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  1. 1. ADVANCED GENERAL DENTISTRY ORIENTATION INFORMATION YEAR 2001-2002 Baltimore College of Dental Surgery Dental School University of Maryland, Baltimore 666 W. Baltimore Street Baltimore, MD 21201
  2. 2. Orientation Information The Purpose and Goals - Philosophy The Advanced General Dentistry Program is designed to improve and refine residents’ scientific knowledge and clinical skills in the practice of general dentistry. It prepares the resident to assess the patient’s general health status relative to anticipated dental treatment and to plan and deliver that treatment. Where specialist care is required, the generalist learns to serve as the principal coordinator. Didactic and clinical training and experience in patient, personnel and practice management is stressed. The clinical experience will include a broad range of clinical cases and be designed to match each resident’s specific needs and interest. In addition, the clinical facility is organized as a simulated private group practice with responsibility for managing the practice. The overall goal of the program is to facilitate the transition from an undergraduate dental program into general practice through advanced didactic training and clinical experience in a simulated general practice environment. Responsibilities Duties of the Resident Each resident shall: 1. Provide professional comprehensive care and treatment to assigned patients; keep a complete record of activity, maintain portfolio (pg. 32). 2. Maintain at all times the highest professional conduct with respect to patients and support staff. 3. Consult with faculty members when arriving at a diagnosis and treatment plan. 4. Function under the supervision and guidance of the teaching staff. 5. Develop the ability to assume increasing independence. As a result, a greater amount of responsibility will be placed on your clinical judgement as the year progresses. 6. Enter all treatment plans on the Densyst computer, 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). 7. Assume responsibility for following your patient’s financial accounts; render treatment only after payment is assured. 8. Attend all regular and special dental meetings. 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: a. gaining experience in managing highly complex comprehensive dental care; b. improving clinic management skills; c. pursuing areas of individual concentration, e.g.: temporomandibular disorders, public health dentistry, special patient care, etc; d. 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; e. gaining teaching experience, performing original research and earning a Masters of Science in Oral Biology degree. 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. 2
  3. 3. The Teaching Staff’s 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 AGD patients. Vacations/Leave Residents are granted the following: Holidays: Independence Day, Labor Day, Thanksgiving Break, Christmas- New Years 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. See memorandum on number of days leave allowed. 3
  4. 4. Objectives in Each Specialty 1. Treatment planning: 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 other services. 2. Oral Diagnosis. Oral Medicine, Oral Pathology: 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. Oral 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. Periodontics: 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. c. Supervise auxiliaries in the performance of patient education procedures; prescribe treatment to be rendered by the dental hygienist. d. Diagnose and treat all but the most complex cases of periodontal disease while applying the principles of preventive dentistry. e. Diagnose and treat HIV/AIDS associated periodontal abnormalities. 4
  5. 5. f. Utilize the basic periodontal literature in order to defend your treatment. 5. 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. Operative Dentistry: 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. Prosthodontics (Fixed and Removable): 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. I. Evaluate and organize the clinic laboratory to manage cases for high-risk infectious disease patients. j. Appraise mouth preparations and finished prostheses from the standpoint of improving technique. 8. Occlusion: a. Use the technique of masticatory system assessment to determine the features of a patient’s occlusion. b. Use occlusal adjustment to improve a patient’s occlusion when specifically indicated. 5
