The profession of dental hygiene is expanding

Transcription

1 A Survey of Degree Completion Programs in Dental Hygiene Education Karen M. Portillo, R.D.H., M.S.D.H.; Ellen J. Rogo, R.D.H., Ph.D.; Kristin H. Calley, R.D.H., M.S.; Leigh W. Cellucci, Ph.D. Abstract: The purpose of this descriptive study was to identify specific information related to U.S. dental hygiene baccalaureate degree completion programs. Learning experiences, assessment methods, and baccalaureate institutional partnerships were assessed. Of the sixty dental hygiene programs that offer a degree completion program, the forty-two that met the inclusion criteria (including having operated for at least three years) were invited to participate in a thirty-eight item online survey. A 62 percent (n=26) response rate was obtained. Learning experiences in responding programs included core dental hygiene courses, general education courses, and elective dental hygiene courses. Emphasis areas offered by various programs were in the specialty areas of education, public or community health, and research. Respondents reported that their graduates were employed in multiple settings (65 percent; n=17), with 19 percent (n=5) reporting employment in the combined grouping of private practice, education, and public health. Institutional partnerships included articulation agreements (88 percent; n=21), community college baccalaureate (8 percent; n=2), and university extension (4 percent; n=1) models. The findings of this study provide a baseline for assessing the educational composition and design of U.S. dental hygiene degree completion programs. However, results of this study showed inconsistencies among learning experiences that might raise concerns when considering students level of preparation for graduate education and future leadership roles in the profession. Prof. Portillo is Assistant Professor, Department of Dental Hygiene, Idaho State University; Dr. Rogo is Associate Professor, Department of Dental Hygiene, Idaho State University; Prof. Calley is Interim Department Chair and Associate Professor, Department of Dental Hygiene, Idaho State University; and Dr. Cellucci is Associate Professor of Health Services and Information Management, East Carolina University. Direct correspondence and requests for reprints to Prof. Karen M. Portillo, Department of Dental Hygiene, Idaho State University, 921 South 8 th Avenue, Stop 8048, Pocatello, ID 83209; phone; fax; [email protected]. Keywords: dental hygiene, dental hygiene education, degree completion programs, professional advancement Submitted for publication 12/20/11; accepted 7/10/12 The profession of dental hygiene is expanding in new directions. The American Dental Hygienists Association (ADHA) 2005 report titled Dental Hygiene: Focus on Advancing the Profession outlined six focus areas to move the profession in new directions: research, education, practice and technology, licensure and regulation, public health, and government. 1 The education focus area identified goals for dental hygiene educators and dental hygienists to achieve for professional success. One recommended education goal is to increase the entry-level degree in the profession from an associate degree to a baccalaureate degree. As one aspect of meeting that goal, the ADHA proposed increasing the number of degree completion programs in order to allow dental hygienists holding associate degrees to earn a higher degree. The AHDA also recommended distance learning as a method for offering degree completion programs to accommodate the busy schedules of prospective students. Presently, there are sixty degree completion programs; twenty-seven of these are completely online, while seventeen offer part of their programs online. 2 Accreditation of degree completion programs differs from that for entry-level dental hygiene programs. The institution that houses the degree completion program serves as the umbrella for accreditation; but whereas an entry-level program is accredited directly by the American Dental Association (ADA) as a specialized accrediting agency, degree completion programs are not. Regardless of the accrediting agency, one accreditation requirement for any program is to establish student learning outcomes and measure student achievement of these outcomes for program assessment. 3,4 However, our search found no studies about dental hygiene degree completion programs assessment of their students learning outcomes. In addition, our extensive literature search failed to identify the manner in which associate degree programs partner with institutions awarding baccalaureate degrees at the end of the degree completion program. Most associate degree dental hygiene programs are housed in community colleges; 5 therefore, the nature of the partnerships is 554 Journal of Dental Education Volume 77, Number 5

