1 6 . 3 9 11. 7 6 9 . 5 2 2 9 . 4 3 O n t a r i o 6 . 6 3 6 . 9 1 1 2 . 8 0 1 4 . 9 6 Q u e b e c 3 . 7 5 2 . 9 3 3 . 4 2 1 . 3 1 N f l d . , P . E . I . , N . S . , N . B . 4 . 7 8 2 3 . 2 7 7 9 . 0 1 5 3 . 9 9 T o t a l 6 . 4 1 1 0 . 8 7 2 2 . 0 1 . 1 9 . 7 8 S o u r c e s : D e n t a l E d u c a t i o n R e g i s t e r , C a n a d i a n D e n t a l A s s o c i a t i o n ; B u r e a u o f D e n t a l S t a t i s t i c s , C a n a d i a n D e n t a l A s s o c i a t i o n 5 7 T A B L E I V P e r c e n t o f D e n t i s t s E n r o l l e d i n C o n t i n u i n g D e n t a l E d u c a t i o n i n C a n a d a b y R e g i o n R e g i o n 1 9 6 9 - 7 0 1 9 7 0 - 7 1 1 9 7 1 - 7 2 1 9 7 2 - 7 3 W e s t e r n ( A ) 8 . 6 8 2 0 . 8 2 3 8 . 2 8 3 4 . 8 0 C e n t r a l ( B ) 5 . 6 1 5 . 5 2 1 1 . 6 0 9 . 8 2 A t l a n t i c ( C ) 4 . 7 8 2 3 . 2 7 7 9 . 0 1 5 3 . 9 9 S o u r c e s : D e n t a l E d u c a t i o n R e g i s t e r , C a n a d i a n D e n t a l A s s o c i a t i o n B u r e a u o f D e n t a l S t a t i s t i c s , C a n a d i a n D e n t a l A s s o c i a t i o n T a b l e s I I I a n d I V w i t h c o r r e s p o n d i n g G r a p h s I I I a n d I V a c t u a l l y p r e s e n t a m o r e p r e c i s e i n d i c a t i o n o f w h a t i s r e a l l y h a p p e n i n g i n C a n a d a . T h e d a t a w a s c a l c u l a t e d i n p e r c e n t a g e s r a t h e r t h a n s i m p l e n u m e r i c a l t o t a l s . T a b l e I I I i l l u s t r a t e s s e v e r a l p o i n t s v e r y e x p l i c i t l y ; 1 9 7 0 -7 1 w a s t h e f i r s t y e a r t h a t c o n t i n u i n g d e n t a l e d u c a t i o n w a s o f f e r e d a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a . T h e r e w a s o b v i o u s i n t e r e s t b y t h e 3 0 . 3 3 % f i r s t y e a r e n r o l l m e n t , a n d t h i s f i g u r e h a s c o n t i n u e d t o i n c r e a s e e v e r y y e a r . I t i s a s s u m e d t h a t d e n t i s t s i n t h e p r o v i n c e o f S a s k a t c h e w a n a r e a n x i o u s t o h a v e s u c h p r o g r a m s a v a i l a b l e t o t h e m w i t h i n t h e i r o w n p r o v i n c e a n d t h e i r r e s p o n s e w o u l d b e s i m i l a r t o t h a t s e e n i n B r i t i s h C o l u m b i a . T h e U n i v e r s i t y o f S a s k a t c h e w a n i s t h e o n l y d e n t a l s c h o o l i n C a n a d a w h i c h d o e s n o t o f f e r p o s t - g r a d u a t e d e n t a l e d u c a t i o n . E v e n L a v a l U n i v e r s i t y , t h e m o s t r e c e n t l y 5 8 e s t a b l i s h e d d e n t a l s c h o o l ( 1 9 7 1 ) , o f f e r s c o n t i n u i n g e d u c a t i o n c o u r s e s f o r d e n t i s t s . T h e U n i v e r s i t y o f S a s k a t c h e w a n s h o u l d b e e n c o u r a g e d t o i n s t i t u t e a p r o g r a m , f o r t h e l a c k o f s u c h c r e a t e s a s e r i o u s g a p i n t h e W e s t e r n r e g i o n . T h i s c l e a r l y m a k e s i t v e r y d i f f i c u l t f o r d e n t i s t s i n S a s k a t c h e w a n t o k e e p a b r e a s t o f t h e r e c e n t a d v a n c e s i n k n o w l e d g e a n d t e c h n i q u e s . T a b l e I I I s h o w s a t r e m e n d o u s i n c r e a s e i n e n r o l l m e n t i n 1 9 7 1 - 7 2 o f C a n a d i a n d e n t i s t s i n c o n t i n u i n g d e n t a l e d u c a t i o n p r o g r a m s . T h i s i s p a r t i c u l a r l y t r u e o f t h e A t l a n t i c P r o v i n c e s a n d A l b e r t a , w h i c h s h o w e d t h e g r e a t e s t i n c r e a s e s . T h e g e n e r a l t e n d e n c y , I b e l i e v e , m a y b e p a r t i a l l y a t t r i b u t e d t o t h e a d v e n t o f " p r e v e n t i v e d e n t i s t r y " i n i t s t r u e s e n s e . M a n y c l i m b e d o n t h e b a n d w a g o n t h e n a n d a l t h o u g h 1 9 7 2 - 7 3 s h o w e d a s l i g h t o v e r a l l d e c r e a s e , i t w a s n o t d r a s t i c ( 2 2 . 0 1 % t o 1 9 . 7 8 % f o r t h e C a n a d i a n a v e r a g e ) . O n t a r i o a n d Q u e b e c s h o w a n a m a z i n g l a c k o f i n t e r e s t i n c o n t i n u i n g e d u c a t i o n p r o g r a m s o f f e r e d b y t h e U n i v e r s i t y . A l t h o u g h O n t a r i o h a s c o n t i n u e d t o c l i m b s l o w l y t o 1 4 . 9 6 % , Q u e b e c h a s f a l l e n t o a n e w l o w f o r t h e f o u r y e a r p e r i o d o f 1 . 3 1 % . T h e f i g u r e 1 . 3 1 % m a y b e s l i g h t l y l o w e r t h a n w h a t i s a c t u a l l y t h e c a s e f o r t h e U n i v e r s i t y o f M o n t r e a l , i n r e s p o n s e t o t h e s t u d y q u e s t i o n n a i r e , g a v e n o e n r o l l m e n t t o t a l s f o r t h e 1 9 7 2 - 7 3 y e a r . H o w e v e r , l o o k i n g a t t h e p r e v i o u s f i g u r e s i t i s u n l i k e l y t h a t t h e p e r c e n t a g e t o t a l 5 9 w o u l d c h a n g e s i g n i f i c a n t l y e v e n w i t h t h e a d d i t i o n o f t h e e n r o l l m e n t a t t h e U n i v e r s i t y o f M o n t r e a l . G r a p h I I I P e r c e n t a g e o f D e n t i s t s E n r o l l e d i n C o n t i n u i n g D e n t a l E d u c a t i o n P r o g r a m s i n C a n a d a b y P r o v i n c e , 1 9 6 9 - 1 9 7 3 1 0 0 9 0 1 9 6 9 1 9 7 0 1 9 7 1 1 9 7 2 1 9 7 0 1 9 7 1 1 9 7 2 1 9 7 3 YEAR K e y : 1 —. A t l a n t i c P r o v i n c e s 2 - B r i t i s h C o l u m b i a 3 - M a n i t o b a 4 - A l b e r t a 5 - C a n a d i a n A v e r a g e 6 - O n t a r i o 7 - Q u e b e c 6 0 G r a p h I V P e r c e n t a g e o f D e n t i s t s E n r o l l e d i n C o n t i n u i n g D e n t a l E d u c a t i o n i n C a n a d a b y R e g i o n , * 1 9 6 9 - 1 9 7 3 1 0 0 9 0 8 0 7 0 6 0 P e r c e n t a g e o f 5 0 D e n t i s t s 4 0 3 0 2 0 1 0 s S 1 9 6 9 1 9 7 0 1 9 7 0 1 9 7 1 Y E A R 1 9 7 1 1 9 7 2 * R e g i o n : A B C 1 9 7 2 1 9 7 3 C a n a d i a n A v e r a g e : 6 1 O n t h e c o r r e s p o n d i n g g r a p h ( G r a p h I I I ) t h e t o t a l p e r c e n t a g e s f o r e a c h y e a r s h o w t h a t s i n c e 1 9 7 1 - 7 2 t h e A t l a n t i c P r o v i n c e s h a v e l e a d t h e r e s t o f C a n a d a i n c o n t i n u i n g d e n t a l e d u c a t i o n p a r t i c i p a t i o n . T h e y w e r e f o l l o w e d b y t h e p r o v i n c e s o f t h e W e s t e r n r e g i o n ( B r i t i s h C o l u m b i a , M a n i t o b a , a n d A l b e r t a ) a n d f i n a l l y b y O n t a r i o a n d Q u e b e c . G r a p h I V r e p r e s e n t s t h e d a t e i n T a b l e I V . R e g i o n a l l y , t h e A t l a n t i c P r o v i n c e s l e a d i n p e r c e n t e n r o l l m e n t , f o l l o w e d b y t h e W e s t e r n r e g i o n a n d l a s t l y t h e C e n t r a l r e g i o n . F r o m a l l t h i s d a t a s e v e r a l b r o a d c o n c l u s i o n s c a n b e d r a w n . T h e r e i s a d e f i n i t e i n c r e a s i n g i n t e r e s t i n c o n t i n u i n g d e n t a l e d u c -a t i o n c o u r s e s . A f t e r c o n s i d e r i n g t h e f i g u r e s f r o m a l l a s p e c t s , t h e g r e a t e s t a c t i v i t y i n t h i s a r e a a p p e a r s t o b e i n t h e W e s t e r n r e g i o n , i n s p i t e o f t h e l a c k o f a v a i l a b l e p r o g r a m s i n S a s k a t c h e w a n . T h e A t l a n t i c r e g i o n i s a l s o v e r y a c t i v e , e s p e c i a l l y c o n s i d e r i n g t h a t o n l y o n e U n i v e r s i t y , D a l h o u s i e , p r o v i d e s a l l f o u r p r o v i n c e s i n t h e r e g i o n . F i n a l l y , t h e C e n t r a l r e g i o n , h a v i n g s u c h a l o w p e r c e n t a g e o f p a r t i c i p a t i o n , i s n o t t a k i n g f u l l a d v a n t a g e o f p o s t -g r a d u a t e d e n t a l e d u c a t i o n o f f e r e d a t t h e f i v e d e n t a l s c h o o l s i n O n t a r i o a n d Q u e b e c . 6 2 S U B J E C T A R E A S T A B L E V • • • C o n t i n u i n g D e n t a l E d u c a t i o n P r o g r a m s O f f e r e d b y C a n a d i a n U n i v e r s i t i e s : S u b j e c t A r e a s a n d E n r o l l m e n t , 1 9 6 9 - 1 9 7 3 1 S U B J E C T A R E A 1 9 6 9 - 7 0 1 9 7 0 - 7 1 1 9 7 1 - 7 2 1 9 7 2 - 7 3 D e n t a l E m e r g e n c i e s — 1 9 7 1 1 0 0 D e n t a l M a t e r i a l s — 1 8 8 E n d o d o n t i c s 3 2 1 0 2 9 1 9 9 O c c l u s i o n 2 0 3 1 3 7 2 1 O r a l S u r g e r y 6 6 5 7 2 3 4 1 5 0 O r t h o d o n t i c s 4 0 4 2 1 0 5 1 2 7 O r a l M e d i c i n e — — 7 9 P e d o d o n t i c s 2 0 8 2 3 8 1 1 4 P e r i o d o n t i c s 5 2 7 9 1 0 8 . 5 9 P h a r m a c o l o g y — — 2 1 1 5 P r a c t i s e M a n a g e m e n t — 6 6 1 0 3 1 5 P r e v e n t i v e D e n t i s t r y — 2 0 2 9 5 2 0 9 P r o s t h o d o n t i c s 4 2 6 7 5 9 9 1 R a d i o l o g y 7 — 2 7 1 3 R e s t o r a t i v e ( O p e r -a t i v e ) D e n t i s t r y 6 2 5 6 1 7 6 2 5 6 S e d a t i o n — 2 8 — 2 7 U t i l i z a t i o n o f A u x i l i a r i e s — 5 7 4 0 6 0 _^  , 2 O t h e r 1 1 8 1 0 0 2 6 4 1 3 6 T o t a l 4 5 9 8 0 6 1 6 8 7 1 5 7 9 I S o u r c e : D e n t a l E d u c a t i o n R e g i s t e r , C a n a d i a n D e n t a l A s s o c i a t i o n ; S t u d y Q u e s t i o n n a i r e , 1 9 7 2 - 1 9 7 3 . 