advanced general dentistry - University of Maryland, Baltimore

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ADVANCED EDUCATION IN GENERAL DENTISTRY
ORIENTATION INFORMATION
2011 -2012
Director: Douglas M. Barnes, D.D.S., M.S.
Associate Director: Gary J. Kaplowitz, D.D.S., M.A., M.Ed, ABGD
Assistant Director: Ira T. Bloom, D.D.S.
Department of Health Promotion and Policy
Chair: Norman Tinanoff, D.D.S., M.S.
Division of General Dentistry
Division Head: Douglas M. Barnes, D.D.S., M.S.
Baltimore College of Dental Surgery
Dental School
University of Maryland, Baltimore
650 W. Baltimore Street
Baltimore, MD 21201
TABLE OF CONTENTS
Page
I.
General Information ...........................................................................................1
A. Introduction ..................................................................................................1
B. Vision Statement ..........................................................................................1
C. History ..........................................................................................................2
D. Orientation Information ...............................................................................3
a. Purpose and Goals – Philosophy ...........................................................3
b. Year Two Goals and Objectives ............................................................3
E. Responsibilities.............................................................................................4
a. Duties of the Resident .............................................................................4
b. The Teaching Staff Responsibilities .......................................................5
F. Vacations/Leave ..........................................................................................5
G. Sick or Late (Notification) ..........................................................................5
H. Tuition .........................................................................................................5
I. Advanced General Dentistry Faculty and Staff ...........................................6
J. 2011-2012 AEGD Residents........................................................................7
K. Academic Due Process ................................................................................8
II.
Clinic Information ............................................................................................11
A. Malpractice ...............................................................................................11
B. Communication Policy...............................................................................11
C. After Hours Emergencies - Responsibilities .............................................11
D. Operating Hours .........................................................................................11
E. Scheduling of Emergency Patients ............................................................12
F. College Park Clinic Rotation Objectives ...................................................12
G. Cecil County Clinic Rotation Objectives ...................................................12
H. Treatment Plans .........................................................................................13
I. Medical Consults .......................................................................................13
J. Medical Updates ........................................................................................14
K. Dental Hygiene ..........................................................................................14
L. AEGD Dental Assistants............................................................................14
M. Clinic Coordinator .....................................................................................15
N. Communication and Teamwork .................................................................15
O. Monthly Production/Budget Reports .........................................................15
P. Production Report ......................................................................................15
Q. Dental School Medical Emergency Response Protocol.............................16
R. Screening Protocol .....................................................................................18
S. Preliminary Patient Dental Care Needs Assessment Form.........................19
T. Managing and Reporting an Exposure .......................................................20
U. Laboratories ...............................................................................................22
a. Professional Labs ..................................................................................22
b. Lab Prescriptions ..................................................................................22
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c. Dental Lab Cases ..................................................................................22
d. Infection Control ...................................................................................23
e. Time Required .......................................................................................23
f. In-House Adjustments ..........................................................................23
g. Remake Policies ....................................................................................23
V. Restorative Materials Used in the AEGD Clinic .......................................24
W. Air Abrasion and Intra-Oral Camera.........................................................26
a. Clinical Camera .....................................................................................26
b. Itero and Cerec 3D Systems ..................................................................26
X. Documentation and Charts .........................................................................27
a. ATEN Notes ..........................................................................................27
b. Signatures ..............................................................................................28
Y. Guidelines for Completing a Medical Consultation Form .........................29
Z. Outline of Physical Examination (H&PE) .................................................31
AA. Introduction to Treatment Planning ........................................................33
a. Technical Criteria: Format for Comprehensive .................................33
Treatment Plan Work Up
BB. Periodontal Screening & Recording System (PSR) .................................37
CC. Example of Monthly Productive Report ..................................................38
DD. Production Report ...................................................................................39
EE. Treatment Requirements ...........................................................................40
III.
Clinical Forms
A. AEGD Case Complete Record Evaluation ................................................42
B. AEGD Record Evaluation..........................................................................43
C. AEGD Implant Progress Form...................................................................44
D. Scan ............................................................................................................45
E. Request for Medical/Consultation .............................................................46
IV.
Curriculum
A. AEGD Course Organization ......................................................................48
a. Patient Responsibilities .........................................................................48
b. Course Format/Outline...........................................................................48
c. Resident’s Duties and Responsibilities .................................................49
d. Specialty Coverage ...............................................................................49
e. Critiques and Evaluation .......................................................................50
f. Quality Assessment Audit .....................................................................50
B. Advanced General Dentistry Seminar Format ...........................................51
a. Mini Presentation .................................................................................52
b. Literature Review – Abstract Example .................................................53
c. Planned Seminar Objectives in Each Program Area .............................54
d. Case Presentation Format .....................................................................58
e. Curriculum Review/Instructor Feedback Guide ...................................59
f. Example of How Objectives Are To Be Entered in .............................61
The Curriculum Review Form
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V.
Program Evaluation
A. Tri-Annual Resident Evaluation by Faculty Mentor..................................62
B. Overall Clinical Competence .....................................................................63
a.
General Dentistry Check-Off List for ...........................................64
Tri-Annual Resident Evaluation
C. Professional Performance Definitions of Tri-Annual Survey ....................65
D. Treatment Planning/Case Presentation Evaluation ....................................67
E. College Park Dental Clinic Rotation Evaluation Form..............................68
F. Cecil County Rotation Evaluation Form....................................................69
G. Resident Survey of Program ......................................................................70
H. Advanced Education in General Dentistry Faculty Evaluation .................79
I. Advanced Education in General Dentistry Dental Hygiene Evaluation ....80
J. Outcomes Assessment Survey ...................................................................81
VI.
Competencies and Proficiencies For An AEGD Graduate ..............................83
A. Introduction ................................................................................................84
B. Competency and Proficiency Statements...................................................85
C. Second Year Competency and Proficiency Statements .............................90
D. Definitions..................................................................................................91
VII.
Portfolio Evaluation System ............................................................................94
A. Competency and Proficiency Statement Certification Sheets..................100
B. Second Year Competency and Proficiency Statements ...........................105
C. Certificate of Completion of Competency ..............................................106
and Proficiency Documentation
D. Summary of Portfolio Evaluation System for ..........................................107
Completion of a Postdoctoral General Dentistry Program
E. Acknowledgement Statement ...................................................................109
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I.
GENERAL INFORMATION
INTRODUCTION
The program is accredited by the American Dental Association’s Commission on Dental
Accreditation Complaints. Complaints with the Commission can be made by writing or calling
the ADA Commission on Dental Accreditation:
The Commission on Dental Accreditation will review complaints that relate to a program’s
compliance with the accreditation standards. The Commission is interested in the sustained
quality and continued improvement of dental-related education programs but does not intervene
on behalf of individuals or act as a court of appeal for individuals in matters of admission,
appointment, promotion or dismissal of faculty, staff or students.
A copy of the appropriate accreditation standards and/or the Commission’s policy and procedure
for submission of complaints may be obtained by contacting the Commission at 211 East
Chicago Avenue, Chicago, IL 60611-2678 or by calling 1-800-621-8099 extension 4653.
The above Complaints Notice is also posted in select locations of the University of Maryland
Dental School and on the school’s website.
VISION STATEMENT
The Baltimore College of Dental Surgery will build on its tradition as the world’s first Dental
School to become a full partner with the University of Maryland, Baltimore and the University of
Maryland Medical System in achieving eminence in education, science and practice related to
health, with a special emphasis on health of the oral-facial region. Embraced by and subscribing
to the University and System visions, BCDS will be a leader for dentistry in:
developing innovative educational offerings in dentistry and related disciplines;
devising and adopting technological advances in dental education and practice;
producing new basic and applied knowledge;
preparing practitioner-scholars as future leaders;
integrating service activities with the needs of the community;
initiating programs that cross school, university, state and national boundaries;
preparing practitioners and educators capable of functioning competently at the fullest
breadth and depth of their professional areas of expertise; and
influencing oral health care policies.
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In living this vision, BCDS will achieve greater prominence through activities that bring
recognition. Students will find excellent faculty, unexcelled intellectual stimulation and the
opportunity to deliver to patients, high quality and caring treatment. The school’s performance
will exceed the expectations of its supporters. BCDS will continually contribute to the resolution
of health-related problems which plague mankind, and through special concentration in the oralfacial region, improve the quality of life.
HISTORY
The Baltimore College of Dental Surgery, Dental School, University of Maryland has the
distinction of being the first dental college in the world. Formal education to prepare students for
the practice of dentistry originated in 1840 with its establishment. The chartering of the school
by the General Assembly of Maryland on February 1, 1840 represented the culmination of the
efforts of Dr. Horace H. Hayden and Dr. Chapin A. Harris, two physicians who recognized the
need for systematic formal education as the foundation for a scientific and serviceable dental
profession. Together, they played a major role in establishing and promoting formal dental
education, and in the development of dentistry as a profession.
Convinced that support for a formal course in dental education would not come from a medical
school faculty that had rejected the establishment of a department of dentistry, Dr. Hayden
undertook the establishment of an independent dental college. Dr. Harris, an energetic and
ambitious young man who had come to Baltimore in 1830 to study under Dr. Hayden, joined his
mentor in the effort to found the college.
The Baltimore College of Dental Surgery soon became a model for other schools throughout
America. This was due in no small part to BCDS’s emphasis on sound knowledge of general
medicine and the development of the skills needed in dentistry.
The present Dental School evolved through a series of consolidations involving the Baltimore
College of Dental Surgery, founded in 1840; Maryland Dental College, founded in 1873; the
Dental Department of the University of Maryland, founded in 1882; and the Dental Department
of the Baltimore Medical College, founded in 1895. The final consolidation took place in 1923,
when the Baltimore College of Dental Surgery and the Dental Department of the University of
Maryland were combined to create a distinct college of the University under state supervision
and control. As part of the University of Maryland, the Dental School was incorporated into the
University System of Maryland (USM), formed by Maryland’s General Assembly in 1988.
Hayden-Harris Hall, the school building erected in 1970 and renovated in 1990, will be replaced
by an entirely new facility, which opened in September 2006.
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ORIENTATION INFORMATION
THE PURPOSE AND GOALS – PHILOSOPHY
The Advanced Education Program in General Dentistry is an educational program designed to
provide training beyond the level of pre-doctoral education in oral health care, using applied
basic and behavioral sciences. Education in this program is based on the concept that oral health
is an integral and interactive part of total health. The program is designed to expand the scope
and depth of the graduates’ knowledge and skills to enable them to provide comprehensive oral
health care to a wide range of population groups.
The goals of the one-year program should include preparation of the graduate to:
1.
Act as a primary care provider for individuals and groups of patients. This includes:
providing emergency and multidisciplinary comprehensive oral health care; providing
patient focused care that is coordinated by the general practitioner; directing health
promotion and disease prevention activities, and using advanced dental treatment
modalities.
2.
Plan and provide multidisciplinary oral health care for a wide variety of patients
including patients with special needs.
3.
Manage the delivery of oral health care by applying concepts of patient and practice
management and quality improvement that are responsive to a dynamic health care
environment.
4.
Function effectively and efficiently in multiple health care environments within
interdisciplinary health care teams.
5.
Apply scientific principles to learning and oral health care. This includes using critical
thinking, evidence or outcomes-based clinical decision-making and technology-based
information retrieval systems.
6.
Utilize the values of professional ethics, lifelong learning, patient centered care,
adaptability, and acceptance of cultural diversity in professional practice.
7.
Understand the oral health needs of communities and engage in community service.
Two Year Program Goals and Objectives
The two year AEGD program incorporates all the goals and objectives of the one year program
and is designed to expand the educational opportunities offered by:
1.
2.
3.
4.
5.
gaining experience in managing highly complex comprehensive dental care;
improving clinic management skills;
pursuing areas of individual concentration, e.g.: temporomandibular disorders, public
health dentistry, special patient care, etc;
*providing residents with an interdisciplinary graduate foundation in the biological and
clinical sciences for careers in dental research and/or education and the practice of
dentistry;
*gaining teaching experience, performing original research and earning an optional
Masters of Science degree if indicated.
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* This is only the Masters tract. Not all Year II residents are enrolled in Masters
coursework or do research.
Note: In order to achieve the above, a personal camera and computer are strongly recommended
for each resident. The program has an intraoral video camera to aid in case
documentation.
RESPONSIBILITIES
DUTIES OF THE RESIDENT
Each resident shall:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Provide professional comprehensive care and treatment to assigned patients; keep a
complete record of activity, maintain a portfolio.
Maintain at all times the highest professional conduct with respect to patients, faculty and
support staff.
Consult with faculty members when arriving at a diagnosis and treatment plan.
Function under the supervision and guidance of the teaching staff.
Develop the ability to assume increasing independence. As a result, a greater amount of
responsibility will be placed on your clinical judgment as the year progresses.
Manage all treatment plans for assigned patients, maintain primary responsibility for
discussing treatment cost with each patient, and utilize one of the acceptable protocols for
the collection of all fees (see Clinic Manual).
Assume responsibility for following your patient’s financial accounts; render treatment
only after payment is assured.
Attend all regular and special dental meetings.
Review and sign the Attendance Policy.
Review and follow Policies of the Clinic Manual, Medical Emergencies, Infection
Control and OSHA policies (www.dental.umaryland.edu). Select “Current Students”,
then, Policies – Clinic Manual.
Residents are assigned an email address. Emails are used as a means of communication.
Residents should check their emails on a daily basis.
Support the On-Call Service by responding to pages.
Read and understand UMB Dental School Academic Due Process Policy found on page 8
of the manual.
Residents will participate in the Journal Club and other academic activities.
Each resident will be responsible for formally presenting a completed comprehensive
case at the end of the year. Format found on page 58.
Residents must correct their Missing Charges Reports on a bi-weekly basis. Reports are
to be return to the Business Office within 5 days. Failure to comply may result in a
Judicial Board violation and the resident may be subject to suspension of clinical
privileges.
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THE TEACHING STAFF RESPONSIBILITIES
1.
Be fully aware of the philosophy and objectives of the Advanced General Dentistry
Program.
2.
Present seminars, lectures, conferences, journal clubs; attend treatment planning
seminars, and engage in other research and service.
3.
Review charts of patients assigned to residents to assure their accuracy and
comprehensiveness. Countersign charts. Perform quality assessment audits.
4.
Discuss patient evaluation, treatment planning, management, complications, and
outcomes of all cases with residents.
5.
Supervise residents in clinical sessions, pre-approve extractions, removable deliveries
and fixed cementations.
6.
Serve as a role model by being involved in the active treatment of patients.
7.
Attend all staff meetings scheduled that involve them.
8.
Be current in all disciplines of clinical general dentistry.
9.
Screen new AEGD patients.
VACATIONS/LEAVE
Residents are granted the following:
Holidays: Independence Day, Labor Day, Thanksgiving Break, Winter Break, Dr. King’s
Birthday, Spring Break and Memorial Day. In addition, the residents are allowed 10
vacation/sick/personal leave requests.
Requests for personal days shall be submitted in writing, for approval, to the Director AT
LEAST THREE WEEKS in advance of the anticipated dates (unless an emergency situation
exists). If approved, it is the responsibility of the resident taking leave to do the following:
1. Make sure that no conflicting assignments exist and all assigned duties are completed
(i.e.: seminar chairperson).
2. Notify the receptionist concerning patient scheduling.
3. Ten days of leave is allowed. These days may be used for sick, personal or vacation.
4. Promptness and attendance are critical to maintaining schedules. Repeated tardiness
and/or absences will not be tolerated. Any missed time past the ten days of allowable
leave will need to be made up before receiving a certificate.
SICK OR LATE (NOTIFICATION)
1.
Residents should notify either Ms. Chenowith, Dr. Barnes or Dr. Kaplowitz, if they are
going to be late or out sick.
Sharon Chenowith – 410.706.4156 (office); 443.504.8292 (cell)
Dr. Douglas Barnes – 443.271.2194 (cell)
Dr. Gary Kaplowitz – 443.504.8292 (cell)
TUITION
Tuition for the Master’s program is charged to the master track resident.
