In this episode of the Smile Reconstruction Podcast, Dr. Tanner Townsend and Dr. Josh Muir are joined by Dr. James Rutkowski, Program Director for the JU Implantology Program, and Dr. Michael Rosen, a third-year resident. Together, they discuss the unique structure of the Jacksonville University Implantology Program, focusing on the critical role of site directors and the mentorship dynamics that help residents develop their clinical skills.

Dr. Tanner Townsend 0:00 Welcome back to the Smile Reconstruction Podcast. I’m your host. Dr. Townsend, and I’m here with my co-host. Dr Muir,

Dr. Josh Muir 0:12 Hi there,

Dr. Tanner Townsend 0:12 and we have two wonderful guests with us. Dr. James Rutkowski, the program director for the JU Implantology Program, and Dr. Michael Rosen, who is a final, third year resident in the JU program. Thanks for coming on, guys.

Dr. Michael Rosen 0:28 Thank you for having me.

Dr. Tanner Townsend 0:29 Today, we’re going to talk a little bit more about the Jacksonville program and what it has to offer from the site director perspective, but also what’s to glean from the resident perspective as well. And so we’ve got a few different individuals here that have vast experience on both fronts. Dr. Rutkowski, this is more for you. What do you feel like the role of a site director is, and why is it so important for you?

Dr. Rutkowski 0:56 The site director is the most important, important person in the development of the resident, because they’re with them on a daily basis. They’re with them as they are onboarding a patient with their diagnosis, with materials that they’re gathering for that diagnosis, construction of that treatment plan, the presenting of that treatment plan to the patient,the informed consent with that patient, and getting it all ready to actually perform the case, and going through all the steps so that once they get into the case, that there’s no regrets. What we want is we want clinicians who take on these very difficult, very advanced cases, many times with patients in their sixth, eighth or ninth decades of life, we’re coming with a whole list of pathologies, a whole list of medications that they’re taking, and all of those things can interact and affect the treatment for that patient, because sometimes these treatments, They might be removing multiple teeth of a terminal dentation, doing an alveolectomy, having to play in just exactly how much bone should move so the in prosthesis, there’s enough room for it. And aesthetically, that’s going to be pleasing, that the flange of the denture that at the edge of it, the lip of it, isn’t showing on a big smile. Doing it right, so that when they get to the other side, there’s no regrets in saying, I wish I would have had I known. And there isn’t a case that any of us have done that afterwards, we say, well, maybe I could have done this a little bit differently, but we don’t want it to be a major issue. And that’s where that director helps that resident in so many ways. And it’s, it’s holding their hand more so at the beginning, but then later on, as they progress through it, letting go of that hand and letting them be who they are.

Dr. Tanner Townsend 2:52 It’s great to have that experience. And in terms of the more hand-holding in the beginning, and then taking the training wheels off, in a sense, to really get the ball rolling, and letting that doctor really kind of grow into their own as they’ve kind of learned things from their director. So one of the questions that we kind of have for you, Michael is, when do you feel like you’ve had a challenging scenario that you were able to basically overcome because you had that guidance from your director.

Dr. Michael Rosen 3:26 Think that happens every day, even especially when we started off. So I came into Brighter Way Dental down in Phoenix. Came up with some background experience with surgery restorative, placed some implants before, but definitely Dr. Ericson, at first, we started doing cases together, working up cases. I get stuck on some extractions, and every time he’d come in and give me some good pointers. Help me get the tooth out, take over. Let me watch what he’s doing each time I gained and gleaned some good experience that he’s gained over the years, sure, from his mentors and from which they got from their mentors, it’s so valuable to have that just what a breath of knowledge and experience that the mentor provides that you don’t necessarily get just going to work in a private practice or just taking C courses and going back to start doing cases on your own, but when we’re able to take the knowledge that we get from lectures or from discussions we have with other doctors and put into practice With the mentorship that the Clinical Director provides, in my case, Dr. Erickson really helps guide you towards success in what you’re doing.

Dr. Tanner Townsend 4:48 Yeah, I think that guiding towards success is is critical because, and just like Dr. Rutkowski had mentioned, avoiding those pitfalls before they even happen is such a valuable thing to have.

Dr. Michael Rosen 4:59 I mean that’s, that’s where experience comes in, is, hey, I made the mistake. Let me help you avoid it.