2 " 0 t h e r " i n c l u d e s M y o f a c i a l T h e r a p y , O c c l u s i o n , D e n t a l C a r e f o r H a n d i c a p p e d , e t c . 6 3 T a b l e V s h o w s t h e m a j o r s u b j e c t a r e a s o f c o u r s e o f f e r i n g s i n c o n t i n u i n g d e n t a l e d u c a t i o n a t C a n a d i a n U n i v e r s i t i e s . I n e x a m i n i n g t h e f i g u r e s i t m u s t b e b o r n e i n m i n d t h a t e a c h y e a r t h e t e n C a n a d i a n f a c u l t i e s o f d e n t i s t r y o f f e r a v a r i e t y o f c l i n i c a l a n d b a s i c s c i e n c e c o u r s e s r e l a t e d t o d e n t i s t r y . C o n s e q u e n t l y , e a c h a r e a i s n o t n e c e s s a r i l y a v a i l a b l e a t e v e r y d e n t a l s c h o o l e v e r y y e a r . I n a n y c a s e , t h e t a b l e f u r t h e r i l l u s t r a t e s t h e i n c r e a s i n g i n t e r e s t o f d e n t i s t s i n m a i n t a i n i n g a n d f u r t h e r i n g t h e i r d e n t a l e d u c a t i o n . A r e a s t h a t h a v e s h o w n a t l e a s t a t w o - f o l d i n c r e a s e i n e n r o l l m e n t o v e r t h e f o u r y e a r p e r i o d a r e d e n t a l e m e r g e n c i e s , e n d o d o n t i c s , o r a l s u r g e r y , o r t h o d o n t i c s , p r e v e n t i v e d e n t i s t r y , a n d r e s t o r a t i v e ( o p e r a t i v e ) d e n t i s t r y . D u e t o t h e c u r r e n t i n t e r e s t i n s e d a t i o n t e c h n i q u e s i n d e n t i s t r y , t h i s s u b j e c t a r e a h a s b e e n a m o r e r e c e n t a d d i t i o n t o t h e p r o g r a m s o f c o n t i n u i n g e d u c a t i o n . I t w o u l d b e d a n g e r o u s , h o w e v e r , t o a c c e p t t h e d a t a s e e n i n T a b l e s I - V a n d G r a p h s I - I V a s t h e s o l e r e p r e s e n t a t i o n o f t h e n u m b e r o f d e n t i s t s p a r t i c i p a t i n g i n c o n t i n u i n g d e n t a l e d u c a t i o n . T h i s a n a l y s i s i s a n e n r o l l m e n t a n d s u b j e c t a r e a b r e a k d o w n o f t h o s e p r o g r a m s o f f e r e d b y C a n a d i a n U n i v e r s i t y d e n t a l s c h o o l s o n l y . A g r e a t d e a l o f i n f o r m a t i o n i s a l s o m a d e a v a i l a b l e t o t h e p r a c t i s i n g d e n t i s t t h r o u g h l o c a l d e n t a l s o c i e t i e s . T h e s e s o c i e t i e s f o r m a n 6 4 i m p o r t a n t p a r t o f c o n t i n u i n g d e n t a l e d u c a t i o n i n t h a t t h e y p r e s e n t t o t h e i r m e m b e r s o n c e a m o n t h a g u e s t s p e a k e r w h o i s i n v o l v e d i n s o m e a s p e c t o f d e n t i s t r y . T h e s e m e e t i n g s a r e w e l l a t t e n d e d a n d a g r e a t d e a l o f i n f o r m a t i o n i s e x c h a n g e d . T h e y f o r m a n i n t e g r a l p a r t o f t h e c o n t i n u i n g e d u c a t i o n m e c h a n i s m . E X P E N D I T U R E I n 1 9 6 3 - 6 4 , t h e A m e r i c a n A s s o c i a t i o n o f D e n t a l S c h o o l s c a r r i e d o u t a c o s t s t u d y o f d e n t a l e d u c a t i o n . T h e y f o u n d t h a t t h e C a n a d i a n p e r d e n t i s t e x p e n d i t u r e o n c o n t i n u i n g d e n t a l e d u c a t i o n 2 p r o g r a m s w a s $ 1 2 . 3 7 , o r a t o t a l o f $ 7 4 , 2 4 1 f o r t h a t y e a r . T h e m e a n e x p e n d i t u r e p e r d e n t i s t p e r y e a r , C a n a d a a n d t h e U n i t e d S t a t e s 3 c o m b i n e d , w a s $ 1 5 . 6 2 , o r $ 1 , 6 8 5 , 4 8 3 t o t a l . I n t h e i r c o n c l u s i o n s a n d r e c o m m e n d a t i o n s t h e y s t a t e , " E x p e n d i t u r e s p e r p r a c t i s i n g d e n t i s t a r e s o l o w t h a t i t a p p e a r s t h a t l i t t l e s u c c e s s h a s b e e n a c h i e v e d i n p r o v i d i n g t r a i n i n g a t a l e v e l c o m m e n s u r a t e w i t h t h e n e e d s o r t h e f i n a n c i a l r e s o u r c e s o f 4 t h e p r a c t i t i o n e r . L e a d e r s h i p m u s t c o m e f r o m d e n t a l s c h o o l s . " _ C o s t S t u d y o f D e n t a l E d u c a t i o n , T h e A m e r i c a n A s s o c i a t i o n o f D e n t a l S c h o o l s , S p o n s o r e d b y W . K . K e l l o g g F o u n d a t i o n , 1 9 6 5 , p . 4 3 3 0 p . c i t , p . 4 3 ^ O p . c i t , p . 7 3 6 5 T h e s e f i g u r e s a r e t e n y e a r s o l d . N o c o s t s t u d y h a s b e e n d o n e i n C a n a d a s i n c e . H o w e v e r , w e h a v e s e e n t h a t o n t h e a v e r a g e o n l y 1 9 . 8 7 % o f t h e d e n t i s t s i n C a n a d a a r e t a k i n g p a r t i n t h e s e p r o g r a m s . T h e y a r e n o t t a k i n g f u l l a d v a n t a g e o f t h i s v e h i c l e o f a d v a n c i n g t h e i r d e n t a l e d u c a t i o n a n d s k i l l s . T h e r e f o r e , d e s p i t e t h e i n c r e a s e d i n t e r e s t a n d e n r o l l m e n t , i t i s p r o b a b l y s a f e t o s a y t h a t t h e m o n e y s p e n t b y t h e d e n t a l p r a c t i t i o n e r f o r s u c h p r o g r a m s i s s t i l l v e r y s m a l l , r e l a t i v e l y s p e a k i n g . T h e b l a m e m a y n o t r e s t s o l e l y w i t h t h e i n d i v i d u a l t h o u g h . I f d e n t i s t s a r e e x p e c t e d t o t a k e p a r t i n c o n t i n u i n g d e n t a l e d u c a t i o n p r o g r a m s , t h e s e p r o g r a m s m u s t b e m a d e e a s i l y a v a i l a b l e . I n B r i t i s h C o l u m b i a , t h e m a j o r i t y o f b o t h t h e g e n e r a l p o p u l a t i o n a n d t h e d e n t i s t p o p u l a t i o n i s c e n t e r e d i n t h e L o w e r M a i n l a n d V a n c o u v e r a r e a . T h e d e n t a l s c h o o l i s a l s o l o c a t e d i n V a n c o u v e r a n d o f f e r s c o n t i n u i n g e d u c a t i o n c o u r s e s o n t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a c a m p u s . B u t t h e r e a r e m a n y d e n t i s t s s e r v i n g t h e p u b l i c e l s e w h e r e i n B r i t i s h C o l u m b i a w h o a r e u n a b l e t o l e a v e t h e i r p r a c t i c e s i n o r d e r t o a t t e n d s u c h c o u r s e s b e c a u s e o f t h e d e m a n d f o r t h e i r s e r v i c e a n d / o r g e o g r a p h i c r e a s o n s . A l t h o u g h t h e y r e c e i v e p r o f e s -s i o n a l j o u r n a l s , a n d m a y h a v e a l o c a l d e n t a l s o c i e t y , o t h e r m e t h o d s o f m a k i n g i n f o r m a t i o n r e a d i l y a v a i l a b l e t o t h e m m u s t b e d e v e l o p e d . B r i t i s h C o l u m b i a i s b y n o m e a n s u n i q u e i n t h i s r e s p e c t . B e c a u s e o f t h e s h e e r v a s t n e s s o f g e o g r a p h y i n C a n a d a , t h e o t h e r p r o v i n c e s m u s t 6 6 f a c e t h e s e o b s t a c l e s a s w e l l . A s o l u t i o n t o t h e p r o b l e m m i g h t b e e x p e d i t e d b y t h e i n n o v a t i v e e x p e r i m e n t a t i o n a n d a p p l i c a t i o n o f a l l f o r m s o f c o m m u n i c a t i o n t e c h n o l o g y . F o r e x a m p l e , p r o g r a m m e d i n s t r u c t i o n , c a s s e t t e t a p e s , v i d e o t a p e s , e t c . s h o u l d b e u t i l i z e d m o r e t h a n t h e y a r e a t t h e p r e s e n t t i m e . A n o t h e r m e t h o d o f p r o v i d i n g p r a c t i c e w i t h i n a c l i n i c a l s e t t i n g m i g h t b e t o h a v e a t r a v e l l i n g d e n t a l c l i n i c i n a t r a i l e r . T h i s w o u l d a l l o w f o r c l i n i -c a l p r e s e n t a t i o n s a n d p a r t i c i p a t i o n i n c o u r s e s a w a y f r o m t h e u n i v e r s i t y s e t t i n g . T h e r e a l k e y t o s u c c e s s , t h o u g h , i s h a v i n g t h e u n i v e r s i t y , a s a l e a r n i n g i n s t i t u t e , t o t a l l y c o m m i t t e d t o c o n t i n u i n g , l i f e l o n g d e n t a l e d u c a t i o n o f t h e d e n t i s t a n d t o t h e s u p p o r t o f t h e s e p r o g r a m s . I t i s h o p e d t h a t i t i s r e a l i s t i c t o p r e s u m e t h a t u n i v e r s i t i e s a n d d e n t a l s c h o o l s , b e c a u s e o f e x t e r n a l a n d i n t e r n a l p r e s s u r e s , w i l l a l l o c a t e a n i n c r e a s i n g p e r c e n t a g e o f t h e i r t o t a l r e s o u r c e s , b o t h p e r s o n n e l a n d f i n a n c i a l , t o t h e p o s t - g r a d u a t e p h a s e o f d e n t a l e d u c a t i o n . S U M M A R Y T h e a n a l y s i s o f p o s t - g r a d u a t e d e n t a l e d u c a t i o n , o r c o n t i n u i n g d e n t a l e d u c a t i o n , w a s d o n e w i t h r e g a r d t o t h o s e p r o g r a m s o f f e r e d b y t h e u n i v e r s i t i e s o n l y . T h e r e f o r e , t h e f i g u r e s d o n o t t a k e i n t o 6 7 a c c o u n t l o c a l d e n t a l s o c i e t y p r o g r a m s a n d m e e t i n g s o r p r o x