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The Commission on Dental Accreditation recently implemented new predoctoral standards that require dental schools in the United States to provide students with community-based dental education (CBDE) experiences. The objective of this study was to examine the perspectives of supervising dentists (also known as dental preceptors) at rural CBDE sites regarding the University of Nebraska Medical Center program's effectiveness in improving the competencies of dental students. Surveys were sent to all forty-three preceptors in two subsequent years: nineteen responded to all questions in 2012 and sixteen in 2013, for a total of thirty-five participants. These preceptors evaluated the effectiveness of the program based on the American Dental Education Association (ADEA) Competencies for the New General Dentist. Overall, these preceptors rated the CBDE program as effective (excellent or very good) in improving the students' competence in five of the six ADEA domains: Critical Thinking, Professionalism, Communication and Interpersonal Skills, Health Promotion, Patient Care: Assessment, Diagnosis, and Treatment Planning, and Patient Care: Establishment and Maintenance of Oral Health. Practice Management and Informatics was found to be the least effective domain of competence. CBDE provides a unique opportunity to develop a competent dental workforce with an appreciation for the value of community service. Applying a competency-based framework to program evaluation can provide valuable information on program effectiveness to program administrators, educators, and the dental preceptors.

Postgraduate general dentistry programs are facing critical problems with funding, resident recruitment and viability. Recent federal actions reduced and eliminated graduate medical education (GME) support for some programs, and rising student debt and increasingly lucrative private practice opportunities reduce the value of postgraduate general dentistry experiences. Faced with these complex and interlinked challenges, the University of Nebraska Medical Center College of Dentistry General Practice Residency implemented a gainshare plan. The first 12 months of the plan produced a 44% increase in production and a concomitant 42% increase in actual collections resulting in enough funds to provide remuneration over base salary for residents, staff and faculty. The plan also compensated the Dean, the host department and the College of Dentistry while also funding the development of a reserve account for program enhancement and future stipend support. Gainshare concepts, rationale and details of the pilot plan are presented along with a discussion of key outcomes and experiences.

Based on the findings of this study, the following specific strategic recommendations are offered: 1. Offer continuing education courses throughout the state at reasonable fees. The courses should emphasize recognition of AIDS related lesions and infectious diseases, aseptic techniques/infectious disease control, AIDS, Hepatitis B, and infections/antibiotics. In addition, continuing education courses in the area of medical history taking methods should be offered to teach methods of inquiring about sexual and drug-use histories. 2. Establish a state resource center for information regarding infectious diseases. This could, perhaps, be a cooperative venture with the Department of Health, the Nebraska Dental Association, and the College of Dentistry. There is a need to gather, interpret and disseminate periodic updates on infectious disease research. This venture should also focus on developing literature for practitioners with consistent information about infection control regulations and guidelines. 3. Either through continuing education courses or through the information resource center, provide instruction on realistic assessment of the risk of infectious disease transmission in dentistry. 4. Develop a public relations campaign to educate the public about infection control policies in dentistry, what is being done to protect the public. 5. A research effort should be undertaken to determine the discrepancy between self-reported infection control practices and observed infection control practices. This could be accomplished through patient and dentist surveys, interviews, and/or observations. 6. Establish a confidential HIV blood screening program for health care providers.