FEATURE ARTICLE: FOCUS ON ACADEMICS
The Wilford Hall Medical Center Tri-service Orthodontic Residency Program
Questions posed to Colonel Drew W. Fallis, DDS, MS, Chairman
What is the overall mission of your Program?
The mission of the Tri-service Orthodontic Residency Program (TORP) is to develop U.S. Air Force (USAF), U.S. Army (USA), and U.S. Navy (USN) residents into the most highly qualified clinical orthodontists possible. In addition to the clinical focus of the program, there is also a strong emphasis on craniofacial growth and development, surgical-orthodontics, and interdisciplinary treatment. These areas are provided to fully prepare graduates for their future roles in managing transfer cases involving the wide variety of treatment techniques and philosophies encountered in an overseas military practice. To support this mission, the TORP provides the biological and clinical science education necessary to support the clinical practice of orthodontics while utilizing cutting-edge technologies to enhance diagnostic and treatment efficiency.
Tell us about the history of the Program:
The Wilford Hall Medical Center Orthodontic Residency Program matriculated its first class on July 1, 1997. As the first military “joint” dental specialty training program, it acquired a notable place in the annals of military dental history.
The Army Dental Corps actually started the first military orthodontic residency in 1985. Colonel James D’Anna was the Director of that inaugural program at Ft. Knox, Kentucky. Lieutenant Colonel Fred Regenitter assisted him. At the same time, Lieutenant Colonel Kendall Barrows was laying the groundwork for another Army residency at Fort Meade, Maryland and was joined in 1986 by Colonel Chuck Meyers. The first class included Major Tom Chubb (USA), Major Jim Ferriter (USA), and LCDR Al Maskeroni (USN). Both programs were considered by orthodontic educators to be outstanding residencies. This is evidenced, in part, by the fact that in 1992, Major Ross Stryker (USA), a graduate of the Ft. Meade program, achieved the highest score on the Phase II written portion of the ABO exam and was presented the Earl E. Sheppard Award. Other graduates have gone on to excel in various academic, clinical, and research positions.
During the late 1980s and early 1990s, the Army orthodontic corps increased to just over 70 orthodontists. Unfortunately, the mid-1990s brought severe budget and personnel reductions to the military. The Ft. Knox program closed its doors in 1994, and Ft. Meade graduated its last class in 1995.
In 1995, Colonel Marion Messersmith, Special Consultant in Orthodontics for the Air Force, explored the possibility of establishing a joint Air Force-Army orthodontic residency. In 1996, Air Force and Army Headquarters approved a combined Army/Air Force program at Lackland Air Force Base. The program was granted provisional approval by the ADA in early 1997, and officially began on July 1, 1997. Col. Messersmith retired that summer to accept an academic position, so its inaugural staff consisted of Col. Erik D. Langsjoen (USAF), Chairman and Program Director; Col. Dennis Harper (USA), Assistant Program Director; Col. Kirk Satrom (USAF), and LTC Anne Compton (USA), Training Officers; and Lt. Col. Dave Gonzales (USAF) and Col. Clarence Bryk (USAF/RET) as part-time faculty members. Col. Langsjoen retired in 1998, but under the superior leadership of Col. Satrom as Chairman and COL Harper as Program Director, the orthodontic program became fully accredited by the ADA Commission on Dental Accreditation on July 23, 1999.
The first graduates of the Army/Air Force Orthodontic Residency received their Certificates in Orthodontics on June 24, 1999. These first four graduates included Major Daniel Haberman (USAF), Major Natalie A. Luce (USAF), Captain Clifford L. Martin (USA), and Major Thomas S. Sympson (USA).
On July 1, 1999, the Wilford Hall Medical Center Tri-Service Orthodontic Residency Program (TORP) was born with the addition of one Navy faculty member and one Navy resident—creating a truly unique tri-service residency program. Due to a shortage of active duty Army orthodontists, four Army residents were accepted into the program that year, and combined with two Air Force residents and one Navy resident, that class size grew to seven, for a total of 11 residents in both classes.
Along with the growth of class size, a nearly complete turnover in faculty members occurred. Colonel John M. Denny (USAF) took over as Chairman of the Department; Captain Curtis L. Hayden (USN) became the Program Director, along with the following changes in the positions noted: Colonel Darrell W. Childers (USA) as Junior Training Officer; Colonel Louis J. Taloumis (USA) as Director of Dental Research; Lt. Col. Charles B. Peters (USAF) as Senior Resident Training Officer; and Lt. Col. Craig A. Flickinger (USAF) as Director of Orthodontics for the Advanced Education in General Dentistry (AEGD)-2 Residency.