All residents are paid a stipend. Stipends vary from year-to-year and are discussed during the
interview process.
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ADVANCED GENERAL DENTISTRY
FACULTY AND STAFF
2011 - 2012
Dr. Robert Sachs, Perio/Prosthodontist
Dr. John Savukinas, General Dentist
Dr. Elliott Schwartz, General Dentist
Dr. Keith Schmidt, General Dentist
Dr. Nahid Shahry, General Dentist
Dr. Robert Shub, General Dentist
Dr. Dennis Stiles, General Dentist
Dr. Bradley Trattner, Endodontist
FACULTY
Dr. Douglas Barnes, Director
Dr. Gary Kaplowitz, Associate Director
Dr. Ira Bloom, Assistant Director
Dr. Qoot Alkhubaizi, General Dentist
Dr. Carol Anderson, General Dentist
Dr. Norman Bartner, General Dentist
Dr. Jeffrey Behar, General Dentist
Dr. Lawrence Blank, General Dentist
Dr. Jane Brodsky, General Dentist
Dr. Dennis Byrne, General Dentist
Dr. Paul Bylis, General Dentist
Dr. Mark Choe, General Dentist
Dr. Harvey Cohen, General Dentist
Dr. Howard Cohen, Endodontist
Dr. Jeffery Cross, General Dentist
Dr. Richard Englander, General Dentist
Dr. Karen Faraone, Prosthodontist
Dr. Bryan Fitzgerald, Periodontist
Dr. Charles Foer, General Dentist
Dr. Sidney Fogelman, General Dentist
Dr. Adam Frieder, General Dentist
Dr. David George, General Dentist
Dr. Edward Grace, General Dentist, TMD
Dr. Richard Grubb, General Dentist
Dr. Nadia Kamanagar, General Dentist
Dr. Steven Kurdziolek, General Dentist
Dr. Albert Lee, General Dentist
Dr. Marvin Leventer, Dental Anesthesiology
Dr. Harold Levy, General Dentist
Dr. Mitchell Lomke, General Dentist
Dr. Michael Mann, General Dentist
Dr. Richard Miller, General Dentist
Dr. Nadia Kamangar, General Dentist
Dr. Dmitry Nova, General Dentist
Dr. Wayne O’Roarke, General Dentist
Dr. Se Lim Oh, General Dentist
Dr. Mary Passaniti, General Dentist
Dr. Jeffrey Rajaski, General Dentist
Dr. Steven Rattner, General Dentist
STAFF
Sharon Chenowith, Office Manager
DENTAL HYGIENE
Karen Taylor, Supervisor
Jelinda Blum
DENTAL ASSISTANTS
Denise Loverde, Supervisor and Clinic
Coordinator
Anita Brown
Armenita Davis-Bentley
Wanda Johnson
Bridget Johnson-Ingram, CMS
Debbie Marshall
Latonya Owens
Jamal Robinson, CMS
Tashauna Spears
Asia White
Lauren Wilson
FRONT DESK
Miriam Dyson, Screening Coordinator
Janet Campbell
Victoria Jones
Rita Mason
Debbie Mitchell
Sarah Montgomery
Julia Thalwitzer, Accounting Clerk
RESEARCH
Patricia Warren, Research Coordinator
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University of Maryland Dental School
Advanced Education in General Dentistry
2011-2012 AEGD Residents
YEAR I
Dr. Aqdar Akbar
Dr. Sheila Arbabi
Dr. Fana Aragaw (Part Time)
Dr. Adrian Batchelor
Dr. Nada Binmadi
Dr. Alex Fishman
Dr. Sara Franz
Dr. Hussein Irhama
Dr. Sanaz Izadi
Dr. Vilija Mickute
Dr. Khalid Mutawalli
Dr. Neal Patel
Dr. Maria Salnik
Dr. Jonathan Soistman (Part Time)
Dr. Aaron Tosky
YEAR II
Dr. Oluwayemisi Akinrefon
Dr. Yaqoub Al Abwah
Dr. Weam Alfouzan
Dr. Bassam Algheryafi
Dr. Munawer Al Houli
SCHOOL
Kuwait University
University of Maryland
University of Maryland
University of Maryland
King Abdulaziz University
University of Maryland
University of Maryland
University of Pacific
University of Maryland
University of Maryland
Cairo University
University of Maryland
University of Maryland
University of Maryland
University of Maryland
DATE OF GRADUATION
2009
2011
2011
2011
2003
2011
2011
1999
2011
2011
2007
2011
2011
2011
2011
2010
2007
2007
2005
2000
Dr. Asma Buhamrah
Dr. Brynne Reece
Dr. Mohammad Sabti
University of Maryland
University of Missouri-Kansas City
King Saud University
King Saud University
St. Petersburg, Pavlov State
Medical University
University of Dundee
University of Maryland
Kuwait University
YEAR III
Dr. Awdah Al Thunayyan
Kuwait University
2006
DIAMOND SCHOLAR PROGRAM
JULY 1, 2011 – JUNE 30, 2012
Ms. Jordan Bauman
University of Maryland
Ms. Lisa D’Affronte
University of Maryland
Ms. Kristen Nelson
University of Maryland
Ms. Diana Shoe
University of Maryland
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2002
2010
2009
6/17/03
Academic Due Process Policy
Advanced Dental Education (ADE) Programs
Dental School, University of Maryland, Baltimore
All matters of professional ethics and conduct that involve ADE students will be referred to the
Judicial Board of the Dental School for adjudication. The ethical and conduct standards for
student enrolled in ADE programs are identical to the standards of conduct for students enrolled
in the pre-doctoral and dental hygiene programs. Judicial Board matters are not governed by
the policy contained in this document. An Advanced Dental Education student who believes he or
she has been harassed on the basis of his/her sex shall be referred to the UMB Policy on Sexual
Harassment of Students, VI-1.20(B).
I. Academic Standards
A. Students in ADE Programs are expected to maintain high levels of academic success.
Academic dismissal from an ADE Program can result from failure to achieve a Program’s
requirements or failure to meet minimal levels of academic achievement as they are defined in the
Catalog of the Baltimore College of Dental Surgery. Clinical competence in all areas of patient
management and treatment constitutes a vital sector of academic achievement. A student must
maintain a B (3.0) or better overall average to remain in good standing. If the student’s performance
falls below this level of performance he/she will be placed on academic probation during the
following semester. In the event that the student’s overall average remains below a 3.0 at the end of
the semester of probation, he/she will be dismissed from the Program. All failing and incomplete
grades must be rectified before a certificate is conferred.
B. Faculty will provide feedback to students in all matters related to didactic and
clinical performance. This feedback can be oral or written, but must be in writing, at appropriate
intervals, as determined by each Program's accreditation standards noted under "Evaluation."
Program directors will ensure that each ADE student receives a copy of the Program’s
Accreditation Standards as part of the program orientation for new residents.
II. Unsatisfactory Performance
A. Unsatisfactory performance in knowledge, skills, clinical competence and/or
patient management may be documented in several ways, and corrective actions or sanctions can
range from oral or written counseling to dismissal from the Program. The process for such
actions is as follows:
1. Initial notification of a deficiency/problem can be addressed orally by the program
director or the faculty identifying the problem. After so doing, a dated notation will be placed in
the student's file by the program director.
2. Should the problem continue, or new problems develop, the student will be sent a
letter or counseling form by the program director, identifying the deficiency/deficiencies and
required actions to be taken by the student to correct the deficiency/deficiencies. A time period
8
for correcting the deficiency/deficiencies will be specified. A copy of the counseling form will
be kept in the program or course director's file, and a copy will be sent to the Assistant Dean for
Research and Graduate Studies. The student should acknowledge receipt of the letter or
counseling form by signing the original and returning it to the program director. The letter or
counseling form will be placed in the student's file. The student should keep the copy for future
reference.
3. Should student performance still not improve, the program director, or program’s
designate acting in (his/her)stead, will notify the student in writing that he/she will be placed on
academic probation. Actions required of the student and a time line (not exceeding those of
academic probation noted above) to correct the deficiency/deficiencies will be detailed in the
letter. The student must sign the letter, keep a copy for his/her files and return the original letter
to the program director, who will place the letter in the student's file. Copies will be sent to the
department chair and the Assistant Dean for Research and Graduate Studies.
4. If the student fails to rectify the deficiency/deficiencies in the time specified, the
program director, in consultation with the program faculty, will recommend dismissal from the
program to the department chair, the Assistant Dean for Research and Graduate Studies, and the
Advanced Dental Graduate Education (ADGE) Committee. The ADGE Committee will review
the recommendation for dismissal.
III. Review
A. The student will be given the opportunity to be heard by the ADGE Committee on the
recommendation for dismissal by offering his/her own statements, and, if appropriate, testimony
of witnesses and presentation of evidence. The ADGE Committee may choose to call for further
testimony and documents. Hearsay evidence is admissible only if corroborated. Any irrelevant
or unduly repetitive evidence will be excluded. If the student fails to appear for his/her hearing
without good cause, he/she will be deemed to have waived his/her right to meet with the ADGE
Committee.
B. Following its review and any subsequent meetings, the ADGE Committee will
conduct its deliberation and make a decision on the basis of a majority vote. If the ADGE
Committee determines that the student should be dismissed, the recommendation will be
forwarded to the Dental School’s Faculty Council for action. In the case of dismissal decisions,
the Assistant Dean for Research and Graduate Studies will notify the student in writing that s/he
has been dismissed from the Program.
C. The Assistant Dean for Research and Graduate Studies shall maintain the
documentary evidence from the hearing for at least 4 years from the date of the hearing. The
student may obtain a copy of the record upon paying the cost of reproduction.
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IV. Appeals Process
A. In the event that the student elects to appeal the dismissal decision, the student may
not take part in any academic or clinical activities of the program until and unless action on the
appeal reverses the decision for dismissal.
B. If the student disputes the dismissal, he/she may contact the Program Director within
five business days of notification of dismissal for informal discussion. Should the student
remain dissatisfied, the student may file a formal appeal.
C. A student wishing to file a formal appeal of a dismissal decision must initiate the
appeal process regarding dismissal from the Program within 10 business days of receiving the
written notification. The appeal must be submitted in writing to the Assistant Dean for Research
and Graduate Studies. The written appeal must include: the decision the student is appealing; the
specific ground for the appeal (only newly discovered evidence or lack of due process); and the
academic status that the student is requesting. The student may present and prioritize more than
one alternative to dismissal from the Program.
D. The Assistant Dean for Research and Graduate Studies will review the appeal and
designate a three person Appeals Panel. Faculty who have been substantially involved in this or
any other decision or actions against the student prior to dismissal are excluded from the Panel.
Where possible and practical, the Panel will consist of three members of the full-time faculty.
The Assistant Dean for Research and Graduate Studies will appoint one of these three as
Chairperson of the Appeals Panel.
E. The Chairperson will then schedule a meeting with the members of the Panel within 5
business days when possible or practical. The Panel will determine whether the student's written
appeal meets the criteria outlined in C. and report their decision in writing to the Assistant Dean
for Research and Graduate Studies. Should the Panel determine that an appeal lacks the required
evidence, the appeal will be denied. In these circumstances, there is no further appeal.
F. If the Panel determines that newly discovered information, not originally considered
by the ADGE Committee does exist, then the matter should be referred back to the ADGE
Committee for reconsideration.
G. If the Panel determines that there was a failure of due process, an appeal on the record
will be heard. The decision of this Panel will be final. The student and the Assistant Dean for
Research and Graduate Studies will be notified of the decision in writing.
Approved by Dental School Faculty Council: April 8, 2003
Approved by University Counsel: June 19, 2003
Approved by Dean: June 30, 2003
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II.
CLINIC INFORMATION
MALPRACTICE INSURANCE
Malpractice Insurance is provided by the program and is only for patient care provided in the
school.
COMMUNICATION POLICY
1.
2.
3.
4.
Residents are required to provide a contact number (cell phone number is preferred).
There is no overhead pager system.
Residents should respond to pages promptly (ideally within 5 minutes, more than 15
minutes is considered not answered).
Residents will be provided with a University of Maryland e-mail address which will
become the official e-mail address for Program communication.
Residents should review their University of Maryland e-mail account at least once a
day and Friday afternoon before leaving work. E-mail will be the primary source of
non-urgent communication.
AFTER HOURS EMERGENCIES - RESPONSIBILITIES
1.
2.
3.
4.
All residents must be accessible (24 hours/7days a week) in order to manage
treatment of your emergency patients during non-clinic hours (cell phone number is
preferred).
Handle all “emergency” telephone inquiries from your assigned patients (provide a
referral if necessary or a prescription).
Contact either Dr. Kaplowitz (443.683.2456), Dr. Barnes (443.271.2194) or Ms.
Chenowith (443.504.8292) for assistance as required.
The next work day, after the emergency care, the AEGD Office Manager will pull the
chart to ensure that the resident makes an entry and have it co-signed by a faculty
member.
OPERATING HOURS FOR AEGD CLINIC
1.
2.
3.
4.
Patient appointments are 8 am to 4 pm, except on Wednesdays when we will have
extended hours. Residents are required to arrive by 7:30 am and not to depart until
4:30 pm.
CLINIC Schedule
First Patient – 8 am to 9:30 am
Second Patient – 9:30 am to 11 am
Third Patient – 11 am to 12 noon
LUNCH – 12 pm to 1 pm
Fourth Patient – 1 pm to 2:30 pm
Fifth Patient – 2:30 pm to 4 pm
The 3rd Session Day will be on Wednesdays–clinic hours will be extended until 7 pm.
The 3rd session will start at 4 pm.
11
SCHEDULING OF EMERGENCY PATIENTS
1. If emergency patient is assigned to a resident, anyone in the TEAM will see the patient if
there is an opening.
2. Emergency patients will be given any empty slot in the appointment schedule with any
available resident.
3. If there is no empty slot, the TEAM captain will decide who will see the patient.
UNIVERSITY OF MARYLAND - COLLEGE PARK DENTAL CLINIC ROTATION
OBJECTIVES
1. Function effectively as part of the Health Center staff, interacting with other departments
through consultation, committee participation, etc.
2. Demonstrate in-depth understanding of the organization, functioning and responsibilities
of the medical staff; and the organization and functioning of the dental department within
the Health Center structure.
3. Plan and provide multidisciplinary oral health care for a particular population including
HIV patients.
4. Understand the oral health care needs of the community and engage in community
service.
5. Utilize the values of professional ethics, lifelong learning, patient centered care,
adaptability, and acceptance of cultural diversity in professional practice.
See page 68 for College Park Dental Clinic Rotation Evaluation form.
UNIVERSITY OF MARYLAND – CECIL COUNTY ROTATION OBJECTIVES
1. The Perryville clinic is a collaboration between Union Hospital, Cecil College, Harford
and Cecil County Health Department, the University of Maryland Dental School, the
Robert Wood Johnson Foundation and the Health Services Research Administration.
2. The clinic’s conception arose out of concerns from Cecil County school nurses
regarding the numbers of children that they saw with dental issues.
3. The Dental School will be renting space from Union Hospital in one of several medical
buildings that will be at this site. The first building will house the dental clinic on the
second floor and medical imaging on the first floor.
4. The dental facility will have 26 chairs, as well as study areas for students.
5. The scope of practice will be limited to treating poor children and poor elderly adults.
6. The practitioners will be dental residents (4), dental students (8), and dental hygiene
students (8).
7. In addition the site will serve as a clinic for a satellite dental hygiene program in
collaboration with Cecil Community College. Initially, there will be eight dental
hygiene students taking their third and fourth year training at this site.
8. The projected start date for the clinic is mid-July.
See page 69 for Cecil County Clinic Rotation Evaluation form.
12
TREATMENT PLANS
1.
All treatment plans must be reviewed by an attending and signed by the patient,
resident and attending before any restorative treatment can begin.
2.
In treatment planning cases, especially if they are complex, residents must first collect
all necessary data, including mounted diagnostic casts. Sometimes, diagnostic waxups may be required and patient can be charged for it. There is no charge to the
patient if the wax-up is done for the resident’s benefit, unless wax-up is done by
outside laboratory (only if approved by the faculty).
