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Appendix E: Minimum Procedural Experiences, Departmental Competency / Examinations & the Points ProgramRevised 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 OBJECTIVES 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.
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.
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 Quality Assurance: Ms. Susan Rodd Room 335 QUALITY ASSURANCE Record Audits – Year 3 or 4
Post Treatment Examinations - Year 4
Year 4.
INFECTION CONTROL II. ENDODONTICS DEPARTMENT 10 canals (one treated tooth must be a molar) Two “1/2” day Endodontic Assists in Postgraduate Endodontics: 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. 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.
i) The endodontic procedure must be finished.
The Final Grade in Endodontics Consists of: 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 Clinical Oral Diagnosis and Treatment Planning: Dr. Donald Hanson Third floor
Year 3 B. DENTAL EMERGENCY Year 4 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 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 MEDICINE IN MEDICINE III COURSE (HOSPITAL CLERKSHIP) PROGRAM- YEAR 3 Medical Record Review – Year 3 Students work in groups of five for this. The presentation of the case is done orally. Problem-based learning – Year 3 IN CLINIC – Year 3 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 ORAL HEALTH PROMOTION Year 3 Year 4 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.
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