Appendix E: Minimum Procedural Experiences, Departmental Competency / Examinations & the Points Program

Revised 09/03

Tufts University School of Dental Medicine’s Vision Statement is “Patient centered education committed to excellence”. Students’ comprehensive care of patients is an integral part of that vision. To assess patient care and to educate students, Minimum clinical experiences, Competency examinations, and a total Point program have been established. This document serves as a guideline to these measurements.

The student must also accomplish other Department-specific required courses, rotations, seminars, and workshops. These are detailed in the Student Schedule and summarized in the Clinic Manual.

NOTE: Students must prepare for each clinic session by studying in advance the relevant department manuals concerning the procedure that they have scheduled for the patient. Department faculty will expect students to be prepared to answer questions. Preparation is part of the daily clinical grade. For department patient procedures involving laboratory work, the laboratory work must be seen by a faculty member or laboratory technician before the visit.

GOALS AND OBJECTIVES OF THE MCP PROGRAM

GOALS
The primary goal of the clinical program is to teach students how to provide comprehensive patient care. This document is designed to inform the students in April Year 2, at the beginning of their patient assignment years, what their clinical objectives for graduation are. The ultimate goal is to graduate students who are competent to practice general dentistry and successfully pass clinical licensing examinations.

OBJECTIVES
1. To outline clearly the minimum procedural experiences for all assigned patient clinical procedures.

2. To list the clinical procedures requiring competency as defined by the TUSDM Competency Statements. Each Competency Statement represents the ability to perform a complex service or task.

3. To explain the point values system that supports comprehensive patient care.

MINIMUM PROCEDURAL EXPERIENCES (MPE’S)

One measure of experience is a student’s practice and the faculty’s evaluation of a MANDATORY minimum number of specific procedures. Department faculty has determined which procedures are necessary for a practicing dentist to know for appropriate patient care. These are outlined in the Competency Statements for Tufts University School of Dental Medicine. Performance of enough of these mandatory minimum experiences is necessary for the student to achieve enough skill to independently perform a competency examination for that procedure.

Departments have “step sheets” to use for MPE’S. Students should turn in the completed card to the department, keeping a copy for themselves.

Minimum Procedural Experiences = MPE’S = Minimum “number of completed procedures” in a department needed to graduate - (old term = “requirements”)

DEPARTMENTAL COMPETENCY EXAMINATIONS (CE’S)

Competency is defined as the behavior expected of a beginning practitioner. This behavior incorporates understanding, skill, and values in an integrated response.

A competency examination (departmental competency examination) is an outcomes assessment measurement of the individual student’s ability to independently perform the competency related to specific parameters or criteria. These have been developed to evaluate a student’s ability to perform the procedure independent of faculty input. These are done after the student has completed enough experiences with the procedure to test competency in the procedure.

TUSDM evaluates students’ clinical competency by means of several methods:

1. Clinical Case Presentations, e.g., the student performs a diagnosis and treatment planning procedure with the patient and is observed/graded by department faculty.

2. Clinical Patient Competency Examinations, e.g., the student performs a procedure such as an amalgam restoration on a patient. S/he is observed/graded by department faculty.

3. Manikin Examinations, e.g., the student performs a procedure such as endodontic therapy on a manikin tooth. Department faculty grades the manikin.

4. Objective Simulated Competency Examinations (OSCE’S): the student answers a series of clinical based questions as in the Orthodontics OSCE. This written examination is graded by scantron and reported to department faculty.

5. Oral Examinations, e.g., the student answers a series of questions about a subject such as in the Oral and Maxillofacial Surgery Oral Examination. Department faculty questions the student.

Clinical competency examinations are done during regular patient treatment in the group practices on the student’s own patients (Note: on rare occasions, the Practice Coordinator may allow a student to take a CE on another student’s patient). The student simply requests at the beginning of the session that they would like to do this procedure as a competency examination. Many manikin competency examinations and Oral Examinations are scheduled for the student (see Student Schedule). Many OSCE’S are scheduled during a department’s seminars or rotations (see Student Schedule). For details about the format of the competency examinations, please see each Department’s competency examination step sheets and/or grading criteria forms.