i m a t e U n i t e d S t a t e s p r o g r a m s t h a t m i g h t b e a v a i l a b l e t o d e n t i s t s i n c e r t a i n l o c a t i o n s i n C a n a d a , E x c e p t f o r t h e U n i v e r s i t y o f S a s k a t c h e w a n , e v e r y C a n a d i a n d e n t a l s c h o o l o f f e r s c o n t i n u i n g d e n t a l e d u c a t i o n t o t h e p r o f e s s i o n . O v e r t h e p a s t f o u r y e a r s t h e e n r o l l m e n t i n s u c h p r o g r a m s h a s b e e n s t e a d i l y i n c r e a s i n g , w i t h B r i t i s h C o l u m b i a d e n t i s t s s h o w i n g t h e l a r g e s t n u m b e r p a r t i c i p a t i n g s i n c e t h e i n c e p t i o n o f c o n t i n u i n g d e n t a l e d u c a t i o n a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a i n 1 9 7 0 . O n a p e r c e n t a g e b a s i s , i n 1 9 7 2 - 1 9 7 3 , t h e A t l a n t i c p r o v i n c e s h a d 5 4 % o f t h e p r a c t i s i n g d e n t i s t s t a k i n g p a r t i n c o n t i n u i n g d e n t a l e d u c a t i o n . B r i t i s h C o l u m b i a f o l l o w e d w i t h 4 8 % . O n t a r i o a n d Q u e b e c s h o w e d a s u r p r i s i n g l y l o w p a r t i c i p a t i o n o f 1 5 % a n d l e s s t h a n 3% r e s p e c t i v e l y . T h e C a n a d i a n a v e r a g e s h o w e d t h a t o n e d e n t i s t i n f i v e p a r t i c i p a t e d i n c o n t i n u i n g d e n t a l e d u c a t i o n d u r i n g 1 9 7 2 - 1 9 7 3 . R e g i o n a l l y , t h e A t l a n t i c p r o v i n c e s a r e m o s t a c t i v e , f o l l o w e d b y t h e W e s t a n d f i n a l l y b y t h e C e n t r a l r e g i o n . M a n y d i f f e r e n t s u b j e c t a r e a s a r e o f f e r e d a n d o f c o u r s e e a c h u n i v e r s i t y d o e s n o t o f f e r e v e r y s u b j e c t e v e r y y e a r . T h e m o s t p o p u l a r c o u r s e s p r e s e n t e d w e r e o p e r a t i v e d e n t i s t r y , p r e v e n t i v e d e n t i s t r y , o r a l s u r g e r y a n d o r t h o d o n t i c s , i n t h a t o r d e r . 6 8 I n 1 9 6 4 t h e A m e r i c a n A s s o c i a t i o n o f D e n t a l S c h o o l s c o n d u c t e d a c o s t s u r v e y w h i c h s h o w e d t h a t t h e C a n a d i a n d e n t i s t ' s p e r c a p i t a e x p e n d i t u r e o n c o n t i n u i n g d e n t a l e d u c a t i o n w a s $ 1 2 . 3 7 . I t i s a s s u m e d t h a t t h i s f i g u r e h a s r i s e n o v e r t h e y e a r s , b u t i n s p i t e o f t h e i n c r e a s e d i n t e r e s t a n d e n r o l l m e n t i n p o s t - g r a d u a t e d e n t a l e d u c a t i o n p r o g r a m s , t h e e x p e n d i t u r e i s p r o b a b l y s t i l l l o w , r e l a t i v e l y s p e a k i n g . I f i n t h i s e r a o f r a p i d e x p a n s i o n o f k n o w l e d g e a n d i t s a p p l i c a t i o n t h e d e n t i s t s a r e e x p e c t e d t o k e e p a b r e a s t o f t h e c h a n g e s , i t b e c o m e s t h e c h a l l e n g e o f t h o s e d i r e c t l y i n v o l v e d i n c o n t i n u i n g d e n t a l e d u c a t i o n p r o g r a m s t o m a k e t h i s i n f o r m a t i o n r e a d i l y a c c e s -s i b l e t o t h e m e m b e r s o f t h e p r o f e s s i o n . P e r h a p s t h i s c a n b e e n h a n c e d t h r o u g h m o r e e x t e n s i v e u t i l i z a t i o n o f t h e v a r i e t y o f c o m m u n i c a t i o n r e s o u r c e s n o w a v a i l a b l e . C H A P T E R V - C O N C L U S I O N S I n t h e p r e c e d i n g c h a p t e r s t h e s i t u a t i o n a s r e g a r d s e x i s t i n g g r a d u a t e d e n t a l e d u c a t i o n p r o g r a m s i n C a n a d a h a s b e e n a n a l y s e d b o t h o n a p r o v i n c i a l a n d r e g i o n a l b a s i s w i t h r e s p e c t t o t h e d e n t a l h e a l t h c a r e d e l i v e r y s y s t e m a s i t p r e s e n t l y e x i s t s . T h e r e s u l t s o f t h e s e a n a l y s e s p r o v i d e t h e b a s i s f o r a n i n - d e p t h e x a m i n a t i o n o f t h e p o s s i b i l i t i e s o p e n t o i m p l e m e n t i n g a g r a d u a t e d e n t a l e d u c a t i o n p r o g r a m i n t h e P r o v i n c e o f B r i t i s h C o l u m b i a . T h e s t u d y a l s o p r o v i d e s s o m e i n d i c a t i o n s o f w h a t c r i t i c a l f a c t o r s n e e d t o b e t a k e n i n t o a c c o u n t a n d w h a t p a r a m e t e r s t o c o n s i d e r f o r t h e e s t a b l i s h m e n t o f s u c h a g r a d u a t e p r o g r a m . T h e o v e r - r i d i n g c o n c e r n o f t h e d e n t a l p r o f e s s i o n i s t h e e f f i c i e n t a n d e f f e c t i v e d e l i v e r y o f d e n t a l h e a l t h c a r e t o t h e p u b l i c . T h i s i n v o l v e s b o t h t h e t r e a t m e n t a n d p r e v e n t i v e a s p e c t s o f d e n t a l d i s e a s e . U n d e r g r a d u a t e d e n t a l p r o g r a m s a r e o r g a n i z e d t o w a r d s t h e p u b l i c ' s n e e d f o r r e g u l a r d e n t a l c a r e . G r a d u a t e d e n t a l e d u c a t i o n g o e s o n e s t e p f u r t h e r i n p r o v i d i n g q u a l i f i e d p e r s o n n e l f o r r e s e a r c h i n t h e f i e l d o f d e n t i s t r y , p r e p a r a t i o n o f t e a c h e r s f o r d e n t a l e d u c a t i o n , a s w e l l a s t r a i n i n g i n d e n t a l s p e c i a l t i e s r e q u i r i n g a d v a n c e d s k i l l s . C o n s e q u e n t l y t h e a i m o f b o t h u n d e r -g r a d u a t e a n d g r a d u a t e d e n t a l e d u c a t i o n i s t o p r o v i d e t h e k n o w l e d g e , s k i l l s a n d m a n p o w e r n e c e s s a r y t o m e e t t h e d e n t a l h e a l t h c a r e d e m a n d s o f t h e c o m m u n i t y . 70 S U P P L Y A N D D E M A N D T h e n e e d a n d d e m a n d f o r d e n t a l s e r v i c e s a r e t w o e n t i r e l y d i f f e r e n t m a t t e r s ; t h e y a l s o h a v e d i f f e r e n t r e l a t i o n s h i p s w i t h r e g a r d t o s e r v i c e . B e c a u s e d e n t a l d i s e a s e i s m a n ' s m o s t w i d e -s p r e a d a n d c h r o n i c d i s e a s e , t h e n e e d f o r d e n t a l c a r e h a s a l w a y s b e e n e v i d e n t t o t h e p r o f e s s i o n . H o w e v e r , t h e p u b l i c ' s d e m a n d f o r t h e t r e a t m e n t a n d e l i m i n a t i o n o f d e n t a l d i s e a s e h a s n e v e r e q u a l l e d t h e i r n e e d t o g i v e a p p r o p r i a t e a t t e n t i o n t o t h i s p r o b l e m . A s f a r a s t h e p r o f e s s i o n i s c o n c e r n e d t h i s d i f f e r e n c e b e t w e e n d e m a n d a n d n e e d i s f o r t u n a t e i n t h a t t h e d e g r e e t o w h i c h t h e p u b l i c s o u g h t d e n t a l h e a l t h c a r e w a s s t i l l t o o g r e a t t o b e m e t b y t h e d e n -t a l p r o f e s s i o n . N o w w i t h - t h e a d v e n t o f p r e p a i d d e n t a l c a r e p l a n s , p l u s t h e p u b l i c ' s a w a r e n e s s t h a t i t i s t h e i r r i g h t t o e n j o y g o o d d e n t a l h e a l t h , t h e s i t u a t i o n i s b e c o m i n g m o r e a c u t e . T h i s i n c r e a s e i n d e m a n d f o r s e r v i c e , a n d e s p e c i a l l y f o r s e r v i c e s r e q u i r i n g a d v a n c e d s k i l l s , c a n n o t b e m e t b y t h e u n d e r g r a d u a t e d e n t a l p r o g r a m s a s t h e y n o w e x i s t i n C a n a d a . E d u c a t i o n b e y o n d t h i s l e v e l , i . e . g r a d u a t e d e n t a l e d u c a t i o n , i s t h e b e g i n n i n g o f a p a r t i a l s o l u t i o n t o t h e p r o b l e m . I n e x a m i n i n g t h e f i g u r e s p r e v i o u s l y p r e s e n t e d , i t b e c o m e s c l e a r t h a t n o t o n l y B r i t i s h C o l u m b i a b u t a l s o C a n a d a a s a w h o l e i s i n n e e d o f m o r e d e n t a l e d u c a t o r s i f u n d e r g r a d u a t e e n r o l l m e n t i s t o b e e x p a n d e d ; m o r e r e s e a r c h w o r k e r s i f t h e e l u s i v e a n s w e r s 71 t o t h e m a j o r p r o b l e m s i n d e n t i s t r y a r e t o b e f o u n d ; a n d m o r e c l i n i c a l s p e c i a l i s t s i f t h e p u b l i c i s t o b e a f f o r d e d t h e t r e a t -m e n t n e c e s s a r y i n s p e c i a l t y a r e a s . B r i t i s h C o l u m b i a i s o n t h e t h r e s h o l d o f b e i n g i n v o l v e d w i t h t h e g o v e r n m e n t i n t h e d e l i v e r y o f d e n t a l c a r e t o t h e p e o p l e o f t h e p r o v i n c e . T h e p r o g r a m a n d m e t h o d o f i m p l e m e n t a t i o n h a s n o t y e t b e e n d e c i d e d a t t h e t i m e o f t h i s r e p o r t ; h o w e v e r , t h e h o p e i s t h a t e v e n t u a l l y b o t h r e g u l a r a n d s p e c i a l d e n t a l c a r e w i l l b e a v a i l a b l e t o e v e r y o n e i n B r i t i s h C o l u m b i a . I n o t h e r c o u n t r i e s w h e r e g o v e r n m e n t a n d t h e d e n t a l p r o f e s -s i o n h a v e c o o p e r a t e d i n p r o v i d i n g d e n t a l c a r e p r o g r a m s , f o r e x a m p l e i n N o r w a y a n d S w e d e n , t h e i r s u c c e s s f u l o p e r a t i o n h a s n e c e s s i t a t e d d e n t i s t p o p u l a t i o n r a t i o s o f 1 / 1 , 3 0 0 a n d 1 / 1 , 2 0 0 r e s p e c t i v e l y t o m e e t t h e d e m a n d f o r c a r e . " * " B r i t i s h C o l u m b i a ' s r a t i o o f 1 / 2 , 3 1 5 w o u l d n o t a l l o w s u c h a p r o g r a m t o f u n c t i o n w i t h -i n t h e p r o v i n c e . M o r e d e n t a l m a n p o w e r i s n e e d e d . A p r o g r a m a b l e t o t r e a t a n d c o n t r o l d e n t a l d i s e a s e e c o n o m i c a l l y w o u l d a l s o r e q u i r e p u b l i c h e a l t h m e a s u r e s o f p r e v e n t i o n , i n c l u d i n g d e n t a l h e a l t h e d u c a t i o n p r o g r a m s a n d m o r e d i r e c t l y f l u o r i d a t i o n o f t h e d r i n k i n g w a t e r . R e c e n t f l u o r i d a t i o n s t a t i s t i c s s h o w t h a t B r i t i s h C o l u m b i a D e p a r t m e n t o f N a t i o n a l H e a l t h a n d W e l f a r e , A d H o c C o m m i t t e e o n D e n t a l A u x i l i a r i e s R e p o r t , I n f o r m a t i o n C a n a d a , O t t a w a , 1 9 7 0 . 