  6. 6. c. Determine when each mode of occlusal treatment is indicated. d. Diagnose and treat patients with temporomandibular disorders using a multidisciplinary approach. e. Illustrate the functions and limitations of the major types of articulators. 9. Pedodontics/Orthodontics: a. Treat normal, difficult, handicapped and HIV/AIDS infected children in the dental operating room. b. Recognize a developing or established malocclusion. c. Correct selected malocclusions amenable to treatment by a general dentist. d. Use selective orthodontics as an adjunct to treatment when indicated. e. Understand the limitations of orthodontics in general practice, act as a primary diagnostic resource and refer when indicated. f. Perform pedodontic and orthodontic treatment with full consideration of the principles of preventive dentistry and periodontics with consideration of infectious disease patients. g. Apply the principles of esthetic dentistry to pedodontic and orthodontic procedures. 10. Practice Management a. Appraise the direction and utilization of auxiliary personnel in a general practice setting. b. Appraise the management and operation of a group general practice that includes treatment of infectious disease patients with respect to efficiency and quality of care. c. Effectively manage patients applying behavioral science principles. d. Evaluate the business management aspects of a general practice including financial and data base management. e. Evaluate the purchase and use of computer hardware and software in dental practice. f. Certify in CPR level C. 11. Miscellaneous: a. Lead seminar discussions and make formal case presentations. 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. 6
  7. 7. ADVANCED GENERAL DENTISTRY COURSE ORGANIZATION 1. Patients - You are responsible for all phases of patient care. A. Necessary documentation for complete cases and case presentations: 1. six basic photographs - intraoral anteriors, right and left posteriors, mandibular and maxillary occlusals; and full face (photographs only for case presentations) 2. masticatory system assessment 3. periodontal chart, plaque index 4. full mouth radiographs and panoramic 5. complete verified dental record 6. medical history updated - blood pressure 7. consultations if applicable 8. written treatment plan 9. 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 II. Course Format/Outline a. Seminars 1. Treatment planning 7. Prosthodontics 2. Articulators a. Literature review a. Literature review b. Lab exercises b. Hand-on training 8. Orthodontics 3. Occlusion/TMD a. Literature review a. Literature review b. Lab exercises b. Demonstrations 9. CPC-oral pathology and oral diagnosis 4. Operative a. Literature review a. Literature review b. Lab exercises b. Reports 10. Implants 5. Endodontics a. Case reviews a. Literature review b. Guest lecturers b. Case review 11. Dental office medical emergencies 6. Periodontics 12. Practice Management a. Literature review b. Case treatment planning c. Case review 7
  8. 8. III Duties and Responsibilities A. Administrative Duties 1. Routing forms 2. Complete accurately filling out all appropriate documentation 3. Portfolio (see p. 22 ) 4. Computerized Treatment plans on all patients signed by faculty, resident and patient. 5. Financial/Insurance forms 6. Assistant evaluations 7. Complete Implant Programs/Order Forms (p. 34-35) 8. Complete Quality Assessment Audits and chart audits (p.19-20) 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. In your own best interest, it is required that you see all final wax-ups before the lab proceeds to the next step; this must be indicated on the laboratory form. *Must be signed off by the business manager once financial arrangements have been made. 50% must be paid before work is sent to the lab. IV. Specialty Coverage A. Periodontics - specified times/on call B. Prosthodontics - specified times/on call C. Endodontics - specified times/on call D. Orthodontics - specified times/on call E. Oral Surgery - specified times/on call F. All others available on call through AGD staff V. Critiques and Evaluation A. Critiques by Residents 1. Curriculum Review/Instructor Feedback forms on short courses, lectures and seminars (pg. 10-12). 2. Program critique at the end of the year 3. Faculty Evaluation 4. Quarterly critique of program by residents found in the Quarterly Evaluation of Resident 5. One year post graduation follow-up critique/outcomes assessment (recent resident survey) B. Critiques by Faculty 1. Quarterly Evaluation of resident (see pages 23-29) 2. Quality Assessment Audit (see pages 30-31) 8