Dr. Tanner Townsend 5:05 So Dr. Muir, how have you noticed that, like the JU program, it’s, it’s a little bit different than, like a traditional academic residency program, it’s not a whole lot of, I mean, there is book work involved, there are classes involved, but it’s very clinical with your site director, working things through working problems. How have you seen that be a benefit to myself, because I’m your resident, how is that? Have you seen that from your perspective?

Dr. Josh Muir 5:33 I think that’s a great question. It’s different in that, you know, a lot of times in a typical student, teacher relationship, the teacher will come to the rescue when there’s a problem. But as we collaborate together and plan together, it’s not a rescue at all. It’s It’s tapping your teammate for the next step. And I think that really illustrates the whole idea behind this daily working side by side is we go over cases together, we plan together, and then as those cases are are being performed, or the procedures are being performed, it’s really, hey, we already talked about this. This is the part where it might get a little bit hairy. And so just holler, when you get to that point. And, you know, a lot of times, I may just come in and see if you’re at that point, and you may say, You know what, I’ve got this. And that’s, I mean, how wonderful is it to continue until you need that help and you get to the point where you don’t I mean, it’s a it’s a great teaching model.

Dr. Tanner Townsend 6:52 I think it’s really an awesome teaching model. What were you guys going to say?

Dr. Michael Rosen 6:56 As you keep doing repetitive procedures and each case is unique, the same time you get more comfortable with your skills, and sign of a good director, which I’ve had, is each time you’re a little more hands on yourself, a little more hands off on the director’s end, until you’re autonomous. But even once you’re smooth sailing, you have that guy to rely on, which is really good security blanket. Even once you’re two threes in the residency, and you have that connection, like you guys said, even after you graduate, you have that person to call and run cases by.

Dr. Josh Muir 7:32 That’s that’s very well said. And it’s, you know, it’s interesting, because you start this, this relationship together, and you have a new resident, and they’ll think, oh, man, this guy’s Superman. He can do anything. And over time, you know, you’re not needed as much as a as a supervisor or a site director. And that transition takes place where the resident is doing more and more and more, and it’s a little bit sad because you don’t feel quite as cool, but at the same time, it’s wonderful to see just how far someone can grow in their skill set. And anyway, so it’s been a lot of fun to do that, but like you said, Dr. Rosen, it’s really also about building relationships, and unless you just simply don’t mesh well, you spend two or three years with someone working side by side with common goals, and you can’t help but build a relationship that absolutely should last throughout your entire career. And I think that is just a really neat program to offer that, you know, you go to these other courses, and even if it’s a maxi course, for example, which will be parts of about a week a month for 10 months, that’s a lot of time together. But there are so many residents that go through those courses, it’s hard to get the one on one relationship and and with this Jacksonville program, you know, we’re working one on one and so that relationship flourishes, and really in the future, that we’ll have time to continue conversing and planning and talking about these cases and our both of our continued educations.

Dr. Tanner Townsend 9:23 Dr. Rosen, do you have like a specific example of when you had a case that was a little bit more challenging, or you kind of got stuck on a certain aspect of a case, you felt like your site director came in and was able to kind of help the outcome be better, even from the get go.

Dr. Michael Rosen 9:40 There are many cases of impacted third molars when I was starting off. That’s more simple level. We have another case for sure, where, where medical history comes into play. And there are patients that come in with complex medical histories. And off the bat, especially earlier in my residency, I’m lost. So this patient, I think you talked to Dr. Rutkowski about where the patient came in with 450 pound guy, recently out of prison, drank like 14 or like nine, what are the big soda sizes per day? Two, three packs of cigarettes per day. And he comes in says, I want implants and kind of learning, how do I navigate this? Because the guy’s clearly not healthy. Is a one sees close to up 12 to 14, something like that. It really took the relationship with my director may sit down be like, Hey, this guy wants implants. He’s a young guy. How do I not just tell this guy, no, but use the implants as a motivating factor to get this guy healthier and eventually get him, get him into implants because he really didn’t want to denture. It’s a young guy needed a full upper single minutes on the lower. And that’s why I was able to game plan with my instructor. Okay, this is how we’re going to approach this patients far beyond the actual skills of placing the implants and doing the and doing the surgery, because that we can all learn, it’s the patient interaction and the patient approach. So it’s very easy to tell this patient, no, go find somewhere else. But rather, how are we going to get this patient on our team and get him to see where we can take him? If he cooperates and really, with Dr. Erickson’s help, you’re able to get that patient, once he’s down to seven or eight, he lost 150 pounds, stop drinking soda, stop smoking. And now he has a full upper FP1. It’s beautiful. And he’s also patient for life. He says, I saved his life. It’s really he’s much healthier than he was, but it’s the the patient, patient communication skills is just when you learn from someone that has all the experience that you don’t have, it can really that’s the biggest thing you can really take.