7 2 h a s t h e l o w e s t p e r c e n t a g e o f p o p u l a t i o n ( 1 1 . 5 % ) e n j o y i n g t h e 2 b e n e f i t o f f l u o r i d a t e d w a t e r . T h e C a n a d i a n n a t i o n a l a v e r a g e i s 4 5 . 7 % . F o r a n y d e n t a l c a r e p l a n t o b e s u c c e s s f u l , i n t e r m s o f e c o n o m i c s a n d a c t u a l c o n t r o l o f d e n t a l d i s e a s e , f l u o r i d a t i o n i s a m u s t . I n B r i t i s h C o l u m b i a t h e d e m a n d f o r s e r v i c e i s p r e s e n t a n d i n c r e a s i n g b y v i r t u e o f a g r o w i n g p o p u l a t i o n , a n i n c r e a s i n g a w a r e n e s s o n t h e p u b l i c ' s p a r t t h a t i t i s t h e i r r i g h t t o e n j o y g o o d d e n t a l h e a l t h a n d t h e i m m i n e n t o p p o r t u n i t y t o p a r t i c i p a t e i n a p r e p a i d d e n t a l c a r e p l a n . T h e r e i s a F a c u l t y o f D e n t i s t r y a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a w h i c h c o u l d p r o v i d e t h e n e c e s s a r y f a c i l i t i e s f o r a g r a d u a t e d e n t a l e d u c a t i o n p r o g r a m . O f t h e 7 2 c e r t i f i e d s p e c i a l i s t s p r a c t i s i n g i n B r i t i s h C o l u m b i a , 8 2 % ( 5 8 ) r e c e i v e d t h e i r u n d e r g r a d u a t e t r a i n i n g i n C a n a d a . H o w e v e r , o n l y 1 4 % ( 8 ) r e m a i n e d i n C a n a d a , w h i l e 8 6 % ( 4 9 ) w e n t t o t h e U n i t e d S t a t e s f o r t h e i r g r a d u a t e w o r k . T h e r e a r e s e v e n d e n t a l s c h o o l s i n C a n a d a w h i c h o f f e r g r a d u a t e c o u r s e s i n v i r t u a l l y e v e r y a r e a o f i n t e r e s t i n d e n t i s t r y a n d w i t h i n t h e s e p r o g r a m s t h e r e a r e v a c a n c i e s . W h y t h e n d o s o m a n y C a n a d i a n d e n t a l g r a d u a t e s l o o k t o t h e U n i t e d S t a t e s f o r g r a d u a t e t r a i n i n g ? S e v e r a l f a c t o r s m a y a c c o u n t f o r t h i s . C a n a d i a n D e n t a l A s s o c i a t i o n J o u r n a l , F e b r u a r y , 1 9 7 4 , 4 0 , N o . 2 , p . 9 5 . 7 3 S o m e U n i t e d S t a t e s ' p r o g r a m s a r e o f p a r t i c u l a r l y h i g h q u a l i t y a n d t h e r e f o r e d r a w C a n a d i a n a p p l i c a n t s . S o m e s t u d e n t s v a l u e a n e x p e r i e n c e i n a d i f f e r e n t e n v i r o n m e n t i n a d i f f e r e n t c o u n t r y a n d c o n s e q u e n t l y a r e a t t r a c t e d t o t h e U n i t e d S t a t e s . M a n y A m e r i c a n d e n t a l s c h o o l s o f f e r g r e a t e r f i n a n c i a l s u p p o r t d u r i n g g r a d u a t e w o r k a n d t h i s , a l o n g w i t h t a x a d v a n t a g e s , p r o v i d e s a n e n t i c e m e n t t o C a n a d i a n s t u d e n t s . T h e l a t t e r r e a s o n m a y e v e n p r e v e n t s t u d e n t s f r o m p u r s u i n g g r a d u a t e w o r k w i t h i n C a n a d a i f t h e y a r e u n a b l e t o t r a v e l t o t h e U n i t e d S t a t e s . T h e y o u n g d e n t i s t w h o e n t e r s g r a d u a t e s t u d i e s s t a n d s t o l o s e m o r e i n u n e a r n e d i n c o m e t h a n o t h e r h e a l t h p r o f e s -s i o n a l g r a d u a t e s . D u r i n g h i s f i r s t y e a r o f p r a c t i s e h e c a n e a r n a g o o d i n c o m e a n d t h i s g e n e r a l l y i n c r e a s e s d u r i n g t h e f i r s t f e w y e a r s . F i n a n c i a l s u p p o r t f o r g r a d u a t e s t u d y c a n n o t e q u a l i n c o m e f r o m g e n e r a l p r a c t i s e , b u t t o a s k a d e n t a l g r a d u a t e w h o h a s j u s t c o m p l e t e d o n e o f t h e m o s t e x p e n s i v e u n d e r g r a d u a t e p r o g r a m s a t t h e u n i v e r s i t y t o c o n t i n u e t o m a k e f i n a n c i a l s a c r i f -i c e s i s p e r h a p s a s k i n g a b i t t o o m u c h . A r e a l i s t i c a p p r o a c h t o t h e s u p p o r t o f g r a d u a t e s t u d e n t s d u r i n g t h e i r t r a i n i n g m u s t b e f o u n d i f r e c r u i t s a r e t o b e d r a w n f r o m C a n a d i a n u n d e r g r a d u a t e p r o g r a m s . T h e e s t a b l i s h m e n t o f a g r a d u a t e p r o g r a m i s b a s e d o n t w o f u n d a m e n t a l s — a w e l l e s t a b l i s h e d u n d e r g r a d u a t e p r o g r a m a n d 74 a d e q u a t e p r o v i s i o n f o r r e s e a r c h a c t i v i t y . A g r a d u a t e d e n t a l p r o g r a m h a s d e f i n i t e p o s i t i v e e f f e c t s o n t h e u n d e r g r a d u a t e p r o g r a m . T h e g r a d u a t e p r o g r a m s t i m u l a t e s t h e s t u d e n t s i n t h e u n d e r g r a d u a t e p r o g r a m t h r o u g h e x p o s u r e t o a d v a n c e d t r a i n i n g a n d r e s e a r c h w i t h i n t h e p r o f e s s i o n . I t a l s o h e l p s m a i n t a i n a h i g h c a l i b r e o f p r o f e s s i o n a l i s m a m o n g f a c u l t y m e m b e r s , w h o i n t u r n i n f l u e n c e t h e u n d e r g r a d u a t e p r o g r a m . T h e d e n t a l f a c u l t y h a s a r e s p o n s i b i l i t y t o c a r r y o u t r e s e a r c h o r e l s e i t i s n o t c o n t r i b u t i n g t o t h e a d v a n c e m e n t o f k n o w l e d g e . I f t h i s h a p p e n s , i t t h e n c e a s e s t o b e a t r u e e d u c -a t i o n a l i n s t i t u t i o n a n d b e c o m e s r a t h e r a t r a i n i n g s c h o o l . I f d e n t a l e d u c a t i o n i s t o b e e f f e c t i v e t h e r e m u s t b e a p r o p e r b a l a n c e b e t w e e n r e s e a r c h a n d t e a c h i n g . T h e d e n t a l s c h o o l i s t h e o b v i o u s p l a c e f o r s u c h r e s e a r c h a c t i v i t y . I t s t r e n g t h e n s t h e t e a c h i n g p r o g r a m i n t h e i n s t i t u t i o n a n d a l l o w s u n d e r g r a d u a t e s t u d e n t s c o n t a c t w i t h t h o s e w h o s e i n t e r -e s t s r a n g e b e y o n d t h e p e d a n t i c . S i n c e t h e u n d e r g r a d u a t e p r o g r a m s i n g e n e r a l p r o v i d e t h e p o o l f o r f u t u r e g r a d u a t e s t u d e n t s , t h i s c o n t a c t w i t h i n d i v i d u a l s e n g a g e d i n g r a d u a t e s t u d i e s i s i m p o r t a n t f o r i t c a n i n s p i r e s o m e s t u d e n t s t o e n t e r a n a c a d e m i c c a r e e r i n v o l v i n g t e a c h i n g a n d / o r r e s e a r c h o n a f u l l o r p a r t t i m e b a s i s . G r a d u a t e d e n t a l e d u c a t i o n i s v e r y e x p e n s i v e b o t h f r o m t h e u n i v e r s i t y ' s a n d t h e s t u d e n t ' s p o i n t o f v i e w . I n o r d e r t o h a v e 75 c o s t s m o r e r e a l i s t i c , g r a d u a t e s t u d e n t s s h o u l d b e r e c r u i t e d i n s u f f i c i e n t n u m b e r s s o t h a t t h e i m p l e m e n t a t i o n o f a g r a d u a t e p r o g r a m - c a n b e e c o n o m i c a l l y f e a s i b l e . T h i s w o u l d m e a n t h a t i n t h e p r o p o s a l a n d e s t a b l i s h m e n t o f a n e w g r a d u a t e p r o g r a m , a s m a n y a r e a s o f i n t e r e s t a s p o s s i b l e s h o u l d b e m a d e a v a i l a b l e a t t h e o u t s e t a n d a c t i v e r e c r u i t i n g s h o u l d b e d o n e t o f i l l t h e p r o g r a m . I n g r a d u a t e s t u d i e s , t h e r e a r e t w o a r e a s o f e m p h a s i s — c l i n i c a l s c i e n c e s o r s p e c i a l t y p r o g r a m s a n d b a s i c m e d i c a l o r d e n t a l s c i e n c e p r o g r a m s . T h e l a t t e r c a t e g o r y c o u l d b e i n v o l v e d e x c l u s i v e l y w i t h r e s e a r c h . H o w e v e r , m o s t p r o g r a m s a r e