100 Years of ADEA: Dr. Kenneth Kalkwarf

Kenneth L. Kalkwarf, D.D.S., M.S.

Senior Consultant
AAL

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Dr. Kenneth Kalkwarf has never shied away from change, starting back in his early days as a college student, when he switched from architecture to dentistry, and later as founding Chair of the ADEA Commission on Change and Innovation in Dental Education, which helped usher in many dynamic changes in dental education. In his Q&A, he shares how he made the decision to become a dental educator and how he has advocated for and encouraged evolution in dental education. He also reflects on the professional achievements he is most proud of.

Q. Some dentists knew from childhood that they wanted to become dentists, but you originally started in the field of architecture. How did you eventually conclude that dentistry was the right profession for you?

I was born in 1946 as an only child on a sharecropping farm in eastern Nebraska and spent my early years doing farm labor. Although no one in my extended family had attended college, my parents encouraged me to do so. No one I knew could advise me about college, and I went to a small, consolidated school with little guidance counseling. I remember taking an aptitude test once in high school that returned a result saying I should consider being a health care provider or a science teacher. I promptly ignored that advice and decided that since, as an only child, I spent a lot of time building models (first out of the box, then customized, then by fabricating and assembling parts), I should study design. The decision was to study architecture and apply only to the program at the University of Nebraska. It was a land-grant institution, and thus affordable—and they had invited me to walk on to play football.

The School of Architecture had a minimal grade point requirement to progress to the second year, and midway through the first year, it was very apparent that I would not meet that goal. I had failed! After some soul-searching, I decided to step up, give up football and focus on my future. The high school aptitude test results popped into my head. I didn’t feel I had the patience to be a teacher. Medicine appeared intimidating. Pharmacy seemed confusing, and everyone I knew at that time felt nurses should be women. It was off to student services to get information about the dental college.

After a few semesters of academic toil, I had a very interesting interview process with the admissions committee. I lost an eye at age seven due to a traumatic accident. The committee was a little concerned about graduating a one-eyed dentist; one member wanted to know how I would ensure that I wouldn’t burn the building down with the casting torch. A few weeks of talking to a group of ophthalmologists I had rounded up must have convinced the committee that the building would be safe—and I became a member of their class of 1970.

It would be a few years before I would decide that dentistry was the right profession for me.

Q. After you graduated from dental school, you had the chance to join Project Hope and help the underserved in Egypt, join a private practice in Montana or pursue a Ph.D. in Connecticut, but you instead decided to become a faculty member at the University of Nebraska Medical Center. Why did you decide to go into academia, and what advice would you offer graduating dental students facing similar choices post-graduation?

Following dental school, I completed a general practice residency in Milwaukee and returned to Nebraska for a periodontics graduate program. In the final stages of training, I was considering my options for the future. I was 26 years old, single and other than a summer research internship in Chicago and a year in Milwaukee, I had never been outside of Nebraska. Project Hope was looking for a periodontist for a clinic in Alexandria, Egypt. The University of Connecticut had a premier immunology program with stellar faculty members focused on the immunological aspects of periodontal diseases, and a multi-specialty group in Helena, MT, wanted me to join. Each option was exciting—and completely different.

I interviewed with Project Hope and quickly heard back from them. Tensions were rising in the region (eventually leading to the Yom Kippur War), and they had decided to delay expansion in Egypt. My Chairman and Program Director asked to meet with me that same afternoon. A faculty member had announced he was leaving, and they wanted to know if I would consider filling the open academic position for a year and practicing in their office. (A full-time position at the dental college at that time was four days with one day to practice outside.) The Hope situation demonstrated to me the fragility of opportunities, and a year without being a “resident” would let me (without obligations) try out private practice and see what education was all about. I accepted the offer—and it turned out to be the second-best decision I ever made. (More about that later.)

I soon became submerged in a busy, part-time practice and matured significantly as a clinical periodontist. More importantly, I gained experience across the spectrum of academic dentistry, dental assisting, dental hygiene, predoctoral dental, post-graduate periodontics and translational/clinical research. However, the most significant outcome was discovering a mentor. I had begun having lunch with a senior restorative dentist with a wealth of academic experience.

One day, I told him, “I have a passion for education. I love being the smartest person in the classroom and telling students what they need to know!”

He leaned back—and, using a little more colorful language—said, “You’re really screwed up.”