3.
Format for treatment planning is discussed on pages 31-36.
4.
Residents are expected to have a treatment plan written out before approaching an
attending for evaluation. By presenting the case in such a manner, a more meaningful
discussion will emerge. Always bring mounted casts, x-rays and the chart for
treatment planning.
5.
A sequenced treatment plan should be written after final attending approval and
discussion.
6.
All treatment plans must be entered into Axium and swiped by attending faculty.
7.
When a comprehensive treatment is completed and prior to entering the patient into
the recall system, a chart audit (record review) and case complete audit must be
performed (see pages 42, 43).
MEDICAL CONSULTS
For medically compromised patients where dental treatment plans will need to be altered due to
patient condition, a medical consult form must be filled out. Residents will send the information
request via the patient to the medical doctor. The patient will then return the form to the resident
and it will be added to the patient’s dental chart. An example of a medical consult form maybe
found on pages 46-47. Any ASA III and IV patient requires a medical consult and medical
clearance prior to dental treatment.
When residents are phoning medical doctors for patient consults, it is advised that the resident
prepare in advance what to say. In general, the resident should include the following:
1. Identify yourself (DDS, Dental Resident at UMAB) and your patient.
2. State the known health condition of the patient.
3. Describe the dental procedures planned. Medical doctors tend not to have a detailed
understanding of these procedures; thus, account the details of the surgery, the extent of
bleeding predicted, the intended local anesthetic or medication to be used, and/or the
possible effects of the dental treatment on the patient.
4. Specifically ask the information required from the medical doctor. Examples: “Should
antibiotic prophylaxis be administered prior to dental therapy?” “Is the use of
epinephrine in the local anesthetic contraindicated?” Avoid asking too general a
question like, “Is there anything that should concern me about the patient?”
5. Document discussion in the Progress Notes of the patient’s record and ask for written
documentation from attending physician.
13
MEDICAL UPDATES
Medical updates form should be completed for every patient who has not been in the AEGD
Clinic in the last one year and shall be co-signed by a faculty member. It should be resident’s
customary question to ask about any changes in patient’s medical condition in every visit.
DENTAL HYGIENE
An integral part of the AGD family are the hygienists; they provide oral care instructions,
prophylaxis treatment, debridements, and fluoride treatments and placement of Arestin. These
services are available via (1) completed prescribed treatment plans and/or (2) appointed recall
visits with the hygienist. Treatment plans are to be comprised of full mouth probings and
chartings and radiographs annually. During the recall, the hygienists uses the PSR system for
record bleeding points (see page 37).
Hygiene visits can commence prior to or in conjunction with restorative appointments. At
completion of the hygiene visit a recall card is completed to be mailed at the appropriate interval
as a reminder for the patient. There are also hygiene products available for application or by
prescription or for purchase via the clinic.
AEGD DENTAL ASSISTANTS
We, the assistants welcome you to AEGD. We are looking forward to working with you during
this next year. Listed below are items that you can expect from us as a group each and every
day:
I.
Chair Setup – You will be completely setup for your patient (cassette, medicaments,
disposable handles, etc.). This can only be accomplished with schedules posted and
procedures noted. During the course of the day, residents could be expected to cleanup
and setup their own chairs.
II.
Chairside Assisting – There is not an assistant for each resident. Assistants will be able
to help residents during the critical part of the procedure. (Mixing and placing of
amalgams, mixing impression materials, placing of composites, etc.). Surgeries always
have first priority.
III.
Screening – If a resident is doing screening on any day, the assistant in that zone will
help with the charting. The resident will be expected to take the necessary radiographs.
IV.
Radiographs – Assistants will take PA’s and BW if available. Residents will take FMS.
V.
Rubber Dam – The assistants are asking the residents to use the rubber dam whenever
they can. This will help the resident during the procedure, especially when they won’t
have an assistant available.
VI.
Become Familiar with Layout – We are asking residents to know what is in cluster
cabinets in your zones and what is in the drawers at your chairs.
14
CLINIC COORDINATOR
The Clinic Coordinator provides patient support services that are both efficient and caring.
1. Acts as a patient advocate, acquainting patients with policies and procedures relevant to
their care and helping them navigate the system as necessary. Provides excellent
customer service to internal and external calls regarding information, treatment and
special needs. Responds to patient concerns and forwards concerns to the program
director as necessary.
2. Provides individualized coordination of care; when necessary, reviews chart to monitor
patient clinical progress.
3. Assesses outcomes of care; analyze complaints to determine trends. Surveys patient via
questionnaires; resolve complaints.
4. Assists students with patient management.
COMMUNICATION AND TEAMWORK
These are the items you can expect from the assistant on a day-to-day basis. The key to a great
relationship between residents and assistants is communication. Talk to your assistant. Let them
know if there is a change in your schedule. Communicate to them what time you will really need
their assistance. The more we talk to one another, the easier the day will flow.
MONTHLY PRODUCTION REPORT/BUDGET REPORT
Each resident receives a Monthly Production Report so that they can monitor their productivity.
The resident is responsible for maintaining this record in their portfolio. (See page 38.)
PRODUCTION REPORT
This report is given monthly to the resident to monitor procedures completed by ADA codes.
The resident is responsible for maintaining the record in their portfolio. (See page 39.)
15
Dental School Medical Emergency Response Protocol
When assistance is needed (after no response from a verbal outcry), leave to get help after
reassuring the victim that you will return as quickly as possible:
1.
2.
During the Normal Business Hours of Monday through Friday 8:00AM – 5:00 PM;
Tuesday, Wednesday and Thursday (C-3 Clinic) 5:00PM – 7:00 PM :
A.
For Immediate Life-Threatening Emergencies, or Serious Behavioral
Incidents:
(1)
Use a clinic phone to call Campus Police by dialing 711 (DO NOT dial 9
first). Campus Police will call for an ambulance if needed, and/or send
officers to assist.
(2)
Follow a call to campus police with an immediate page for the Dental
School Emergency Response Team (follow ‘Protocol for Dental
School Emergency Response Team Paging’ below).
B.
For Non Life-Threatening Emergencies:
(1)
Page the Dental School Emergency Response Team only
C.
For A Glucometer Test or Blood Pressure Verification on an Asymptomatic
Patient:
(1)
Members of the Emergency response team can be paged individually at
the pager numbers listed at the bottom of this page. Nurses are to be
paged before the Doctor.
After Normal Business Hours or when there is no nurse coverage or no nurse
available:
A.
Use clinic phones to call 711 (campus police will call for an ambulance or come
to assist as needed).
B.
Report the incident to a Dental School nurse verbally or by email at the earliest
opportunity.
Protocol for Dental School Emergency Response Team Paging:
1.
The Emergency Response pager number is programmed into the speed dial location
on clinic wall phones, and is marked as “Emergency” and highlighted in pink.
A.
From a non clinic phone within the building, page using the number
9-410-389-1324.
2.
After triple beep tone, enter the nearest room/quad # where the emergency is occurring
(exceptions: ground floor -enter letter G as zero; for example: G205 would be 0205;
CMS on lower level -enter 777).
3.
Emergency responders will report to the room/quad & provide treatment.
Before Responders Arrive:
1.
If bodily fluids present and/or victim is coughing, don the appropriate PPE
2.
The first responder will act as “captain” and direct interventions until a more qualified or
experienced individual arrives to take over that role.
A.
Position victim so as to protect from further injury on the floor or in a dental
chair.
16
(1)
B.
C.
If patient is feeling faint or has fainted, lower head of chair and/or raise
feet unless doing so might cause further injury.
If campus police have been called to send an ambulance, designate a person to
alert the guard in the atrium lobby, and to assist the EMTs to the emergency.
If possible bring, or have someone bring the Emergency Cart/Oxygen tank into
the room/quad (located outside clinic prep area or in some side hallways off
main corridors).
(1)
Start oxygen with a nasal cannula for oxygen support at 2-4 L/min, or
with a non-rebreather mask, if the patient is distressed due to shortness of
breath, at 10-15L/min.
(2)
Provide treatment if trained; at minimum assess ABC’s (Airway,
Breathing, and Circulation).
(3)
Start CPR if necessary – Don’t wait for the response team!
Members of the Emergency Response Team include, but are not limited to the following
individuals who will be alerted when the emergency pager number 9-410-389-1324 is activated:
Personal Pager # Phone # Room
1. RN II (Oral Surgery Nurse) (9-410-389-1334) 6-4026 1326
2. RN II (Infection Control Nurse) (9-410-389-1298) 6-6344 4317
3. LPN (Dental School Nurse) (9-410-389-1331) 6-7496 2318
4. Dr. Idzik-Starr (9-410-389-1332) 6-4010 OMS
5. Dr. Leventer (9-410-389-0729) 6-2470 2470
Reviewed 4/15/2011
17
SCREENING PROTOCOL
1. Patient calls or stops in
2. Screening person explains the procedure
a.
Treatment to be performed (exam and x-rays ONLY)
b.
Cost
c.
NON-refundable/ NON-transferable fee of $70.00
3. The letter is given or mailed to the patient
4. Payment of $70.00 is made in person or mailed
5. Screening appointment is arranged 30 minutes prior to the actual appointment time
6. Confirmation of appointment by post card and/ or telephone call
7. The actual screening visit consists of reviewing personal information and verifying
insurance; obtaining patient’s medical history, charting the whole mouth and attaining
signatures from patient, resident and faculty.
CHART IS REVIEWED BY FACULTY AND COUNTERSIGNED IN THE
APPROPRIATE AREAS:
1. Continuation Sheet (gray)
2. Medical (pink)
3. O M Screening form (yellow)
4. Radiation Control Log (white)
GOAL:
Entry into the clinic system, review dental concerns and formulate a treatment plan.
APPOINTMENTS
Mondays, Wednesdays (8am to 12pm)
8am – 9am; 10am; 11am
Thursdays (1pm to 4pm)
1pm; 2pm; 3pm
SCREENING ROTATION
July thru December – Resident keeps all patients.
January thru April – Resident can keep patient or refer to Clinic Coordinator for other
assignment.
18
PRELIMINARY PATIENT DENTAL CARE
NEEDS ASSESSMENT
Patient Information
Patient Name__________________
Available (circle): M
T W Th F
Date of Assessment:_______________
Age:___________
Dentsyst #_________________
Home Phone:_________Work Phone:____________
Specific Areas of Needed Dental Care:
Urgent Care:
( ) Deep Caries
( ) Amal. Core ( ) Dent. Rep.
( ) Fract. Tooth
( ) Other:
Periodontics:
( ) Class I
( ) Class II
(
Oral Surgery:
( ) Urgent
( ) Surgical
(
Endodontics:
( ) Urgent
( ) Caries Control
(
General Dentistry:
( ) Anterior Caries
( ) Posterior Caries
(
Fixed Prosthodontics:
( ) Ant. Crowns
( ) Post. Crowns
(
Removable Prosthodontics:
U= upper
L=lower
( ) Reline
( ) Repair
(
Orthodontics:
( ) Space/Crowding
( ) Crossbite
(
The above were checked ( ) without
( ) with
( ) Interim PD
) Class III
( ) Class IV
) Biopsy
( ) Pre-Prosth.
) Single Root
( ) Multi Root
) Simple TP
( ) Complex TP
) Ant. Bridge
B=both
) Complete
( ) Post. Bridge
( ) Partial
) Tipped Abutment
( ) General
radiographs
Comments/ Special Management of Patient: ________________________________________________________
Screening Faculty Signature:_______________________
Initial Case Disposition
1.
2.
Assign to:
( ) Pre-Doctoral ( ) Clerkship
( ) Postgraduate
( ) Endo Only ( ) Ortho Only
( ) AEGD
( ) SPC
Assign to Oral Surgery first, then: ______________________________________________
Final Case Disposition
Assign to: ______________________________ Dentsys: ____________ GP:___________
Signed: __________________________________________________ Date:__________
Revised 10/01/94 mfr
01.03011
19
UMB Dental School
Managing and Reporting an Exposure to Blood, and Other Potentially Infectious Materials
Student Procedure1.
If an exposure has or may have occurred:
A.
Immediately remove the instrument or tool that resulted in the exposure from the
instrument tray, so it is not reused (if reused, a DOUBLE exposure has occurred)
2.
DO NOT DISMISS THE SOURCE PATIENT/INDIVIDUAL:
A.
If the source individual has been dismissed, maintain his or her contact
information.
(1)
A Dental School Nurse will contact the source patient to set up an
appointment when he or she can return for blood testing as follow up to
the exposure incident.
B.
If there is no nurse available proceeded with steps 3, and 4 below, but in step 5
skip to C.
3.
Remove gloves (do not throw them away if exposure to hands is believed to have
occurred, but a glove breech is not obvious):
A.
Put gloves in a separate small red bio-hazardous waste disposal bag so they can be
checked to verify that a puncture occurred (perform first aid as applicable;
described in step 4 below, then check glove for leak as needed).
(1)
Don PPE and carefully fill glove(s) with water, twist open end to seal, and
apply pressure as you observe for a leak. (If glove has a hole in it, an
exposure took place, even if there is no wound on the hand.)
4.
Provide first aid to the exposed area:
A.
Wash any wounds briskly with soap and water, apply disinfectant and bandage as
needed.
B.
Flush eyes and mucous membranes with clear cool water for 15 minutes.
5.
Report the exposure, or double exposure:
A.
Monday through Friday prior to 5pm:
(1)
Contact a Dental School Nurse to report the exposure. Patient Care Coordinators
can help.
(2)
If a Dental School Nurse cannot be contacted by any other means, page the
emergency response team from one of the clinic phones; follow instructions
posted on the pink sign above the wall phone, or use pager number 9-410-3891324 and enter nearest room/quad#.
B.
Tuesday, Wednesday and Thursday (C-3 Clinic) from 5pm to 7pm only:
(1)
Page the nurse using the emergency response team pager number
9-410-389-1324 entering nearest room/quad #, or use a clinic wall phone
and follow instructions posted on the pink sign above the phone.
C.
If there is no nurse coverage or no nurse available:
(1)
Go to one of the nurses offices (Room 2318 or Room 4317).
(2)
Take a student injury packet for instructions on how to contact the
Needlestick Hotline, or page the Needlestick Hotline @ 8-2337; ID #7845
and enter a 9 digit call back number. You may use the nurse’s phone and
phone number.
(3)
Stay near the phone until someone returns your page & they will advise
you how to proceed.
20
(4)
6.
After reporting to the Needlestick Hotline (step (2) above), return to your
patient and ask if he or she would be willing to return for a free,
confidential blood test for HIV, Hepatitis B and Hepatitis C
(OSHA/MOSH protocol). If pt. agrees, notify dental school nurse the
next business day, with the time the patient will return.
(5)
Always report the details of the incident to the dental school as soon as
possible (email notification is acceptable).
Complete paperwork necessary for dental school injury/exposure reporting:
A.
Complete Report of Special/Adverse Incident from inside Student Injury Packet,
and submit it to a nurse.
B.
Report incident Online at http://incident.umaryland.edu\ (user name is: dental\
followed by your first initial and last name with no spaces between; password is:
your dental school PC password). Follow online report with a verbal or email
report to a nurse, if a dental school nurse was unavailable at the time of the
exposure incident.
Staff Procedure- Follow Student Post Exposure Guidelines steps 1. through 6. listed above.
1.
In addition, the incident will need to be reported to Environmental Health and
Safety (EHS) so that a claim number can be assigned for Workers’ Compensation. All of
the necessary forms for State and Corporate Employees and Dental School
Volunteers are located in a bin on the nurses’ office doors (Rooms 2318 and 4317).
A.
State Employees can also go to the UMB EHS website
http://www.ehs.umaryland.edu/riskmgmt/InsuranceManual/med_treat.cfm for the
necessary forms to be filed electronically, or printed and faxed immediately, or as
soon as possible
B.
Corporate Employees - may download forms from the UMB EHS website
http://www.ehs.umaryland.edu/riskmgmt/InsuranceManual/med_treat.cfm
(1)
Forms for Corporate Employees are not to be sent to UMB EHS.