2 important to explore. One study described four baccalaureate partnership models: 1) articulation model, 2) university extension model, 3) university center model, and 4) community college baccalaureate model. 6 Each model has advantages and disadvantages for students to advance their education to the baccalaureate level. Increasing the use of articulation agreements might provide dental hygiene students with the opportunity to earn baccalaureate degrees and facilitate their entrance into graduate education. 1 The purpose of our study was to establish baseline data regarding U.S. dental hygiene degree completion programs. We also sought to describe the learning experiences offered to students, assessment methods used to measure student learning outcomes, and explore the baccalaureate partnerships existing among institutions of higher education that enable entry-level dental hygiene graduates to advance their education in degree completion programs. Review of the Literature Need to Expand the Entry-Level Degree While entry-level degrees at the associate degree level were adequate for the 1950s, the knowledge and skills needed and expected of a practitioner today are more complex. 1 The roles of the entry-level dental hygienist have increased as clinician, health promoter/educator, advocate, administrator/manager, and researcher in a variety of settings. 7 These expanded roles require that dental hygiene programs revise their curricula in order to better prepare dental hygienists to respond to the needs of the public. However, many entry-level programs, especially at the associate degree level, find that their curricula are overcrowded and are hard pressed to incorporate new content and techniques to address the growing public demands in oral health care. 1 Today, most two-year dental hygiene curricula include as many as credits, especially in programs that teach expanded functions. 1 Most current dental hygiene curricula require graduates to have significantly more knowledge and skills than in the past to prepare them both to provide care for an increasingly aging and diverse population and to utilize the technology used in everyday practice. 1 With the two-year curriculum being stretched to its capacity, expanding the entry-level degree to a baccalaureate degree based on four years of coursework has become an issue under consideration. Even if two-year associate degree programs can educate dental hygiene students with all the knowledge and skills required, other health care disciplines and consumers might value the dental hygiene profession more if the entry level into the profession were a baccalaureate degree. 8 Darby 9 argued that goals such as self-regulation, direct reimbursement for services, and the ability to have more autonomy in professional decisions and practice will only be possible when the public and other health care disciplines view the dental hygiene profession as one that is educated beyond the associate degree level. Degree completion programs are the platform for advancing to the baccalaureate level for dental hygienists holding entry-level associate degrees. A 2011 article by Jacks 10 provides a step-by-step process for dental hygienists seeking a baccalaureate degree through a degree completion program. Jacks suggested that these dental hygienists investigate institutions that have articulation agreements with their alma mater, determine if credits from previously taken courses can be applied a bachelor s degree, and consider the preferred delivery method between traditional classroom and online learning. Studies focused on online delivery of degree completion programs have assessed students preferences for delivery 11 or the quality of education in an online format 12 or have compared student performance in traditional and online formats. 13,14 For busy working professionals, online degree completion programs were found in one study to be the preferred format. 11 Tsokris 15 investigated student satisfaction in distance education and found students appreciated the convenience and flexibility that distance education can provide. Online learning provides the flexibility for place-bound students to complete coursework without having to drive to a campus at a set time. Faculty Shortages As more entry-level programs are established, the need for additional faculty members grows as well. In 2002, there were 260 entry-level programs, whereas in 2011 there were 327 programs with more slated to open in The shortage of qualified educators has been an ongoing problem in dental hygiene education to fill positions in both existing and new programs. 16 Faculty shortages, regardless of the degree program, are becoming more severe as retiring faculty members need to be replaced. 16 May 2013 Journal of Dental Education 555

3 In an article published in 2004, Nunn et al. 17 called attention to the faculty shortages existing among all allied dental education programs and raised concern about prospects for staffing the new entry-level associate degree programs. These authors surveyed 554 accredited allied dental programs, consisting of 263 dental assisting programs, 266 dental hygiene programs, and twenty-five dental laboratory technology programs. Of the 139 responding dental assisting program directors, 44 percent reported needing to replace full-time faculty within the next five years; 78 percent of the vacancies were due to retirement. Of the 125 dental hygiene program directors who responded, 68 percent reported needing to replace full-time faculty; 73 percent of the vacancies were due to retirement. In all, these dental hygiene program directors anticipated about 196 full-time faculty positions would need to be filled because of anticipated vacancies. The fifteen dental laboratory technology programs that responded reported that 50 percent of their full-time faculty would need to be replaced; 100 percent of the vacancies were due to retirement. Majeski 18 pointed out that not only will newly established entry-level programs and degree completion programs have a need for qualified educators, but the profession will need highly educated faculty to teach in the advanced practitioner program and other graduate programs. Programs can compensate for the shortage of faculty by increasing the workload of existing faculty members; however, the impact of doing so has the potential to increase faculty burnout. 