Advanced education in general dentistry orientation information



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SECOND YEAR COMPETENCY AND PROFICIENCY STATEMENTS

The following are competency and proficiency statements that describe the additional areas beyond those of the first year program, that apply to residents completing the second year program.


1. Integrate all aspects of dentistry in the treatment of patients with complex dental, medical and social situations. (P)
2. Perform advanced procedures in the selected clinical Area of Concentration. (P)
3. Use proper dental school protocol when treating and managing patients in a health

center environment. (P)


4. Participate in the management of a system of continuous quality improvement in a dental practice. (P)
5. Supervise and chair the literature review seminars for AEGD first year residents. (P)
6. Develop and participate in the second year curriculum that is customized for their

particular interests. (P)


7. Perform and maintain uncomplicated endosseous implant restorations. (C)
DEFINITIONS- adapted from Chambers and Gerrow 1
Assess. Evaluation of physical, written, and psychological data in a systematic and comprehensive fashion to detect entities or patterns that would initiate or modify treatment, referral, or additional assessment. Assessment entails understanding of relevant theory, and may also entail skill in using specialized equipment or techniques. But assessment is always controlled by an understanding of the purpose for which it is made and its appropriateness under the present circumstances. Recognition is a more limited term that does not subsume the notion of evaluating findings. Diagnosis is a more inclusive term, which relates evaluated findings to treatment alternatives.
Competency. Behavior expected of the beginning practitioner. This behavior incorporates understanding, skill, and values in an integrated response to the full range of requirements presenting in practice. The level of performance requires some degree of speed and accuracy consistent with patient well being but not performance at the highest level possible. It also requires an awareness of what constitutes acceptable performance under the circumstances and desire for self-improvement.
Diagnose. Diagnosing means systematically comparing a comprehensive database on the patient with an understanding of dental and related medical theory to identify recognized disease entities or treatable conditions. The concept of diagnosis subsumes an understanding of disease etiology and natural history.
Discuss (communicate, consult, explain, present). A two-way exchange that serves both the practitioner's needs and those of patients, staff, colleagues, and others with whom the practitioner communicates. The conversation, writing, or other means of exchange must be free of emotional or other distorting factors and the practitioner must be capable of expressing and listening in terms the other party understands. [Caution should be exercised with using these verbs to ensure that the communication is between the practitioner and the patient. Communication between the student and faculty is language reminiscent of the old instructional objectives and is not evidence of competency.]
Document. Making, organizing, and preserving information in standardized, usable, and legally required format.
Manage. Management refers to the selection of treatment including: no intervention; choice of specific care providers-including hygienists, and medical and dental specialists; timing and evaluation of treatment success; proper handling of sequel; and insurance of patient comprehension of and appropriate participation in the process. In circumstances where the graduate may perform some treatment but is more likely to oversee treatment or refer, the term "manage" is used. In situations where it is expected that practitioners will be capable of and likely to provide treatment as well as oversee it, the terms "treat", "provide", or "perform", will be used.
Monitor. Systematic vigilance to potentially important conditions with an intention to intervene should critical changes occur. Normally monitoring is part of the process of management.
Obtain (collect, acquire). Making data available through inspection, questioning (patients, physicians, relatives), review of records etc., or capturing data by using diagnostic procedures. Health histories, radiographs, casts, and consults are obtained. It is always assumed that the procedures for obtaining data are performed accurately so that no bias is introduced, are appropriate to the circumstances, and no more invasive than necessary, and are legal.
Patients With Special Needs. Those patients whose medical, physical, psychological, or social situations make it necessary to modify normal dental routines in order to provide dental treatment for that individual. These individuals include, but are not limited to, people with developmental disabilities, complex medical problems, and significant physical limitations.
Perform (conduct, restore, treat). When a procedure is performed, it is assumed that it will be done with reasonable speed and without negative unforeseen consequences. Quality will be such that the function for which the procedure was undertaken is satisfied consistent with the prevailing standard of care and that the practitioner accurately evaluates the results and takes needed corrective action. All preparatory and collateral procedures are assumed to be a part of the performance.
Practice. Used to describe a general habit of practice, such as "practice consistent with applicable laws and regulations."
Prepare (see perform).
Present (see discuss).
Prevent [the effects of]. The negative effects of known or anticipated risks can be prevented through reasonable precautions. This includes understanding and being able to discuss the risk and necessary precautions and skill in carrying out the precaution. Because preventing future damage is of necessity a response to an internalized stimulus rather than a present one, additional emphasis is placed on supportive values.