(2)
Forms need to be submitted immediately to the Corporate HR Manager
in Cubical 6425 in the Dental School Building.
C.
Volunteers need to complete a Report of Special/Adverse Incident (in
appropriately labeled yellow folder in bin on nurse’ office door) and a JE
Authorization form (in appropriately labeled blue folder).
Reviewed 4/15/2011
21
LABORATORIES
PROFESSIONAL LABS
1.
Friendship, Empire and Americus dental labs handle the Dental School’s fixed and
removable prosthodontic cases.
2.
Microdental Lab may be used for involved esthetic cases.
LAB PRESCRIPTIONS
1. Please make sure all necessary information is present in the prescription for the lab to
complete the case. Residents sign the prescription and then it must be countersigned by
the attending faculty.
2. Laboratory prescriptions must also have the signature of the office manager in order to
ensure that a minimum of 50% payment was made. The lab will not process the case
without these signatures, nor will they do so without the patient name and chart number.
3. Any laboratory prescription involving new technology products and an alternative
laboratory should be approved by the Director.
The Dental School is moving towards an electronic lab tracking system which the AEGD
program is testing. Access Axium Links for up-to-date information.
DENTAL LAB CASES
1.
All lab work for AEGD department is submitted to the Dental School in-house labs. This
work will be routed to an outside lab. Any case that needs to be glazed and polished will
be completed in the in-house lab.
3.
Lab pans are used to store active lab cases going to removable and fixed labs. When the
case is delivered, please empty and return the lab pan. All old models, impressions,
yellow and white prescription forms should be thrown away.
3.
The AEGD department uses the Dental School prescription form. All copies should be
attached to the lab pan. All cases must be signed out before going to the dental labs (4:00
pm on prior day).
4.
All impression, wax and metal try-in’s must be disinfected before going to the labs and
indicated on prescription form.
5.
Cases that are ready to be sent to the lab, should be placed in bags and left on the lab cart
inside the clinic conference room #2312.
6.
All lab cases must be signed by a faculty member and the office manager, prior to being
sent out to the lab.
7.
Fixed, Remo and Ortho lab cases are delivered and picked up once a day at
approximately 9 a.m.
8.
Incoming lab cases are signed in; then placed on the lab cart inside the clinic conference
room #2312.
22
9.
To expedite the process of having your case returned to you as quickly as possible, please
be sure to include the date forward, the date of return, and the clinic’s letters (AEGD) on
your prescription form. Also, start your day count for your case to be returned on the
next working day. Don’t forget to exclude holidays and clinic closings.
10.
Mr. Rick Baier is the Dental School’s Prosthodontics Lab Supervisor.
11.
Name and date all study models.
12.
Check your lab shelf at least twice a day, every day for returned lab cases for dies that
need to be trimmed, MD Bridge designs, RPD designs, etc.
13.
Prepare for patients who may need lab work at their next appointment by checking your
patient schedule, and their charts at least 2 days prior to their next appointment.
INFECTION CONTROL
1.
Note that impressions MUST be properly disinfected and bagged prior to delivery to
the labs. The laboratory form must be labeled “disinfected”.
2.
Remove gloves and wash hands BEFORE entering the lab area.
TIME REQUIRED
1.
Both fixed and removable cases require pre-set working days depending on the
complexity of the case. Rushing cases may not be possible, so schedule the patient
accordingly: (Laboratory time requirements are posted within the AEGD clinic).
2.
Please note that fixed cases that returned to the resident for final die trimming and
identification of margins using a red pencil.
IN-HOUSE ADJUSTMENTS
1.
University of Maryland is fortunate to have in-house lab technicians who can do
minor adjustment procedures; i.e., glazing a crown.
REMAKE POLICIES
1.
A re-make request form must be completed and signed by a full time faculty and the
office manager before the case can be sent back to the lab. This is to verify the need
for the re-make and to determine the onus of the financial responsibility.
2.
It is advised to remake impressions if remaking crown/bridge cases so as to avoid
repeating the same error.
3.
All items from the first case must be returned to the lab, including the models and
rejected restorations.
23
RESTORATIVE MATERIALS AND
EQUIPMENT USED IN THE AEGD CLINIC
AMALGAM
Sybraloy
FastSet
TEMPORARY CROWN MATERIAL
A. Acrylic/Jet Alike
B. Resin
Integrity
C. Inlays
Fermit
COMPOSITE
TPH 3
Esthet X-Flowable
GLASS IONOMERS
A. Class V
Ketac
B. Build Ups
FluoroCore II
KetacFil
C. Liner
Vitrebond
CEMENTING SYSTEMS
A. Without Bonding
Zinc Phosphate
Duralon
Fuji Cem
B. With Bonding
Panavia F
Calibra
Variolink
Smart Cem II
BONDING AGENTS
Prime + Bond NT
Clearfil Repair
Photo Bond
PORCELAIN OR COMPOSITE
VENEERS, INLAYS AND ONLAYS
Variolink
Calibra
Smart Cem II
SEALANTS
DeltonLC
BLEACHING SOLUTIONS
A. In Office
*White Speed JumpStart
*Night White
*Zoom
B. Home Treatment
Night White Excel 16%
DESENSITIZING AGENTS
Gel Kam
Protect
Duraphat
SE Bond
POST AND CORE MATERIAL
FluoroCore II
Amalgam
TPH Composite
ParaPost
Flexi-Post
Impression Posts/Cast Post
24
HEMOSTATIC SOLUTIONS
Hemodent
Visco Stat Plus
IMPRESSION MATERIAL
Alginate
Reprosil
Aquasil
BITE REGISTRATIONS
Blu-Mousse
Duralay
Regisil
RELINE MATERIALS
GC Reline (soft)
Coe-Soft (soft)
Coe-Comfort (soft)
UfiGel (hard C)
TEMPORARY CEMENTS
Duralon
IRM
Temp Grip
ENDO SUPPLIES
Ept, EndoIce
Apexlocator (RootZX)
SS and Profile GT Files
SealAPex
CaOH2
Cavit
IMPLANTS
3i Implant
ITI (Straumann)
Camlog
Nobel Biocare
MISCELLANEOUS
Perio: freeze dried bone
Graft material, endogain,
Goretex membranes
Cerec
Laser – Soft Tissue
Interra Chairside Occlusal Guard
25
AIR ABRASION
1.
2.
An air abrasion unit is available and it can be moved into the clinic as required.
Unless familiar with the apparatus, a resident’s first use should be under close
supervision of an attending who is comfortable with the equipment.
Some of the many applications for air abrasion are:
a. Removal of stains
b. Preparation of pit and fissures prior to sealants
c. Preparation of cavity preps that are small, including cervical abrasion sites
d. Micro-etching porcelain for composite repairs
e. But, NOT for amalgam removal
CLINICAL INTRA-ORAL CAMERA
There is one conventional clinical camera and an intraoral video camera available for
documenting cases.
Residents must purchase a digital media compact flash (256 mb) for their own use.
ITERO AND CEREC 3D Systems
The AEGD clinic has an Itero system and Cerec 3D system. Training will be provided before
the resident can use the system.
26
DOCUMENTATION AND CHARTS
Patient Chart Entries: All Patient Record entries require the use of the
Assessment/Treatment/Evaluation Next Appointment (ATEN) system.
Standardized Format for Progress Notes
A standardized format for Progress Notes will be used for all patient record entries, except for
Oral Surgery that already uses a standardized SOAP note. The “data elements” and “examples”
of the Progress Note format are shown below.
Data Elements of Progress Note
A: Assessment – reason for visit; pt. health/medical management considerations; consent
T: Treatment – concise and detailed description of procedures performed and medications
E: Evaluation – appraisal of treatment; patient’s reaction to treatment; extenuating circumstances
N: Next Visit – specific plans for next visit
Examples of Progress Note
Date
A: Patient presents for tx of occlusal caries on #19; no Changes in med. hx. since 1/15/99; pt.
understands risks of today’s tx and reaffirms consent.
T: Mandibular block with 1.8 cc 2% Xylocaine; 1:100,000 epi.; rubber dam; #19 occlusal
caries removal, CaOH2 (Dycal), Vitrebond, amalgam (Contour) restoration.
E: Patient apprehensive as usual regarding local anesthesia; deep caries approaching
pulp, but no exposure; patient advised that tooth could need endodontic therapy;
treatment completed.
N: 6 month recall, check for caries progression on mesial of #3 by radiograph.
Student Signature & #
Faculty Signature & #
Date
A: Patient presents for SC/RP of ULQ; reports new RX, nifedepine for hypertension; BP right
arm sitting: 145/80; pt. understands risks of today’s tx and reaffirms consent; plaque score:
65%.
27
T:
Reinforced home care instructions, showed patient literature on gingival hyperplasia
associated with nifedepine; local infiltration in area of #14 with 0.5ml of 2% Xylocaine
with 1:100,000 epi.; ultrasonic removal of gross calculus followed by hand curette
scaling and root planing; irrigated DL pocket of #14 with sterile saline.
E:
Patient understands risk for hyperplasia, showed extra motivation to follow home care;
7mm pocket DL #14 difficult to complete instrumentation due to furcation; revaluation
required.
N:
Next visit 10/27/99: URQ SC/RP, whole mouth polish and fluoride; check tissue
response and finish RP of distal furcation #14 before starting URQ.
Student Signature & #
Faculty Signature & #
1. At the end of each appointment period, all clinical services rendered during the
appointment must be recorded on the "Continuation Sheet" of the patient's chart. This
form must have a signature (no initials) and Provider Number recorded by the instructor
supervising the student during the appointment period. An entry in Axium must be made
for each appointment.
2. Using the ATEN system of chart entries, the following information should be listed in
the continuation notes: 1) date, 2) department, 3) tooth number, 4) diagnosis, 5)
treatment listing all restorative materials (with brand names following each in
parenthesis), 6) use of rubber dam, 7) appropriate remarks and/or post-operative
instructions listed under E (Evaluation). Standard accepted abbreviations maybe used.
Students and faculty must sign every entry and included their provider number.
SIGNATURES
1.
2.
3.
All Daily Treatment Records MUST have an attending signature before the end of
the day. Treatment Plans should have three signatures: patient, resident, and
attending before treatment can begin.
Prescriptions for narcotic-based medications must be signed by a Maryland licensed
dentist who has a DEA number.
Prescriptions for the laboratory work must be signed by the resident, the financial
officer, and the faculty.
28
GUIDELINES FOR COMPLETING A MEDICAL CONSULTATION FORM
A.
Reasons For Requesting a Medical Consultation
1.
Clarification of a specific condition or a specific drug therapy
2.
Clarification of a condition that may require pre-operative antibiotic coverage
3.
Requesting specific
a.
Laboratory test results, or
b.
Complete findings from a recent complete physical examination
B.
Providing Information to the Consulting Healthcare Practitioner
1.
Oral diagnoses
2.
Use language suitable to the knowledge of the other healthcare provider
3.
Include all oral diagnoses
4.
Include some indication of the severity of each diagnosis
a.
i.e. “moderate to severe” periodontitis
b.
“1.5 cm.” squamous cell carcinoma with “associated
lymphadenopathy”
C.
Advising HCWs About Recommended Dental Treatment
1. Include all foreseeable forms of treatment that may be employed
a.
All procedures that will cause significant bacteremia (e.g. deep
scaling, C&B cord, etc.)
b.
All procedures that involve mucogingival surgery
1)
Biopsies, exodontia, implant placement
c.
All modes of anesthesia
1)
Local anesthetic; regional block anesthesia
2)
N2O, IVSD, general anesthesia
d.
Drug therapies: antibiotic pre-meds, antibiotic management of perio
dx, alteration of Coumadin, Amicar
2. This is the most important part of any medical consultation request
a.
It establishes, for the physician or other HCW, that you have been
careful
in:
1)
Taking a thorough patient history
Assessing the patient’s simple or complex medical status, AND MOST
IMPORTANTLY
3. That you have appropriately analyzed the significant medical factors in the
patient’s history and FORMULATED A SPECFIC SET OF RELEVANT
QUESTIONS.
4. All medical consultations should be narrowly tailored to ask specific medical
management questions that call for specific objective answers.
29
5. Only if the objective data is particularly open to a fairly wide range of clinical
judgment, should an opinion on that objective data be expressly requested by the
dentist and given by the consulting physician or other HCW.
6. Better medical consultations identify the dental management problem for the
physician to consider, in the first line of this section, and then suggest a specific
management approach to be used to ameliorate the problem.
7. Example: 72 y.o. AA female è h/o MI x 3, CABG, and A-fib, on Coumadin.
a. Must have patient’s
INR  2.0-2.5 to proceed. If pt.’s INR is higher, we would normally D/C
Coumadin 2 days prior to tx, do stat PT/INR the AM of tx, and resume
Coumadin at the next scheduled dose. OK?
Please report the pt.’s most recent INR and advise.
8.
It is extremely important that a medical consultation reflects the patient’s
comprehensive needs so that repeated consults are not required because the
dental practitioner failed to think through potential medical complications
which may arise with different modalities of treatment.
9.
Telephone consults are strongly discouraged!
a. They should be limited to clarification of the physician’s recommendation,
if it is illegible or contrary to regular regimens employed throughout
Dentistry or Medicine.
b. For example, chronic renal failure patients on hemodialysis may require a
different antibiotic for SBE prophylaxis, and/or a different dosing regimen
than other patients.
c. A contemporaneous note in the chart should summarize this clarification
of the initial consult.
D.
The following patients may be unable to reliably relate their medical histories:
1.
Elderly
2.
Those suffering dementia or Parkinson’s disease
3.
Developmentally Challenged; Special Needs Patients
4.
Mentally Disable (psychosis patients)
5.
In these cases, the only reliable method for determining relative safety
to treat is the Complete Physical Examination findings.
6.
The Complete Physical Examination
7.
Interpreting the Findings for Relative Safety to Treat the Dental
Patient
8.
Who Cannot Reliably Relate a Medical History.
30
OUTLINE OF PHYSICAL EXAMINATION (H&PE)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Vital signs: Temperature, pulse, blood pressure (both arms), respiratory rate. These
observations need not be repeated under their respective subheadings.
General appearance: state of orientation; development, state of nutrition, degree of
discomfort, cooperativeness, other conspicuous general characteristics of appearance
(including dress, neatness, behavior, gait and posture).
Skin: color, temperature, texture, moisture, eruptions, ecchymoses or petechiae, hair
distribution, nails. Significant scars.
Head and face: Conformation, symmetry, abnormal movements, signs of injury,
tenderness.
Eyes: extraocular movements, sclerae, conjunctivae, pupils, (size, equality,
regularity, reaction to light and accommodation), gross vision and visual fields.
Ears: pinna, external canal, tympanic membrane, gross hearing, mastoids.
Nose: obstruction, discharge, septal perforation or deviation. Sinus tenderness.
Mouth: breath, mucous membranes, teeth, tongue, tonsils, faucial pillars, postnasal
drip.
Neck; stiffness, masses, venous distention, abnormal pulsations, thyroid, position of
trachea; carotid bruits.
Lymph nodes: size, consistency, tenderness, and mobility of cervical,
supraclavicular, axillary, inguinal. (All nodes may be described here, or the regional
nodes may be described with appropriate areas as examined.)
Thorax: configuration, AP diameter, symmetry, and amplitude of motion.
Breasts: masses, tenderness, discharge from nipples, areolae.
Lungs:
Inspection: respiratory excursion, rhythm, symmetry.
Palpation: fremitus (tactile).
Percussion: resonance, lung borders and descent.
Auscultation: breath sounds, spoken and whispered voice sounds (vocal fremitus),
rales, friction rubs.
Heart:
Inspection: Precordial movements, precordial bulging.
Palpation: apex impulse and PMI, thrills, shocks.
Percussion: Heart borders, sternum.
Auscultation: rhythm, heart sounds, murmurs (include left lateral position and sitting
in full expiration), friction rubs, extracardiac.