18 Another option is to use more part-time faculty members in full-time faculty positions, although part-time faculty members may not have the required credentials to teach in didactic situations. 18 Lowering the quality of instruction runs the risk of reducing the quality of the graduates education and compromising client care. Degree completion programs can provide additional baccalaureate-prepared faculty members to teach in associate-level programs. A study conducted by Siladie 19 and an abstract by Gancarz-Gojgini and Barnes 20 assessed how degree completion programs could address faculty shortages in their respective states. Siladie 19 reported that graduates of degree completion programs were being placed in positions that utilized their advanced degree in Florida. Gancarz-Gojgini and Barnes 20 discussed the possibilities of a degree completion program developed in Massachusetts in an attempt to address the shortage of dental hygiene educators in the Northeast region. Methods A thirty-eight-item survey instrument was designed and administered online through SurveyMonkey. The survey consisted of six sections designed to collect information about the current status of degree completion programs related to 1) profile of the program, 2) profile of program directors, 3) student learning outcomes and assessment of outcomes, 4) students learning experiences, 5) graduates information, and 6) institutional partnerships. After approval from the Idaho State University Internal Review Board (Human Subjects Committee, # 3329), three Idaho State University faculty members and a statistician reviewed the survey for content and clarity. After minor revisions, the survey was pilot tested by three degree completion program directors whose programs did not meet the inclusion criteria for the study. Comments and suggestions for improvement from the pilot test were incorporated into the final survey instrument. In addition, the responses to the pilot test were reviewed by the researchers and questions were modified to enhance clarity and response choices. To be included in the study, the program needed to be housed in a U.S. academic institution, included on the ADHA list of degree completion programs, 2 and established for at least three years to ensure student learning outcomes could be assessed. Fifty-seven degree completion program directors were contacted to ensure their programs met the inclusion criteria. Forty-two programs met the inclusion criteria and were invited via electronic mail to participate in the study and obtain informed consent. Following consent, a cover letter with a direct link to SurveyMonkey was sent. The survey was available to the program directors for four weeks, and reminders were sent to nonrespondents at one-week intervals. After data were collected and downloaded into a Microsoft Excel program, the surveys were coded. Statistical analyses were performed using the data analysis tools provided in Microsoft Excel and SurveyMonkey, which provided frequency distributions and response percentages. Results A response rate of 62 percent (n=26) of the directors of qualified programs was obtained. The degree completion programs included were located 556 Journal of Dental Education Volume 77, Number 5

4 in the Southeast, Northeast, Southwest, Midwest, and Northwest regions of the United States. The majority of the programs were housed in an urban university without a dental school and awarded a Bachelor of Science in Dental Hygiene degree. Eighty-five percent (n=22) of the programs offered online courses to accommodate working and place-bound students. Table 1 shows the characteristics of degree completion programs included in the study. Ninety-six percent (n=25) of the responding program directors were dental hygienists, and twentyeight percent (n=7) had more than thirty years of den- Table 1. Characteristics of dental hygiene degree completion programs in study, by number and percentage of total respondents (n=26) Characteristic Percentage Number Characteristic Percentage Number U.S. region Southeast 35% 9 Northeast 23% 6 Southwest 19% 5 Midwest 15% 4 Northwest 8% 2 Population type Urban (population 50,000) 81% 21 Rural (population <50,000) 19% 5 Type of higher education institution University without a dental school 60% 15 University with a dental school 28% 7 Community college 8% 2 Technical college 4% 1 Other dental hygiene programs at institution Entry-level Associate degree 36% 9 