Advanced education in general dentistry orientation information

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Introduction 84

Competency and Proficiency Statements 85
Second Year Competency and Proficiency Statements 90
Definitions 91
The Portfolio Evaluation System 94
Competency and Proficiency Statement Certification Sheets 100
Second Year Competency and Proficiency Statements 105
Certificate of Completion of Competency and Proficiency Documentation 106
Summary of Portfolio Evaluation System 107
Acknowledgment Statement 109

Postdoctoral General Dentistry (PGD) programs play an important and expanding role in the education of the nation's primary health care providers in dentistry. These programs build on and complement predoctoral dental education. In these postdoctoral programs, dental school graduates: learn new techniques; become proficient in previously learned techniques; become capable of providing dental care for patients with complex medical, dental, and social conditions; and learn to integrate professional values with various aspects of dental treatment in order to provide long term comprehensive care to individuals and communities of patients.
There is a growing trend in dental education to describe curricula in terms of their impact on students (expressed as competencies) rather than on discipline-based content (expressed as behavioral objectives).3 Such a description focuses attention on the outcome, in terms of graduate’s abilities, of educational experiences, rather than on the process of education. This focus is more likely to create a graduate with the desired skills and to encourage program directors to choose and provide educational experiences that will lead to the development of graduates with those skills.
The director and faculty of the Advanced Education Program in General Dentistry (AEGD) at the University of Maryland, Dental School are committed to incorporating competency and proficiency concepts and evaluation methodologies into the program. This document presents a method for describing graduates of University of Maryland Dental School AEGD program in terms of their abilities and methodologies for assessing those abilities. It is anticipated that this document will be useful for: applicants to the program desiring to know what skills they can expect to gain in the program; residents in the program who will be able to measure their progress and document their accomplishments in the areas of competency and proficiency described; and for the program director and faculty who will be able to use these measures for outcomes assessment and continuous improvement of the program.

The following statements describe the graduates of University of Maryland, Dental School's AEGD program. They are intended to communicate the expectations of the faculty to the resident and serve as the basis for evaluation of resident's satisfactory completion of the program.
In order to facilitate reading this list of statements, certain terms have been predefined so they could be used in the manual without repetitive definition. These definitions are listed in the next section of this manual. In general, the definitions proposed by Chambers and Gerrow5 have been followed, although some new definitions have been added and some definitions modified. In situations where it is expected that the PGD program graduate will be able to, and likely to, actually perform the necessary procedures, the terms "perform", "provide", "restore", or "treat" have been used. In circumstances where the graduate may perform some treatment but is more likely to oversee treatment or refer, the term "manage" is used. The term "appropriate" is not used in these statements to eliminate repetitive verbiage. It is assumed that all knowledge, skills, and procedures described will be performed for appropriate reasons, in appropriate circumstances, and in an appropriate manner. In this manual each statement is designated as either an area of competency (C) in which graduates are expected to have little experience at the beginning of their programs, or as an area of proficiency (P) in which graduates are expected to be competent at the beginning of their programs and gain further experience, skill, and judgment as the program progresses.
A graduate of the University of Maryland, Dental School's AEGD program will:
In regard to planning and providing comprehensive multidisciplinary oral health care

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

  1. 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)

  1. Integrate multiple disciplines into an individualized, comprehensive, sequenced treatment plan using diagnostic and prognostic information for patients with complex needs. (P)

  1. Modify the treatment plan, if indicated, based on unexpected circumstances or patient's individual needs. (P)

  1. Diagnose and manage a patient's occlusion. (C)

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

In regard to health care delivery:

  1. Treat patients efficiently in a dental practice setting. (C)

  1. Use scheduling systems and insurance and financial arrangements to maximize production in dental practice. (C)

  1. Support the program's mission statement by acting in a manner to maximize patient satisfaction in a dental practice. (C)

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

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

  1. 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)

  1. 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)

  1. Participate in organized dentistry. (C)

In regard to information management and analysis:
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 decisions regarding the use of new and existing medications, procedures, materials, and concepts. (P)

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. Understand and use 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)

In regard to oral disease detection and diagnosis:

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 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. (P)
In regard to promoting oral and systemic health and disease prevention:
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. (P)
In regard to assessment of medical risk:
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.

In regard to sedation, pain, and anxiety control:
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)
In regard to restoration of teeth:
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)
In regard to replacement of teeth using fixed and removable appliances:
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)
In regard to periodontal therapy
41. Diagnose and treat early and moderate periodontal disease using non-surgical 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)

In regard to pulpal therapy:
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)

In regard to hard and soft tissue surgery:
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)
In regard to treatment of dental and medical emergencies
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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