Students must keep up with Competency Examination completion by doing several competency examinations during each trimester. The Checkpoint Chart with this document outlines when each minimum procedural experience, competency examination, and point value must be achieved during a student’s clinical patient assignment years (Starting April of Year 2 and ending in April of Year 4). The objective is to gradually achieve procedures, competency, and points in all areas.

Competency Examinations are timed carefully on the Checkpoint Chart to ensure that:

6. It is at the point in the student’s clinical program that s/he is doing a lot of the procedures so that s/he is confident to challenge the procedure by means of a competency examination.

Explanation: The student starts a patient’s treatment usually with periodontology procedures such as Phase I therapy. Therefore, the first Non-Surgical Periodontal Therapy Clinical CE must be taken in the winter semester of Year 3. It is at this point that the student is doing and has completed enough non-surgical periodontal procedures that they feel confident and should take the CE. By summer of Year 3, most of the student’s patients have received their initial periodontal therapy (except for recare) and are now receiving other treatments, such as crowns and removable/fixed prosthodontics. Therefore, the student has fewer opportunities to accomplish the non-surgical periodontal competency examination. The second Non-Surgical Periodontal Therapy Clinical CE must be taken in Fall of Year 4. This is when the student is recalling many of the previously completed patients. It is at such a recare visit that the second Non-Surgical Periodontal Therapy CE is done.

7. TUSDM clinical competency completion does not occur too close to licensing examinations when patients are needed for licensing examination procedures.

Explanation: By winter of Year 4, students are searching for Non-Surgical Periodontal Therapy patients to treat during the licensing boards such as NERB’S. If the student has failed to complete their Fall Non-Surgical Periodontal Therapy CE, they may have to search for 2 Non-Surgical Periodontal Therapy patients: one for the CE and one for the licensing examination. This is not an easy task, as the licensing examinations have strict guidelines regarding amounts of calculus; these types of patients are scarce.

8. The student learns and challenges competency examinations for less complex procedures first and more advanced procedures last.

Explanation: In the winter of Year 3, the student is best able to challenge the CE’s in Periodontology Diagnosis and Treatment Planning or Oral Health Promotion. In the fall and winter of Year 4, the manikin interim fixed partial denture and endodontics CE’s are scheduled.

Each department has competency examination Grading forms (with grading criteria), which the student/faculty uses during the examination. Completed CE forms must be turned into the department. The student should keep his or her own copy of all step sheets (for MPE’s) and all CE sheets.

Competency Examinations and Grading

For both the Year 3 and Year 4 clinical grades, departments will include not completing the necessary year-end competency examinations (see Checkpoint document) in the determination of the final clinical grades by a 100% rule. The following is the policy that will be used to determine clinical grades:

9. Departments will count 100% of the competency examinations in the determination of grades.

10. For any competency examination that was required to be completed by year’s end, but has not yet been completed, a grade of 70 will be averaged in for that competency examination in the overall department grade.

11. When a student does finally take any missing competency examination (after the deadline), the maximum grade that they can receive in that competency examination is a 70.

The only exception to this rule is the Salud students, at the end of year 3. These students will receive an extension (until October of year 4). If they do not complete the required CE’s before they leave for Salud, they will receive a “Y” grade.

Competency Examinations = “Tests” of the student’s independent ability

NOTE: CE’s may become computer based in the future.

POINTS

An important component of a comprehensive care program for patients is attaching value to every procedure that the student accomplishes for the patient. This encourages treating individual patient needs. Toward this end, all procedures are given value. The name used for that value is points. All competency examinations and minimum procedural experiences have point values.

The remaining clinical care experiences must total 1000 points. These points may be done in any combination of clinical treatment procedures listed for credit in the Clinical Procedure and Fee Schedule booklet.

NOTE: In 2002, points were also assigned to Fluoride carriers (Code 5986= 2 points) and Nitrous oxide oxygen sedation techniques (Code 9230 = 1 point).

