Dave Keller

The reality is that a cover letter, while the expected norm when applying for a leadership position, poorly presents any individual in an honest light. I worked hard to pick the right “power words” and phrases, but they cannot really describe who I am and why I believe I can bring tremendous value to your program. So, completely consistent with my character, I’m going to stick my neck out and make a personal statement that I believe much more fairly reveals who I am. If you have the endurance, this will be thought provoking. While I’ll try to be brief and focused, I am complex, my life has wandered, and in that journey my best qualities are displayed. The olive branch I extend is my best attempt to organize this story thematically.

LEADERSHIP

I have always been a leader. Where it comes from, I cannot say, but it’s always come naturally to me. In junior high and high school, I saw classmates who struggled to make decisions, to organize and collaborate, so I stepped in and quickly discovered that I had a knack for both. Those early experiences have profoundly shaped the direction of my life. 

In junior high and high school my leadership mostly consisted of being elected or appointed as a leader-class officer, ASAB, those sorts of roles. But, as you’ll hear from most returned missionaries for the LDS church, my mission to Argentina profoundly changed me, including my approach to leadership. I discovered my capacity to change the world around me.

At BYU, I was appointed as the President for the College of Biology and Agriculture. This provided space for me to meet weekly with the Dean where I gave and received feedback about how students experienced BYU. With his support, I resurrected the BYU pre-dental club and created a program with Dr. Gordon Christensen and what was then called Clinical Research Associates where students who wanted to learn more about dentistry could tour his campus and schedule observations with the various specialists working at his dental complex.

This was noticed by Dr. Don Bloxham, the Health Professions Advisor at BYU, who asked me to join the committee that interviewed and wrote letters of recommendation for BYU students applying to medical and/or dental school, one of two students on that committee mostly made up of school faculty. I interviewed and wrote letters of recommendation for dozens of my fellow students, but I also had a large number of opportunities to work one-on-one with students for whom we could not provide as glowing of a recommendation as desired and help them chart a course for improvement and future success.

At the same time that I was serving as college president, I served as the vice-president of the student alumni association where I organized and facilitated communications and events with fellow student leaders across all of the colleges at BYU, liaised with the BYUSA (BYU’s student body leadership association), and with faculty across the campus.

Leaving BYU, I attended the University of Washington for dental school. Within a few weeks I realized that my professional success would depend both on the skills I was trying to master while in school and maybe more importantly, on how I continued to acquire and hone skills after I graduated. That forced me to start to ask questions about how I was supposed to learn and improve once I left dental school. In that quest, I discovered the Academy of General Dentistry (AGD) and their Fellowship and Mastership programs. Enticed by the possibilities offered through the AGD, I found name of the president of the Washington AGD (WAGD) and gave her a call. She was Linda Edgar, who became a trusted friend and mentor and went on to be both the AGD and ADA President. Linda invited me to get involved and offered me a seat on the WAGD Board, one of the first such positions offered to a student anywhere in the country.

For three and a half years while in dental school, I served on the WAGD board where I helped schedule and support lunch and learn lectures, on and off-campus activities, helped develop mentor/mentee relationships between classmates and AGD members, and helped recruit faculty representatives.

I brought to the attention of the WAGD board that one area we were lacking in UW’s curriculum was developing the skill to document and describe the clinical cases we were doing. As a board, we developed the Howard Memorial Award, a student case presentation competition. Participants documented and presented a personal clinical case to a panel of practicing dentists. This taught participants the process of documenting the care they provided and professionally sharing that care, complete with diagnostic justifications, with other practicing dentists. While I took 2nd place in the first ever Howard Memorial Award, the idea was shared with the national AGD headquarters and quickly became adopted by dental schools across the country, enhancing the vision of what undergraduate dental students can and need to achieve for future success.

While in school, I, with classmates Jane Gillette and Connie Manson, volunteered to assist in a children’s dental clinic with the federal ABCD program, a Medicaid-based program that provides early access and intervention for children needing dental care. After our experience, we created a program called Husky Smiles to recruit and encourage all our fellow classmates to also support the ABCD program and leave a legacy of commitment to the underserved children in our community. That program spread from the three of us to about 25 in our class and, at the time of our graduation, it was incorporated formally into the curriculum at the UW. Furthermore, the idea was spread through ASDA and by our faculty mentor Dr. Peter Milgrom and now it has dedicated support from many dental schools across the nation.