program Entry-level Bachelor degree 28% 7 program Entry-level Bachelor and M.S.D.H. 20% 5 degree programs Entry-level Certificate or Associate, 8% 2 Bachelor, and M.S.D.H. degree programs Entry level Certificate and Bachelor 4% 1 degree programs No other dental hygiene program 4% 1 Degree awarded for degree completion program Bachelor of Science in Dental 76% 20 Hygiene Bachelor of Science 8% 2 Bachelor of Applied Science in 4% 1 Dental Hygiene Bachelor of Health Science 4% 1 Bachelor of Science in Dental 4% 1 Hygiene Education Bachelor of Science in Public 4% 1 Health Dental Hygiene Instructional delivery of program Online format (courses offered 50% 13 via Internet) Hybrid format (online and 31% 8 traditional course offerings) Traditional classroom format 19% 5 (face-to-face format) Percentage of curriculum delivered online 100% 52% % 8% % 8% % 12% % % 20% 5 Online learning management system Blackboard 44% 10 WebCT 17% 4 Angel 17% 4 Moodle 9% 2 Desire2Learn 9% 2 Sakai 4% 1 Required student presence on campus Yes 62% 16 Complete courses (38%) (10) Orientation (15%) (4) Complete courses and (4%) (1) orientation Present practicum experience (4%) (1) No 38% 10 Student progression Individual basis enrolled as 77% 20 part-time status (<12 credits) Cohorts (students as a group 15% 4 complete the same courses in the same time frame) Individual basis enrolled as 8% 2 full-time status (12 or more credits) Accommodations for working and place-bound students Provide online courses 85% 22 Provide evening courses 38% 10 Provide weekend courses 12% 3 Typical size of class (number of students) % % % % % 4 Note: Percentages may not total 100% due to rounding. May 2013 Journal of Dental Education 557

5 tal hygiene teaching experience. The highest degrees earned were master s degrees (62 percent; n=16) and doctoral degrees (38 percent; n=10). The majority of the responding directors were member of the AHDA (89 percent; n=23) and the American Dental Education Association (85 percent; n=22). Table 2 shows the characteristics of these program directors. The respondents reported existing student learning outcomes as goals (65 percent; n=17), competencies (54 percent; n=14), objectives (46 percent; n=12), or abilities (15 percent; n=4). One program reported no articulated outcomes. The qualitative analysis showed learning outcomes for professional development, ethics, communication, critical thinking, evidence-based practice, career roles, leadership, community oral health, health promotion/disease prevention, dental hygiene clinical care, interprofessional collaboration, dental hygiene education, and preparation for graduate studies. Table 2. Characteristics of program directors in study, by number and percentage of total respondents (n=26) Characteristic Percentage Number Gender Female 92% 24 Male 8% 2 Type of oral health professional Dental hygienist 96% 25 Not an oral health care professional 4% 1 Highest degree obtained Doctoral degree 38% 10 Ed.D. (27%) (7) Ph.D. (12%) (3) Master s degree 62% 16 M.Ed. (23%) (6) M.S. (15%) (4) M.S.D.H. (8%) (2) M.A. (4%) (1) M.P.H. (4%) (1) M.S.Ed. (4%) (1) M.B.A. (4%) (1) Number of years in dental hygiene education 5-10 years 12% years 20% years 8% years 12% years 20% 5 More than 30 years 28% 7 Membership in professional organizations American Dental Hygienists 89% 23 Association (ADHA) American Dental Education 85% 22 Association (ADEA) Note: Percentages may not total 100% due to rounding. (Data for the qualitative analysis and assessment of student learning outcomes will be reported in a separate article.) The participants were asked several questions about learning experiences provided in their degree completion programs. Table 3 shows the core dental hygiene courses required, as well as the general education requirements and type of elective courses. In addition, the table reports the number of programs requiring students to complete other learning experiences such as capstone projects and those offering student teaching opportunities, as well as specialty tracks or emphasis areas offered. Learning experiences in specialty areas such as education, public or community health, and research were reported by twenty-five of the twenty-six programs (Table 3). A specialty area in dental hygiene education was the one most frequently reported (42 percent; n=11). Specific learning experiences within this specialty area were education theory and teaching concepts, student teaching experience in didactic and clinical education, dental hygiene curricular concepts, advanced clinical teaching, educational technology, educational psychology, and philosophy of education. The second most frequently cited specialty area was public or community health (39 percent; n=10). Learning experiences specific to this specialty area were field experience in communitybased settings, global oral health, advanced community health, ethics in health administration and/ or public health administration, gerontology, biostatistics, and epidemiology. The research specialty area was the third most frequently offered emphasis with learning experiences reported in theoretical and scientific basis of dental hygiene practice, review of the literature, principles of scientific