n o t i n t e n d e d t o m a k e r e s e a r c h w o r k e r s o u t o f s t u d e n t s b u t t o g i v e t h e m a t h o r o u g h g r o u n d i n g i n t h e p r i n c i p l e s a n d p h i l o s o p h y o f r e s e a r c h . T h e r e f o r e , e a c h p r o g r a m s h o u l d h a v e a r e s e a r c h c o m p o n e n t ; o t h e r w i s e , t h e g r a d u a t e w i l l b e p o o r l y t r a i n e d . S P E C I A L T Y T R A I N I N G S p e c i a l t y t r a i n i n g r e f e r s t o a w i d e v a r i e t y o f c l i n i c a l s c i e n c e p r o g r a m s s u c h a s o r t h o d o n t i c s , o r a l s u r g e r y , p e r i o d o n -t i c s , e t c . , w h i c h m o s t o f t e n l e a d t o t h e e s t a b l i s h m e n t o f p r i v a t e p r a c t i c e w i t h i n o n e o r o t h e r o f t h e s e a r e a s u p o n g r a d u a t i o n . T h e s e s p e c i a l i s t s a r e i n d e e d i m p o r t a n t t o t h e d e n t a l c o m m u n i t y a n d t o t h e p u b l i c . T h e y p r o v i d e a s p e c i a l s e r v i c e b e y o n d t h a t 76 w h i c h c a n b e o f f e r e d b y t h e g e n e r a l p r a c t i t i o n e r . T h e d e l i v e r y o f s p e c i a l i s t s ' s e r v i c e n o t o n l y i n c r e a s e s t h e v a r i e t y o f s e r v i c e a v a i l a b l e b u t a l s o m a i n t a i n s t h e h i g h q u a l i t y o f d e n t a l c a r e w h i c h i s a f f o r d e d t h e p u b l i c . W h e r e p r o p e r l y u t i l i z e d , s p e c i a l -i s t s ' s e r v i c e c a n e v e n d e c r e a s e t h e c o s t o f d e l i v e r y o f s u c h c a r e . S p e c i a l t y t r a i n i n g i s n e c e s s a r y f o r t h e r e i s a l i m i t e d a m o u n t o f t i m e a v i a l a b l e i n t h e u n d e r g r a d u a t e d e n t a l p r o g r a m a n d t h e r e i s o n l y s o m u c h t h a t c a n b e t a u g h t a n d m a s t e r e d w i t h i n a f o u r y e a r p e r i o d . U n d e r g r a d u a t e d e n t a l p r o g r a m s h a v e , o v e r t h e y e a r s , i n t r o d u c e d s o m e t r a i n i n g i n c e r t a i n c o m p l e x s p e c i a l t y a r e a s , e g . i n t e r c e p t i v e o r t h o d o n t i c s , b u t t h e a l r e a d y h e a v i l y b u r d e n e d c u r r i c u l u m w i l l n o t a l l o w a d d i t i o n s b e y o n d t h e b a s i c d e n t a l p r o g r a m b e c a u s e o f t h e t i m e e l e m e n t i n v o l v e d i n t h e m a s t e r y o f a s s o c i a t e d s p e c i a l k n o w l e d g e a n d s k i l l s . U n d e r g r a d u a t e s t u d e n t s s h o u l d , h o w e v e r , b e e n c o u r a g e d t o d e v e l o p t h e i r i n t e r e s t s i n c e r t a i n f i e l d s s o t h a t u p o n g r a d u a t i o n t h e y c a n p u r s u e t h e m t h r o u g h p a r t i c i p a t i o n i n c o n t i n u i n g d e n t a l e d u c a t i o n a n d r e a d i n g . T h i s w o u l d a l l o w s e v e r a l g e n e r a l p r a c t i t i o n e r s w i t h d i f f e r e n t i n t e r e s t s t o f o r m a g r o u p p r a c t i c e i n a w a y t h a t t h e i r s k i l l s a n d i n t e r e s t w o u l d b e c o m p l e m e n t a r y . T h i s c o u l d h e l p t o e a s e t h e d e m a n d f o r s e r v i c e o n t h e s p e c i a l i s t s . B e y o n d t h i s , s p e c i a l i s t d e n t a l s e r v i c e s a r e a s i m p o r t a n t t o t h e g e n e r a l p r a c t i t i o n e r a s t h e y a r e t o t h e p u b l i c . T h e 77 g e n e r a l p r a c t i t i o n e r ' s t r a i n i n g m a y n o t e q u i p h i m t o p r o v i d e s p e c i a l s e r v i c e s f o r h i s p a t i e n t s ; c o n s e q u e n t l y , t h e s p e c i a l i s t i s r e q u i r e d f o r r e f e r r a l . O n t h e o t h e r h a n d , i n d i v i d u a l s w i t h i n s o c i e t y m a y f e e l t h e w a n t o f s p e c i a l a t t e n t i o n a n d e x p e r t i s e a n d t h e r e f o r e w i l l s e e k a s p e c i a l i s t ' s s e r v i c e . A s d e n t a l s e r v i c e s d e v e l o p a n d c o u n t r i e s s p e n d m o r e a n d m o r e d o l l a r s o n d e n t a l h e a l t h s e r v i c e s , t h e n e e d s t a n d s o u t f o r d e n t i s t s t o r e c e i v e s p e c i a l t r a i n i n g i n d e n t a l p u b l i c h e a l t h . T h e d i a g n o s i s o f t h e c o m m u n i t y d e n t a l h e a l t h p r o b l e m s , t h e p l a n n i n g a n d a d m i n i s -t r a t i o n o f d e n t a l c a r e p r o g r a m s , t h e d e t e r m i n a t i o n o f a c o u n t r y ' s d e n t a l m a n p o w e r n e e d s , a n d r e s e a r c h t o i m p r o v e t h e o r g a n i z a t i o n o f d e n t a l h e a l t h s e r v i c e s a r e s o m e e x a m p l e s o f t h e t a s k s f a c i n g t h e p u b l i c h e a l t h d e n t i s t . S p e c i a l s k i l l s n e e d e d b y a d e n t i s t w h o w i s h e s t o o r i e n t h i s c a r e e r t o w a r d s p u b l i c h e a l t h f u l l y j u s t i f y t h e d e v e l o p m e n t o f d e n t a l p u b l i c h e a l t h a s a s p e c i a l t y . C o u n t r i e s w i t h l a r g e p u b l i c d e n t a l h e a l t h s e r v i c e s o r w i t h d e n t a l s e r v i c e s i n c l u d e d i n n a t i o n - w i d e h e a l t h i n s u r a n c e s y s t e m s w i l l n e e d m o r e s p e c i a l l y t r a i n e d d e n t i s t s t h a n t h o s e o f f e r i n g l i m i t e d d e n t a l s e r v i c e s t h r o u g h t h e p r i v a t e s e c t o r . O n l y o n e s u c h p r o g r a m f o r a d i p l o m a i n d e n t a l p u b l i c h e a l t h i s a v a i l a b l e i n C a n a d a , a t t h e U n i v e r s i t y o f T o r o n t o , a n d i t w o u l d s e e m r e a s o n a b l e f o r t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a t o m a k e a v a i l a b l e t o W e s t e r n C a n a d a t h e o p p o r t u n i t i e s o p e n t o t h e p r o f e s s i o n i n E a s t e r n C a n a d a . 7 8 W e k n o w t h a t w h e r e d e n t i c a r e s e r v i c e s a r e p r o v i d e d t h r o u g h a p u b l i c h e a l t h i n s u r a n c e s c h e m e , t h e n u m b e r o f s p e c i a l i s t s i s t o o s m a l l t o m e e t i n c r e a s e d p u b l i c d e m a n d f o r s p e c i a l s e r v i c e s . T h i s w o u l d b e t h e c a s e i n B r i t i s h C o l u m b i a . T h e r e i s o n e f a c t o r t h o u g h w h i c h c l o u d s t h e e v a l u a t i o n o f t h e s i t u a t i o n i n B r i t i s h C o l u m b i a , a s w e l l a s i n t h e r e s t o f C a n a d a . B e c a u s e e a c h p r o v -i n c e i s a b l e t o s e t i t s o w n c r i t e r i a f o r r e c o g n i t i o n o f c e r t i f i e d s p e c i a l i s t s , t h e r e i s n o c o n s i s t e n c y i n h o w s p e c i a l i s t s a r e r e c o g -n i z e d a n d w h a t s p e c i a l i s t s s h a l l b e r e c o g n i z e d i n C a n a d a . S u r e l y t h e p r o f e s s i o n , i n a s s o c i a t i o n w i t h t h e p r o v i n c e s , c o u l d c o m e t o a n a g r e e m e n t a n d f o r m u l a t e a n a t i o n a l p o l i c y i n t h i s r e g a r d . T h i s w o u l d n o t o n l y a l l o w a m o r e a c c u r a t e p i c t u r e o f t h e n u m b e r o f p r a c t i s i n g s p e c i a l i s t s w i t h i n C a n a d a b u t w o u l d a l s o e q u a l i z e p u b l i c o p p o r t u n i t i e s f o r s p e c i a l i s t s e r v i c e s . I n a s i m i l a r v e i n , t h e f a c t t h a t g r a d u a t e s w i t h a d i p l o m a o r d e g r e e a r e a b l e t o o f f e r a s p e c i a l t y s e r v i c e w i t h o u t b e i n g c e r t i f i e d d o e s n o t p e r m i t a p r e c i s e e s t i m a t i o n o f w h a t s p e c i a l t y s e r v i c e s a r e a v a i l a b l e a n d t o w h a t d e g r e e . T h i s t o o s h o u l d b e c o n s i d e r e d w h e n f o r m u l a t i n g a n a t i o n a l p o l i c y . P e r h a p s a r e g i s -t r a t i o n l i s t o f c e r t i f i e d s p e c i a l i s t s a n d o t h e r s w h o a r e l i m i t i n g t h e i r p r a c t i c e w o u l d p r o v i d e a m o r e r e a l i s t i c v i e w o f t h e e x i s t i n g l e v e l o f s e r v i c e a v a i l a b l e t o t h e p u b l i c . I t w o u l d a l s o e n a b l e a m o r e a c c u r a t e e s t i m a t i o n o f t h e n u m b e r o f s p e c i a l i s t s n e c e s s a r y t o m e e t p u b l i c d e m a n d s . 