Dr. Tanner Townsend 12:09 Yeah, and I 100% agree with you. I think there’s a lot of CE courses out there that’ll teach you how to place an implant, how to do all the surgical side of it. But I think one of the underrated parts about the JU program is the fact that it is a wonderful program in terms of teaching all aspects, the prosthetics, the patient interaction, the health history. I think just like your example showed that oftentimes the success of a case is not necessarily on, because you get to a certain point where your place, your placement of the implant is, is excellent or very good. In most cases, it’s more of the managing the health and the complications that becomes the biggest part and the wild card. And I think that is the part that the JU residency kind of takes to the next level, which is wonderful in teaching you that,

Dr. Michael Rosen 13:04 There’s two places you find yourself. One is excelling in the patient communication, management and getting medical history under control. And you said, yeah, the implant placement ends up perfect. You look at your X rays, everything perfect. But you really, after two to three years in the JU program, get to the point where, when you look at your implant, where 99 out of 100 people say, hey, that’s perfect, and you start to criticize yourself and think what other people think is perfect is just, hey, that’s ugly. I could do so much better. Get down to the microns of tissue positioning and and bone height, and just really go trying to go from good to perfect. That’s really where you get after two to three years in the Ju program, and that’s been the biggest blessing I see, and the biggest curse, because I drive myself crazy now, but I know that if I did in this program all the work that I’m criticizing myself on now is just, hey, that’s perfect. Restore it.

Dr. Josh Muir 14:07 Dr. Rosen, I appreciate that you said that, because when when you look at programs, well, when you look at this program, any doctor that’s willing to dedicate two years additional years to education,

Dr. Michael Rosen 14:24 Three on my end.

Dr. Josh Muir 14:26 Yeah, sorry, two or two or three years to education. It speaks volumes about that doctor, because it says, Hey, I know I can learn some things in an easier way, in a more condensed and consolidated way, but I’m humble enough to know that there are ways where I can learn more, there are better ways I can serve my patients. And so what you describe as being able to criticize your own work, it’s actually a really good sign and and I would hope that all of the doctors in. the program would get to that point, because it’s, you know, it’s not a perfect science. Every patient’s different, every site’s different, and so you strive for an ideal, and there’s no definition of what that is in every case. So way to go for for

Dr. Michael Rosen 15:25 The challenge, is learning to take each patient towards that ideal. Each one has its own roadmap.

Dr. Josh Muir 15:31 Yeah,

Dr. Michael Rosen 15:32 I also plug in when you’re talking about mentorship in the program. I think what’s really looked over because we have our Clinical Directors who are with every day but but the beauty of the JU program is that the didactic is being taught by clinicians who are all taught in their field, rather a lot of times in a university setting. The person who’s teaching you has been in academics their whole life, and they haven’t had as much clinical experience before the academic, right? So, so the fact that the instructors that we have in the didactic portions are one all experts in the field have their own clinical experience and are able to show their own cases, and they’re they all act like additional clinical directors in terms of, if you have a case, they’re all open for you to call them, to sit with you, to review your case, to get the results, and have all those additional experts to run your cases by. It’s just a big blessing.

Dr. Tanner Townsend 16:39 Yeah, and I think that goes back to expanding your pool, like you said, Dr. Rosen, of your mentors and the people that you can reach out to if, when you graduate, that are in your pool, and now you have, like, all these, like, I am so privileged to even know the other residents, like, Dr. Rosen, like, we’ve like, I don’t know you very well, but it’s nice. I feel comfortable that I can reach out to you. I can reach out to Dr. Rutkowski When I’m done. And Dr. Rutkowski is a legend, you know, and so it’s such a wonderful blessing to have those connections, to be able to tap into.