Abdomen:
Inspection: contour, engorged veins, protrusions, umbilicus, visible peristalsis.
Percussion: Hepatic, splenic, bladder dullness, gaseous distention, shifting dullness.
Auscultation: peristaltic sounds, vascular bruits.
Palpation: tenderness, rebound tenderness, rigidity, fluid wave, liver, spleen, kidney
masses, hernias. If liver or spleen are palpable, note character or edge.
Costovertebral tenderness.
Spine: Vertebral curvatures, mobility, tenderness.
31
16.
17.
18.
19.
Extremities:
Joints: swelling, effusion, deformities, tenderness, increased warmth, mobility.
Clubbing, cyanosis, edema. Calf tenderness, Homan's sign. Character and equality of
radial, femoral, posterior tibial and dorsalis pedis pulses; sclerosis of arterial walls;
abnormal venous structures (varicosities, telangiectases).
Neurological: A limited or screening neurological examination is part of every routine
physical examination. When positive findings make a more complete study necessary,
the complete examination is done. Mental status; gait and station, abnormal movement;
cerebellar signs; cranial nerves; muscle strength, atrophy, fasciculations; sensation:
touch, pain, vibration, position sense; reflexes: (biceps, triceps, Hoffman, abdominals,
cremasterics, knee jerks, ankle jerks, plantar); meningeal irritation (nuchal rigidity,
Kernig's sign).
Genitalia:
a.
Male: penis, scrotum, testes, epididymis, spermatic cord. Discharge, inguinal
canals.
b.
Female: speculum examination of vagina and cervix, palpation of uterus and
adnexa. papa smears, culture when indicated.
Rectal: External hemorrhoids, fissures.
Digital: Sphincter, hemorrhoids, prostate, seminal vesicles (or uterus and cervix), Feces
(description of gross appearance) and test for occult blood.
* Summary
Concise summary of relevant points in history and physical examination.
* Formulation
This is intended to alert the reader to the basis on which the diagnoses were made and the
direction in which the work-up will process.
It is a statement of what the leading diagnoses are, which diagnoses you favor and why,
how you will differentiate between the likely diagnoses and a general approach to
therapy, if there is a presumptive diagnosis.
Diagnosis:
Plans for further investigation and management:
32
INTRODUCTION TO TREATMENT PLANNING
TECHNICAL CRITERIA:
FORMAT FOR COMPREHENSIVE TREATMENT PLAN WORK UP
I.
II.
History (S)
A.
Chief Complaint (CC)
1.
It should be a symptom - record the patient’s impression of
disease/problem in his/her own words.
B.
History of Present Illness (HPI)
1.
Record details of chief complaint and related complaints - history of chief
complaint.
C.
Past Medical History (PMH)
1.
Record health history of systemic conditions, injuries, and hospitalizations
in detail - medical consultation is present, if indicated.
a.
Childhood diseases
b.
Serious illnesses/transfusions
c.
Family health history which may bear on patient’s present or future
health status
2.
Allergies and sensitivities
3.
Current medications
4.
Review of systems (ROS)
D.
Environmental/social history
1.
Describe in detail any environmental factors that could impact on
diagnosis and treatment planning, i.e., alcohol intake, tobacco usage,
vocation, finances, etc.
E.
Dental History
1.
Describe in detail the patient’s awareness of and involvement in previous
dental treatment.
2.
Family dental health history (parents, siblings, spouse, children)
3.
Oral hygiene habits
Examination - Findings; list problems requiring attention, all of these must be addressed
in TX sequence; charting must be complete - (O)
A.
B.
List general observations and systemic findings - age, vital signs, skin, limbs,
development nutrition.
Record oral and extraoral findings: perform a thorough examination of the head,
neck, face, and oral tissues.
1.
Head, neck, eyes, ears, nose, skin and secretions
2.
Lips, oral mucus, palate, pharynx, tongue and floor of mouth
3.
Gingival - color, texture, consistency, contour, amount of keratinized
tissue, bleeding; details of periodontal condition on appropriate form
33
4.
5.
6.
Occlusion/musculature - a general statement of condition; details on
appropriate form
Dentition - a general statement of condition; details on appropriate form
Oral hygiene - a general statement of condition; details on appropriate
form
C.
Radiographic Findings
1.
Obtain indicated radiographs which may include the following:
a.
periapical films (full mouth survey)
b.
posterior bitewing films
c.
panoramic film
d.
any necessary supplemental films
D.
Microscopic - if indicated, obtain a phase contrast evaluation of microflora
NOTE: The case is mounted on an articulator, all required radiographs,
laboratory and clinical tests are obtained.
III. Diagnosis - (A)
A.
List disease processes and abnormalities that address all pertinent findings.
1.
Systemic diagnosis
2.
Dental diagnosis
IV. Treatment Objectives - (A)
A.
Make a general statement of the desired goals of treatment taking into account the
findings, the patient’s situation and the resources of the practitioner. List
considerations:
1. Patient health
2. Patient desires
3. Patient age
4. Patient financial restraints
5. Prognosis (long and short term)
6. Provider skills
V.
B.
Devise ideal (long-term) treatment objectives and immediate objectives (if
applicable) that will support the ideal; formulate a segmented (progressive)
treatment plan. Discuss all treatment options with the patient.
C.
All fees for all treatment must be listed when the treatment plan is presented to
the patient.
Planned Treatment Sequence - (P)
(The Written Treatment Plan)
A.
A planned, well organized sequence of treatment is listed according to treatment
phases that addresses all diagnosis and pertinent findings; materials to be used and
34
alternate treatment plans are listed; best treatment plan for that individual patient
is presented.
B.
Order of treatment (Enter Each Phase - e.g., If N/A Enter “Phase 1 - N/A”)
1.
Systemic phase
Systemic health considerations. Consult with physician when in doubt.
Determine need for premedication, diet, precautions to protect patient and
dental team, etc.
2.
Urgent phase
Treat problems of acute pain, bleeding, lost restorations, etc.
3.
Hygienic phase (most import phase - steps necessary to control disease)
for this specific patient generally in the order listed:
a.
Patient education and instruction in plaque control; fluoride
program
b.
Biopsies if necessary
c.
Preliminary gross scaling - if necessary
d.
Caries control, and endodontic therapy
e.
Extraction of hopeless teeth. Temporary CPD’s and RPD’s if
needed.
f.
Root planning
g.
Maintain plaque control
h.
Preliminary occlusal adjustment if indicated
I.
Minor tooth movement/orthodontic treatment
j.
Occlusal splints if indicated
k.
Definitive occlusal adjustment when necessary
l.
Continuous evaluation of oral hygiene and tissue response, and
reassessment of the entire treatment plan
4.
Corrective phase: correct environment to allow patient to maintain good
oral hygiene
a.
Hemisections with temporary splinting
b.
Periodontal surgery, bone and soft tissue grafting
c.
Treatment of hypersensitive teeth
d.
Implants
e.
Restorative dentistry (should wait at least two months following
extensive surgery)
f.
Recheck and refine occlusion
5.
Maintenance phase:
a.
Re-examine for effectiveness of plaque control, recurrence of
periodontal disease, caries, and occlusal problems: reinforce oral
hygiene instruction, perform prophylaxis including topical fluoride
application. Recall based on the specific patient’s needs.
b.
Complete periodic radiographic survey of the dentition if
indicated. Compare with prior radiographs
c.
Recheck prosthetic treatment
d.
Treatment of any active periodontal disease
e.
Treatment of recurrent carious lesions
35
f.
g.
h.
Endodontic therapy if pulpal and/or periapical lesions have
developed or not resolved
Replacement of restorations which no longer satisfy health,
function or esthetic requirements
Make new occlusal splints when old ones are broken down, worn
out or lost
VI.
Prognosis
1.
State a prediction, based on an educated calculation, of the response of hard and
soft tissue to the treatment planned, both long and short term.
VII.
Signing the Treatment Plan
1.
The patient must sign the treatment plan prior to any treatment being rendered.
This is to establish that the patient accepts the treatment plan. The resident and
faculty member should also sign the treatment plan.
36
37
EXAMPLE OF MONTHLY PRODUCTION REPORT
Actual
Revenue
March
Budget
Variance
Revenue
Budget
Actual
Charges
March
Budget
Variance
YTD
Budget
YTD
Actual
Revenue
YTD
Budget
Variance
$3,800
$2,665
($1,145)
$3,800
$2,983
($817)
$29,100
$19,415
($9,685)
$3,800
$3,562
($238)
$3,800
$3,984
$814
$29,100
$32,389
$3,289
$3,800
$3,721
($79)
$3,800
$1,724
($2,076)
$29,100
$24,059
($5,041)
$3,800
$3,001
($799)
$3,800
$4,323
$523
$29,100
$20,914
($1,846)
$3,800
$5,006
($1,206)
$3,800
$6,783
$2,983
$29,100
$31,535
$2,435
$3,800
$3,954
$154
$3,800
$4,570
$770
$29,100
$27,254
($1,846)
$3,800
$2,051
($1,749)
$3,800
$2,118
($1,682)
$29,100
$14,694
($14,406)
$3,800
$4,431
$631
$3,800
$5,155
$1,355
$29,100
$32,348
($3,248)
$3,800
$5,119
$1,319
$3,800
$7,278
$3,478
$29,100
$27,100
($2,100)
$3,800
$3,984
$184
$3,800
$5,656
$1,856
$29,100
$19,414
($9,686)
$3,600
$4,105
$505
$3,600
$13
$27,000
$23,517
($3,483)
$3,600
$1,398
($2,202)
$3,600
$893
($2,707)
$27,000
$18,047
($8,953)
$3,400
$2,181
($1,219)
$3,400
$1,415
($1,985)
$25,500
$15,573
($9,927)
$3,400
$2,967
($433)
$3,400
$3,341
($59)
$25,500
$15,573
($9,927)
$3,200
$2,620
($580)
$3,200
$3,401
$201
$24,000
$14,580
($9,420)
$3,200
$3,351
$151
$3,200
$1,889
($1,311)
$24,000
$17,904
($6,096)
$3,200
$3,174
($26)
$3,200
$3,007
($193)
$24,000
$21,092
($2,908)
$3,200
$4,472
$1,272
$3,200
$4,925
$1,725
$24,000
$23,198
($802)
$3,200
$1,426
($1,774)
$3,200
$1,392
($1,808)
$24,000
$10,164
($13,836)
$3,200
$1,324
($1,876)
$3,200
$1,421
($1,779)
$24,000
$17,004
($6,996)
Revenue
Provider
Budget
March
Resident
38
$3,613
PRODUCTION REPORT
Treatment Details by Provider from 02-Nov-2003 to 30-Nov-2003
AGD-R- AGD Resident Activity
Provider
ROO327-Mel G
Procedure
D0120-Periodic oral evaluation
D0140-Limited oral eval-prob focused
D0150-Comprehensive oral eval
D0210-Intraoral-complete series
D0220-Intraoral-periapical 1st film
D0274-Bitewing-4 films
D0330-Panoramic film
D1110-Prophy-adult
D1351-Sealant-per tooth
D2330-Resin-based comp-1 surf, ant
D2331-Resin-based comp-2 surf, ant
D2332-Resin-based comp-3 surf, ant
D2335-Resin-based comp-4+ surf, ant
D2391-Resin-based comp-1 surf, post.
D2392-Resin-based comp-2 surf, post.
D2393-Resin-based comp-3 surf, post.
D2759.1-Start Procedure
D2751.1-Start Procedure
D2940-Sedative Filling
D2950-Core buildup-including pins
D2954-Prefab post and core
D33191,1-Start Procedure
D3320.1-Start Procedure
D3320.2-Complete Procedure
D3320-Endo therapy-bicuspid
D4263-Bone repl graft – 1st site/quad
D4-266-Guided tissue regen-resorb
D5110.1-Start Procedure
D5214.1-Start Procedure
D5630-Repair or replace broken clasp
D5640-Replace teeth-per tooth
D6240.1-Start Procedure
D6750.1-Start Procedure
D7140-Extraction, eruptd tth/exp rt
D9430-Office visit-observation only
D9972-External bleaching-per arch
R00327-Mel G Totals
39
TX#
2
3
16
9
3
3
1
3
2
8
10
2
3
3
1
2
2
1
1
1
1
1
2
2
2
1
1
1
1
1
1
2
2
11
1
2
RVU
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4.00
48.00
90.00
22.00
42.00
18.00
9.00
22.00
0.00
0.00
2.00
14.00
5.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.00
0.00
0.00
0.00
0.00
0.00
4.00
Amount
60.00
135.00
720.00
720.00
51.00
117.00
75.00
171.00
66.00
520.00
750.00
200.00
363.00
225.00
95.00
240.00
0.00
0.00
45.00
119.00
140.00
0.00
0.00
0.00
750.00
90.00
385.00
0.00
0.00
105.00
70.00
0.00
0.00
803.00
28.00
290.00
108
282.00
7,333.00
Treatment Requirements
Resident Name:
Page 1 of 2
Provider Number:
Pt. Name & No.
Tx
Date
Tx
Plan
Prep
Impression
Temp
BW
Cementaion
Final Signature
Complete
1
2
3
Pt. Name & No.
Tx
Date
Tx
Plan
Dx. Cast
Impression
VDO
Wax Try-In
Delivery
Final Signature
RPD
Pt. Name & No.
Tx
Date
Tx
Plan
Surveyed
Prep &
VDO
Wax Try-In
Delivery
Final Signature
Dx. Cast
Impression
Start Film
M. Cone
Film
Final Film
Fix
1
2
3
1
2
3
ENDO
1
2
3
Pt. Name & No.
Tx
Date
Tx
Plan
Access
Simple
Extraction
Pt. Name & No.
Tx
Date
Tx
Plan
Start Check
Final Check
1
2
3
40
Final Signature
Final Signature
Treatment Requirements
Resident Name:
Page 2 of 2
Provider Number:
Pt. Name & No.
Tx
Date
Tx
Plan
Start Check
Final Check
Final Signature
Filling
1
2
3
Pt. Name & No.
Tx
Date
Tx
Plan
Start Check
Final Check
Final Signature
Post
1
2
3
Pt. Name & No.
Tx
Date
Tx
Plan
Post Space
Cementation
Surgical
Extraction
1
2
3
Director Signature:
41
Core
PA
Final Signature
III.
CLINICAL FORMS
42
43
44
SCAN
PATIENT NAME:
DATE:
REFERRING DOCTOR:
Address:
FEE: $350.00 Patient Scan
Guide
$100.00 for separate scan of prosthesis for Nobel
(Procera Software)
AREA OF SCAN:
Mandible
Both
Patient to wear Radiographic Guide:
YES
NO
Guide to be scanned separately:
YES
NO
Data Conversion:
Both
Maxilla
DICOM Multifile
I-CAT VISION
(for Simplant or Procera software)
(with data conversion)
Patient to be given DATA DISK:
YES
address)
___________________________________________
Doctor’s Signature
Date
45
NO
(if no – please list mailing
REQUEST FOR MEDICAL/CONSULTATION FORM
46
47
IV.
CURRICULUM
ADVANCED GENERAL DENTISTRY COURSE ORGANIZATION
1.
II.
Patients - You are responsible for all phases of patient care.
A.
Necessary documentation for complete cases and case presentations (monthly
and end of year case conferences)
1. six basic photographs - intraoral anteriors, right and left posteriors (retracted
and unretracted); mandibular and maxillary occlusals; and full face (lips in
repose – profile); (photographs only for case presentations)
a. masticatory system assessment
b. periodontal chart, plaque index
c. full mouth radiographs and panoramic
d. complete verified dental record
e. medical history updated - blood pressure
f. consultations if applicable
g. written treatment plan
h. mounted study casts
B.
Accept patients from other departments or residents only after going through
AGD faculty first.
C.
Type of patients you will be treating:
1. carry over from previous years, there will be a very small amount
2. emergency patients.
3. two multidisciplinary cases
4. “Least experience” areas in which you desire more exposure
5. list of patients who are available on short notice
6. follow-up patients who present interesting clinical situations
7. minor teeth movement cases
8. radiation, infectious disease, and special patients
Course Format/Outline
A.