While not formally part of my leadership story, my application to my residency program illustrates a key aspect of my leadership. I entered dental school as a second lieutenant (2LT) in the US Army on an HPSP scholarship. My plan was to apply for an AEGD-2 residency program out of dental school. The obstacle I ran into was that the US Army had never taken any residents into their AEGD-2 right out of dental school. The policy was that residents had to be in the ranks of mid-career major to early lieutenant colonel (9-13 years of practice) to apply.

I did my research, asked questions and sent emails and discovered that the time in grade requirement was a preference, not a CODA requirement, so I applied despite the requirement. I was part of the first class ever accepted into an AEGD-2 by the US Army right out of dental school.

While in my residency, I did not enjoy formal leadership opportunities. Army leadership is based on rank and with a lieutenant colonel in my class, as a captain there were no opportunities. However, I did convince my commander COL Daniel Pietz to allow me to serve as an Army delegate to the AGD’s house of delegates. I also requested and was authorized to attend the Army’s prestigious Combat Casualty Care Course (C4), the only resident to be granted that privilege while a resident. Finally, while in residence as the C4 course, I participated in the Advanced Trauma Life Support (ATLS) course, a course in which I was the only dentist to pass the course and where a high percentage of my physician classmates failed the course.

Upon graduation from residency, I immediately moved my family to Germany and deployed to Iraq. When I arrived in Iraq, I asked my Commander how I could best help her be successful in our mission. She appointed me to her special staff as the brigade dental surgeon and in addition made me her investigations officer. As a result of my dedication to these assignments I was given an Army Commendation medal.

After my first year, I ran for and was selected as secretary for the Army AGD component, the only captain to have ever done that, and for which I was given a Commander’s Coin from the US Army Dencom Commander. I served in that position until I separated from the military in 2008. While serving as the Secretary, it was my job to apply for the various awards that the AGD offers to constituents to encourage them to provide meaningful service to AGD members under their purview. I was quite aggressive at reaching out literally around the world to AGD dentists serving across the globe to gather the information needed to meaningfully compete for these awards. Through the consistently hard work of Army dentists and my efforts to document and promote their efforts, we won the following awards while I was secretary: the Public Information Award of Excellence, the Membership Award, and both years I served we were awarded the Constituent of the Year.

After starting my dental practice, I chose to enroll in business school via correspondence at Northcentral University studying organizational leadership. I wanted to learn how to better lead organizations big and small. I specifically studied how to lead professional organizations, how to lead non-governmental organizations, and how to help others learn how to lead.  My MBA provided the training not provided in undergraduate dental education to successfully lead and operate a small business in an industry that is facing increasingly strong headwinds.

Upon separating from the Army, I was quickly approached by the Washington AGD to rejoin their Board, which I did. I was also elected as president elect for the WAGD, where I served for a year, and then for two years as WAGD President.

In my tenure as WAGD president, I made it a point to recruit, train, and motivate a high functioning dental board. We hired a dynamic executive director and through our combined efforts, we increased our membership while much of the country was experiencing declining membership.

After my service as WAGD president, I stepped away from leadership in dentistry to focus on a different sort of leadership: I was called as the bishop of my LDS ward, where I served for five years. While I am happy to describe this joyful time of my life in detail, I will highlight that during my tenure we experienced both a ward boundary realignment and a stake boundary realignment with the concurrent leadership demands required to staff, restaff, and restaff again a large, dynamic ward.

As my time of service as bishop came to a close, the state dental association (WSDA) approached me and asked me to join their regulatory affairs committee, the arm of the WSDA designed to monitor and influence policy with our state legislature, as well as to monitor and influence, as much as is possible, the state regulatory environment. I’ve served on this committee with distinction since 2017.

In this role I’ve spent many hours reviewing CODA requirements and explaining to dentists, policy makers, regulators, and stakeholders what CODA is and is not. I’ve had a lot of firsthand experience with regulatory and scope of practice problems created by misunderstanding the CODA process and how such misunderstandings place the public at risk. I’ve also gained tremendous experience lobbying state legislators and helping them as they craft and defend bills meant to improve oral health, improve access to care, and solve budgetary and financial constraints that hurt Washingtonians.