  9. 9. VI. 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. To assess the quality of work being performed 2. 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. 9
  10. 10. Advanced General Dentistry Chart Audit I. Forms: Status and Quality Present Absent Comments Patient Information ______ ______ Financial Information ______ _______ Medical History ______ _______ Dental History ______ _______ Consent for Treatment ______ ______ Soft Tissue Review ______ ______ Hard Tissue Review ______ ______ Treatment Plan ______ ______ Daily Log ______ ______ Recall Form ______ ______ Record of Payment/Bill ______ ______ Radiation Control Log ______ ______ Follow-up procedure and date: Faculty Signature: 10
  11. 11. ADVANCED EDUCATION IN GENERAL DENTISTRY PROGRAM CURRICULUM REVIEW/INSTRUCTOR FEEDBACK GUIDE Date: ___________ Time: __________ Hours: ________________ Title/Topic: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Presenter: ________________________________________ Format: Seminar Literature Review Lecture TX Planning Conference Hands-on Learning Objectives: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Comments/Critique: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Number in attendance: ________ Use of audiovisual aids: Yes or No Chair: __________________________ Signature 11
  12. 12. This form is to be completed during session observed. 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? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 12
  13. 13. 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. Objective: 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. 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 13
  14. 14. Resident Evaluation of Program 1. Quality and relevance of classroom instruction 2. Quality and relevance of seminars 3. Quality and amount of clinical instruction 4. Clinical and laboratory support 5. Staff’s approach 14
  15. 15. RESIDENT SURVEY OF PROGRAM 1. Is number of faculty adequate to complete objectives of program? Y/N 2. Does Director actively participate in teaching program? Y/N 3. Do all faculty possess some clinical skills? Y/N 4. Are faculty members responsive to educational needs? Always Sometimes Never 5. Do faculty discuss patient evaluation, treatment planning, management, complications and outcomes of all cases with them? Always Sometimes Never 6. Do faculty supervise students in clinical activities? Y/N 7. Is there adequate secretarial staff to assume efficient administration of the program? Y/N 8. Is there sufficient auxiliary personnel to allow for training and experience in four handed dentistry? Y/N 9. Are there adequate facilities to support the program, i.e. lab, clinic radiology? Y/N 10. Do you have access to a well equipped operatory when providing direct patient care? Always Sometimes (Approximate % ) Never 11. Are instruction and experiences provided in: YES NO ENDO OPER O.S. ORTHO PEDO PERIO FXD. PROS. REMV. 15
  16. 16. 12. Is instruction and experience provided at an advanced level? Y/N 13. Do you perform a minimum of extra-oral lab procedures and instead work with lab techs using work authorizations? Y/N 14. Do you exercise a major degree of independent judgement beyond that in undergrad? Always Sometimes (Approximate % ) Never 15. Are you assigned patients with increasingly difficult problems and been given increasingly greater clinical responsibility? Y/N 16. Is a faculty member present in clinic and readily available for consultation during all clinic sessions? Y/N Always Sometimes (Approximate % ) Never 17. Are the basic sciences applied in clinical settings? Y/N 18. Is emphasis placed on the most appropriate sequence of treatment for each patient? Always Sometimes (Approximate % ) Never 19. Have you received training and experience in Physical Evaluation? Y/N 20. Is the application of the behavioral sciences stressed in the program? Y/N 21. Have you been given assignments requiring critical review of dental or related literature and research? Y/N 22. Do you maintain responsibility for overall patient management and for the end result of all treatment modalities? Always Sometimes (Approximate % ) Never 16