Proficiency. A level of practice that exceeds competency. Proficiency entails slightly greater speed and accuracy of performance, ability to handle more complicated and unusual problems, and problems presenting under less than ideal circumstances, and greater internalization and integration of professional standards.
Provide care (see perform).
Recognize (differentiate, identify). Identify the presence of an entity or pattern that appears to have significance for patient management. Recognition is not as broad as assessment -- assessment requires systematic collection and evaluation of data. Recognition does not involve the degree of judgment entailed by diagnosis. [Caution is necessary with these terms. They are often use in the old instructional objectives literature to refer to behavior students perform for instructors. They can only be used for competencies when practitioners recognize, differentiate, or identify for patients or staff.]
Refer. A referral includes determination that assessment, diagnosis, or treatment is required which is beyond the practitioner's competency. It also includes discussion of the necessity for the referral and of alternatives with the patient, discussion and cooperation with the professionals to whom the patient is referred, and follow-up evaluation.
Restore (see perform).
Skill. The residual performance patterns of foundation skills that is incorporated into competency. The importance of the skill is more than speed and accuracy: it is the coordination of performance patterns into an organized competency whole.
Treat (see perform).
Use. This term refers to a collateral performance. In the course of providing care, precautions and specialized routines may be required. For example, infection control and rapport building communication are used. Understanding the collateral procedure and its relation to overall care is assumed. It is often the case that supporting values are especially important for procedures that are needed -- they are usually mentioned specifically because their value requires reinforcement. ["Utilize" is a stylistic affectation that should be avoided.]
Understanding. The residual cognitive foundation knowledge that is incorporated into competency. Understanding is more than broad knowledge of details: it is organized knowledge that is useful in performing the competency. [Caution should be used with this term. Understanding alone is not a competency; it must be blended with skill and values.]
Values. Preferences for professional appropriate behavior in the absence of compelling or constraining forces. Values can only be inferred from practitioner's behavior when alternatives are available. "Talking about" values reflects a foundation knowledge; valuing can be inferred by observing the practitioner's attempts to persuade others. [Caution should be used with this term. Valuing alone is not a competency; it must be blended with skill and understanding.]
References
1.Chambers DW, Gerrow JD, Manual for developing and formatting competency statements. J Dent Educ 1994;58:361-6.

VII. THE PORTFOLIO EVALUATION SYSTEM
THE PORTFOLIO EVALUATION SYSTEM FOR COMPLETION OF UNIVERSITY OF MARYLAND, DENTAL SCHOOL'S ADVANCED EDUCATION IN GENERAL DENTISTRY PROGRAM
The Portfolio
A portfolio is a collection of authentic evaluation evidence of a resident's ability to perform tasks in realistic, unaided situations representative of what will be performed after completion of the program. The portfolio refers literally to a loosely bound document in which residents assemble and organize for presentation various pieces of evidence that they have satisfied program competencies and proficiencies. The evidence may consist of checklists, case documentations, write-up of interviews, papers, letters and other documentation. It is the resident’s responsibility to assemble two copies of the portfolio. An important tenant in competency-based education and portfolio evaluation is the shift of responsibility from teachers to students. One copy of the portfolio will be kept by the program as a part of the program's outcomes assessment documentation. The other copy is kept by the resident and may be used in applications for employment or for other programs or for documentation for hospital privileges, etc.
Competencies and Proficiencies
The Program Director will provide the program's competency and proficiency list for the residents and faculty and train them in the evaluation methodology and technique of developing a portfolio.
Evidence
The statements in the competency and proficiency list can be divided into several categories for the purpose of determining appropriate evaluation methodologies.



  1. Statements related to technical procedures: Statements 5-9, 26-28, 33-57.

    1. These all represent procedures that are performed on or with patients and can be directly observed by faculty members.

    2. At the beginning of the program, faculty members are designated as responsible for evaluation of each technical competency and must certify the resident as competent in that area based on observation of the resident's work in that area.

    3. The resident will work with the designated faculty member from start to completion on a particular patient or procedure, but the performance must be independent. If faculty intervention is necessary, that procedure cannot be counted as evidence toward competency.

  2. Observation can be documented by:

    1. a signed case write-up including case history, procedures performed, and

outcomes, supplemented with appropriate photographs or x-rays.