At the same time, I’ve spent the past six years on the AGD’s Legislative and Governmental Affairs committee doing the exact same thing with Congress. This has included annual trips to Washington DC to lobby, creating policy for the Academy, building consensus and support with the ADA, specialty organizations, and other stakeholders, and trying to help our elected officials make informed and high-quality bills and decisions.

Finally, I’ve spent the past two years as a board member for the American Dental Association’s Political Action Committee (ADPAC). In this role, I’ve helped shape the ADA’s efforts collect funds which we’ve used to support congressional campaigns, build brand recognition, and support events that have opened doors to us as we attempt to engage our Congressmen in support of the ADA’s political agenda. Of note, while I am a small cog in a big wheel, we are consistently in the top 3 most impactful and effective association PACs at the federal level in our great nation.

To summarize, the picture I’m trying to paint is this-I am deeply committed to my profession. I have spent a career trying to get to the table where decisions are made, bring people with me, and when there, to build consensus and craft solutions that help improve the lives of those at and not at the decision table.

HOSPITAL EXPERIENCE

I served as the hospital dentist for the US Army Hospital in Wurzburg, Germany from 2004-2006. My duties included providing direct patient care to all US Army personnel who worked at the hospital and their dependents. I provided emergency and on-call care to all hospital staff and all in and often recently discharged out-patients. I provided any needed dental consultations and/or pre-surgical clearances for in-patients and through patients using our hospital as a waypoint when moving around the theater in Europe or through Europe in route back to the US. Finally, in this role I also served as the hospital Chief of the Dental Section, equivalent to being a department head, including involvement in staffing, personnel management, and interdisciplinary care across hospital medical departments and in concert with the Wurzburg Dental Command.

In my local community, through providing IV sedation services, I served as a safety net and referral destination for patients who are best treated with IV sedation, including many children and adults with movement and/or developmental challenges that made conventional treatment impossible.

CURRICULUM DEVELOPMENT and OVERSIGHT

When I sat my boards in 2004, the process I followed was intimidating and rigorous. On day one, there were eight hours of oral examinations in 16 topics related to dentistry: oral surgery endodontics, material science, periodontics, etc.…Day two was the written examination, which lasted the entire day. Day three I was given example complex clinical cases for which I needed to diagnose any problems, create a comprehensive treatment plan, and then properly sequence the appropriate care for each case. Then I was to defend my decision making. It was highly demanding and more than a little overwhelming.

To prepare for my exam, I attend the 1-week review course at Lackland Air Force Base in San Antonio, TX. The review course was a typical review course-lots of lectures to prepare for the oral and written portions of the board examination and then a full-day mock simulation of the day three portion of the exam. To my surprise, shortly after arriving back at my residency program, I received a letter from the director of the residency program at Lackland and the course director of the review course who asked me if he could use my day three course write-up, treatment plan, and defense as the new example for subsequent review courses to use as their standard for their preparation.

I share not entirely to self-promote, but to illustrate a key philosophy I have: with good training and rigor, complexity can be reduced, and difficult problems can be sequenced and tackled in a way that is predictable. It is impossible to learn all there is to know in dentistry. Even if you limit yourself to a single discipline, the rate at which materials, techniques, technology, and the regulatory environment in which we practice are changing is truly alarming. Good residents can become comfortable with that deluge through proper diagnostic and didactic training to break down those complexities into manageable. My overarching philosophy with curriculum is to use the curriculum to develop residents who, with confidence, can break down complexities into manageable pieces and then sequence care such that consistently good results can be achieved.

I fully believe in as broad of an exposure to the variety available in clinical practice as is possible and practical within the safe confines of a residency program. As a program director, I strongly feel an obligation to be well-aware and actively looking to expose residents to new techniques and technologies. At the same time, I also feel keenly that a solid foundation is key to long-term practice success. Having worked with and supervised dentists trained at dozens of dental schools, I acknowledge that there is a large breadth of clinical skills and interests. Good residents are both confident and comfortable with the skills they plan to use regularly and well-prepared to add new skills into their practice. Great residents, in addition, can guide their patients and specialists in the intelligent application of new techniques and technologies as they are developed and introduced into clinical practice.

Owing to the dynamic nature of the evolving dental world, I see faculty recruitment as a continuous process, even from class to class. If a particular class is highly interested in digital denture design and application, for instance, added experts in that area will need to be found and encouraged to assist in the training of this particular class. This will require the program director to develop a vast network of potential clinical instructors and keep it up to date.