The amount of clinical treatment performed by each student is reported as total points. Point reports are generated on a regular basis to allow students, faculty, and administrators to evaluate student progress. In each trimester, students’ point performance is evaluated at ten weeks. If a student is found deficient, procedures are initiated to help the student to rectify this deficiency. These procedures are outlined in the Student Handbook. Repeated failure to keep up with the Checkpoint Chart will result in serious consequences (See Student Handbook).

A work effort of 1000 points is used for evaluating minimum experience in patient care during the patient assignment clinical years (Third Trimester Year 2; Years Three and Four).

NOTE: International and Middlesex students must achieve 1075 points as they have no externship assignment (a 75-point value).

NOTE: Students may lose points for failure to follow administrative requirements, for example: failure to follow financial, record, scheduling and attendance policies.

Points = “Value” attached to all clinical experiences.

SUMMARY

Together, the successful completion of departmental mandatory minimum procedural experiences and competency examinations are necessary to assure student competency in patient care. Competency examinations test a student’s ability to perform procedures independently and at levels satisfactory for licensing examinations and graduation (minimum competency). The achievement of 1,000 points assures that students have enough experiences and competency examination opportunities to attain the competency level required for graduation.

THE MINIMUM PROCEDURAL EXPERIENCES AND COMPETENCY EXAMINATIONS BY TUSDM’S EIGHT ACADEMIC DEPARTMENTS

I. CLINICAL AFFAIRS
Head: Associate Dean Russell Room: 303A (Dept extension: 6791)
Janet Markell Admin. Asst. Third floor

Quality Assurance: Ms. Susan Rodd Room 335
Infection Control: Ms. Bette Schwarz Fourth Floor

QUALITY ASSURANCE

Record Audits – Year 3 or 4

• Students must complete one record audit as a minimum procedural experience in year 3.
• Students must complete one record audit competency examination in year 4.
• Students do the record audit(s) with their Practice Coordinators. Students must bring all completed forms to Ms. Susan Rodd.

Post Treatment Examinations - Year 4

• Students must complete five Post Treatment Examinations as documented minimum procedural experiences. Two must be done in Year 3; three must be done in year 4. However, every patient that a student treats must have a post treatment exit examination.
• Students must complete one Post Treatment Examination as a Competency Examination in

Year 4.

• Students do the Post Treatment Examinations with their Practice Coordinators. Students must bring all completed forms to Ms. Susan Rodd.

INFECTION CONTROL
Infection Control Audits - Year 3 and 4
Students must have two competency examinations (audits) in Infection Control by Ms. Bette Schwarz in their Year 3 and two in their Year 4.

II. ENDODONTICS DEPARTMENT
Department Chair: Dr. Daniel Green Room: 417
Predoctoral Director: Dr. Charles Rankin (Dept Extension:6796)
Patricia Morrow Admin. Asst. Fourth floor

10 canals (one treated tooth must be a molar)
Total Minimum Experience in Endodontics

Two “1/2” day Endodontic Assists in Postgraduate Endodontics:
The first assist must be performed before embarking on any clinical endodontic treatment.

THE SECOND ASSIST MAY BE COMPLETED ANY TIME BEFORE GRADUATION. FIRST ENDODONTIC ASSIST, BEFORE TREATING YOUR FIRST ENDODONTIC PATIENT, MUST BE PERFORMED IN THE UNDERGRADUATE ENDODONTIC CLINIC. THE PREDOCTORAL ENDODONTIC STUDENT’S FIRST CLINICAL ENDODONTIC EXPERIENCE WILL BE MORE PRODUCTIVE AND MEANINGFUL IF S/HE HAS THE EXPERIENCE OBSERVING A FELLOW UNDERGRADUATE WORKING IN THE UNDERGRADUATE ENDODONTIC CLINIC. EXPOSING THE PREDOCTORAL STUDENT TO THE PROTOCOL, PAPERWORK, PATIENT MANAGEMENT AND ENVIRONMENT WILL CERTAINLY ENHANCE THE CLINICAL PREDOCTORAL ENDODONTIC EXPERIENCE.