Dr. Michael Rosen 17:17 I’ll tell you I went over my dad’s a dentist, speaking implants. And I went through some of the old stuff I acquired. And there was a program from an A I D meeting like 25 years ago. I’m going through the list of speakers, and I’m saying, hey, that’s one of my instructors, that’s one of my instructors. That’s one of my instructors. It was crazy. I really realized, Hey, this is the kind of people I’m learning from the top of the field.

Dr. Tanner Townsend 17:47 Yeah, it’s really something to kind of fall back on and be like, Man, I know some real leaders in the field of implant dentistry, which is really cool to kind of say that you were taught by these individuals. So Dr. Rutkowski for you, when you when you have a site director as as the program director, how would you hope that every site director, like trains their their resident, or what are your goals for each site director in terms of getting their resident to that next level like Dr. Rosen’s gotten to

Dr. Rutkowski 18:22 I want every site director to look on the their resident as a young person, a younger person, because some of our residents are in their 30s and 40s, but a younger person, traditionally, that is just so eager to learn and to give them the guidance, the one on one, and the encouragement, but a accurate critique of what they are doing, and not just say, Yeah, that’s good. That’s good. That’s good when maybe it’s not, but having the the ability and the strength, the wherewithal to be critical, but yet to still remain encouraging to the the resident and the to realize that the resident at the beginning is going to need more support than they will later on. And I have a resident that just came out of dental school and came directly into the program, so doesn’t have a lot of clinical experience at this time, yet, they are working with a resident director that realizes that and says, you know, we’ve gotta help this doctor learn all of dentistry, not just how to put a screw in the bone and to put a crown on top of it, but this entire patient evaluation, and I’ve worked closely both with this director, whom I just had a lengthy phone conversation with two nights ago. Go and as well as with this resident, and I’ve seen this young man who was so excited about coming in, so eager, and he was, and then he went through a stage of just being completely overwhelmed, and I don’t know whether I can do this drowsy. And I said, Well, let’s your resident director, and myself and you. Let’s just talk, and let’s see where we need to go. And now this young man who and truly a young man, I’m sure he’s maybe 26, 27, 28 years old, just out of dental school, but I have seen him take off in the last month, and I just see him growing right before me, and I’m thinking, Wow, what a legacy for this director to leave behind, because he’s a little bit older, and, you know, who knows? Maybe this individual might end becoming a partner in his practice, remind him becoming a buyer in his practice, so that the patients that that director had in a show the consideration of professional courtesies that he’s shown to this young resident, that’s what it’s all about. And it’s the real world that they’re showing it. It’s not in a hospital setting or in a university setting where, oh, don’t worry. Well, that didn’t work out. We’re gonna ask somebody from cross or from perio or from oral surgery come in and help with this and etc, etc. And all our residents are taught how to make referrals and to interact with all those people professionally. In fact, that’s one of the 89 EPA and trusted professional activities is, can they interact properly with other medical and dental professionals? So they’re getting the real world experience what it’s going to take to become successful in clinical practice, and they don’t necessarily get that in a hospital setting or university settings. And this is this program enables everybody to grow, not just that resident but that resident director grows. And I have a resident director who has got a young doctor who has been with them for about six months now, and he called me and reached out to me. He said, Jim, this is going so well. What do I gotta do to get it stuck on one? And I thought, ring the bell. That’s what it’s all about. You know? He said, This resident is helping me so much in my practice. And the resident, as in turn, has spoke to me and said, I can’t believe how much I’m learning. So what a better environment. And that’s what implant dentistry needs, because it is so complex. It is oral surgery, it is perio, it is pros and it is general dentistry. It is all of the above, and not just in one little box by itself. And so the resident director, I’ve got a great group of them. We’ve got 21 of them at the moment, and I’ll tell you what they’re I’m proud to be associated with all 21 of them as I am. I’m proud to be associated with all 27 residents. So I’m sitting here and listening to Dr. Rosen, and I am just beaming inside. I think the smiles come across on my face, but it just makes me so happy to see there’s Dr. Rosen and Dr. Tanner Townsend, who are just growing and becoming and go and thank you, Dr. Muir, for being one of our directors. You’re you’re part of this whole formula.

Dr. Josh Muir 23:46 You’re welcome. It’s a pleasure.