investigation, research methodology, evidence-based practice, and independent study in research (16 percent; n=4). These program directors reported courses for practicum, internship, or externship as both a core dental hygiene course (66 percent; n=17) and an elective course (31 percent; n=8) (Table 3). As such, there were a variety of goals for the learning experiences related to these courses including experiences to apply knowledge in an educational or community oral health setting, provide an in-depth understanding in one of the specialty areas, offer a hands-on or real world opportunity in the field, and present opportunities to explore areas of interest other than clinical practice and various occupational settings such as geriatrics and community settings. Some directors indicated that the goals of the practicum, internship, 558 Journal of Dental Education Volume 77, Number 5

6 or externship were designed on an individualized basis to meet students areas of interest. The participants were also asked to identify the type of settings in which the degree completion graduates were employed. The program directors reported that the majority of their graduates were employed in multiple settings (see Table 4). The survey did not ask at what point the program directors assessed the graduates current employment settings (i.e., soon after graduation or a year thereafter); therefore, these data might be questionable. When program directors were asked the number of graduates who directly transitioned into a graduate program, the most frequent response was one to five graduates (68 percent; n=17). Finally, responding program directors reported the means by which their degree completion program was able to award a baccalaureate degree. The majority of the respondents reported that an articulation agreement (88 percent; n=21) was the type of baccalaureate partnership the program had in place. In addition, 100 percent of the responding programs required that the degree completion applicants be a graduate of an accredited dental hygiene program. Table 5 details the types of baccalaureate partnerships reported, as well as the type of entry-level degree accepted by the program and transfer credits applied toward the higher degree. Discussion The findings of this study showed a wide variety of general education and learning experiences offered in dental hygiene degree completion programs. The study also provides a view of institutional partnerships established to award graduates a baccalaureate degree. Although this study provides a baseline for understanding dental hygiene degree completion programs, it also offers an opportunity for suggestions for the future. It was no surprise to find the majority (60 percent; n=15) of responding institutions housing degree completion programs were in university settings with or without a dental school; however, the most revealing aspect of the profile of programs was that two degree completion programs (8 percent; n=2) were located in community and technical colleges (see Table 1). Universities are the institutions of higher education that traditionally award baccalaureate degrees, while community and technical colleges most often award associate degrees. In addition to the degree comple- Table 3. Learning experiences reported in dental hygiene degree completion programs in study, by number and percentage of total respondents (n=26) Type of Learning Experience Percentage Number Core dental hygiene courses Research 89% 23 Educational methodology 66% 17 Practicum, internship, and/or externship 66% 17 Advanced community oral health 46% 12 Professional ethics 35% 9 Critical thinking 35% 9 Advanced periodontology lecture 31% 8 course Leadership 31% 8 Professional communication 27% 7 Advanced periodontology clinical 12% 3 course Pain management 12% 3 Contemporary issues in dental hygiene 12% 3 General education requirements Humanities 89% 23 English 81% 21 General mathematics 65% 17 Social science 65% 17 Statistics 62% 16 Science 62% 16 Foreign language 23% 7 Philosophy 12% 3 Computer science 12% 3 Dental hygiene elective courses No electives required 42% 11 Independent study 31% 8 Practicum, internship, and/or externship 31% 8 Educational methodology 27% 7 Pain management 15% 4 Clinical administration 12% 3 Public health 8% 2 Advanced clinical dental hygiene 8% 2 Clinical teaching 8% 2 Require a capstone project Yes 77% 20 No 23% 6 Student teaching opportunities Yes; students can teach at another 58% 15 program Yes; students teach on campus 46% 12 No 12% 3 Specialty tracks or specialty areas Education 42% 11 Public or community health 39% 10 Research 16% 4 Advanced clinical practice 8% 2 Contemporary organizations and 4% 1 management Health policy and administration 4% 1 Marketing, business, psychology or 4% 1 prerequisites for dental or physician assistant program Note: For all items except the one on the capstone project, respondents could select all that applied. May 2013 Journal of Dental Education 559