Seminars/Literature Review/Case Conferences (every Monday afternoon 1:00PM
to 5:00PM)
1.
2.
3.
4.
5.
6.
7.
8.
planning and providing comprehensive multidisciplinary oral health care
patient assessment and diagnosis
hard and soft tissue surgery
periodontal therapy
pulpal therapy
restoration of teeth
replacement of teeth using fixed and removable appliances
pediatric dentistry/orthodontics
48
9. practice management
10. Miscellaneous
a. obtaining informed consent
b. promoting oral and systemic health and disease prevention
c. sedation, pain and anxiety control
d. treatment of dental and medical emergencies
e. medical risk assessment
11. Digital Dentistry – Cerec/Iterro
12. Esthetic Dentistry
III.
Duties and Responsibilities
A.
Administrative Duties
1. Become proficient with Axium (Dental School’s computer program).
2. Complete accurately filling out all appropriate documentation
3. Portfolio
4. Treatment plans on all patients signed by faculty, resident and patient and
entered into Axium.
5. Financial/Insurance forms
6. Assistant evaluations
7. Complete Implant Programs/Order Forms
8. Complete Quality Assessment Audits and chart audits
B.
Miscellaneous Responsibilities
1. The physical upkeep and cleanliness of the clinic spaces is the responsibility
of everyone. Each week a resident will be assigned responsibility for the
cleanliness of the laboratory. If you see areas needing attention, report them
to the dental assistant supervisor. IF YOU MAKE A MESS, ESPECIALLY
IN AREAS LIKE THE LABORATORY, YOU ARE RESPONSIBLE FOR
THE CLEAN UP.
2. Most laboratory work will be sent to the Restorative Dental Laboratories. All
work must be accompanied by a completed laboratory form, signed by an
instructor. *Must be signed off by the office manager once financial
arrangements have been made. 50% must be paid before work is sent to the
lab.
IV.
Specialty Coverage (see posted Faculty Coverage Schedule)
A.
B.
C.
D.
E.
F.
Periodontics - specified times/on call
Prosthodontics - specified times/on call
Endodontics - specified times/on call
Orthodontics - on call if needed
Oral Surgery - specified times/on call
All others available on call through AGD staff
49
V.
VI.
Critiques and Evaluation By Residents
A.
Critiques by Residents
1.
Curriculum Review/Instructor Feedback forms on short courses, lectures
and seminars
2.
Complete an on-line program critique at the end of the year.
3.
Faculty Evaluation by students.
4.
Tri-annual critique of program by residents found in the tri-annual
Evaluation of Resident.
5.
One year post graduation follow-up critique/outcomes assessment (recent
resident survey).
6.
Exit interview with Dental School administration
a.
quality and relevance of classroom instruction
b.
quality and relevance of seminars
c.
quality and amount of clinical instruction
d.
clinical and laboratory support
e.
staff’s approach
f.
faculty’s approach
B.
Critiques by Faculty
1.
Tri-annual evaluation of resident
2.
Quality Assessment Audit
Quality Assessment Audit - One mechanism of outcome measurement is to regularly
evaluate the degree to which goals and objectives of the Advanced General Dentistry
program are being met.
A. Purpose:
1.
2.
To assess the quality of work being performed
To verify the timely and sequential delivery of treatment as prescribed by
a formal treatment plan developed by residents and faculty.
B. Mechanism:
1.
To be performed at a final appointment, upon completion of treatment of
comprehensive care patients and prior to placement into the recall system,
or at any time at the discretion of the faculty or request of the resident.
2.
At least one faculty member and resident will:
a. Review chart to insure uniformity of organization and presence of all
appropriate forms (chart audit).
b. Review post-treatment radiographs if indicated.
c. Completely fill out quality assessment audit sheet and file in portfolio.
50
ADVANCED EDUCATION IN GENERAL DENTISTRY SEMINAR FORMAT
1.
A general dentistry resident will be appointed by the General Dentistry Faculty to serve
as chairperson for each seminar date. The chairperson will be responsible for the over-all
conduct of the seminar and for guiding the discussion.
2.
The chairperson, after consultation with the faculty will develop an outline for the
discussion. This outline should reflect the desired learning objectives for the seminar.
3.
Mini presentation by chairperson (see page 52).
4.
The faculty may provide a reading list for the seminar. (Not all seminars are literature
based.) Each resident will be responsible for:
a.
b.
c.
5.
Reading all assigned materials
Abstracting one article assigned by the chairperson and providing copies as
required (see page 53).
Discussing the articles in relation to clinical practice.
All seminars will be evaluated and attendance will be taken.
Abstract Form For Literature Review (see page 53)
1.
Across the top of a piece of standard paper will be: date of seminar, topic, name of
resident doing abstract. If more than one page is required this information should be
duplicated on other pages and the pages sequentially numbered.
2.
Beneath this information, accurately list the reference in the form approved by the
National Library of Medicine.
3.
When appropriate, the body of the abstract will be under the following headings:
a.
b.
c.
d.
e.
f.
1.
2.
3.
4.
5.
Statement of the problem
Purpose of the study
Methods and materials
Results
Conclusions
Comments - personal evaluation:
Are the problem and purpose clearly stated?
Is the subject population appropriate for the study?
Is research methodology reliable and valid?
Does article suggest lines of further research?
Are the conclusions consistent with the materials and methods and results?
51
UNIVERSITY OF MARYLAND
A.E.G.D.
TREATMENT PLANNING CASE PRESENTATIONS
MINI PRESENTATION
WHO:
The chairperson of each seminar will present.
The advisor and AGD faculty will serve as instructors.
WHEN:
The first 15 minutes of each seminar will be devoted to mini presentations.
WHAT:
You will be required to present a case (or part of a case) that is directly
related to the seminar topic (e.g., endodontics, patient management,
medical complications). Photographic slides, radiographs and written
materials (e.g., charting) are required as appropriate. Comments from the
instructors and other residents will be encouraged.
EXAMPLE:
A – this 36 year old Caucasian male reports with pain in tooth number 9 secondary to
getting elbowed playing basketball two months ago.
medical history – WNL; #9 fractured (show slide), EPT – N.R., radiograph – apical
radilucency (show film), periodontal condition – slight bleeding on probing (show
slide), remaining condition of teeth – caries (not relevant to this presentation).
Acute apical periodontitis; gingivitis
T - Endodontic therapy tooth #9 (show radiographic series) using local anesthetic, 2%
xyclocaine u/1/100,000 epi. Then scale, prophy, OHI by RDH
E – Patient apprehensive as usual regarding local anesthesia; patient advised that tooth
could need crown in future; treatment completed.
N – 6 month recall, then 1 periapical film in 1 year.
The audience will evaluate your management of this part of the case and the adequacy of
your endodontic fill as seen radiographically.
52
LITERATURE REVIEW
ABSTRACT EXAMPLE
February 5, 2004
Dr. Leider
Zadic, D., Chosack, A., and Eidleman, E.: The prognosis of traumatized permanent anterior teeth
with fracture of the enamel and dentin. Oral Surg., 47:173-175, Feb. 1979
Problem: diagnosis and treatment of traumatized anterior teeth has not been completely studied.
Purpose: the purpose of this study was to examine the diagnostic and prognostic value of vitality
tests in teeth which had suffered fracture of the enamel and dentin without pulp exposure, and to
determine the recommended time intervals for follow-up examinations.
Method and Materials: eighty-four children aged 6 to 14 years with 123 traumatized teeth were
examined within 10 days after trauma. The tests included vitality tests with ethyl chloride,
electric pulp test, percussion, and periapical radiographs. The teeth were examined every week
during the first three months, then at three month intervals for two years.
Results: of the 123 teeth examined, 109 gave a positive response to vitality tests, initially. Of
these 109 teeth, 71 remained vital through the two years, and 32 remained vital during the one
year they were followed. Of the other 6 teeth, three tested non-vital at 3 months and remained
non-vital, and the other three became non-vital and showed other signs of pulpal degeneration
and underwent root canal therapy at 12 months, 14 months, and 2 years. At the initial exam, 14
teeth did not respond to the vitality tests. Of these, 5 became positive within three months, 7
underwent root canal therapy within 4 months, and 2 teeth at 2 years.
Conclusion:
1.
2.
3.
4.
Most teeth with fractures of the enamel and dentin which were vital
immediately after the trauma, remained vital.
Some teeth that test vital initially will develop pathologic changes and
should be examined at 3 months, then every 6 months.
If the initial pulpal response is negative the prognosis is unfavorable.
Frequent examinations in the first three months are indicated during which
time a positive response will be received or more usually root canal
therapy will be done.
Root canal therapy is indicated in any tooth which has not regained vitality
after 6 months.
Comment:
Because this study is a clinical study, I think it has direct application to our own
experiences in the clinic. While the prognosis is not always clear-cut, the article does at least
give some general guidelines on what to expect.
53
PLANNED SEMINAR OBJECTIVES IN EACH PROGRAM AREA
(all objectives may not be covered during the course of the year)
1.
Planning and providing comprehensive multidisciplinary oral health care:
a.
Construct and judge treatment plans insuring integration of all applicable
medical/dental specialties following a total patient approach. Assume
responsibility for all phases of dental treatment.
b.
Properly request and evaluate consultations to/from physicians and other health
care providers.
c.
Participate in monthly case conference.
2.
Patient assessment, diagnosis and medical risk assessment:
a.
Interview patients and obtain a complete health history.
b.
Perform necessary diagnostic procedures and devise a differential diagnosis for
oral conditions using clinical presentation, demographic information, historical
findings and radiographic, laboratory and physical examination.
c.
Arrive at definitive diagnosis when histopathologic findings are correlated with
the above.
d.
Recognize the oral manifestations of systemic diseases and understand their effect
on the oral cavity.
e.
Order and interpret the clinical and/or medical laboratory tests necessary in the
diagnosis and treatment of oral conditions.
f.
Prescribe pharmacological agents properly and understand the mechanism of
action and effects of drug interaction.
g.
Perform treatment procedures when necessary and refer patients with
oral/systemic pathology when indicated.
3.
Hard and soft tissue surgery:
a.
Maintain the “CHAIN OF STERILITY” when performing surgery in the dental
operatory and the hospital operating room.
b.
Discuss the anatomy and physiology of the respiratory, circulatory and nervous
systems and their response to various pharmacologic agents used in preoperative
medication, conscious sedation, local anesthesia and pain control.
c.
Demonstrate the techniques of head and neck examination utilized by the oral
surgeon.
d.
Monitor respiration and circulation as well as manage the patient’s airway.
e.
Perform resuscitative technique and demonstrate proficiency in the early
management of medical emergencies in the dental office.
f.
Diagnose, treatment plan and manage patients with non-complex surgical
problems in such areas as exodontia, biopsy and infection.
g.
Discuss basic principles in the management of patients with facial injuries.
4.
Periodontal therapy:
a.
Perform a periodontal evaluation on all patients treated.
b.
Employ preventive dentistry principles in your personal dental care and in all
phases of your dental practice.
54
c.
d.
e.
f.
Supervise auxiliaries in the performance of patient education procedures;
prescribe treatment to be rendered by the dental hygienist.
Diagnose and treat all but the most complex cases of periodontal disease while
applying the principles of preventive dentistry.
Diagnose and treat HIV/AIDS associated periodontal abnormalities.
Utilize the basic periodontal literature in order to defend your treatment.
5.
Pulpal therapy (endodontics):
a.
Diagnose pulpal and periradicular pathosis.
b.
Use the principles of sterile technique, chemotherapy, bacteriology and preventive
dentistry in endodontic treatment.
c.
Treat traumatic, acute and chronic endodontic emergencies.
d.
Perform conservative endodontic therapy in uncomplicated and selected complex
cases with consideration of patients with infectious diseases.
e.
Assist in surgical endodontic therapy when indicated.
f.
Choose appropriate endodontic equipment, materials and methods for the clinical
situation in which each is indicated.
6.
Restoration of teeth:
a. Determine the clinical situations in which the different restorative materials may be
used.
b. Appraise new and established dental materials to determine their usefulness in
clinical situations.
c. Perform operative treatment with full consideration of the principles of preventive
dentistry and periodontics with consideration of patients with infectious diseases.
d. Appraise teeth preparations and finished restorations from the standpoint of
improving technique.
e. Apply the principles of esthetic dentistry to operative procedures.
7.
Replacement of teeth using fixed and removable appliances (prosthodontics):
a.
Identify the clinical situations in which fixed or removable prostheses are
required.
b.
Treat a complex case using a semi-adjustable articulator employing fixed and/or
removable prostheses.
c.
Teamed with other specialty residents, treat a case using osseointegrated implants.
d.
Construct complete dentures for problem cases, i.e., atrophied ridges, Class III
jaw relations, minimal interocclusal space, gaggers, etc.
e.
Use the science of color and optical illusion to produce esthetic restorations.
f.
Perform prosthodontic treatment with full consideration of the principles of
preventive dentistry and periodontics with consideration of the special
requirements of the infectious disease patient.
g.
Evaluate your own laboratory work as a basis for improving your skills and
helping others to improve theirs.
h.
Appraise the work of dental technicians from the standpoint of improving
communications with the laboratory.
55
i.
j.
k.
Evaluate and organize the clinic laboratory to manage cases for high-risk
infectious disease patients.
Appraise mouth preparations and finished prostheses from the standpoint of
improving technique.
Occlusion:
1.
Use the technique of masticatory system assessment to determine the
features of a patient’s occlusion.
2.
Use occlusal adjustment to improve a patient’s occlusion when
specifically indicated.
3.
Determine when each mode of occlusal treatment is indicated.
4.
Diagnose and treat patients with temporomandibular disorders using a
multidisciplinary approach.
5.
Illustrate the functions and limitations of the major types of articulators.
8.
Pediatric dentistry/orthodontics:
a. Recognize a developing or established malocclusion.
b. Correct selected malocclusions amenable to treatment by a general dentist.
c. Use selective orthodontics as an adjunct to treatment when indicated.
d. Understand the limitations of orthodontics in general practice, act as a primary
diagnostic resource and refer when indicated.
e. Be able to manage pedodontic and orthodontic treatment with full consideration of
the principles of preventive dentistry and periodontics with consideration of
infectious disease patients.
f. Apply the principles of esthetic dentistry to pedodontic and orthodontic procedures.
9.
Practice management included the following topics:
a. Management of auxiliaries and other office personnel.
b. Quality of management.
c. Principles of peer review
d. Business management and practice development
e. Principles of professional ethics, jurisprudence and risk management (Refer to #14)
f. Alternative health care delivery systems
g. Managed care
h. Obtaining informed consent
10. Management of Pain and Anxiety
a.
Use Nitrous oxide sedation in treatment of patients
b.
Understand the concepts of I.V. and I.M. sedation
c.
Understand basic concepts of Oral sedation (to exposure level)
d.
Understand basic concepts of Pharmacology of conscious sedation
e.
Perform Basic Life Support
f.
manage pain and anxiety in delivering outpatient care using behavioral and
pharmacological modalities beyond local anesthesia.
11.
Promoting Oral and Systemic Health and Disease Prevention:
a.
Use the principals of prevention in the everyday practice of general dentistry.
56
b.
c.
d.
e.
12.
Understand current concepts of in oral hygiene and hygiene instruction.
Use fluoride and other antimicrobic agents in treatment of patients.
Understand the technique for preventive resins and use in practice.
Understand and use the PSR recall system.
Miscellaneous:
a.
Lead seminar discussions and make formal case presentations at monthly case
conferences.
b.
Evaluate the content, validity and reliability of journal articles.
c.
Establish a reference file of dental literature with consideration of infectious
diseases.
d.
Make oral presentations before a group.
e.
Instruct auxiliaries and other practitioners on the management of infectious
disease patients.
f.
Evaluate quality assurance programs to continually raise the level of patient care.
g.
Utilize performance logic in the delivery of dental care.
h.
Evaluate your own intraoral photography as a basis for improving your skills and
helping others to improve theirs.
i.
Use the computer to improve the quality of dental practice.
j.
