Reexamining educational philosophy: the issue of professional responsibility, "Cleveland First".

This paper proposes a shift of emphasis in the dental curriculum from measures to protect and improve the oral health of individuals to measures to protect and improve the oral health of the community or society. This shift represents a fundamental change in educational philosophy of the dental school. To illustrate this shift in emphasis, this paper describes a demonstration project to test the feasibility of this approach involving all seventy first-year students in the Case Western Reserve University School of Dentistry in a four-week experience placing dental sealants in erupting molars of second and sixth graders in fifty schools of the Cleveland City School System. In future years, the program is expected to reach all second and sixth graders in the Cleveland School System. The experience is a required integral component of the curriculum, involving every student in the class, and is designed to make a demonstrable difference in oral health in the City of Cleveland. The experience is reinforced with course material on professional responsibility. The school is developing additional intensive experiences for second-, third-, and fourth-year classes involving smoking prevention for adolescents, oral health maintenance for nursing home residents, and dental care delivery in the inner city. The initial year of the program has had effects on students' responses to other elements of the first-year curriculum that go beyond the experience of placing sealants in children's teeth. The focused efforts of dental students every year are expected to have a measurable effect on the disparities in oral health found in the City of Cleveland as well as a measurable effect on dental students' and dentists' attitudes concerning professional responsibility.