He informed me that effective education was not telling students things so they can be as good as you. Instead, it’s helping them develop their inquisitiveness and skills to find answers to today’s questions, so they are prepared to address tomorrow’s questions. I never forgot that moment of enlightenment.

Throughout that year, I learned that dentistry was the right profession for me. I liked providing periodontal care in a part-time practice environment (and would continue doing so throughout my career), but I loved being in the academic setting, surrounded by eager students and residents and collaborating with innovative and tremendously talented faculty members to tackle a myriad of oral health challenges.

Halfway through the year, I was given the opportunity to apply for a full-time, tenure-track position. I jumped at the chance and was selected. The following year, I made my best-ever decision—we will be married 50 years next summer.

Q. While Associate Dean, you successfully helped convince the Texas Legislature to keep open the UT Health San Antonio School of Dentistry. What advice would you give to dental professionals who want to be more proactive in advocating for oral health and dental education at a state and federal level?

Following a few years on Nebraska’s faculty, I accepted a position at a newly opened school, the University of Oklahoma. It was a wonderful experience working with relatively young faculty members from across the country and all their new ideas. I also learned that sometimes you must negotiate to accomplish things with others who think differently. While in Oklahoma, I completed my specialty board certification, and Nebraska asked if I would return to direct the Periodontal Program. I returned to Nebraska, led the residency, and was appointed Director of Advanced Education for the school. I was recruited in 1986 to a position at what is now UT Health San Antonio as the Associate Dean for Advanced Education.

As some can remember, the early to mid-1980s was a tumultuous time for the country and dental education. Multiple factors contributed to high-interest rates (home mortgages at 16 to 17%) and an economic recession that crippled the economy.

A highly respected financial publication outlined the effects of opening new dental schools and expanding existing ones during the 1970s, water fluoridation and reduced caries prevalence and the recession’s impact on discretionary consumer spending on the dental profession. It declared the future for dentists as “dismal”. Organized dentistry “shouted” that dentists were not busy, and their proposed solution was reducing the pipeline of new dentists by closing schools.

Although Texas survived the worst of the early recession, the state faced a “savings and loan crisis” in 1986, caused by speculation and high risk-taking, compounded by recession-affected borrowers who could not pay off their debt. The Texas Legislature faced an upcoming session with depleted tax revenues and a significant player in its economy under duress.

There were three dental schools in the state at the time. There was Baylor College of Dentistry, a private institution founded as State Dental College in 1905. It had state funding equal to the other two schools: The University of Texas Dental Branch in the UT System, which was founded in Houston in 1905, and The University of Texas Health Science Center at San Antonio Dental School in the UT System, which was founded in 1970. The Texas Dental Association (TDA) developed a legislative policy to lobby for a significant reduction of dental students graduating in Texas, and a TDA Past President was a member of the Texas House of Representatives.

A bill was filed in the Texas Legislature outlining the closure of San Antonio. The rationale was to remove 150 new dentists from the pipeline. (The appropriate number according to data from the TDA.) San Antonio was the newest school and a second school in the UT System, so by closing it and the state’s budget would be reduced. The TDA with the highest funded Political Action Committee (PAC) in Texas, and the Texas Medical Association with the second largest PAC and a sense that they may have a similar issue in the future, endorsed the bill.

Three of us from the dental school administration were responsible for addressing the bill. In the most positive sense, politics is an art of negotiation, where, ideally, all sides can accept the outcome and move forward. In this case, we determined that the TDA’s top priority was a significant reduction in dental graduates, the schools’ primary consideration was retaining their state resources and the legislators’ primary consideration was maintaining their donors’ support. We calculated that the actual dollar savings to Texas outlined in the bill were minuscule compared to the entire state budget.

We were provided with outstanding support from the offices of governmental affairs on campus at the UT System, and at the American Association of Dental Schools (ADEA’s predecessor). We coordinated with Houston’s dental school and received cooperation from Baylor’s dental school. We met with legislators, business leaders, partners in education and clinical care from across the state, and TDA leadership to explore plans for resolution. Ultimately, the bill was modified to downsize each dental school by 50 students, while maintaining their state financial support—with an understanding that funds would be diverted from education to support new research initiatives. The TDA, the schools and the legislators each got a result they could accept, and a dental school remained in San Antonio the following year when I was named Dean.