Evaluate infection control procedures insuring maximum possible sterility in all
phases of treatment with emphasis on barrier and sterilization techniques in
treating infectious disease patients.
k.
Evaluate hazard control procedures insuring maximum possible safety in all
phases of treatment.
l.
Certify in CPR level C
m.
Obtaining informed consent
n.
Medical risk assessment
o.
Treatment of dental and medical emergencies
13. Lunch and Learn Seminars
a.
Residents are responsible for scheduling these.
14. Ethics and Professionalism
a.
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.
57
CASE PRESENTATION FORMAT
All residents are required to present one fully photo-documented comprehensive case at the end
of the year. The cases should be presented in Powerpoint and should include at least three of the
following disciplines: oral surgery, endo, perio, operative, fixed prosthodontics, removable
prosthodontics or osseointegrated technology.
These cases will be compiled in photographic sequential format to be submitted as a final
requirement prior to receiving the certificate for graduation.
The case presentation includes:
1.
Typed Patient History and physical, dental examination, and treatment summary.
(Standard Format)
2.
1 or 2 photos of radiographic examinations (Panorex and periapical surveys).
3.
Preoperative state photos*.
4.
Treatment photos with temporization, surgery, or preparations*.
5.
Final treatment results*.
*Centric occlusal view, maxillary arch view, mandibular arch view, both lateral buccal views,
whenever possible.
Copy of the presentation should be submitted on a CD to be kept in the resident’s portfolio.
58
ADVANCED EDUCATION IN GENERAL DENTISTRY PROGRAM
CURRICULUM REVIEW/INSTRUCTOR FEEDBACK GUIDE
Date: ___________
Title/Topic:
Time: __________
Hours: ________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Presenter:
________________________________________
Format:
Seminar
Literature Review
Lecture
TX Planning Conference
Hands-on
Learning Objectives:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Comments/Critique:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Number in attendance:
________
Use of audiovisual aids:
Chair’s Signature: __________________________
This form is to be completed during session observed.
59
Yes or No
Rate the following items using a scale of 0-3: 0=poor; 1=fair, 2=good; 3=excellent. If a question
does not pertain to a particular session, record N/A.
1.
_____ Instructor started promptly.
2.
_____ Instructor effectively deal with student questions.
3.
_____ Instructor expressed self clearly and concisely.
4.
_____ Instructor used time well.
5.
_____ Instructor seemed prepared.
6.
_____ Instructor showed interest and enthusiasm for material taught.
7.
_____ Instructor ended session promptly.
8.
_____ Educational objectives were adequately covered.
9.
_____ Behavioral objectives were adequately covered.
10.
_____ Instructor exhibited flexibility to adapt to unplanned contingencies.
11.
_____ Content level was appropriate to class.
12.
_____ Content was scientifically accurate.
13.
_____ Audio-visual aids were used effectively.
14.
_____ Material organized in a systematic and logical manner.
15.
_____ Students were attentive during the lecture.
16.
_____ Students asked questions.
What one thing, if any, could you suggest to the instructor that might have improved this session,
or might improve subsequent presentations?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
60
Example of How Objectives Are To Be Entered In The Curriculum Review Form
EVALUATION OF ROOT CANAL TREATMENT
SEMINAR OUTLINE
Dr. El Fayez
February 26, 1991
I.
Learning Objectives: Each participant should analyze the factors that significantly
influence prognosis following root canal therapy, and evaluation of criteria for success.
a. Describe the consequences of over instrumentation and over filling in root
canal therapy.
b. Identify the clinical practices which contribute to a favorable prognosis.
c. Defend the criteria for determining success or failure.
d. Relate clinical and radiographic findings to healing and success.
e. Explain the conclusion that radiographic interpretation is subjective in nature.
II.
Comments/Critique (main points):
A.
Factors that significantly influence prognosis following root canal therapy
1.
Endodontic “Triad”.
2.
Local factors influencing healing.
3.
Systemic factors influencing healing.
B.
Criteria for success
1.
Radiographic
2.
Clinical
3.
Types of regeneration
C.
Factors influencing success or failure
D.
Causes for failure
1.
Indications
2.
Causes
E.
My criteria for success
1.
Absence of pain or swelling
2.
Disappearance of a sinus tract
3.
No loss of function
4.
No evidence of tissue destruction
5.
Roentographic evidence of an eliminated or arrested area of rarefaction
after a post-treatment interval of 6 months to 2 years.
61
V.
EVALUATIONS
TRI-ANNUAL RESIDENT EVALUATION
BY FACULTY MENTOR
Resident’s Name: __________________________________________________________
Period:
1st_____
2nd_____
3rd_____
Professional Performance
1. Clinical application of basic sciences
0
___
1
___
2
___
3
___
2. Thoroughness of history and physical exam
___
___
___
___
3. Discriminating use of prosthetic laboratory
___
___
___
___
4. Clinical judgment
___
___
___
___
5. General technical skill
___
___
___
___
6. Caliber of case presentation
___
___
___
___
7. Willingness to learn
___
___
___
___
8. Interest in teaching
___
___
___
___
9. Effectiveness as a teacher
___
___
___
___
10. Interest in clinical research
___
___
___
___
11. Rapport with patients
___
___
___
___
12. Rapport with other personnel
___
___
___
___
13. Efficiency in work organization
___
___
___
___
14. Promptness in work completion
___
___
___
___
15. Administrative ability
___
___
___
___
16. Assumption of responsibility
___
___
___
___
17. Effectiveness as a practice manager
___
___
___
___
18. Correct Missing Charges Reports
___
___
___
__
19. Rotation to College Park Dental Clinic
___
___
___
___
20. Rotation to Perryville Dental Clinic
___
___
___
___
Key:
0
1
2
3
Not observed
Honors (Superior)
Pass (Satisfactory)
Fail (Unsatisfactory)
62
OVERALL CLINICAL COMPETENCE
Circle the number which best describes overall clinical competence.
HONORS
(Superior)
9 8
7
PASS
(Satisfactory)
6
5
FAIL
(Unsatisfactory)
4
3
2
1
I have reviewed this evaluation. Comments are as above.
Date: _____________
Resident’s Signature: ________________________________
Program Director’s Signature: _____________________________________________________
Comments:
63
GENERAL DENTISTRY CHECK-OFF LIST
FOR TRI-ANNUAL RESIDENT EVALUATION
A. Faculty evaluation of resident
1. Review of Portfolio
a. CPR Card
b. Pink Copy of Treatment Plans With Appropriate Signatures
c. Case Completes/ Quality Assessments (at least 10)
d. Seminar schedule/CE Courses
e. Case Presentations/Mini Presentations
f. Monthly Procedural Utilization Report
g. Monthly Productivity/Budget Report
h. Treatment Requirement Forms
i. Tri-annual Evaluation forms
j. Competency Statements
k. Competency and Proficiency Certification Forms
l. Resume
m. Signed Orientation Manual
n. Other documentation including biopsy reports, prescriptions, consults, ce
credits, etc.
2. Review of Status of Patient Treatment
3. Review of Needs (treatment areas where resident needs more experience)
4. Review of Clinical Performance
a. Quality of Work
b. New Techniques Learned
c. Complexity of Cases
d. Quantity of Work (Productivity sheets)
e. Q.A. Review (Case Complete and Chart Audits)
5. Review of Didactic Performance
a. Quality of Portfolio
b. Seminar Planning and Leading
c. Seminar Participation
d. Examination scores and grade transcripts
B.
Resident Evaluation of Program
a. Quality and relevance of seminars
b. Quality and amount of clinical instruction
c. Clinical and laboratory support
d. Staff’s approach
e. Faculty’s approach
f. Q.A. review (End of year evaluations)
64
PROFESSIONAL PERFORMANCE DEFINITIONS OF TRI-ANNUAL SURVEY
1.
Clinical Application of Basic Sciences
 Integrates didactic principles into patient care.
2.
Thoroughness of Medical/Dental History and Physical Exam
 Obtains detailed medical history as it pertains to dental treatment.
 Obtains and correctly interprets medical laboratory tests as required.
 Obtains vital signs on all patients.
 Observes pathology and abnormalities associated with the whole patient and acts
on pertinent findings.
 Obtains medical consultation as required.
3.
Discriminating Use of Prosthodontics Laboratory
 Writes clear, detailed laboratory prescriptions.
 Properly prepares casts, dies, etc. to be sent to the laboratory including infection
control procedures.
 Performs enough laboratory work to understand procedures while not detracting
from time spent in direct patient care.
4.
Clinical Judgment
 Performs the appropriate procedure on the appropriate patient at the appropriate
time.
 Involves choice, sequencing of treatment and integrating dental care into total
patient needs.
5.
General Technical Skill
 Produces dental work of outstanding quality.
 Conforms to objective criteria of high quality work.
6.
Caliber of Case Presentation
 Presents cases in a clear, well-organized manner.
 Conforms to the objective criteria of good speech making
 Produces high quality photographic work.
7.
Willingness to Learn
 Is open to new ideas and techniques.
 Actively seeks knowledge.
 Maintains a literature and photographic file.
 Accepts constructive criticism as a growth experience.
8.
Interest in Teaching
 Expresses a desire to fulfill a teaching role.
9.
Effectiveness as a Teacher
65

Demonstrates ability to teach assistants and fellow residents in a formal setting
such as in-service training and seminars.
10.
Interest in Clinical Research
 Expresses a desire to continue clinical research beyond requirements.
11.
Rapport with Patients
 Treats patient with gentleness, care and consideration.
 Is well liked by his/her patients.
12.
Rapport with Other Personnel
 Treats everyone with appropriate courtesy, respect, politeness, deference, and
manners consistent with highest professional standards of conduct.
13.
Efficiency in Work Organization
 Structures time, material and personnel resources in an efficient and mission
effective manner.
14.
Promptness in Work Completion
 Submits all clinical, didactic and administrative work on time or ahead of
schedule.
15.
Administrative Ability
 Completes and submits all administrative forms in a timely and accurate manner,
including portfolio.
16.
Assumption of Responsibility
 Volunteers to perform tasks in addition to program requirements.
 Leadership/participation in dental organizations. Management of clinical areas,
laboratory ortho cart, etc.
17.
Effectiveness as a Practitioner Manager
 Utilizes resources to effectively carry out quality assurance, infection control,
financial management and staff morale programs.
NOTE: All of the above definitions represent the criteria necessary to receive a grade of
“Superior” on the rating scale.
66
TREATMENT PLANNING/CASE PRESENTATION EVALUATION
RESIDENT NAME: ___________________________________________________________
RATING
Outstanding-1
Good-2
1. CASE PRESENTATION
A. Oral Communication
B. Written Documents/Powerpoint
C. Clinical Photographs
D. Radiographs
E. Quality of Case Materials
F. Clear and Concise
Satisfactory-3
Marginal-4
Unsatisfactory-5
2. TREATMENT PLAN
A. Diagnosis/Chief Complaint
B. Medical Considerations
C. Appropriateness of Treatment
D. Sequencing of Treatment
E. Patient Management
F. Appropriate Referrals
____
____
____
____
____
____
3.TREATMENT RATIONAL
A. Professional Knowledge
____
B. Logic/Reasoning
____
C. Supported by Current Research ____
D. Time and Resource Considerations ____
4. PROFESSIONAL DEMEANOR
A. Appearance and Bearing
B. Use of Proper Terminology
C. Attitude Towards Audience
D. Consideration and Respect
for Patient
____
____
____
____
____
____
____
____
____
____
5. OVERALL PERFORMANCE RATING ____
6. COMMENTS:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Name of Evaluator: _____________________________________________________________
Signature: _______________________________________ Date: _________________________
Name of Program Director: _______________________________________________________
Signature: _______________________________________ Date: _________________________
6/16/2005 revised
67
UNIVERSITY OF MARYLAND - COLLEGE PARK DENTAL CLINIC
ROTATION EVALUATION
RESIDENT
DATES: START
FINISH
1.
Did the College Park rotation meet your overall
expectations? Explain briefly:
YES
NO
2.
Did the teaching staff seem genuinely interested?
If NO, explain and specify:
YES
NO
3.
Was the rotation organized well?
YES
NO
YES
NO
YES
NO
YES
NO
4.
5.
Would you do the rotation again?
Having completed the rotation, do you feel you
understand its value in the Program curriculum?
6.
Did you treat any HIV patients?
How many? _____
7.
Suggestions and recommendations:
68
UNIVERSITY OF MARYLAND DENTAL SCHOOL
CECIL COUNTY ROTATION EVALUATION
RESIDENT
DATES: START
FINISH
1.
Did the Cecil County rotation meet your overall
expectations? Explain briefly:
YES
NO
2.
Did the teaching staff seem genuinely interested?
If NO, explain and specify:
YES
NO
3.
Was the rotation organized well?
YES
NO
YES
NO
YES
NO
YES
NO
4.
5.
Would you do the rotation again?
Having completed the rotation, do you feel you
understand its value in the Program curriculum?
6.
Did you treat any HIV patients?
How many? _____
7..
Suggestions and recommendations:
69
RESIDENT SURVEY OF PROGRAM
INSTITUTIONAL AND PROGRAM EFFECTIVENESS
1.
Do you have the same privileges and responsibilities provided
residents in other professional education programs at this
institution?
Comments:
YES
NO
YES
NO
YES
NO
YES
NO
______________________________________
__________________________________________________
2.
Based on your knowledge of the program, have overall program
goals and objectives been developed?
Comments:
_______________________________________
___________________________________________________
3.
Do the overall program goals and objectives emphasize general
dentistry, resident education, and patient care?
Comments:
_______________________________________
___________________________________________________
4.
Have you been given the opportunity to evaluate if the program
has met its stated goals and objectives?
Comments:
_______________________________________
___________________________________________________
70
N/A
EDUCATION PROGRAM
Curriculum
5.
Have goals and objectives OR competency and proficiency
statements been developed for each area of resident training?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
planning and providing comprehensive multidisciplinary
oral health care;
YES
NO
obtaining informed consent;
YES
NO
promoting oral and systemic health and disease prevention; YES
NO
sedation, pain and anxiety control;
NO
Comments:
_______________________________________
___________________________________________________
6.
Do the goals and objectives OR competency and proficiency
statements describe the intended outcomes of the resident’s
education?
Comments:
_______________________________________
___________________________________________________
7.
Has your instruction and training included providing
comprehensive multidisciplinary oral health care?
Comments:
_______________________________________
___________________________________________________
8.
Do you think your instruction and training has been at a skill
and level beyond that of dental school?
Comments:
_______________________________________
___________________________________________________
9.
Have you received didactic and clinical training and experience
in each of the following areas?
patient assessment and diagnosis;
71
YES
restoration of teeth;
YES
NO
replacement of teeth using fixed and removable appliances YES
NO
periodontal therapy;
YES
NO
pulpal therapy
YES
NO
hard and soft tissue surgery
YES
NO
treatment of dental and medical emergencies
YES
NO
medical risk assessment
YES
NO
YES
NO
Comments:
_______________________________________
___________________________________________________
10.
Have the instruction and experiences received prepared you to
competently request and respond to requests for consultations
from physicians and other health care providers?
Comments:
_______________________________________
___________________________________________________
72
11.
Do you feel you have had adequate instruction and experience
in the management of pain and anxiety using behavioral and
pharmacological modalities beyond local anesthesia when
delivering outpatient care?
Comments:
YES
NO
_______________________________________
___________________________________________________
12.
Are patient care conferences held monthly
for discussion of diagnosis, treatment
planning, and progress and outcomes of
treatment?
Comments:
ALWAYS SOMETIMES
NEVER
________________________
____________________________________
13.
Have you been given assignments that require critical review
of relevant scientific literature?
YES
NO
YES
NO
If this is a two-year program, do you feel the goals and objectives YES
OR competency and proficiency statements of the second year
of resident training are at a higher level than those of the first
year of the program?
NO
Comments:
_______________________________________
___________________________________________________
14.
Do you think the instruction received in the principles of
practice management is adequate?
Comments:
_______________________________________
___________________________________________________
Program Length
15.