Dr. Tanner Townsend 23:48 Well, that was excellently said. I I think just kind of to close so we can hear a site director side of what, what’s been rewarding for you, but also Dr. Rosen’s side, how it’s been rewarding for you being a part of this program. Dr. Muir, to start off, how has this experience been rewarding from your experience? We heard Dr. Rutkowski share a couple other site directors experience. But how has it been rewarding for you?

Dr. Josh Muir 24:13 You know, anytime you can help someone, I mean, we we do this, hopefully on a daily basis with our patients, but if we can help one of our peers, someone that’s that’s coming to us for some guidance. It feels good, but that’s not the only thing this that being a site director does. It also helps me re-evaluate why I do every little thing that I do, and put a reason on that. Because when I get asked a question, oh, you know, why do you do it this way? I have to be able to say, you know, why do I do it that way? And it’s also been very refreshing. When Dr. Townsend will come with something, they’ll say, Hey, this is what we learned. I’ll say, my goodness, let’s try it that way. That makes a lot of sense. And so it, it absolutely keeps me up to date with what’s new and and out there. It’s so it’s been rewarding on all those different levels. But then also it allows, it allows me to be two places at once a lot of times, because we’ll both be seeing patients in the practice and helping more people. We’ve been able to introduce more technology, because it’s difficult to know how to do everything all the time, but as we can divide and conquer our responsibilities in the office, that’s been just a wonderful blessing, and so it’s been a wonderful experience. And I just, you know, I’m an advocate for the program, but I’m really an advocate for education and truly trying to be the best that you can be. And we again, we help our patients do that, we improve their smiles, we help them be the best that they can. But you know how wonderful that we can in each of our roles, come together and help each other be the best that we can be, and what we’re doing as well.

Dr. Tanner Townsend 26:11 Couldn’t be better, said Doctor Rosen.

Dr. Michael Rosen 26:14 So for me, I something I realized is that whole program I was in from the first year, and all the ups and downs of a whole new program, and kind of just fell out. The whole the whole opportunity to be a resident just fell into my lap, and it was really meant to be, because I feel that I’ve wanted to make a career in implant dentistry. And where I am now would have taken me 20 years to get to the same point if I just stayed in private practice. Did one case here and there really propelled my career, and I really have the program, Dr.Rutkowski and all the Dr. Erickson and all the otherdirectors the entire program to thank for that. I know it’s just the beginning. There’s always more to learn. Even when I finish, there’s always more to learn, like I said, so you can always get better and better. As long as we’re striving to be better, we end up being doing good for our patients and for ourselves. And to touch on what you said you really when you’re teaching is really when you’re learning the most, because I’m less than our site to have three residents under me and to have a senior position there, and really, like you said, I tell them to do something one way, but then I have to tell them why I’m telling them, and a lot of times, and I’m just figuring out my own way. I’m not questioning it, or I’m not giving a reasons why I’m doing things you said you always have to give a reason. And really makes you a better, better clinician through the teaching.

Dr. Tanner Townsend 27:50 The teaching really elevates you to another level to become the very best you can be. And I think that’s the whole goal that Dr Rutkowski has got here, is to help us be able to turn around and hopefully teach it to the next set of doctors one day as well. So well, I think that’s kind of our episode that we wanted to touch on today, of the importance of the site director in the Ju program, and the benefits both to the site director, but also to the resident and the program as a whole. And so if you have more that you want to learn about, either how to become a site director in the JU program, or become a resident and learn more. Please feel free to reach out to us or reach out to Dr. Rutkowski, and we would love to kind of help you along that path. If that’s something you’re interested in.

Dr. Rutkowski 28:39 I want to say thank you to Dr. Muir and Dr. Townsend for what they’re doing with this podcast and helping to promote the program. I know there’s people out there watching and listening, because we get questions, we get new applicants, and it is through programs like this and your desire to spread the word and to help others. And that’s when I was listening to Doctor Muir and Doctor Towson talk in that you know, everything that they’re doing is in helping people and helping others, and what a lofty goal to have in life. And Doctor Rosen, I want to thank you for being who you are and all the things that you do well.

Dr. Tanner Townsend 29:21 Thank you guys once again for coming on the show, and that is it for today’s episode of the smile reconstruction podcast. We will catch you next time,

Dr. Josh Muir 29:28 See you next time.

Dr. Michael Rosen 29:29 Thank you.

Dr. Rutkowski 29:30 Bye