Anyone being introduced into a political environment—whether local, statewide or national—should carefully do their homework and consult with others to determine the background issues and the priorities of all parties directly or indirectly involved in the negotiation. Realizing that compromise will probably be needed, honest, open discussions focused on allowing all parties to achieve some level of winning are required.

Q. You were the founding Chair of the ADEA Commission on Change and Innovation in Dental Education. What are the biggest changes to dental education do you think the Commission helped facilitate?

In 2005, I was asked to Chair the ADEA Commission on Change and Innovation in Dental Education (ADEA CCI). ADEA CCI’s intent was to provide leadership for developing a systemic, collaborative and continuous process of innovative change in the education of general dentists. The anticipated outcome was graduates entering the profession competent in meeting the oral health needs of the public throughout the 21st century and functioning as integral members of efficient and effective health care teams. ADEA CCI was structured to include broad representation from various ADEA constituencies, the American Dental Association, the Joint Commission on National Dental Examinations, the Commission on Dental Accreditation, the American Association of Dental Examiners and other health care and higher education disciplines. CCI’s mantra became “to ensure future dentists are lifelong learners, providing evidence-based care that meets society’s needs.”

Over several years, ADEA CCI was successful in doing the following:

• It published 22 manuscripts focused on topics including:
  • Development of Problem-Solving, Critical Thinking and Self-Directed Learning;
  • Making Academic Dentistry More Attractive to New Teacher-Scholars;
  • Dentistry and Dental Education in the Context of the Evolving Health Care System; and
  • Faculty Development to Support Curriculum Change and Teaching Effectiveness.
• It created toolboxes to assist in the development of Critical Thinking Skills and Dental Student Assessment.
• It created CCI Liaison groups in most U.S. dental schools that met regularly to share the outcomes of education quality improvement projects they were conducting in their institutions.
• It released the draft of Competencies for the New General Dentist, which was approved by the ADEA House of Delegates in 2008.
• It created the background documents to support the 2007 Joint ADEA/Commission on Dental Accreditation Task Force formed to revise the Predoctoral Dental Accreditation Standards.
• It provided support for the Integrated National Board Dental Examination to complete its evolution to a one-part exam and move to a system of pass/fail scoring supporting the intent of its exam structure.
• ADEA CCI’s successes led the Association to implement CCI 2.0 and become the driving force to incorporate oral health care into discussions of interprofessional education/collaborative care.

Q. Which of your accomplishments in relationship to ADEA and/or dental education, in general, are you most proud of?

I was an active member of AADS/ADEA from 1973 to 2014 and am proud of being involved in many of its collaborative activities. A few stand above the others:

• In 1990, shortly after it was reported that Kimberly Bergalis had been infected with HIV during dental care, the San Antonio dental school found through a routine post-needle stick protocol that a junior dental student was HIV-positive.
  
  As there were no previously reported cases of positive dental students, the school implemented Centers for Disease Control and Prevention (CDC) guidelines and formed an expert panel that executed appropriate look-back procedures and assessments. AADS offices were involved throughout the process and during the follow-up curriculum modifications for the student who successfully graduated. Following the incident, the school and AADS were recognized by CDC for their leadership within health care education.
• The mid-1990s marked a significant change: the American Dental Education Association was adopted as the new name for the former American Association of Dental Schools. More importantly, the Association’s philosophy was dramatically altered. No longer was it to be a trade organization designed to protect predoctoral dental education in its wars with organized dentistry and dental examiner groups. It was redesigned as an inclusive organization of institutions and individuals across the entire oral health education spectrum. Its mantra was “The Relentless Pursuit of Strategic Alliances” to improve education and care. The collaborations that resulted from these changes allowed the evolution of activities, such as the ADEA CCI discussed previously.
• In 2000, ADEA initiated its Leadership Institute (LI). As apparent from some of my previous answers, I often flew by the seat of my pants as an administrator. When the LI was conceived, I was very supportive of the concept that allows individuals considering leadership positions to participate in a structured environment of self-assessment to develop and refine leadership skills and establish collaborative networks.
  
  When San Antonio had an upcoming opening in a leadership position and a faculty member who had demonstrated interests and traits that appeared to be compatible with that position, I nominated them to participate in the LI. It was always a pleasure to see them return from a session full of excitement, new ideas and new colleagues with whom to collaborate. At the close of my academic career, I had the opportunity to serve as an LI mentor and experience the process. I often wished I could have participated in the LI as a young faculty member. ADEA should be exceptionally proud of its LI and the accomplishments of the graduates.

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