79 TEACHERS AND RESEARCH WORKERS Students enrolled in graduate dental education programs dealing with basic medical and dental science provide the pool for the selection of faculty members of Canadian dental schools. They obviously constitute an important part of graduate dental education. Most often they w i l l remain within the educational system upon graduation and w i l l help maintain and improve teach-ing and learning at the undergraduate level. These individuals are involved in research of various kinds, attempting to solve some of the problems within the f i e l d of dentistry. Therefore, in any proposed graduate dental education program, i t is necessary to offer basic medical and dental science programs to ensure a proper balance with c l i n i c a l specialties and to ensure that Canadian institutions have a constant supply of high calibre teachers and research workers for eventually they themselves w i l l become the backbone for the perpetuation of a reputable graduate program. Education for research and teaching can be given similtan-eously. Since graduates of these programs w i l l be involved in teaching at both the graduate and undergraduate level i t seems logical that within the graduate dental education program there must be some grounding in teaching methodology and learning. A l l too often at the university level experts within their f i e l d 8 0 a r e c a l l e d u p o n t o t e a c h . T h e y a t t e m p t t o d o s o — b u t o f t e n v e r y p o o r l y . K n o w l e d g e o f l e a r n i n g t h e o r y , p s y c h o l o g y a n d t e a c h -i n g t e c h n i q u e s w o u l d h e l p a l l e v i a t e t h e f r u s t r a t i o n f e l t o n t h e p a r t o f t h e s t u d e n t a s w e l l a s t h e t e a c h e r . C O N T I N U I N G D E N T A L E D U C A T I O N P o s t - g r a d u a t e o r c o n t i n u i n g d e n t a l e d u c a t i o n p r o g r a m s o f f e r e d a t C a n a d i a n u n i v e r s i t i e s a r e g a i n i n g t h e s u p p o r t o f t h e m e m b e r s o f t h e d e n t a l p r o f e s s i o n . E n r o l l m e n t s h a v e s t e a d i l y i n c r e a s e d o v e r t h e l a s t f i v e y e a r s s u c h t h a t o n e i n e v e r y f i v e C a n a d i a n d e n t i s t s p a r t i c i p a t e d i n c o n t i n u i n g d e n t a l e d u c a t i o n c o u r s e s d u r i n g 1 9 7 2 - 1 9 7 3 . T h e f a c u l t i e s o f d e n t i s t r y , t h r o u g h m a k i n g s u c h c o u r s e s a v a i l a b l e , a r e p e r f o r m i n g a g r e a t s e r v i c e t o t h e p r o f e s s i o n . T h e m a i n t e n a n c e o f e x p e r t i s e b y t h e d e n t i s t i s a s i m p o r t a n t t o t h e p u b l i c a s i t i s t o t h e i n d i v i d u a l . S o m e p r o v i n c i a l l i c e n s i n g b o d i e s h a v e r e c o g n i z e d t h i s a n d h a v e s e t c o n t i n u i n g d e n t a l e d u c a t i o n r e q u i r e m e n t s a s a p r e r e q u i s i t e f o r m a i n t e n a n c e o f l i c e n s u r e w i t h i n t h a t p r o v i n c e . F o r e x a m p l e , M a n i t o b a s e t t h e s e r e q u i r e m e n t s i n 1 9 7 3 , w h i l e A l b e r t a h a s l e g i s l a t i o n i n p r o c e s s . T h i s i s o n e w a y i n w h i c h t h e p r o f e s s i o n c a n h e l p m a i n t a i n a h i g h s t a n d a r d o f p e r f o r m a n c e a m o n g i t s m e m b e r s a n d e n s u r e t h a t t h e p u b l i c i s r e c e i v i n g t h e b e s t p o s s i b l e d e n t a l c a r e . 8 1 I f a n d w h e n p a r t i c i p a t i o n i n c o n t i n u i n g d e n t a l e d u c a t i o n p r o g r a m s b e c o m e s a r e q u i s i t e f o r t h e m a i n t e n a n c e o f t h e p r o f e s -s i o n a l l i c e n s e i n a l l p r o v i n c e s , i t w i l l b e n e c e s s a r y f o r t h e u n i v e r s i t i e s t o m o d i f y t h e i r m e t h o d s o f d e l i v e r y o f t h e s e p r o g r a m s t o t h e p r o f e s s i o n . M a n y f a c t o r s m a y m a k e i t i m p o s s i b l e f o r a d e n t i s t t o t r a v e l w i t h a n y f r e q u e n c y t o t h e n e a r e s t f a c u l t y o f d e n t i s t r y t o t a k e p a r t i n c o n t i n u i n g d e n t a l e d u c a t i o n . C o n s e q u e n t l y , t h o s e r e s p o n s i b l e f o r p r o g r a m s m u s t b e g i n n o w t o d e v e l o p n e w w a y s o f f u l l y u t i l i z i n g m o d e r n t e c h n o l o g y a n d c o m m u n i c a t i o n s o a s t o f a c i l i t a t e l e a r n i n g b e y o n d t h e u n i v e r s i t y w a l l s . I f p r o g r a m s a r e m a d e a c c e s s i b l e t h e n , a n d o n l y t h e n , c a n t h e d e n t i s t b e r e q u i r e d b y l a w t o p a r t i c i p a t e i n c o n t i n u i n g d e n t a l e d u c a t i o n p r o g r a m s i n o r d e r t o m a i n t a i n a l i c e n s e t o p r a c t i s e . R E C O M M E N D A T I O N S I n o r d e r f o r a l l o r a n y o f t h e s e r e c o m m e n d a t i o n s t o b e i m p l e m e n t e d s e v e r a l t h i n g s m u s t h a p p e n . F i r s t , i t i s t h e r e s p o n s i b i l i t y o f e a c h f a c u l t y m e m b e r t o c o n s i d e r s e r i o u s l y t h e i m p o r t a n c e o f b e c o m i n g i n v o l v e d i n g r a d -u a t e t r a i n i n g a n d t h u s t o i n c r e a s e h i s p o t e n t i a l f o r s i g n i f i c a n t c o n t r i b u t i o n t o t h e p r o f e s s i o n a s a w h o l e . S e c o n d , i f t h e r e c r u i t m e n t o f h i g h c a l i b r e s t u d e n t s t o g r a d -u a t e c a r e e r s i s t o b e r e a l i z e d , t h e n a c t i v e a n d c o n s t a n t s u p p o r t 82 o f t h e i r a s p i r a t i o n s m u s t b e e f f e c t e d . G r a d u a t e d e n t a l e d u c a t i o n p r o g r a m s m u s t b e w e l l s t r u c t u r e d t o p r o v i d e a w i d e v a r i e t y o f c l i n i c a l t r a i n i n g i n t h e d i f f e r e n t s p e c i a l t y a r e a s . F o r t h o s e p u r s u i n g a n a c a d e m i c c a r e e r i n t e a c h i n g a n d / o r r e s e a r c h , t h e o p p o r t u n i t i e s f o r p r o m o t i o n a n d a d v a n c e m e n t s h o u l d b e a v a i l a b l e , p a r a l l e l w i t h p r o f e s s i o n a l g r o w t h . E v e r y g r a d u a t e s t u d e n t s h o u l d b e g i v e n a d e q u a t e m e a n s o f s u p p o r t d u r i n g h i s t e r m o f s t u d i e s i n v e i w o f t h e i m p o r t a n c e o f h i s s p e c i a l i z e d s k i l l s t o t h e p r o g r e s s o f t h e p r o f e s s i o n . U p o n g r a d u a t i o n , o p p o r t u n i t i e s f o r b o t h f u l l t i m e a n d p a r t t i m e p o s i t i o n s w i t h i n t h e f a c u l t y s h o u l d b e o f f e r e d t o g r a d u a t e s t o m e e t t h e v a r i o u s n e e d s o f t h e d e n t a l e d u c a t i o n p r o g r a m s . F i n a l l y j p r o f e s s i o n a l a s s o c i a t i o n s , i n c o n j u n c t i o n w i t h u n i v e r s i t i e s a n d g o v e r n m e n t s , m u s t a s s u m e r e s p o n s i b i l i t y f o r t h e l i f e l o n g e d u c a t i o n o f t h e h e a l t h p r o f e s s i o n a l — b e i t t h r o u g h c o n t i n u i n g o r g r a d u a t e d e n t a l e d u c a t i o n p r o g r a m s , f o r , u n t i l a l l a r e c o o p e r a t i v e l y a n d t o t a l l y c o m m i t t e d , a p r o g r a m w i t h o u t t h e i r s u p p o r t c o u l d n e v e r b e a . s u c c e s s . B I B L I O G R A P H Y 8 3 A d H o c C o m m i t t e e o n D e n t a l A u x i l i a r i e s R e p o r t . T h e D e p a r t m e n t o f N a t i o n a l H e a l t h a n d W e l f a r e . O t t a w a : I n f o r m a t i o n C a n a d a , 1 9 7 0 . A n n u a l R e p o r t o n A d v a n c e d D e n t a l E d u c a t i o n . T h e A m e r i c a n D e n t a l A s s o c i a t i o n , 1 9 7 2 - 1 9 7 3 . A n n u a l R e p o r t o n D e n t a l E d u c a t i o n . T h e A m e r i c a n D e n t a l A s s o c i a t i o n , 1 9 7 2 - 1 9 7 3 . T h e B r i t i s h N o r t h A m e r i c a A c t . O t t a w a : Q u e e n ' s P r i n t e r , 1 9 5 7 . C l a r k , I r a C . T h e D e v e l o p m e n t o f P h y s i c i a n C o n t i n u a t i o n  E d u c a t i o n . T h e U n i v e r s i t y o f I o w a , 1 9 6 6 . C o s t S t u d y o f D e n t a l E d u c a t i o n . S p o n s o r e d b y t h e W . K . K e l l o g g F o u n d a t i o n . A m e r i c a n A s s o c i a t i o n o f D e n t a l S c h o o l s , 1 9 6 5 . D e n t a l E d u c a t i o n i n C a n a d a . R o y a l C o m m i s s i o n o n H e a l t h S e r v i c e s . O t t a w a : Q u e e n ' s P r i n t e r , 1 9 6 4 . D e n t a l E d u c a t i o n R e g i s t e r . T h e C a n a d i a n D e n t a l A s s o c i a t i o n , 1 9 6 9 - 1 9 7 2 . D i s t r i b u t i o n o f D e n t i s t s i n t h e U n i t e d S t a t e s b y S t a t e , R e g i o n , D i s t r i c t a n d C o u n t y . A m e r i c a n D e n t a l A s s o c i a t i o n , B u r e a u ° f E c o n o m i c R e s e a r c h a n d S t a t i s t i c s , 1 9 7 1 . H a s t i n g s , J . E . F . " L a b o u r ' s P l a n f o r M e d i c a l C a r e ; P r o g r a m m e  f o r T o r o n t o . " T o r o n t o : T o r o n t o L a b o u r H e a l t h C e n t r e O r g a n i z i n g C o m m i t t e e , 1 9 7 2 . ( U n p u b l i s h e d p a p e r . ) H u n t e r , T . H . " N e w K n o w l e d g e a n d I t s A p p l i c a t i o n . " P a p e r r e a d b e f o r e t h e W h i t e H o u s e C o n f e r e n c e o n H e a l t h , W a s h i n g t o n , D . C , N o v e m b e r 3 , 1 9 6 5 . J o u r n a l o f t h e C a n a d i a n D e n t a l A s s o c i a t i o n . C a n a d i a n D e n t a l A s s o c i a t i o n , F e b r u a r y 1 9 7 4 , 4 0 ( 2 ) . J o u r n a l o f D e n t a l E d u c a t i o n . A m e r i c a n A s s o c i a t i o n o f D e n t a l S c h o o l s . 