RESIDENT SUPERVISION AND EVALUATION

In the Army, graduates of an AEGD-2 are considered specialists. As such, my entire time on active duty I had other dentists I was assigned to supervise and/or mentor. These duties included inspecting crown preps, providing treatment planning and treatment outcome guidance, co-developing and sequencing complex dental care, and helping these mostly recent graduate dentists gain clinical competence and confidence. Those experiences exposed me to the undergraduate philosophies taught at dozens of dental schools across the United States and gave me the opportunity to help recent grads discover for themselves the advantages and disadvantages of how they were taught and how that differed from other providers in their clinics. Weekly I was involved with one-on-one mentoring with dentists whose clinical and/or diagnostic skills fell short. These experiences are some of my most treasured memories as I developed lifelong friendships through co-discovering how to perform excellent dentistry together.

I believe undergraduate dental education is designed to create a single, safe and predictable way for a student to perform enough dental procedures to support independent practice. Residency is meant to fill in the gaps created in undergraduate education, build upon them through both acquisition of additional advanced techniques and exposure to alternative ways of providing treatment as well as transforming the residents from knowing how to do something to know why or why not to do something. CODA establishes the boundaries, the residency program curriculum will create the general journey from start to finish, and individual residents will have to chart their personal journey to acquire the training they want to have. I believe strongly that residents must be critical thinkers, they must be problem solvers, and their best success will come when they love what they do and do what they love. I believe in creating an environment where residents become comfortable with turning to each other to get the help they need in solving their problems. I believe in on-the-spot correction, given with charity and empathy. I believe in minimum standards, but that every resident has the potential to be far more successful than minimum standards.

I strongly believe in teaching residents correct principles, not an overabundance of rules. I believe in residents honing their own ability to self-evaluate and make decisions based on that internal compass. I believe residents should clearly understand the difference between clinically acceptable and clinically ideal and strive for ideal.

Finally, I love to teach. I’ve taught my entire life. In college at BYU, I was the top score in my gross anatomy class one semester. This opened the door for me to teach a lab section for my fellow undergraduate students in gross anatomy, a position usually given to graduate students. That experience was a high point of my BYU experience and grew into teaching lab sections in histology and in preparing human cadavers for teaching undergraduate gross anatomy.

In dental school I served as a boy scout leader mentoring young men in the Order of the Arrow and approving over 200 Eagle scout projects as the district eagle advancement chairman. In the military I ran dental assisting programs in two different locations to help military spouses with no experience in dentistry get jobs to work in our dental clinics as they accompanied their spouses overseas. When I separated from the military I began thirteen years serving as the dental director for the dental assistant training program at Cascadia Tech Academy, a local alternative school experience for high school students in our community. I also began a similar 13-year period of teaching as a clinical instructor and clinical faculty for the restorative program at our community RDH program at Clark College. I even taught early morning seminary for my church to high school students at 5:30 in the morning every day for four years during the school year. For me, one of the greatest calls to your program is the opportunity I will have to teach and draw out of residents and faculty teaching experiences that will shape lives in powerful ways.

FACULTY DEVELOPMENT

I have lots of ideas here, but I can summarize them in two major thrusts. First, relationships matter, and a residency program director is a chief relationship officer for a program. It would not be cost effective to hire a provider who’s only being used to teach a specific technique, like Botox injections. But knowing who might teach a single lecture or provide a 1-day externship in something so tangential to mainstream dentistry is critical to the long-term success of a residency program. These relationships extend to the university as whole, the university hospital leadership and administration, civic and community stakeholders. Relationships will be a central key.

My second major thrust is communication and vision building. The program director must acknowledge the specialized expertise possessed by, for instance, the periodontists. However, the periodontist will not know the needs of the residents. The program director’s job is to guide each faculty member in, as best as is possible, providing the personalized training required for each individual resident to enjoy their best personal success and accomplishment.

ACCREDIATION AND REGULATORY COMPLIANCE:

I have many years of experience in reviewing CODA standards and trying to help stakeholders understand what they do and do not mean. I feel strongly both about following and documenting adherence to CODA standards and teaching them to residents, faculty, staff, and community stakeholders. I particularly have a research interest in the intersection of CODA and regulations and the difficulties that can arise through the misinterpretation and misapplication of CODA as a justification for the creation of regulations and the perception of standards of care.