  17. 17. 23. Have you been familiarized with the following principles of practice management? a. Management of office personnel and auxiliaries . b. Maintenance and management of patient records . c. Quality assessment . d. Principles of peer review . e. Business management, including 3rd party payment and practice development . 24. Have your communication skills improved during your year in the program? Y/N 25. Have you been acquainted with different systems for delivery of dental care? Y/N 26. Is the majority of your time spent in the delivery of oral health care? Y/N 27. Are you required to attend weekly seminars? Y/N 28. Are the weekly teaching sessions attended and directed by a member of the general dentistry program staff? Always Sometimes (Approximate % ) Never 29. Are the teaching sessions beyond the pre-doctoral curriculum? Y/N 30. Are treatment planning conferences held regularly? Y/N 31. Are treatment planning conferences conducted in concert with other advanced educational programs when appropriate? Always Sometimes Never 32. Is evaluation feedback provided either in writing or in individual meetings with the director? 33. Do we simulate graduate practice environment? Y/N 17
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  20. 20. One-Year Post Graduation 1. Are you a practicing general dentist? Y/N 2. If you answered yes to the previous question, which of the following situations best describes your practice? A. Solo practice B. Group practice C. Associateship D. Dental Education E. U.S. Public Health Service F. U.S. Armed Forces 3. Do you plan to seek further formal dental training? Y/N 4. If you answered yes to the previous question, will your training be in one of the following? A. Dental Specialty B. General Dentistry 5. What year did you complete your training in Advanced General Dentistry? Two year residents are you, and did the program Y PROGRAM help you in: OU 6. a. gaining experience in managing highly complex Y/ Y/N comprehensive dental care N 7. b. improving clinic management skills Y/ Y/N N 8. c. pursuing areas of individual concentration, e.g.: Y/ Y/N temporomandibular disorders, public health dentistry, N special patient care, etc. 9. d. providing residents with an interdisciplinary graduate Y/ Y/N foundation in the biological and clinical sciences for N careers in dental research and/or education and the practice of dentistry 10. e. gaining teaching experience, performing original Y/ Y/N research and earning a Master's of Science in Oral N Biology degree 20
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  22. 22. ADVANCED EDUCATION IN GENERAL DENTISTRY AEGD 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? 5 4 3 2 1 n/a 2. How effectively does the faculty member convey meaningful information via 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 3. How consistent is the information you receive from the individual faculty member? 5 4 3 2 1 n/a 4. How helpful is the faculty member? 5 4 3 2 1 n/a 5. How willing is the faculty member to help? 5 4 3 2 1 n/a 6. How is the faculty member’s availability and accessibility? 5 4 3 2 1 n/a 7. To what extent is the faculty member punctual? 5 4 3 2 1 n/a 8. 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 9. To what extent does the faculty member demonstrate professionalism? 5 4 3 2 1 n/a 22
  23. 23. 10. To what extent is the faculty member a role model for you? 5 4 3 2 1 n/a 11. To what extent is the faculty member an asset to the AEGD Program? 5 4 3 2 1 n/a ADDITIONAL COMMENTS: 23
  24. 24. Resident’s Name: Quarter: 1st_____ 2nd_____ 3rd_____ 4th_____ Professional Performance 0 1 2 3 1. Clinical application of basic sciences ___ ___ ___ ___ 2. Thoroughness of history and physical exam ___ ___ ___ ___ 3. Discriminating use of prosthetic laboratory ___ ___ ___ ___ 4. Clinical judgement ___ ___ ___ ___ 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 ___ ___ ___ ___ Key: 0 Not observed 1 Superior 2 Satisfactory 3 Unsatisfactory Resident’s ability to carry out the following clinical tasks with specific comments for each task, examples of the major strengths and weaknesses observed (i.e., “critical incidents”): 24
  25. 25. GENERAL DENTISTRY CHECK-OFF LIST FOR QUARTERLY RESIDENT EVALUATION A. Staff evaluation of resident 1. Review of portfolio a. CPR card b. Pink copy of Treatment Plans with appropriate signatures c. Quality assessments (case completes) d. Seminar schedule/CE courses e. Case presentations/mini presentations f. Monthly procedural utilization forms g. Monthly productivity forms h. Treatment Requirement Forms i. Comptency Statements j. Quarterly Evaluation forms k. Resume l. Signed orientation manual 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 5. Review of didactic performance a. Quality of reports b. Seminar planning and leading c. Seminar participation d. Examination scores f. Q.A. review 25