7 Table 4. Characteristics of degree completion graduates reported by program directors in study, by number and percentage of total respondents (n=26) Characteristics Percentage Number Graduates employment setting Multiple settings 65% 17 Private practice, education, and public health (19%) (5) Private practice and education (15%) (4) Private practice, education, public health, and marketing (8%) (2) Private practice, education, and marketing (8%) (2) Private practice, education, and research (4%) (1) Private practice, education, public health, and research (4%) (1) Education and public health (4%) (1) Private practice, education, research, public health, and marketing (4%) (1) Private practice 23% 6 Education 4% 1 Unknown 8% 2 Number of graduates who transition directly into a graduate program None 24% % % % 1 Table 5. Institutional partnerships and requirements for offering baccalaureate degree reported by programs in study, by number and percentage of respondents (n=26) Percentage Type of baccalaureate partnership Articulation agreement 88% 21 Community college baccalaureate 8% 2 University extension 4% 1 University center 0 0 Type of entry-level degree accepted Associate of Science degree 85% 22 Associate of Applied Science (vocational or technical degree) 77% 20 Certificate in dental hygiene 23% 6 All degrees from an accredited dental hygiene program 4% 1 Students must be graduates of an accredited program Yes 100% 26 No 0 0 Transfer of general education credits Credits accepted on an individual basis, depending on the institution. 58% 15 All credits are transferred. 42% 11 Transfer of entry-level dental hygiene credits All credits are transferred. 50% 13 Credits accepted on an individual basis, depending on the institution. 50% 13 Note: Percentages may not total 100% due to rounding. Number tion programs, 100 percent of the responding directors specified other dental hygiene degree programs were offered by the institution at the entry-level (certificate, associate, or baccalaureate degree) and/or graduate level. This finding suggests there may be no standalone degree completion programs; every degree completion program in our study was affiliated with either an entry-level or a graduate program to best uti- lize faculty and resources. All of these degree completion programs awarded a bachelor s degree, with the majority granting a Bachelor of Science degree. Eighty-one percent (n=21) of the programs in our study offered at least a portion of the curriculum online, with 50 percent (n=13) of the programs offering the online format as the predominant instructional delivery system (see Table 1). The majority 560 Journal of Dental Education Volume 77, Number 5

8 of programs using the online format (52 percent; n= 13) provided 100 percent of their instruction over the Internet. Degree completion programs seem to be accommodating working dental hygienists by not only providing online courses, but also offering evening (38 percent; n=10) and weekend courses (12 percent; n=3). These findings thus demonstrate that degree completion programs are utilizing online learning as a method to accommodate the schedules of working professionals. 1 Learning experiences in the programs in our study were identified as core dental hygiene courses, general education requirements, and elective dental hygiene courses. The course most likely to be offered in the curriculum (89 percent; n=23) as a core dental hygiene learning experience was a research course. This finding is well above the number of programs identified by Chichester et al. 21 who reported 62 percent of the respondents from baccalaureate programs and 8 percent of the respondents from nonbaccalaureate programs provided a free-standing course in research. In another study, Stanley et al. 22 stated that, in order for students to acquire clinical research skills, it was essential that they obtain a baccalaureate-level degree. Chichester et al. 21 argued that the development of research skills incorporated the application of evidence-based philosophies and critical thinking skills. In our study, 35 percent (n= 9) of the responding degree completion programs included critical thinking as a core course. Table 3 shows that some programs recognize the importance of critical thinking as a core dental hygiene course. In addition to courses in critical thinking and research, it is important for baccalaureate curricula to include courses in leadership. A study conducted by Rowe et al. 23 assessed the professional growth of their program s graduates and determined that several of the baccalaureate graduates continued on to become scholars, educators, and leaders of the profession. These authors concurred with Chichester et al. 21 that it is necessary for the baccalaureate curricula to include courses in research, critical thinking, and leadership for students to develop essential skills enabling them to assume positions of additional responsibility and leadership after graduation. 