Comments:
_______________________________________
___________________________________________________
73
N/A
Evaluation
16.
How often are you evaluated on your progress toward achieving
the program’s written goals and objectives?
Comments:
Frequency
_______________________________________
___________________________________________________
17.
Following each evaluation are you given an opportunity to discuss YES
it with the program director or faculty?
Comments:
NO
_______________________________________
___________________________________________________
18.
FACULTY AND STAFF
Does the faculty have collective competence in all areas of
dentistry included in the program?
Comments:
YES
NO
YES
NO
YES
NO
_______________________________________
___________________________________________________
19.
In your opinion, do general dentists have a significant role in
program development and instruction?
Comments:
_______________________________________
___________________________________________________
20.
Are you given the opportunity to evaluate the performance of
faculty members annually?
Comments:
_______________________________________
___________________________________________________
74
21.
Approximately what percent of time is there a faculty member
present in the dental clinic for consultation, supervision and
active teaching when residents are treating patients in scheduled
clinic sessions?
Comments:
__________ %
_______________________________________
___________________________________________________
22.
Are allied dental personnel and clerical staff available to ensure
residents receive training and experience in the use of modern
concepts of oral health care delivery and to ensure efficient
administration of the program?
Comments:
YES
NO
YES
NO
YES
NO
YES
NO
_______________________________________
___________________________________________________
23.
Do residents and teaching staff regularly perform the tasks of
dental assistants, laboratory technicians or clerical personnel?
Comments:
_______________________________________
___________________________________________________
EDUCATIONAL SUPPORT SERVICES
24.
Are the facilities and resources adequate and appropriately
maintained to support the goals and objectives of the program?
Comments:
_______________________________________
___________________________________________________
25.
Are you aware of specific written due process policies and
procedures for adjudication of academic and disciplinary
complaints?
Comments:
_______________________________________
___________________________________________________
75
26.
Were you encouraged or required to be immunized against and/or YES
tested for infectious diseases, such as mumps, measles, rubella and
hepatitis B, prior to contact with patients and/or infectioius
objects or materials?
Comments:
NO
_______________________________________
___________________________________________________
PATIENT CARE SERVICES
27.
Have you had adequate patient experiences to achieve the
program’s stated goals and objective OR competencies and
proficiencies of resident training?
Comments:
YES
NO
YES
NO
YES
NO
YES
NO
_______________________________________
___________________________________________________
28.
Have you been involved in a structured system of continuous
quality improvement for patient care?
Comments:
_______________________________________
___________________________________________________
29.
Prior to providing direct patient care, were you required to be
certified in basic life support procedures, including
cardiopulmonary resuscitation?
Comments:
_______________________________________
___________________________________________________
30.
Have you been provided with the institution’s policies on
radiation hygiene and protection, ionizing radiation,
hazardous materials, and blood-borne and infectious diseases?
Comments:
_______________________________________
___________________________________________________
76
31.
Does the program have policies that ensure that the confidentially YES
of information pertaining to the health status of each individual
is strictly maintained?
Comments:
_______________________________________
___________________________________________________
In your opinion, what the strengths of the program?
In you opinion, what are the weaknesses of the program?
77
NO
Would you recommend this program to other graduating dental students
YES
Comments:
Two year residents - Did the program help you in:
32.
a.
33.
b.
34.
c.
35.
d.
36.
e.
gaining experience in managing highly complex
comprehensive dental care
improving clinic management skills
Y/N
pursuing areas of individual concentration, e.g.:
temporomandibular disorders, public health dentistry,
special patient care, etc.
providing residents with an interdisciplinary graduate
foundation in the biological and clinical sciences for
careers in dental research and/or education and the
practice of dentistry
gaining teaching experience, performing original
research and earning a Master's of Science in Oral
Biology degree
Y/N
78
Y/N
Y/N
Y/N
NO
ADVANCED EDUCATION IN GENERAL DENTISTRY FACULTY EVALUATION
FACULTY:
DATE:
Please complete the following confidential evaluation for the above faculty member. Please do
not write your name on the form. The following 5 to 1 rating scale will be used, where 5 will
always represent an excellent or the most favorable rating and 1 will always represent a poor or
unfavorable evaluation.
1.
How knowledgeable is the faculty member?
2.
5
4
3
2
1
How effectively does the faculty member convey meaningful information via
3.
4.
5.
6.
7.
8.
9.
10.
n/a
a. discussion
5
4
3
2
1
n/a
b. demonstration
5
4
3
2
1
n/a
c. clinical supervision
5
4
3
2
1
n/a
How consistent is the information you receive from the individual faculty member?
5
4
3
2
1
n/a
How helpful is the faculty member?
5
4
3
2
1
n/a
How is the faculty member’s availability and accessibility?
5
4
3
2
1
n/a
To what extent is the faculty member punctual?
5
4
3
2
1
n/a
To what extent does the faculty member demonstrate
a. a positive attitude towards you
5
4
3
2
1
n/a
b. a positive attitude towards your patients 5
4
3
2
1
n/a
c. a positive attitude towards his/her
responsibilities
5
4
3
2
1
n/a
To what extent does the faculty member demonstrate professionalism?
5
4
3
2
1
n/a
To what extent is the faculty member a role model for you?
5
4
3
2
1
n/a
To what extent is the faculty member an asset to the AEGD Program?
5
4
3
2
1
n/a
ADDITIONAL COMMENTS:
79
ADVANCED EDUCATION IN GENERAL DENTISTRY
DENTAL HYGIENE EVALUATION
HYGIENIST:
DATE:
Please complete the following confidential evaluation for the above hygienist. Please do not
write your name on the form. The following 5 to 1 rating scale will be used, where 5 will always
represent an excellent or the most favorable rating and 1 will always represent a poor or
unfavorable evaluation.
1.
2.
3.
4.
5.
6.
How knowledgeable is the hygienist?
5
4
3
2
1
n/a
5
4
3
2
1
n/a
5
4
How is the hygienist’s availability and accessibility?
5
4
To what extent is the hygienist punctual?
5
4
To what extent does the hygienist demonstrate
a.
a positive attitude towards you
5
4
3
2
1
n/a
3
2
1
n/a
3
2
1
n/a
3
2
1
n/a
3
2
1
n/a
2
1
n/a
2
1
n/a
2
1
n/a
2
1
n/a
How helpful is the hygienist?
How willing is the hygienist to help?
b.
a positive attitude towards your patients
5
4
c.
7.
8.
9.
a positive attitude towards his/her responsibilities
5
4
3
To what extent does the hygienist demonstrate professionalism?
5
4
3
To what extent is the hygienist a role model for you?
5
4
3
To what extent is the hygienist an asset to the AEGD Program?
5
4
3
ADDITIONAL COMMENTS:
80
UNIVERSITY OF MARYLAND DENTAL SCHOOL
Advanced Education in General Dentistry Program
OUTCOMES ASSESSMENT SURVEY
The information from this survey will be combined with information from other graduate’s
surveys to provide a basis for evaluating the effectiveness of the AEGD Program in achieving its
program goals and objectives. Information gained from these surveys can serve as a basis for
change and improvement of the program. Your cooperation in providing this information is
appreciated and is important in the continuing development of the AEGD Program. Thank you.
Name: ___________________________ (optional)
1.
2.
Year: __________________
Please describe your clinical practice involvement at this time.
General Practice
__________
Specialty
__________
which specialty? ____________
Please describe your professional efforts by category:
Practice
%
__________
Hours
__________
Teaching
%
__________
Hours
__________
Research
%
__________
Hours
__________
3.
List the continuing education courses that you have attended in the last year:
4.
List the professional publications that you read regularly:
5.
List the professional organizations to which you belong:
81
PLEASE USE THE FOLLOWING SCALE TO ANSWER THE QUESTIONS BELOW:
1=
2=
3=
4=
5=
minimally
somewhat
moderately
fairly well
greatly
6.
7.
8.
To what extent did the program enhance your clinical skills in the following disciplines:
_____
Operative Dentistry
_____
Periodontics
_____
Fixed Prosthodontics
_____
Removable Prosthodontics
_____
Oral Surgery
_____
Endodontics
_____
Orthodontics
_____
Pediatric Dentistry
_____
Treatment Planning
_____
Implants
_____
Medically-compromised
_____
Oral Medicine/Pathology
To what extent did the program enhance your knowledge in the following disciplines:
_____
Operative Dentistry
_____
Periodontics
_____
Fixed Prosthodontics
_____
Removable Prosthodontics
_____
Oral Surgery
_____
Endodontics
_____
Orthodontics
_____
Pediatric Dentistry
_____
Treatment Planning
_____
Implants
_____
Medically-compromised
_____
Oral Medicine/Pathology
To what extend did the program enhance your ability to make judgments in the following areas:
_____ Diagnosis
9.
10.
__ __ Treatment Planning
_____ Treatment
To what extent did the program enhance your ability to interact with the following health care
providers:
_____
Physicians
_____
Dental Specialists
_____
Other generalists
_____
Dental Hygienists
_____
Assistants
_____
Receptionists
_____
Dental Laboratory
_____
Hospital Staff
To what extent did the program provide experience and enhance your abilities in dental practice
administration:
_____
Dental Practice Administration
82
COMPETENCIES AND PROFICIENCIES
COMPETENCIES AND PROFICIENCIES OF GRADUATES
OF THE UNIVERSITY OF MARYLAND, DENTAL SCHOOL
ADVANCED EDUCATION IN GENERAL DENTISTRY PROGRAM
2011-2012
TABLE OF CONTENTS
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
83
INTRODUCTION
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.
84
UNIVERSITY OF MARYLAND, DENTAL SCHOOL'S ADVANCED EDUCATION IN
GENERAL DENTISTRY PROGRAM: COMPETENCY AND PROFICIENCY
STATEMENTS
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.
Definitions
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)
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. (P)
85
5.
Diagnose and manage a patient's occlusion. (C)
6.
Manage uncomplicated diseases and abnormalities of the pediatric patient. (C)
In regard to health care delivery:
7.
Treat patients efficiently in a dental practice setting. (C)
8.
Use scheduling systems and insurance and financial arrangements to maximize
production in dental practice. (C)
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)
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)
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)
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)
86
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)
87
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)
88
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)
89
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)
90
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.
91
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
92
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.
93
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.
a. These all represent procedures that are performed on or with patients and can be
directly observed by faculty members.
b. 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.
c. 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.
94
2.
3.
4.
5.
2.
3.
Observation can be documented by:
a.
a signed case write-up including case history, procedures performed, and
outcomes, supplemented with appropriate photographs or x-rays.
b.
faculty signature on the "certification" sheet, with evidence listed as
"direct observation”.
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.
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.
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.
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.
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:
i. a complete patient history
ii. dental examination
iii. mounted study models and photographs of the patient's pre-treatment
condition
iv. diagnosis of the patient's conditions
v. alternate treatment plans that could be accomplished for this patient
95
4. 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.
a. Pink treatment plan forms.
5. Statements related to comprehensive care: Statements 1, 2, 4, 31, 32.
a. These statements require evidence of complete care of patients. (IO case
complete reviews signs by AEGD faculty)
b. 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:
i. 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.
ii. Mounted prints of photographs of the patient's pre-operative condition
and post-operative condition.
iii. A write-up summarizing the treatment performed, special
considerations, problems, or modifications encountered and prognosis
and plans for further care.
c. 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.
6. Statements related to providing dental care in a dental practice setting and community
and interprofessional teams: Statements 10-15.
a. 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.
b. 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:
i. a patient questionnaire to be given to the resident's own patients
ii. participation in a community program (health care for homeless, work
opportunity, and PLUS program)
iii. other measure approved by the program director or assistant program
director.
c. The results of these evaluation efforts will be summarized in writing and
presented to the program director or assistant program director for approval.
96
7. Statements related to organized dentistry and professional ethics: Statements 16, 17.
a. Statements related to participation in organized dentistry can be evaluated by
evidence of participation in professional dental meetings.
b. 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.
8. Statements related to gathering and using information about dental practice:
Statements 18-22.
a. 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.
b. Evidence of this ability must be by activities where residents gather and
evaluate information.
c. The residents will design and carry out three information projects in which
they will gather and use data in each of the following areas:
i. 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.
ii. 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.
d. 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.
9. Other evidence:
a. 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.
b. Examples of other forms of evidence that may be used include:
i. A certificate of completion of an CPR course for the competency
related to medical emergencies.
97
ii. Copy of prescription write ups.
iii. Medical consults and pathology reports.
c. 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.
98
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.
99
AEGD COMPETENCY AND PROFICIENCY
STATEMENT CERTIFICATION SHEETS
TYPE OF
EVIDENCE OR
DOCUMENTATION
STATEMENT
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)
8. Use scheduling systems and insurance
and financial arrangements to
maximize production in dental
practice. (C)
9. Support the program's mission
statement by acting in a manner to
maximize patient satisfaction in a
dental practice. (C)
100
CERTIFICATION
BY:
NAME/SIGNATURE
PCC/Faculty
Office Manager
TYPE OF
EVIDENCE OR
DOCUMENTATION
STATEMENT
CERTIFICATION
BY:
NAME/SIGNATURE
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)
101
Office Manager
TYPE OF
EVIDENCE OR
DOCUMENTATION
STATEMENT
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)
102
CERTIFICATION
BY:
NAME/SIGNATURE
TYPE OF
EVIDENCE OR
DOCUMENTATION
STATEMENT
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)
103
CERTIFICATION
BY:
NAME/SIGNATURE
TYPE OF
EVIDENCE OR
DOCUMENTATION
STATEMENT
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)
104
CERTIFICATION
BY:
NAME/SIGNATURE
SECOND YEAR COMPETENCY
AND PROFICIENCY STATEMENTS
STATEMENT
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)
TYPE OF EVIDENCE OR
DOCUMENTATION
105
CERTIFICATION BY:
NAME/SIGNATURE
University of Maryland Dental School
Advanced Education in General Dentistry Program
CERTIFICATE OF COMPLETION OF
COMPETENCY AND PROFICIENCY DOCUMENTATION
Program: _____________________________________________________________
Resident Name: _______________________________________________________
The above named resident has presented in this portfolio evidence of competency or proficiency
in all the areas listed in the program competency and proficiency statements and is therefore
certified as having completed the program competency and proficiency requirements.
Date: ________________________________________________________________
Program Director’s Name: _______________________________________________
Program Director’s Signature: ____________________________________________
106
SUMMARY OF PORTFOLIO EVALUATION SYSTEM FOR
COMPLETION OF A POSTDOCTORAL GENERAL DENTISTRY PROGRAM
The Portfolio
A portfolio is a collection of authentic evaluation of a resident’s ability to perform tasks in
realistic, unaided situations representative of what will be performed after graduation. 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 tenet 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, other
programs or for documentation for hospital privileges.
Portfolio Description
The completed portfolio shall be submitted in duplicate and consist of the following parts:
1.
a section for at least 10 completed Quality Assessment and 5 chart audits.
2.
a section for case documentation materials - Treatment plan presentation cases.
3.
a section for evidence
a.
Productivity sheets/Procedure Utilization Report
b.
Certification (i.e., CPR, Boards, etc.)
c.
Publications/research projects (thesis)
d.
Quarterly evaluations
e.
Certificate of completion of CE courses.
f.
Seminars/lecture schedule
g.
Course schedule/transcript (MSOB and PhD residents)
h.
Resume
i.
Copy of signed treatment plan (pink copy).
Note: The resident may propose alternative forms of evidence to the program director and use
them with the program director’s approval.
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.
107
3.
One month before the end of the program residents will turn in the completed portfolio
for evaluation. The program director may accept it as complete, or request additional
evidence, or other changes.
4.
Two weeks prior to the end of the program the program director will make the final
decision as to granting a program completion certificate.
5.
In case of dispute the resident may ask for an appointment with the Department Chair to
review 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.
ACKNOWLEDGMENT STATEMENT
I, ________________________, have reviewed and understood the 2011 - 2012
AEGD Orientation Manual and Clinic Manual and will adhere to the guidelines set
forth.
Signature: __________________________
Print: _____________________________
Date: _____________________________
108
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