8 4 J o u r n a l o f M e d i c a l E d u c a t i o n . A s s o c i a t i o n o f A m e r i c a n M e d i c a l C o l l e g e s . M a c d o n a l d , J o h n . B . A P r o s p e c t u s o n D e n t a l E d u c a t i o n . V a n c o u v e r : T h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1 9 5 6 . M a c d o n a l d , J o h n B . D e n t a l E d u c a t i o n i n B r i t i s h C o l u m b i a . V a n c o u v e r : T h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1 9 6 1 . M c S y m t h e , C h e v e s , K i n n e y , T . D . , a n d L i t t l e m e y e r , M a r y H . T h e R o l e o f t h e U n i v e r s i t y i n G r a d u a t e M e d i c a l E d u c a t i o n : P r o c e e d i n g s o f t h e 1 9 6 8 C o n f e r e n c e , T h e A s s o c i a t i o n o f A m e r i c a n M e d i c a l C o l l e g e s , 1 9 6 8 . P o p u l a t i o n , C e n s u s D i v i s i o n s a n d S u b d i v i s i o n s ( W e s t e r n P r o v i n c e s ) . O t t a w a : S t a t i s t i c s C a n a d a , 1 9 7 2 . P o s t - G r a d u a t e D e n t a l E d u c a t i o n : R e p o r t o n a C o n f e r e n c e . L o n d o n : W o r l d H e a l t h O r g a n i z a t i o n , 1 9 7 0 . R e g i s t e r o f G r a d u a t e a n d P o s t - G r a d u a t e S t u d e n t s . T h e A s s o c i a t i o n o f C a n a d i a n F a c u l t i e s o f D e n t i s t r y , 1 9 6 9 - 1 9 7 2 . R e g i s t e r o f P o s t - G r a d u a t e a n d G r a d u a t e D e n t a l P r o g r a m s i n  C a n a d i a n U n i v e r s i t i e s . T h e A s s o c i a t i o n o f C a n a d i a n F a c u l t i e s o f D e n t i s t r y , 1 9 6 9 - 1 9 7 2 . R e v a n s , J o h n a n d M c L a c h l a n , G o r d o n . P o s t - G r a d u a t e M e d i c a l  E d u c a t i o n : R e t r o s p e c t a n d P r o s p e c t , a R e p o r t . T h e N u f i e l d P r o v i n c i a l H o s p i t a l s T r u s t , 1 9 6 7 . T h e G r a d u a t e E d u c a t i o n o f P h y s i c i a n s . T h e R e p o r t o f t h e C i t i z e n s C o m m i s s i o n o n G r a d u a t e M e d i c a l E d u c a t i o n , C o m m i s s i o n e d b y t h e A m e r i c a n M e d i c a l A s s o c i a t i o n . J o h n S . M i l l i s , P h . D . , C h a i r m a n , 1 9 6 6 . T r a n s a c t i o n s o f t h e C a n a d i a n D e n t a l A s s o c i a t i o n . C a n a d i a n D e n t a l A s s o c i a t i o n , 1 9 7 3 . V o l l a n , D o u g l a s D . P o s t - G r a d u a t e M e d i c a l E d u c a t i o n i n t h e  U n i t e d S t a t e s . A m e r i c a n M e d i c a l A s s o c i a t i o n , 1 9 5 5 . APPENDIX I 85 DENTAL EDUCATION QUESTIONNAIRE 1. A t t h e p r e s e n t t i m e , d o e s y o u r , s c h o o l have a p rog ram f o r : Yes No ( i ) g r a d u a t e d e g r e e p r o g r a m s ? ( i i ) g r a d u a t e c e r t i f i c a t i o n p r o g r a m s ? ( i i i ) c o n t i n u i n g d e n t a l e d u c a t i o n f o r d e n t i s t s ? ( i v ) c o n t i n u i n g d e n t a l e d u c a t i o n f o r d e n t a l a u x i l i a r y p e r s o n n e l -d e n t a l h y g i e n i s t s ? [ c e r t i f i e d d e n t a l a s s i s t a n t s ? expanded d u t y a u x i l i a r i e s ? c h a i r - s i d e a s s i s t a n t s ? •  ( v ) g r a d u a t e r e s i d e n c y p r o g r a m s ? • 2 . A t t h e p r e s e n t t i m e , does y o u r s c h o o l have any p r o p o s e d p r o g r a m f o r : , Y e ( i ) c o n t i n u i n g d e n t a l e d u c a t i o n f o r d e n t i s t s ? ( i i ) c o n t i n u i n g d e n t a l e d u c a t i o n f o r d e n t a l a u x i l i a r y p e r s o n n e l -d e n t a l h y g i e n i s t s ? c e r t i f i e d d e n t a l a s s i s t a n t s ? e x p a n d e d d u t y a u x i l i a r i e s ? c h a i r - s i d e a s s i s t a n t s ? ( i i i ) g r a d u a t e d e g r e e p r o g r a m s ? ( i v ) g r a d u a t e c e r t i f i c a t i o n p r o g r a m s ? ( v ) g r a d u a t e r e s i d e n c y p r o g r a m s ? I f t h e a n s w e r t o any p a r t o f q u e s t i o n #1 i s " y e s " , p l e a s e c o n t i n u e w i t h t h e q u e s t i o n n a i r e . P l e a s e a n s w e r t h e f o l l o w i n g q u e s t i o n s w i t h r e f e r e n c e t o e x i s t i n g p r o g r a m s o n l y . I f y o u a r e u n a b l e t o a n s w e r e a c h p a r t y o u r s e l f , p l e a s e d i r e c t i t t o t h e most a p p r o p r i a t e i n d i v i d u a l . PART I - GRADUATE DEGREE PROGRAMS 86 Please complete t h i s part with reference to exi s t i n g programs only within your school. Number 3. What i s the present enrollment in graduate degree program(s)? ; 4. Number of f u l l - t i m e enrollments? 5. Number of part-time enrollments! Please indicate the d i s t r i b u t i o n of these graduate student enrollments in course(s) and the f u l l - t i m e faculty/graduate student rations) Course Orthodontics Pedodontics Endodontics Prosthodontics (fixed and removable) Operative Oral Surgery Oral Medicine Community Public Health Oral Pathology Radiology Other (please specify) Number of e n r o l l -ments F/G r a t i o Does your school maintain any record of where graduates from these degree programs go upon graduation? YES NO (b) I f answer i s "yes", please give an approximation of the i n i t i a l d i s t r i b u t i o n of graduates over the past f i v e years: To urban areas To rural areas To another province or state To another country Number Page 2 PART I - GRADUATE DEGREE PROGRAMS - continued 86 8.(a) Have you received any comments from your graduates regarding the degree program(s)? YES NO (b) I f answer i s "yes", in general was the program adequate or inadequate with regard to: ADEQUATE INADEQUATE course content course q u a l i t y course length 9. How are the graduate degree programs in your school financed? YES NO National or Federal support Provincial or State support Private school or alumni support Semi-government agency Private support Other (please specify) 10. Please give an approximation of the dentist/population r a t i o of your province or state: (a) Urban (b) Rural 11. Please give an approximation of the specialist/population r a t i o of your province or state: (a) Urban (b) Rural Page 3 8 7 PART I - GRADUATE DEGREE PROGRAMS - continued 12. In your opinion, are these graduate degree programs meeting the present needs of your province or state? YES NO If "yes", what parameters did you use to assess this ? 13. In your -opinion, w i l l the present programs meet the predicted needs of your province or state? YES NO 14. Could you please supply any background b r i e f s , minutes or l i t e r a t u r e containing the rationale behind the establishment of the above program(s)? Example: Did you, or the committee responsible for the establishment of the program(s), review the ex i s t i n g conditions in Canada or the USA, i.e. what parameters were used to j u s t i f y the inception of the above program(s)? 15. I f any syllabus or calendar of courses i s a v a i l a b l e , could you please enclose a copy with your response? 16. Do you have any other information you feel might be of assistance in t h i s study? Please return to: Dr. M. A. Boyd Department of Restorative Dentistry Faculty of Dentistry University of B r i t i s h Columbia Vancouver 8 , B.C. PART II - GRADUATE CERTIFICATION PROGRAMS 8 8 Please complete t h i s part with reference to exi s t i n g programs only within your school. Number 3. What i s the present enrollment in graduate c e r t i f i c a t i o n ? programs? 4. Number of f u l l - t i m e enrollments? ' 5. Number of part-time enrollments? 6. Please indicate the d i s t r i b u t i o n of the graduate student enrollments in -course(-s) and the f u l l - t i m e faculty/graduate student r a t i o ( s ) Number of F/G Course enrol 1 - r a t i o ments Orthodontics Pedodontics Endodontics Prosthodontics (fixed and removable) Operative Oral Surgery Oral Medicine Community Public Health Oral Pathology Radiology Other (please specify) 7. Does your school maintain any record of where graduates from these c e r t i f i c a t i o n programs go upon graduation? YES NO (b) I f answer i s "yes", please give an approximation of the i n i t i a l . d i s t r i b u t i o n of graduates over the past f i v e years Number To urban areas To rural areas To another province or state To another country D a n o 0 - c - 89 PART II - GRADUATE CERTIFICATION PROGRAMS - continued 8 (a) Have you received any comments from your graduates regarding the c e r t i f i c a t i o n program(s)? YES .NO (b) I f answer i s "yes", in general was the program adequate or inadequate with regard to: ADEQUATE INADEQUATE course content ' course q u a l i t y course length 9. How are the graduate c e r t i f i c a t i o n programs in . your school financed? YES NO National or Federal support ' Provincial or State support ' Private school or alumni support Semi-government agency " Private support Other (please specify) 10. Please give an approximation of the dentist/population r a t i o of your province or state: (a) Urban (b) Rural 11. Please give an approximation of the specialist/population r a t i o of your province or state: (a) Urban (b) Rural ' Page 3 9 0 PART II - GRADUATE CERTIFICATION PROGRAMS - continued 12. In your opinion, are these graduate c e r t i f i c a t i o n programs meeting the present needs of your province or state? YES NO I f "yes", what parameters did you use to assess t h i s ? 