23 Table 3 shows that the degree completion programs in our study not only provide core courses in research and critical thinking skills but also courses in leadership (31 percent; n=8) to prepare graduates for leadership roles in the health care environment. The majority of the programs (66 percent; n=17) in our study reported requiring core dental hygiene courses in educational methodology and practicum, internship, and/or externship experiences (see Table 3). In addition, educational methodology (27 percent; n=7) and practicum, internships, and/or externship (31 percent; n=8) provided these experiences as elective courses. The educational methodology courses and student teaching opportunities offer experiences to prepare graduates for employment in entry-level positions in dental hygiene education. Experiential learning is part of curricula through practicum, internship, and externship coursework. A plethora of additional learning experiences are offered by degree completion programs to advance the knowledge, skills, and values of their graduates. In Dominick s study, 24 twenty-one entry-level baccalaureate dental hygiene students were surveyed to assess their perceptions of the value of internships as a learning experience. The results showed that 100 percent of the students rated the internship course as a valuable opportunity to acquire new skills as well as influence their future career goals. Dominick concluded that learning experiences provided in the form of internships expose students to a variety of practice settings to better prepare graduates for leadership roles in the profession. Of course, there is a difference between entry-level and degree completion programs in offering experiential learning opportunities: for degree completion students, the opportunities should include positions beyond employment in a traditional private practice setting. According to the program directors who responded to our survey, the majority of their degree completion graduates were employed in multiple practice settings, but it was not clarified in the study at what point the graduate outcomes were assessed (Table 4). The respondents reported that one area into which some of their graduates transitioned was education, which was promising considering reported faculty shortages in dental hygiene programs. One possible reason for this career choice could be the students experiential opportunities to teach during their degree completion programs. For other emphasis areas to gain more graduates, such as research or public health, more internship and mentoring opportunities need to be established for students. A majority of the programs in our study reported at least one to five of their graduates transitioned into a graduate program in a given year. Degree completion graduates need to be well prepared to successfully move into a graduate program. Another interesting finding from our study was that the majority of the responding directors May 2013 Journal of Dental Education 561

9 (88 percent; n=21) reported that articulation was the type of baccalaureate partnership their program had in place (Table 5). Articulation for this study was defined as an institution accepting transfer credits from an entry-level dental hygiene program. A recent ADEA document titled Bracing for the Future: Opening Up Pathways to the Bachelor s Degree for Dental Hygienists pointed out the importance of having policies in place for easy transfer of credits between two institutions to encourage associate degree hygienists to seek their baccalaureate degree. 25 In addition, the ADEA report recognized the need for more consistency in requirements among degree completion programs rather than ad hoc approaches. A smaller percentage of the degree completion programs (8 percent; n=2) in our study offered a community college baccalaureate type of model (Table 5). In such a model, the community college has been granted the ability to provide the baccalaureate program and award their graduates baccalaureate degrees. 9 For associate programs wanting to offer a higher level of degree within the institution, the community college baccalaureate model could be an option to investigate if other institutions of higher learning will not support a degree completion program. This model has met with some opposition. There are those who feel once a community college starts to offer baccalaureate degrees, the institution s focus on meeting the community s needs changes and fewer vocational programs might be emphasized to support the area workforce. 26 The limitations of this study included that our survey achieved a response rate of only 62 percent (n=26), which is considered adequate for the type of participants selected namely, busy program directors. To try to increase the response rate, the participants were reminded on three separate occasions to complete the survey. Several program directors opted out of the study; we noted that those participants answered the survey up to the section requiring them to provide student learning outcomes. Another limitation of this study was that the data were dependent on the participants knowledge and recollection; no further investigation was completed to ensure the data were correct. The results of the study showed a wide variety in core and elective courses in dental hygiene baccalaureate degree completion curricula. This variation is influenced by the institution s requirements for awarding a baccalaureate degree including upper division coursework and total number of credits for graduation, as well as the philosophy of the dental hygiene program. The ADHA, the ADEA Section on Dental Hygiene Education, and the graduate program directors should play a key leadership role