A.I. HAMILTON (SUMMER 1978), ARE SPECIALISTS SPOILING DENTAL EDUCATION?, OPERATIVE DENTISTRY, VOL3(3) PP. 81
Are Specialists Spoiling Dental Education?
Dividing an organization, be it an organism or a profession into subdivisions that specialize in some part of the activity of the whole, usually results in improving the performance of the organization. The development of keratin and a stratum corneum, for example, allowed vertebrates to emerge from a watery existence to a life in the vastly different physical conditions of the terrestrial atmosphere. Similarly the development of specialties in dentistry, by allowing dentists to acquire the expertise that comes from repeated performance of similar tasks, has made available to the patient a more skillful but more limited service. Naturally there
is a cost to specialization—the cost is that by narrowing his focus the specialist diminishes his perspective of the treatment of the patient as a whole. However, provided there are enough general practitioners to supply the major demands of patients, there is a real gain to the patient.
Of course when everyone becomes a specialist the organization is likely to disintegrate from a loss of recognition of its overall purpose. The barrier function of the skin or mucous membrane is effective only as long as the proliferation of the constituent epithelial cells subserves a higher purpose. Uncontrolled proliferation leads to the death of the organism. It is unlikely that the practice of dentistry is in danger of excessive specialization, but can we say the same for dental education? The higher academic degrees that often accompany specialization are usually noted with favor by university administrators when they select deans, department chairmen, and other administrators. This trend has been especially noticeable in recent years. The result of such appointments has usually been increased emphasis on the teaching of specialties or pseudospecialties, and reduced emphasis on operative dentistry.
Just as the patient is likely to have a better chance of retaining his teeth if he is under the care of a general practitioner, who will refer him to a specialist if one is needed, so the education of a dental student is more likely to produce the kind of dentist needed if decisions on the content of the curriculum are not dominated by specialists.
This problem of specialization was clearly understood by H G Wells who wrote, “A distinguished specialist is precious because of his cultivated gift. It does not follow at all that by the standards of all-round necessity he is a superior person. Indeed by the very fact of this specialization he may be less practised and competent than the average man.”
Is it now not time to admit that the competence of present-day graduates in treating the most common disease—dental caries—has declined? Is it not time for the specialists to recognize their limitations and relinquish the control of dental education to those more conversant with treating the patient as a whole?
WELLS, HG (1938) World Brain. London: Methuen & Co Limited.
A IAN HAMILTON
University of Washington
School of Dentistry SM-56
Seattle, WA 98195, USA