13. In your opinion, w i l l the present programs meet the predicted needs of your province or state? YES NO 14 . Could you please supply any background b r i e f s , minutes or l i t e r a t u r e containing the rationale behind the establishment of the above program(s)? Example: Did you, or the committee responsible for the establishment of the program(s), review the e x i s t i n g conditions in Canada or the USA, i . e . what parameters were used to j u s t i f y the inception of the above program(s)? 15. I f any syllabus or calendar of courses i s a v a i l a b l e , could you please enclose a copy with your response? 16. Do you have any other information you feel might be of assistance in t h i s study? Please return to: Dr. M. A. Boyd, Department of Restorative Dentistry Faculty of Dentistry, University of B.C., Vancouver 8 , B.C. 9 1 PART III - CONTINUING EDUCATION FOR DENTISTS Please complete t h i s part with reference to exi s t i n g programs only within your school. 3. Is continuing dental education a re q u i s i t e for maintenance of licensure in your province or state? YES NO 4. What was the approximate enrollment in continuing education courses for dentists during: 1968- 69 1969- 70 1970- 71 1971- 72 1972- 73 5. Please indicate the d i s t r i b u t i o n of these enrollments in courses during the past year (1972-73) r„ Number of Course , — e n r o l lments Orthodontics Pedodontics Endodontics Prosthodontics (fixed or removable) Operative Oral Surgery Oral Medicine Pathology Radiology Other (please specify) • Page 2 - Z -9 2 PART I I I - CONTINUING EDUCATION FOR DENTISTS 6. Do t h e p a r t i c i p a n t s e v a l u a t e t h e c o u r s e s ? YES . NO I f " y e s " , i n g e n e r a l , a r e y o u r . c o u r s e s c o n s i d e r e d t o be a d e q u a t e o r i n a d e q u a t e w i t h r e g a r d t o : ADEQUATE INADEQUATE c o u r s e c o n t e n t course q u a l i t y '  c o u r s e l e n g t h 7 . A r e c r e d i t s g i v e n f o r p a r t i c i p a t i o n i n c o n t i n u i n g e d u c a t i o n c o u r s e s ? YES NO 8 . P l e a s e g i v e an a p p r o x i m a t i o n o f t h e d e n t i s t / p o p u l a t i o n r a t i o o f y o u r p r o v i n c e o r s t a t e : (a ) U r b a n (b ) R u r a l 9 . P l e a s e g i v e n an a p p r o x i m a t i o n o f t h e s p e c i a l i s t / p o p u l a t i o n r a t i o i n y o u r p r o v i n c e o r s t a t e : ( a ) U r b a n (b ) > R u r a l 10. I f any s y l l a b u s o f c a l e n d a r o f c o u r s e s i s a v a i l a b l e , c o u l d y o u p l e a s e e n c l o s e a c o p y w i t h y o u r r e s p o n s e ? 11. Do y o u have any o t h e r i n f o r m a t i o n y o u f e e l m i g h t be o f a s s i s t a n c e t o t h i s s t u d y ? P l e a s e r e t u r n t o : D r . M. A . B o y d , D e p a r t m e n t o f R e s t o r a t i v e D e n t i s t r y f n n n t i f t m i i i n - i w o v c - H - x / n f R C . . V a n c o u v e r . 8. B.C. PART IV - CONTINUING DENTAL EDUCATION FOR DENTAL AUXILIARY PERSONNEL 93 Please complete t h i s part with reference to exi s t i n g programs only within your school. 3. Is continuing dental education a r e q u i s i t e for maintenance of licensure in your province or state f o r : dental hygienists? c e r t i f i e d dental assistants? chair-side dental assistants? expanded duty a u x i l i a r i e s ? - a u x i l i a r i e s as those i n Saskatchewan.? YES NO -(in Canada only) 4. What was the approximate enrollment i n continuing dental education courses during l a s t year (1972-73)? dental hygienists c e r t i f i e d dental assistants chair-side dental assistants expanded duty a u x i l i a r i e s NUMBER 5. Do the participants evaluate the courses? YES NO If "yes", i n general, are your courses considered to be adequate or inadequate with regard to: course content course q u a l i t y course length ADEQUATE INADEQUATE 6 . Are cre d i t s given for p a r t i c i p a t i o n in continuing dental education courses? YES NO D-.«-i/-> O - 2 - 9 4 PART IV - CONTINUING DENTAL EDUCATION FOR DENTAL AUXIL IARY PERSONNEL - cont. 7. P l e a s e g i v e an a p p r o x i m a t i o n o f t h e d e n t a l h y g i e n i s t / d e n t i s t r a t i o i n y o u r p r o v i n c e o r s t a t e : ( a ) U rban (b ) R u r a l 8. P l e a s e g i v e an a p p r o x i m a t i o n o f t h e d e n t a l h y g i e n i s t / p o p u l a t i o n r a t i o o f y o u r p r o v i n c e o r s t a t e : ( a ) U r b a n (b ) R u r a l 9. I f any s y l l a b u s o r c a l e n d a r o f c o u r s e s i s a v a i l a b l e , c o u l d y o u p l e a s e e n c l o s e a c o p y w i t h y o u r r e s p o n s e ? 10. Do y o u have any o t h e r i n f o r m a t i o n y o u f e e l m i g h t be o f a s s i s t a n c e i n t h i s s t u d y ? P l e a s e r e t u r n t o : 'D r . M. A . B o y d , D e p a r t m e n t o f R e s t o r a t i v e D e n t i s t r y , F a c u l t y o f D e n t i s t r y U n i v e r s i t y o f B r i t i s h C o l u m b i a , V a n c o u v e r 8, B . C . PART V - GRADUATE RESIDENCY PROGRAMS 9 5 Please complete t h i s part with reference to exi s t i n g programs only within or a f f i l i a t e d with your school. Number 3. What i s the present enrollment in graduate residency programs ? _ _ _ _ _ 4. Number of f u l l - t i m e enrollments? 5. Number of part-time enrollments? Please indicate the d i s t r i b u t i o n of the graduate student enrollments in course(s) and the f u l l - t i m e f a c u l t y graduate student r a t i o ( s ) Course Number of  enrol 1 -ments F/G r a t i o Orthodontics Pedodontics Endodontics Prosthodontics (fixed and removable) Operative Oral Surgery Oral Medicine Community Public Health Oral Pathology Radiology Other (please specify) Does your school maintain any record of where graduates from these residency programs go upon graduation? YES NO (b) I f answer i s "yes", please give an approximation of the i n i t i a l d i s t r i b u t i o n of graduates over the past f i v e years Number To urban areas To rural areas To another state To another country - 2 -9 6 PART V - GRADUATE RESIDENCY PROGRAMS - continued 8.(a) Have you received any comments from your graduates regarding the residency program(s)? YES NO (b) I f answer i s "yes", in general was the program adequate or inadequate with regard to: ADEQUATE INADEQUATE course content course q u a l i t y course length 9 . How are the graduate residency programs in your school financed? National or Federal support State support Private school or alumni support Semi-government agency Private support Other (please specify) 10. Please give an approximation of the dentist/population r a t i o of your state: (a) Urban (b) Rural 11. Please give an approximation of the specialist/population r a t i o of your state: (a) Urban (b) Rural 9 7 PART V - GRADUATE RESIDENCY PROGRAMS 1 2 . I n y o u r o p i n i o n , a r e t h e s e g r a d u a t e r e s i d e n c y p r o g r a m s m e e t i n g t h e p r e s e n t needs o f y o u r s t a t e ? YES NO I f " y e s " , what p a r a m e t e r s d i d you use t o a s s e s s t h i s ? 1 3 . In y o u r o p i n i o n , w i l l t h e p r e s e n t p r o g r a m s meet t h e p r e d i c t e d needs o f y o u r s t a t e ? YES NO 1 4 . C o u l d y o u p l e a s e s u p p l y any b a c k g r o u n d b r i e f s , m i n u t e s o r l i t e r a t u r e c o n t a i n i n g t h e r a t i o n a l e b e h i n d t h e e s t a b l i s h m e n t o f t h e above p r o g r a m ( s ) ? E x a m p l e : D i d y o u , o r t h e c o m m i t t e e r e s p o n s i b l e f o r t h e e s t a b l i s h m e n t o f t h e p r o g r a m ( s ) , r e v i e w t h e e x i s t i n g c o n d i t i o n s i n t h e USA, i . e . what p a r a m e t e r s were used t o j u s t i f y t h e i n c e p t i o n o f t h e a b o v e p r o g r a m ( s ) ? 1 5 . I f any s y l l a b u s o r c a l e n d a r o f c o u r s e s i s a v a i l a b l e , c o u l d y o u p l e a s e e n c l o s e a c o p y w i t h y o u r r e s p o n s e ? 1 6 . Do y o u have any o t h e r i n f o r m a t i o n y o u f e e l m i g h t be o f a s s i s t a n c e i n t h i s s t u d y ? P l e a s e r e t u r n t o : D r . M.A. B o y d , D e p a r t m e n t o f R e s t o r a t i v e D e n t i s t r y F a c u l t y o f D e n t i s t r y , U n i v e r s i t y o f B . C . , V a n c o u v e r 8, B . C . 

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