    1. faculty signature on the "certification" sheet, with evidence listed as "direct observation”.

3. Where observation forms or case write-ups are used, more than one competency may be observed at a time. The observations can, and will in many instances, span several appointments or the entire treatment of a patient. A single evaluation form or case write-up may contain evidence related to several competency or proficiency statements.

4. Where observation forms or case treatment plan write-ups are used, residents will accumulate at least one signed observation form or prepare one case write-ups that contain evidence related to each technical competency. Since each form or case write-up may contain evidence related to several statements, there should be less total forms or case write-ups than technical competency and proficiency statements.

5. Faculty will certify the resident in that competency or proficiency prior to the end

of the program by considering the procedures formally documented and also other examples of procedures observed that are related to that competency or proficiency statement.


2. Statements related to oral disease detection, diagnosis, prevention: Statements 23-25, 29, 30.

1.These statements, as with technical competencies are performed with individual patients, and can be directly observed by faculty members.

2.The process of evaluating and documenting these procedures is the same as that listed above for technical competencies and can use the same evaluation form, case write-up technique, or direct observation.

3.Different faculty members may be designated to be responsible for certifying the resident in these competencies than were assigned to certify the resident on various technical competencies.



3. Statement related to developing treatment plans: Statement 3.

  1. This statement requires evidence of the formation of a treatment plan for a patient with complex needs.

  2. The resident shall prepare one formal treatment plan for presentation at a group treatment planning seminar.

  3. The treatment plan presentation shall include formal documentation of:

      1. a complete patient history

      2. dental examination

      3. mounted study models and photographs of the patient's pre-treatment condition

      4. diagnosis of the patient's conditions

      5. alternate treatment plans that could be accomplished for this patient

  1. The portfolio evidence for the formal treatment plan shall include the write-up of the above treatment plan presentation, and mounted print photographs of the x rays and clinical slides.

    1. Pink treatment plan forms.




  1. Statements related to comprehensive care: Statements 1, 2, 4, 31, 32.

    1. These statements require evidence of complete care of patients. (IO case complete reviews signs by AEGD faculty)

    2. The resident shall document and have signed by the program faculty one multi-disciplinary, comprehensive care. The documentation shall be assembled in a form suitable for inclusion in a portfolio binder. The documentation shall include:

      1. A complete write-up of the patient's history, examination, and treatment plan and effect of patient's psychological, medical, or oral conditions on the treatment plan.

      2. Mounted prints of photographs of the patient's pre-operative condition and post-operative condition.

      3. A write-up summarizing the treatment performed, special considerations, problems, or modifications encountered and prognosis and plans for further care.

    3. The resident shall make one formal case presentation in front of the faculty and other residents documenting complex, multi-disciplinary, comprehensive care. The case presentation shall include the items listed above with slides substituted for mounted prints.




  1. Statements related to providing dental care in a dental practice setting and community and interprofessional teams: Statements 10-15.

    1. These statements refer to activities that take place in conjunction with practice in the program clinic with program staff over a period of time. They can be evaluated by interviews, written evaluations, or questionnaires solicited from staff, faculty, and patients.

    2. The resident is expected to design and carry-out a measure of each of these statements. A single measure can be used for more than one statement. Possible measures are:

      1. a patient questionnaire to be given to the resident's own patients

      2. participation in a community program (health care for homeless, work opportunity, and PLUS program)

      3. other measure approved by the program director or assistant program director.

    3. The results of these evaluation efforts will be summarized in writing and presented to the program director or assistant program director for approval.




  1. Statements related to organized dentistry and professional ethics: Statements 16, 17.

    1. Statements related to participation in organized dentistry can be evaluated by evidence of participation in professional dental meetings.

    1. The ability to engage in an ethical analysis of dental practice situations or case studies and interact with colleagues in an ethical and professional manner can be documented by participation in an ethics discussion seminar series, which can be certified by the program ethicist or faculty.




  1. Statements related to gathering and using information about dental practice: Statements 18-22.

    1. These statements refer to the ability to maintain continuous professional growth by gathering and using information relevant to various aspects of the practice of dentistry.

    2. Evidence of this ability must be by activities where residents gather and evaluate information.

    3. The residents will design and carry out three information projects in which they will gather and use data in each of the following areas:

      1. Documentation of dental materials or procedure evaluation. This project will involve gathering and evaluating information about a new dental material or procedure. It will take the form of a short oral presentation. This write-up will be a maximum of one page plus literature search and references, use at least 3 referenced sources, and include a summary of the referenced literature and conclusions about the use of the material or procedure in dental practice.

