A Residency Experience by Kaveh Baharvand, DMD, MSOL

As a member of the interview team at Jacksonville University School of Orthodontics (JUSO), I had the opportunity to hear from more than 50 applicants and gained a deep understanding of their program expectations. Most wished for a shorter duration in training with low or no tuition and for the program to be in a lively city affiliated with a renowned dental school. In addition, they wanted an unmatched didactic clinical experience to prepare them for the American Board of Orthodontics (ABO) certification and the real world.

Listening to the applicants reminded me of my search for an orthodontic residency program, and while I thought at the time that no program could meet every need, JUSO eventually exceeded my expectations. Here's a breakdown of some of the areas that impressed me.

Demographics
Faculty and resident demographics are a good place to start. Currently, there are 30 residents, five fellowship students and 14 faculty members (seven full time, two part time, and five resource) at JUSO. In addition, JUSO has been active in inviting renowned guest lecturers to share their knowledge with the residents.

The residents pool is diverse. Thirty percent graduated from a dental school outside of the United States. Of the U.S. graduates, 33 percent were from the East Coast, 13 percent from the West Coast, and the remaining 24 percent had their dental education in either the central or southern states. Almost half of the residents had either general dentistry or other forms of residency training before their admission to JUSO.

Clinical and didactic curriculum
While JUSO has been restructured since its inception in 2003, it has continuously maintained its core competency, the heavy clinical exposure. Each resident benefits from about 30 clinical hours per week. Didactic courses and basic science curriculum are taught by onsite and adjunct faculty members and guest lecturers. For example, Dr. Peter Buschang, from Texas A&M University College of Dentistry, lectured on research methodology and the growth and development every week by either visiting us at JUSO or teleconferencing via Skype. JUSO has maintained its accreditation for more than 13 years and is well-prepared for the next accreditation process in 2019.

As far as the clinical exposure is concerned, I can attest to my experience at JUSO. I have been directly involved in the treatment of more 150 patients. Seventy of those were cases I started. I have used traditional MBT, bidimensional, self-ligating and lingual bracket systems. I have two multidisciplinary orthognathic-orthodontic patients awaiting surgery dates. I have five Invisalign cases, one of which is an Invisalign Teen case. I have used MARA, headgear, Herbst and twin block functional appliances. Just to make the list slightly longer, I placed 12 mini-implants (TADs) during the first year of my residency.

ABO Certification
The digital treatment center at JUSO utilizes 35 chairs to ensure each resident and fellow has a working bay. First-year residents are paired up with a second-year students in a cubicle, which, in my opinion is invaluable in knowledge and experience sharing. The residents are trained to select their potential ABO cases early on and plan accordingly. This early awareness at JUSO has resulted in a success rate of 100 percent for the written ABO exam and above 80 percent for the clinical part.

This means more than 12 ABO certified orthodontists graduate from JUSO each year. To help and persuade the residents to become ABO certified, JUSO offers financial and logistical supports to the residents for both the written and the clinical portion of the exam.

Tuition
The cost of the orthodontic education and its length go hand in hand. Let's compare two scenarios: Resident A attends an orthodontic residency for two years and pays a tuition of $90,000 a year, then he graduates and works in a corporate office and earns $170,000 a year in the third year.

Resident B chooses to attend a three-year-long program but to pay a tuition of $40,000 a year. Obviously Resident B will still be in a school during the third year and cannot have an income.

Let's assume both residents have a student loan rate of 6 percent. Using the concept of the time value of the money, one can realize that at the end of the third year, Resident A nets $4,994 while Resident B tolerates a debt of $106,920, which coincidentally is more than one year of tuition for Resident A.

My conclusion is that the program length is most important in the financial planning. Tuition only comes second.

Speaking of finances, I've been listening to Dr. Howard Farran's Dentistry Uncensored podcasts almost every day driving back from the school. I have noticed that Farran values his MBA degree with high regard. I share his viewpoint of the need for the financial literacy among the health care providers. JUSO is less than 300 feet from JU Davis College of Business. Each year at least one resident is enrolled in the leadership or educational tract master's program in the college of business. I decided to attend the Master of Science in Organizational Leadership track, which is like an MBA but with a focus on leadership.

The greatest thing about a business school is the mindset that is never taught in a dental school. Outside the confinements of the dental school and within the arena of business school I could learn entrepreneurship, leadership and business skills to which I would otherwise never be exposed.

Dental school affiliation
Candidates applying to JUSO were not clear on how an orthodontic program can function without being affiliated with a dental school. They presumed that in treating orthodontic patients, regular consultation with dental school professionals would be necessary. At JUSO, however, we consult directly with the patients' outside general practitioners and specialists. We are trained to pick up the phone or to correspond with the outside practitioners about our mutual patients. This has helped me better interact with higher confidence and is a true simulation of an orthodontist's everyday practice life.

The future of JUSO
The strategic plan for JUSO for the next three years is available on its website. JUSO is a young program and is maturing into a well-reputed school.

A diverse pool of faculty, residents and patients enables JUSO to pursue goals that are not achievable by smaller programs or those under the strong red tape of the affiliated dental schools. With such goals, JUSO is preparing to become a notable orthodontic research center by accommodating at least 1,000 new patients a year.

To make this possible, JUSO is undergoing a dramatic change to convert from a 24-month program to a 27-month program. JUSO hopes to increase the likelihood for the residents to have sufficient time to conduct high-quality research projects. By doing so, they can obtain a master's degree in dentistry in addition to the certificate of advanced graduate studies. The extra three months also give residents more time to finish and detail their ABO cases, which in turn strengthens the clinical aspect of the program. JUSO Program Director Dr. Mark Alarbi is a strong believer in maintaining the clinical success record at the school while integrating a more structured research curriculum.

I believe that the expert level performance in orthodontics requires a deliberate practice starting from the first day of residency. I have been fortunate to advance my knowledge and challenge my limits in a young orthodontic program. I extend an invitation on behalf of the JUSO family to all residents and practicing orthodontists to visit its day-to-day operations.