The second endodontic assist in the postgraduate endodontic clinic (anytime before graduation) will expose the predoctoral student to more advanced endodontic instruments and techniques.

Competency Examinations

12. After a student completes at least five canals, one canal will be done independently as a competency examination. Preferably, this should be done on a single canalled tooth.
13. One manikin competency examination is done in the Year 3. One manikin competency examination is done in the Year 4. The student is scheduled to do this in DHS-8 (year 3) and in the group practices (year 4). See Student Schedule.
14. One Endodontic Outcome Assessment competency examination (This is done six months after endodontic treatment is completed. The student brings the patient back for an evaluation.)

To Receive Endodontic Credit:

i) The endodontic procedure must be finished.
ii) The endodontic procedure must be paid for in full.
iii) A definitive coronal restoration must be provided by one of the following methods:

1. Placement of the definitive coronal restoration (at least the coronal substructure must be placed permanently). Proof of placement (Blue A Sheet or case notes) must be presented to the Endodontic Department.
2. If the patient has been discontinued for treatment at TUSDM before the restoration could be placed, the case note documenting “discontinuance” must be signed by the Practice Coordinator and presented to the Endodontic Department.
3. If the patient has been referred to another dental student for the coronal restoration, the case note stating such should include:
   1. Name of the dental student to place coronal restoration
   2. Date of appointment at which time the coronal restoration will be placed
   3. This case note must be signed by the Practice Coordinator and presented to the Endodontic Department.

 

The Final Grade in Endodontics Consists of:
Year 3:

There is no Year 3 clinical grade in Endodontics.

Year 4:

A final Year 4 clinical grade in Endodontics is based on:

1) A minimum of 10 canals completed (one treated tooth must be a molar). Clinical cases are graded according to the completed “Clinical Endodontic Grading Criteria” form, approximately 65 points.

2) One clinical competency examination [to be performed after the student has completed at least five (5) canals]. This clinical examination will be graded according to criteria outlined in the “Clinical Endodontic Grading Criteria” form.

3) Two (2) completed assists in the postgraduate endodontic clinic. The first assist must be completed before initiating endodontic therapy on any assigned patient. The second assist may be completed anytime before graduation.

4) Initiation of the endodontic recall process (Endodontic recall cards must be submitted to the department for all completed cases). One endodontic recall competency examination.

5) The Manikin competency examinations.

III. GENERAL DENTISTRY DEPARTMENT
Department Chair: Dr. Noshir Mehta Room: 617

Clinical Oral Diagnosis and Treatment Planning: Dr. Donald Hanson
Didactic Diagnosis and Treatment Planning: Dr. Paul Vankevich
Head, Division of Nutrition and Oral Health Promotion: Dr. Carole Palmer
Head, Emergency Rotation: Dr. Frank Odlum
Head, Medicine: Dr. Kanchan Ganda
Head, New Patient Encounter: Dr. John Bogis
Head, Oral and Maxillofacial Radiology: Dr. Audrey Furkart
Course Director, Ethics: Dr. John Meade
Behavioral Science Seminar: Dr. Arthur Weiner
Dept Extension: 6814 Patti DiAngelis Department Administrator

Third floor

A. BEHAVIORAL SCIENCE

Year 3
Students must do one behavioral science competency examination. This CE is a questionnaire that the student’s patient fills out concerning the student’s behavior. The Practice Coordinator selects the patient randomly.

B. DENTAL EMERGENCY

Year 4
Each student must take one case presentation competency examination in Year 4 during his or her assigned emergency rotation.

DIAGNOSIS AND TREATMENT PLANNING

An XMRT (0150) is the equivalent of 4 points plus 1 point for oral hygiene and plaque control. An XMRV (0120) is the equivalent of 3 points. There are no minimum procedural experiences because the student must do what is necessary for the number of new patients assigned to him/her.

