CODA's accreditation of graduate dental anesthesiology programs: a benefit to all dental education.

In a 1985 editorial published in Anesthesia Progress, Dr. Ted Jastak advocated for the need for and the critical importance of acquiring accreditation for graduate dental anesthesiology programs.1 He described the “clout” that is afforded training programs that receive formal accreditation. He explained that the survival of hospital-based dental anesthesia programs and the maintenance of privileges that we enjoy as dentist anesthesiologists would require the authorized approval obtained through an officially recognized accreditation process. Three years after this 1985 opinion article was published, the American Dental Association and the American Dental Society of Anesthesiology continued this discussion at a jointly sponsored workshop on anesthesia education. Participants recognized that the limited availability of advanced training programs was the “missing link” in creating an adequate pool of dentist anesthesiologists to provide the anesthesia services and educational expertise needed by the profession. Some of us can recall that approximately 19 training programs in anesthesiology were available to dentists at that time. In 2006, the American Society of Dentist Anesthesiologists petitioned the Commission on Dental Accreditation (CODA) to include graduate dental anesthesiology education within its nonspecialty accreditation program. Although CODA operates under the auspices of the American Dental Association, the Commission functions independently and autonomously in matters related to developing and approving accreditation standards. CODA, similar to other recognized educational accrediting organizations, functions to protect the public by independently reviewing the quality of dental education programs to ensure the highest level of competency of its graduates. Most importantly, CODA is recognized by the U.S. Department of Education and therefore can provide the official national recognition that is critically important for the future of graduate dental anesthesiology programs. In 2007, CODA approved educational standards and began to accept applications from graduate dental anesthesiology programs. The strict educational and program requirements for accreditation ensure the clinical competency of our graduates. Beyond certifying the highest quality of clinical training, the CODA standards broaden the academic scope of training, requiring graduates to be capable of providing evidence-based critical evaluations of current literature and exhibiting an understanding of the fundamentals of clinical research. These skills are essential for future educators, who are sorely needed to adequately prepare pre-doctoral students to deliver safe and effective anesthesia care. The immediate benefits of the CODA process have been astounding. One year ago, only six training programs for graduate dental anesthesiology were available in the United States and Canada: Loma Linda University, Mount Sinai Medical Center, The Ohio State University, University of California at Los Angeles, University of Pittsburgh, and University of Toronto. In total, these programs annually graduate only 12 to 14 dentist anesthesiologists, some of whom continue to broaden their education into other dental specialties. This level of output clearly yields too few personnel to adequately serve the current needs of the population. The most exciting and notable result of the CODA review process for dental anesthesiology programs is the increased interest and support that have been generated for hospital-based graduate anesthesiology programming; two new programs (Stony Brook Medical Center and Lutheran Medical Center) have gained CODA approval, and plans are under way for the development at least two additional programs. The benefits of CODA accreditation of graduate dental anesthesiology training programs are obvious: programs will continually improve the quality of the training they provide, program availability and subsequent student enrollment will increase, and graduates will be given the documentation that they will need to be credentialed for insurance profiles and hospital appointments. These benefits will serve and protect the public by improving access to care for those dental patients who have dental phobias, special needs, complex medical conditions, or dementia. It may not be so obvious that an increase in the number of well-trained dentist anesthesiologists benefits dental schools as well. A large number of academically prepared dentist anesthesiologists are needed to provide up to date anesthesia and medical emergency curriculum, to advance clinical research, and to support the educational infrastructure through the creation of independent departments. The availability of dedicated dental anesthesiology faculty will promote the teaching and research environment fundamental to dental education. The Institute of Medicine report on dental education published in 1995 recommended major changes in dental education.2 It acknowledged the need for schools to enhance the integration of basic and clinical instruction, to create a more clinically relevant curriculum, to prepare pre-doctoral dental students who can manage medically complex conditions, to incorporate active and interactive learning, and to develop critical thinking skills. In few areas of dental education is the need for advanced education in complex patient management more applicable than in anesthesia, therapeutics, and pain control. Clinical experiences in anesthesia allow the best application of a student's didactic knowledge of behavioral science, clinical medicine, anatomy, physiology, pharmacology, and medical emergencies. In contrast to dental schools in Japan, all of which have autonomous departments of anesthesiology,3 the preparation of students to be proficient in basic anesthesia services has not been a priority in most U.S. dental schools.4 Accreditation of graduate dental anesthesiology programs by CODA has encouraged others to create new programs, ultimately resulting in greater numbers of well-trained and desperately needed dentist anesthesiologists. As Ted Jastak recognized in his 1985 editorial, accreditation is an essential step toward securing the future of anesthesiology in dentistry. After a 23-year wait, accreditation has come to fruition. Ted should be delighted.