QUALITY IMPROVEMENT AND ASSESSMENT:

I believe in both subjective and objective evaluation with the intent to demonstrate competence and improvement. When I was a hospitalist, I supervised the lab technician who provided direct lab support for the roughly 24-30 dentists in our local area. This allowed me to directly inspect all crowns preparations provided to the lab and to interact with providers whose work was clinically excellent or suspect. My direct interaction usually involved one-on-one conversations and most often resulted in clinical improvement through consistent mentoring or the ability to glean new techniques from excellent providers and disperse them to all other providers.

ADVANCED CLINICAL SKILLS:

I completed an AEGD-2 at Fort Bragg, NC. There were some significant advantages to my training program that would be difficult to duplicate anywhere in the world. First, it was through the US Army. We had a virtually unlimited budget; we had 50,000 patients who did not pay for any dental care and authorization to provide care to any civilians based on the educational needs of the residents. We were active-duty military and as such, could be commanded to work 24/7, which we often did.

Second, the military requires board certification to promote and stay on active duty for a career. As a result, my education was 100% provided by board-certified specialists in all areas of dentistry-prosthodontics, oral pathology, endodontics, etc.…This education was both didactic and clinical. Every Friday we had lectures from 8-4, and the vast majority of these lectures were provided by board-certified military and retired military providers. Beyond the lectures, they also taught us clinically. As an example, when I first placed an implant in the Army (I’d also placed them at UW), my first implant I assisted the periodontist. My second implant, he assisted me. My third implant he watched me. My fourth implant, he watched me assist and mentor a fellow resident. All of my subsequent implants, his office was 10 steps down the hallway. This was duplicated in every specialty of dentistry. I doubt that it could be duplicated anywhere in the world.

My residency was co-located with an endodontic residency and an oral surgery residency. Both granted an optional degree through either UNC-Chapel Hill, or MCG, August, GA. So many of our lectures in these disciplines were done virtually with the residents at those dental schools and their faculty participating concurrently with us.

Because it was an Army residency, I was also required to train for alternate warfighting roles, which, for a dentist is as a triage officer or anesthesiologist. So I have extensive training with emergency department process and procedure, evaluation and management of emergent patient, and general anesthesiology, including inhalation, although I’ve never personally performed general anesthesia after residency. I have completed thousands of IV (moderate enteral sedations) with a range of medications including ketamine, propofol, opioids, and benzodiazepines, although I have restricted my practice to benzodiazepines entirely for about 10 years. In Iraq after my residency, I was the triage officer for the 67th Combat Support Hospital where I provided dental care, ran the full-service dental clinic, and serve as the triage officer. Owing to the amount and type of combat we faced, I was awarded the Combat Action Badget for doing my job as a triage officer under direct fire, one of the first ever awarded to a dentist.

I was trained to do periodontal surgeries and grafting, place and restore implants, endodontic surgeries including root amps, hemisections, root end surgeries, and perforation repairs. I was taught to remove wisdom teeth, do ridge splits, ridge augmentations, socket preservations, and sinus grafting. I have experience with BSSO and LeFort 1 surgeries, but no clinical expertise. I have experience with acute traumatic facial injuries including diagnosis, stabilization, debridement, the placement and removal of drains, and the rigid fixation of fractured jaws. I am trained to do complex prosthodontics including full mouth rehabilitation, and all of lab work associated with it including digital design, milling, polishing, casting metals, stacking porcelain, and fabricating both conventional and digital dentures. I do not have experience with cast partials beyond waxing frameworks and adding and pressing acrylic to frameworks. I have experience and training with oral and facial pathology, incisional and excisional biopsies, forensic identification/autopsy. Finally, I am trained and have experience with Botox for cosmetic and functional applications in the head and neck area.

CONCLUSION

My entire career I’ve prepared to retire from clinical practice and help shape the clinicians and leaders of tomorrow.  I am excited to meet to discuss how I can bring value to your general practice residency program.

2y-Advanced Education in General Dentistry Residency in the US Army at Ft. Bragg, NC

Four years service on active duty as a comprehensive dentist.

18 years in private practice, including owning a practice for 14 years.

I have a DDS and MBA in organizational leadership.  I completed a 2yr-AEGD and owned a business for 14 years.