As time passed, other inevitable changes occurred in the TORP faculty: Colonel David A. Gonzales became the Program Director on September 1, 2002, when Captain Hayden retired; COL Taloumis transferred that same summer, and Lt. Col. Peters replaced him as Director of Dental Research and CDR John E. Freeman (USN) became the Senior Resident Training Officer. In the summer of 2003, Lt. Col. Curtis M. Marsh (USAF) replaced Lt. Col. Craig Flickinger upon his PCS, and Maj. Lawrence E. Roth (USAF) joined the faculty as Director of Orthodontics for the Oral and Maxillofacial Surgery Residency.
In June 2004, Col. John Denny retired from the Air Force. Col. David A. Gonzales became the Special Consultant in Orthodontics for the Air Force, as well as new Chairman, and remained as the Program Director. The position of Clinical Director was transferred from Lt. Col. Charles Peters to Lt. Col. Drew Fallis (USAF), as Lt. Col. Peters retired from the Air Force; Lt. Col. Michael L Roberts (USA) assumed the position of Junior Training Officer and CAPT John Freeman remained the Senior Training Officer.
The next transition occurred in December 2005 upon the retirement of Col. David A. Gonzales, with Col. Eric J. Brendlinger (USAF) assuming the position of Chairman and Special Consultant in Orthodontics for the Air Force, Col. Drew W. Fallis became the Program Director, Lt. Col. Ray E. Melendez (USA) became the Senior Training Officer, and CDR Brent Callegari (USN) was appointed Junior Training Officer.
In August 2007, LTC Gary D. Gardner (USA) replaced LTC Michael Roberts, assuming a clinical instructor position and Col. Michael D. Signorelli (USAF) replaced Col. Curtis M. Marsh as Director of Orthodontics for the AEGD-2 residency.
On July 1, 2008, Col. Eric J. Brendlinger continued his role as the Special Consultant in Orthodontics for the Air Force, while Col. Drew W. Fallis became Chairman, LTC Ray E. Melendez became the Program Director, CAPT Brent J. Callegari became the Senior Training Officer, and LTC Gary Gardner became the Junior Training Officer.
What are the unique features of your Program?
Due to its designation as the only military orthodontic residency in the United State, the Tri-Service Orthodontic Residency Program certainly has many unique features beyond the attire worn:
Faculty Turnover-
Although this certainly has its challenges and requires much planning and coordination among the services to achieve continuity and program consistency, the TORP provides an excellent venue for junior faculty development. As evidenced in the historical description of the program, junior faculty typically spend 3-4 years in one of the Training Officer/Clinical Instructor roles, and then return later in their careers to assume one of the Directorship positions. This assists in maintaining consistency while also infusing new ideas and philosophies into the program.
Resident Experience-
Residents are selected from a highly competitive applicant pool of active-duty dental officers who are currently serving in the Army, Navy or Air Force. Therefore, residents typically have completed an AEGD training program and have 3-8 years of general dental, as well as operational military experience, prior to beginning the program. Although this level of professional dental experience is sometimes seen in civilian residents, it is the norm for the TORP, and results in a mature residency class that has a proven ability to work effectively with patients and other professionals.
Oral & Maxillofacial Surgical-Orthodontic Integration-
The hospital-based Oral & Maxillofacial Surgery (OMFS) Residency and the TORP share a common digital patient database where patient records and diagnostic work-ups are stored and retrieved for presentation at Dentofacial Deformities Seminars. This system allows consistent diagnostic work-ups, which are presented by Junior Orthodontic and OMFS residents and discussed in an open forum with all faculty members. Progress records (including surgical photos) can be generated from either department and are maintained in this database to document treatment progression, and for later use in didactic case presentations and treatment evaluations. Residents typically start 10 surgical-orthodontic cases, participate in the treatment planning of over 120 other surgical-orthodontic cases, and provide treatment of craniofacial anomalies patients, in coordination with the Craniofacial Anomalies Board at Wilford Hall Medical Center.
Resident:Faculty and Resident:Staff Ratios-
The residents benefit from a 2:1 resident to full-time faculty ratio and receive training and interdisciplinary interaction from a diverse group of instructors, including board-certified specialists in all dental specialty areas. There is also an experienced cadre of clinical research directors and statisticians to solidify the curriculum. Each clinical treatment team, consisting of one Junior resident and one Senior resident has one assigned orthodontic assistant to enhance their clinical efficiency and provide support for a patient load of approximately 120 patients per resident by the beginning of their Senior year. In addition, each clinical period is supervised by two attending faculty, which also allows greater flexibility in faculty and resident schedules.
