in fields such as molecular biology, immunology, and genetics will, in particular, continue to forge links between dentistry and medicine as will the needs of an aging population with more complex health problems. These links combined with the financial strains on the university and academic health center will encourage these institutions to consolidate or otherwise link programs in related areas such as dentistry and medicine. Government and private purchasers of health services can be expected to maintain and indeed increase the pressure on health care practitioners and institutions to develop more highly integrated and constrained systems of care that stress cost containment, primary rather than specialty care, and services provided by teams of professional and other personnel. Although dentistry may experience a less rapid restructuring of its place in health care compared to other health professions, any such respite should be used not as a time to reinforce resistance to these developments but as an opportunity to achieve a smoother transition for patients, practitioners, and educators.

Second, to prepare both their students and their schools for Change, dental educators will need to teach and display desirable models of clinical practice. Such education will be scientifically and technologically up to date, focused on outcomes, interdisciplinary, efficient, patient and community oriented, and team based. For most schools, this will require substantial departures from current practices. These practices fall short for various reasons including incomplete implementation of long-standing and still valid proposals for reforming the curriculum, relatively slow recognition of new emphases on health outcomes and sophisticated information capabilities, and increasingly constrained resources.

Third, securing the resources essential for educational improvement and, indeed, survival will require that dental schools demonstrate their contributions to their parent universities, academic health centers, and communities through achievements not only in education but also in research, technology transfer, and community and patient service. Said differently, dentistry cannot pursue isolation. The process of change may exacerbate tensions with dental practitioners, for example, as dental schools experiment with new models of patient care and extend their outcomes research agenda. Thus, efforts to manage and resolve conflicts must have a high priority.

Fourth, the dental community—educators, practitioners, regulators, and policymakers—will benefit from continued testing Of alternative models of education, practice, and performance assess-



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