      2. Dental records evaluation. This project will involve analyzing outcomes from the resident’s own records. It will take the form of a structured record review with written documentation, analysis, and conclusions.

    4. The resident will propose a specific topic and format for each of the projects described above and present them to the program director or assistant program director for approval. The program director or assistant program director will also sign off on the completed projects.




  1. Other evidence:

    1. Some of the evaluation methods described may be applicable to statements not listed with that method. In addition, there may be other forms of evidence not listed that may be acceptable.

    2. Examples of other forms of evidence that may be used include:

      1. A certificate of completion of an CPR course for the competency related to medical emergencies.

      1. Copy of prescription write ups.

      2. Medical consults and pathology reports.

    1. The resident may propose alternative forms of evidence to the program director or assistant program director and use them after approval.


Portfolio Description

The completed portfolio shall be submitted in duplicate and consist of the following parts:


1. A title page and table of contents. (place for program director’s signature)

2. A completed summary sheet with the competency and proficiency statements listed and the signature of the responsible faculty member. Any procedure observation forms that were used can be included in this section.

3. Documentation of one formal treatment planning seminar presentations as described on page 95, #3.

4. Ten case complete reviews (Quality Assessment Audits)


5. Documentation of one case involving multi-disciplinary comprehensive care as described on page 96, #5.
6. Documentation of measures of the provision of dental care in practice, community, and interprofessional settings as described on page 96, #6.
7. Write up of literature-based treatment considerations for treatment of two patients as described on page 96, #5.
8. Write up of literature-based considerations for use of a dental material or procedure as described on page 97, #8, c. i.
9. Write up of a dental records evaluation project as described on page 97, #8, c. ii.
10. A section for other evidence (i.e. operative reports, certificates of completion of specific training sessions, etc.)
11. Other sections dictated by inclusion of other evidence approved by the program director.
Standards
1. The portfolio must be completed, turned in, and approved by the program director in order to receive a certificate of completion from the program.
2. In case of a dispute the resident may ask to meet with the administrator at the level above the program director for review of the program director's decision.
Logistics
1. Residents will get approval for methodology and projects and gather evidence throughout the program as described above.
2. At the resident’s second review, the residents will submit the data that they have collected for review.
3. One month before the end of the program, residents will turn in the completed portfolio to mentor for evaluation. The program mentor and/or director may accept it as complete, or request additional evidence, or other changes in the portfolio.
4. Two weeks prior to the end of the program the program director will make the final decision about granting a certificate of completion from the program.
5. In case of a dispute, the resident may ask to meet with the administrator at the level above the program director for review of the program director's decision.

6. In addition, the program director must follow the Dental School’s Due Process Policy for Advanced Dental Education for an academic dismissal from the program.



AEGD COMPETENCY AND PROFICIENCY

STATEMENT CERTIFICATION SHEETS




STATEMENT


TYPE OF EVIDENCE OR DOCUMENTATION


CERTIFICATION BY: NAME/SIGNATURE

1. Function as a patient’s primary, and comprehensive, oral health care provider (P)





2. Explain and discuss with patients, or

parents or guardians of patients,

findings, diagnoses, treatment options,

realistic treatment expectations,

patient responsibilities, time

requirements, sequence of treatment,

estimated fees and payment

responsibilities in order to establish a

therapeutic alliance between

the patient and care provider. (C)







3. Integrate multiple disciplines into an

individualized, comprehensive,

sequenced treatment plan using

diagnostic and prognostic information

for patients with complex needs. (P)







4. Modify the treatment plan, if indicated,

based on unexpected circumstances or

patient's individual needs. (C)







5. Diagnose and manage a patient's

occlusion. (C)








6. Manage uncomplicated diseases and abnormalities of the pediatric patient. (C)







7. Treat patients efficiently in a dental

practice setting. (C)





PCC/Faculty

8. Use scheduling systems and insurance

and financial arrangements to

maximize production in dental

practice. (C)





Office Manager

9. Support the program's mission

statement by acting in a manner to

maximize patient satisfaction in a

dental practice. (C)

10.Use and implement accepted sterilization, disinfection, universal precautions and occupational hazard prevention procedures in the practice of dentistry. (C)






11. Provide patient care by working effectively with allied dental personnel, including performing sit down, four-handed dentistry. (C)