Cutting-edge Technologies-
During the past three years, the TORP has acquired and implemented the use of digital technologies in all areas of orthodontic patient and record management. This includes a paperless orthodontic treatment record and appointment management system, digital radiology (including Cone-Beam Computed Tomography) and digital models, as well as ready access to 3D stereophotography and stereolithography systems. Cutting-edge technologies have also been incorporated into the didactic curriculum, with IP-based video-teleconferencing of selected orthodontic topics, with pre-eminent faculty from civilian orthodontic residency programs as part of the AAO-sponsored Distance Learning Project. In addition, wireless audience/resident feedback cards are utilized in seminars to obtain unbiased resident responses when needed to improve the teaching/learning format.
Faculty Availability-
One of the distinct advantages of having only full-time faculty members is the improved access that residents have to them, allowing timely discussion of patient treatment, whether for initial patient work-ups or progress reviews.
What would you like to say about your faculty/staff?
Teamwork is an essential part of any successful organization; however, the faculty of the TORP has perfected it. The individual faculty members bring the unique features and traditions of their respective services to the residency, resulting in a fun, yet professionally challenging environment for both residents and faculty. Our current faculty includes the following:
Colonel Eric J. Brendlinger, USAF, DC (Orthodontic Specialty Consultant): University of Pennsylvania 1998, Military Consultant to the Surgeon General for Orthodontics;
Colonel Drew W. Fallis, USAF, DC (Chairman): University of North Carolina at Chapel Hill 1999;
Lieutenant Colonel Ramon E. Melendez, USA, DE (Clinical Director): Tri-Service Orthodontic Residency Program 2002;
CAPT Brent J. Callegari, USN, DC (Senior Training Officer): University of Indiana 1999. Special Consultant in Orthodontics to Navy Surgeon General and the Assistant Surgeon General for Dental Services;
Lieutenant Colonel Gary D. Gardner, USA, DE (Junior Training Officer): Tri-Service Orthodontic Residency Program 2002; and
Colonel Michael D. Signorelli, USAF, DC (Clinical Instructor): University of West Virginia 2003, Director of Orthodontics for AEGD-2 Residency.
In addition, the program benefits from the guidance of the current Air Force Civilian National Consultant in Orthodontics to the Surgeon General, Dr. P. Lionel Sadowsky, DMD, BDS, MDENT, previous Chairman of the Department of Orthodontics at the University of Alabama at Birmingham, who provides site visits to the TORP on an annual basis.
Are there any plans for renovations, moves, new collaborations on-campus, etc?
The Dunn Dental Clinic at Lackland AFB in San Antonio, Texas is currently the home of the TORP and is nearing completion of a $12 million renovation project, which has certainly benefited the program. Each resident has a designated dental treatment room with a networked computer for use in treatment, patient education, and scheduling, as well as an individual study area with a robust computer designated for digital imaging, 3D image manipulation, and completion of patient work-ups. The department also has a conference/lecture room that is networked to the patient database, allowing discussion of cases during treatment planning seminars.
Groundbreaking is planned for 2010 on a Graduate Dental Residency Complex at Lackland AFB to house all the dental specialty programs under one roof, including the TORP. Additional physical improvements to the residency are planned for the new department as a part of this future building project.
Collaboration with the Orthodontic Residency at the University of Texas Health Sciences Center at San Antonio has been present since its opening; however, future development is in planning to enhance the relationship between the two programs in San Antonio.
What are your biggest needs and plans for future development?
One of the main areas of focus for future development of the residency is in clinical orthodontic research, especially involving the extensive dentofacial deformities and surgical-orthodontic treatment programs. A combined orthodontic and surgical database of 3-D records has been established to provide a resource for future study.
Also, since the TORP was initiated as a 24-month, certificate-only residency, the main emphasis has historically been placed on clinical and didactic instruction. Residents receive didactic instruction in research methodology/biostatistics and must complete a research project prior to graduation; however, although publication of their research has been highly encouraged, it has not been required for graduation.
Therefore, resident research timelines are receiving an increased level of oversight in an effort to increase the publication rate and enhance this portion of the program.
In addition to improving the research/publication portion of the TORP, plans are currently being explored to add a Masters option to additionally enhance this aspect of the residency and better prepare graduates for future academic positions.
Current Residents of the Tri-service Orthodontic Residency Program-
Second Year (Seniors):
Maj Seth Briggs, USAF (Creighton University)
CPT Clinton Cable, USA (Pittsburgh)
LCDR Rachel Holy, USN (LSU)
CPT Dale Nichols, USA (Marquette University)
Capt Heidi Sottek, USAF (University of Michigan)
First Year (Juniors):
CPT Tim Collins, USA (UTHSCSA)
LCDR Sean Donovan, USN (Marquette University)
Maj Jeff Ford, USAF (U of Miss)
Capt Erin Speier, USAF (Pittsburgh)
LCDR OJ Stein, USN (Louisville)
CPT Kevyn Wetzel, USA (University of Oregon)