in advancing the education received in degree completion programs to prepare graduates for master s degree education. Also, educators who teach in degree completion programs need to create more didactic and experiential learning experiences in areas such as research and public and community health. Just as student teaching opportunities expose students to the field of education, which in turn encourages degree completion graduates to seek positions in education, opportunities in the fields of research and public or community health should be provided to encourage more graduates to seek opportunities in these essential fields. Conclusion Degree completion programs offer a wide variety of learning experiences for dental hygienists to advance their entry-level degree; however, these experiences are inconsistent among programs. One advantage of these programs when compared to entry-level programs is the flexibility of the curricula to provide specialty areas within dental hygiene. Degree completion programs have provided the opportunity for many dental hygienists to advance their education, thus diversifying their careers. Dental hygienists with advanced education will lead to a better educated workforce capable of improving care to the public and meeting the growing needs of the health care system. 25 ADEA has an important leadership role to play in the future of allied dental education. As such, ADEA members should take the lead on developing a vision for degree completion programs and common competencies to ensure dental hygienists are provided with the knowledge, skills, and experiences needed to continue on to graduate studies and leadership roles in advanced practice, education, public or community health, and research. REFERENCES 1. American Dental Hygienists Association. Dental hygiene: focus on advancing the profession. Chicago: American Dental Hygienists Association, American Dental Hygienists Association. Education and careers, At: Accessed: September 3, Journal of Dental Education Volume 77, Number 5

10 3. Commission on Dental Accreditation. Accreditation standards for dental hygiene education programs. Chicago: American Dental Association, Council for Higher Education Accreditation. Statement of mutual responsibilities for student learning outcomes: accreditation, institutions, and programs. Washington, DC: Council for Higher Education Accreditation, American Dental Association survey of allied dental education. Chicago: American Dental Association, Floyd DL. Achieving the baccalaureate through the community college. Directions Community Colleges 2006; 135: American Dental Hygienists Association. Standards for clinical dental hygiene practice. Chicago: American Dental Hygienists Association, Henson HA, Gurenlian JR, Boyd LD. The doctorate in dental hygiene: has its time come? Access 2008;22(4): Darby ML. Opening the door to opportunity. Dimens Dent Hyg 2004;2(9): Jacks M. A step-by-step transition from associate to bachelor s degree. Access 2011;25(4): Monson AL, Engeswick LM. ADHA s focus on advancing the profession: Minnesota s dental hygiene educators response. J Dent Hyg 2007;81(2): Moore W. An assessment of online learning in a dental hygiene baccalaureate degree completion program. J Dent Hyg 2007;81(4): Olmstead JL. An analysis of student performance benchmarks in dental hygiene via distance education. J Dent Hyg 2010;84(2): Olmstead JL. Quantitative analysis of learner performance in a distance educational program. J Dent Hyg 2007;81(4): Tsokris M. Bachelor s degree completion students perceptions of their online learning experience. Access 2011;25(4): Coplen A. The need for new qualified dental hygiene educators. Access 2010;24(8): Nunn PJ, Gadbury-Amyot CC, Battrell A, Bruce SI, Hanlon LL, Kaiser C, Purifoy-Seldon B. The current status of allied dental faculty: a survey report. J Dent Educ 2004; 68(3): Majeski J. The educator shortage. Access 2004;18(9): Siladie J. The dental hygiene degree completion program: it s all about access. J Dent Hyg 2007;81(1): Gancarz-Gojgini A, Barnes WG. Development and implementation of a web-based BSDH degree completion program. J Dent Hyg 2007;81(1): Chichester SR, Wilder RS, Mann GB, Neal E. Incorporation of evidence-based principles in baccalaureate and nonbaccalaureate degree dental hygiene programs. J Dent Hyg 2002;76(1): Stanley J, Kinney J, Gwozdek A. Assessment of skills and education necessary for a baccalaureate-prepared dental hygienist to pursue an entry-level role in clinical research. J Dent Hyg 2011;85(2): Rowe DJ, Weintraub JA, Shain S, Yamamoto J, Walsh MM. Outcomes assessment related to professional growth and achievements of baccalaureate dental hygiene graduates. J Dent Educ 2004;68(1): Dominick C. The correlation between expanded career goals and internship courses in BSDH programs: an assessment. J Dent Hyg 2007;81(1): American Dental Education Association and Institute for Higher Education Policy. Bracing for the future: opening up pathways to the bachelor s degree for dental hygienists. Washington, DC: Institute for Higher Education Policy, Wattenbarger J. Colleges should stick to what they do best. Community College Week, April 17, 2000, Sect :4. May 2013 Journal of Dental Education 563