Dental Assistant

12. Provide dental care as a part of an interprofessional health care team such as that found in a hospital, institution, or community health care environment. (C)







Hygienist/PCC

13. Demonstrate the application of the principles of ethical reasoning, ethical decision making and professional responsibility as they pertain to the academic environment, research, patient care and practice management.(C)








14. Participate in organized dentistry.(C)






15. Evaluate scientific literature and other sources of information to determine the safety and effectiveness of medications and diagnostic, preventive, and treatment modalities, and make appropriate decisions regarding the use of new and existing medications, procedures, materials, and concepts. (C)







16. Maintain a patient record system that facilitates the retrieval and analysis of the process and outcomes of patient treatment. (C)








17. Analyze the outcomes of patient treatment to improve that treatment. (C)







18. Utilize a system for continuous quality improvement in a dental practice. (P)






19. Use selected business systems in dental practice including marketing, scheduling patient flow, record keeping, insurance financial arrangement, and continuing care systems.(C)





Office Manager

20. Select and use assessment techniques to arrive at a differential, provisional and definitive diagnosis for patients with complex needs. (C)





21. Obtain and interpret the patient's chief complaint, medical, dental, and social history, and review of systems. (P)








22. Obtain and interpret appropriate clinical and radiographic data and additional diagnostic information from other health care providers or other diagnostic resources. (P)






23. Use the services of clinical, medical, and pathology laboratories and refer to other health professionals for the utilization of these services. (P)






24. Perform a limited history and physical evaluation and collect other data in order to establish a risk assessment for dental treatment and use that risk assessment in the development of a dental treatment plan. (P)






25. Diagnose and manage common oral pathological abnormalities including soft tissue lesions. (C)






26. Participate in community programs to prevent and reduce the incidence of oral disease. (C)







27. Use accepted prevention strategies such as oral hygiene instruction, nutritional education, and pharmacologic intervention to help patients maintain and improve their oral and systemic health. (C)






28. Treat patients with a broad variety of acute and chronic systemic disorders and social difficulties including patients with special needs. (C)






29. Develop and carry out dental treatment plans for patients with special needs in a manner that considers and integrates those patient's medical, psychological, and social needs.(C)






30. Perform dental and medical consultations for patients in a health care setting. (C)






31. Use pharmacologic agents in the treatment of dental patients. (P)








32. Provide control of pain and anxiety in the conscious patient through the use of psychological interventions, behavior management techniques, local anesthesia, and oral and nitrous oxide conscious sedation techniques.(C)





33. Prevent, recognize, and manage complications related to use and interactions of drugs, local anesthesia, and conscious sedation. (C)








34. Restore single teeth with a wide range of materials and methods. (P)





35. Place restorations and perform techniques to enhance patient's facial esthetics. (P)








36. Restore endodontically treated teeth. (P)





37. Treat patients with missing teeth requiring removable restorations. (P)







38. Treat patients with missing teeth requiring uncomplicated fixed restorations. (P)







39. Communicate case design with laboratory technicians and evaluate the resultant prostheses. (P)








40. Manage uncomplicated endosseous implant restorations. (C)






41. Diagnose and treat early and moderate periodontal disease using nonsurgical and surgical procedures. (C)






42. Manage advanced periodontal disease. (C)





43.Evaluate the results of periodontal treatment and establish and monitor a periodontal maintenance program. (C)








44. Diagnose and treat pain of pulpal origin. (P)





45. Perform uncomplicated non-surgical anterior endodontic therapy. (P)







46. Perform uncomplicated non-surgical posterior

endodontic therapy. (C)






47. Treat uncomplicated endodontic complications.



(P)





48. Manage complex endodontic complications. (C)








49. Perform surgical and nonsurgical extraction of teeth. (P)








50. Extract uncomplicated soft tissue impacted wisdom teeth. (C)








51. Perform uncomplicated pre-prosthetic surgery.



(C)





52. Perform biopsies of oral tissues. (C)







53. Treat patients with complications related to

intra-oral surgical procedures. (C)






54. Treat patients with intra-oral dental emergencies and infections. (P)







55. Anticipate, diagnose and provide initial treatment and follow-up management for medical emergencies that may occur during dental treatment. (C)







56. Treat intraoral hard and soft tissue lesions of traumatic origin. (C)








57. Recognized and manage facial pain of TMJ origin. (C)








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