Year 3
Students must present four cases as competency examinations to their Practice Coordinators. These patients must be completed without guidance or consultations. The grading is based on the medical/dental history, chief complaint, radiographic findings, recording of hard and soft tissue findings, interpretations of findings and presentation of the diagnosis and treatment plan to the patient (informed consent). Grading is based on a 1, 2, 3, 4 score with a 1 being a failing score. The student must score 2 or above in each part in order to pass.

During the 2004-2005 academic year (your year 4) you must do a required case presentation in a small group seminar setting. The objective of this exercise is to help you to better integrate the various disciplines of dentistry, and gain an appreciation for comprehensive patient care. (This graded exercise will also be used for us to evaluate your ability to diagnose and treatment plan). Therefore, during the 2003-2004 academic year you should identify at least one patient who requires multidisciplinary treatment as a candidate for the case presentation. Ensure that you keep at least one set of pre-treatment study casts. We will also be introducing clinical photography during the 2003-2004 year, which will enable you to further document cases during the treatment phase. It will not be necessary for you to have completed the treatment by the time of the presentation, but significant progress should have been accomplished to make a meaningful presentation. (if you have any questions, please feel free to ask Dr. Hanson or your PC).

Year 4
A case presentation competency examination will be added to year 4. See above. This CE would consist of the student making an oral presentation about his/her diagnosis and treatment plan for one of his/her patients to a group of students/faculty in a seminar format.

MEDICINE

IN MEDICINE III COURSE (HOSPITAL CLERKSHIP) PROGRAM- YEAR 3

Medical Record Review – Year 3
The student must complete 1 medical record review minimum procedural experience (MPE). The student examines the medical record of a NEMC medically compromised patient. The student must assess and present the patient’s medical history, physical findings, laboratory findings, medications, and the management of the patient. A theoretical serious dental problem (which requires dental surgical intervention at the time of hospitalization) is added.

Students work in groups of five for this. The presentation of the case is done orally.

Problem-based learning – Year 3
The student must complete 1 problem-based learning minimum procedural experience (MPE). Five medically compromised patient case studies are presented to the student. The student has 2-3 weeks to research the cases on Medline. Each student then independently orally presents the five cases. The student’s clinical decision making, critical thinking and treatment planning skills are determined as they answer questions relating to clinical medicine, medications, medical status, medical history or treatment planning.

IN CLINIC – Year 3
The student must have two medicine oral case presentations: 1 medically compromised patient case presentation as a minimum procedural experience (prerequisite) and 1 as a Competency Examination.

The student evaluates medically compromised random dental patients obtained from screening. They obtain a medical history, do a physical examination, and evaluate the medications the patient is taking. The student does a comprehensive medical evaluation and establishes the dental management of the patient, including determining which anesthetics, analgesics, and antibiotics can or cannot be used. Prescription writing is part of the CE.

ORAL APPLIANCE

Year 3 or 4
Students must do 1 oral appliance for bruxism/clenching (or other occlusal concerns) as a minimum procedural experience.

ORAL HEALTH PROMOTION

Year 3
Students must complete 1 competency examination in Oral Health Promotion (OHP), in the Year 3. The competency examination will be a written case-based examination covering Preventive Needs Assessment, Treatment Planning, and Treatment. Subjects include risk assessment, appropriate use of pharmacotherapeutic agents (fluoride, antimicrobials), diet screening and guidance, and home care methods, approaches, and materials. Behavioral aspects will be stressed. Cases will include adults, elders, and persons with special health care needs. NOTE: This CE may become computer based in the near future.

Year 4
Students must complete 1 minimum procedural experience in OHP in the Year 4. This consists of a written presentation of the student’s Oral Health Promotion management of one of his/her patients.

ORAL AND MAXILLOFACIAL RADIOLOGY

New Patient Encounter ROTATION – Oral and Maxillofacial RADIOLOGY SPECIFIC experiences:

There are minimum procedural experiences that all students must meet while on assignment to the New Patient Encounter Rotation. If any of the following MPE’s are not met, the student receives an incomplete grade (I) for his/her NPE Rotation, which is not removed until the MPE is met.

• The student must have completed ICE