  26. 26. B. Resident Evaluation of Program 1. Quality and relevance of classroom instruction 2. Quality and relevance of seminars 3. Quality and amount of clinical instruction 4. Clinical and laboratory support 5. Staff’s approach 26
  27. 27. OVERALL CLINICAL COMPETENCE Circle the number which best describes overall clinical competence. Acceptable Superior Satisfactory Unsatisfactory 9 8 7 6 5 4 3 2 1 I have reviewed this evaluation. Comments are as above. Date: _____________ Resident’s Signature: ________________________________ Program Director’s Signature: _____________________________________________________ Comments: 27
  28. 28. Professional Performance Definitions 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 Judgement 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. 28
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  30. 30. 8. Interest in Teaching Expresses a desire to fulfill a teaching role. 9. Effectiveness as a Teacher 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. 30
  31. 31. I. Treatment Planning Demonstrates the ability to devise an overall treatment plan for all patients encountered. Is able to resolve complex situations and manage comprehensive care that integrates all major disciplines of dentistry. Comments: Rate: __________ Superior __________ Satisfactory __________ Unsatisfactory II. Evaluating Demonstrates the ability to arrive at own sound criteria for evaluating all forms of dental treatment. Comments: Rate: __________ Superior __________ Satisfactory __________ Unsatisfactory III. Teaching Demonstrates the ability to act as an advisor and consultant to other dentists with regard to all facets of patient treatment. Comments: Rate: __________ Superior __________ Satisfactory __________ Unsatisfactory IV. Patient Care Demonstrates the ability to treat all but the most complex clinical situations in each of the dental specialties. Demonstrates the ability to manage all clinical situations with respect to behavi oral considerations. Comments: Rate: __________ Superior __________ Satisfactory __________ Unsatisfactory V. Affective Area Demonstrates good clinical judgement and a willingness to learn. Enjoys good rapport with patients and staff. Demonstrates efficiency in work organization and the ability to assume responsibility. Comments: Rate: __________ Superior __________ Satisfactory __________ Unsatisfactory 31
  32. 32. Patient: ________________________ Densyst #: __________________ Date: _____________ Resident: ______________________ Reviewer: ___________________ Quality Assessment Audit Follow-up Procedure A. General Patient Status Yes No N/A & Date 1. Is the patient satisfied and comfortable? ___ ___ ___ _________ 2. Was medical/social history reviewed at each appointment? ___ ___ ___ _________ 3. Is blood pressure reading up to date? ___ ___ ___ _________ 4. Were there any untoward events? ___ ___ ___ _________ B. Oral Medicine/Oral Diagnosis 1. Are there any undiagnosed lesions? ___ ___ ___ _________ 2. Were biopsies taken where indicated? ___ ___ ___ _________ 3. Were medical and dental consultations recorded and followed? ___ ___ ___ _________ 4. Was the treatment plan completed as sequenced? ___ ___ ___ _________ 5. Are patient progress and treatment entries complete and ___ ___ ___ _________ legible? 6. Were necessary radiographs taken and properly recorded? ___ ___ ___ _________ 7. Were necessary clinical/laboratory tests performed/ordered? ___ ___ ___ _________ C. Periodontics 1. Is the tissue free of inflammation? ___ ___ ___ _________ a. If no, what action will be taken? __________________ _________ 2. Are pockets eliminated or maintainable? ___ ___ ___ _________ 3. Have plaque and bleeding scores been recorded ___ ___ ___ _________ 4. Is home care instruction individualized and documented? ___ ___ ___ _________ 5. Has the recall interval been established? ___ ___ ___ _________ D. Surgery 1. Were necessary extractions accomplished? ___ ___ ___ _________ 2. Has healing taken place? ___ ___ ___ _________ 3. Were tissue reductions accomplished where indicated? ___ ___ ___ _________ E. Endodontics 1. Are endodontically treated teeth asymptomatic? ___ ___ ___ _________ 2. Are they properly restored and functional? ___ ___ ___ _________ 3. Is there a six month post-op radiograph evidence of healing? ___ ___ ___ _________ F. Restorative (Operative & FPD’s) 1. Are all restorations well polished? ___ ___ ___ _________ 2. Are contours and contacts correct and embrasures formed? ___ ___ ___ _________ 3. Is occlusion within accepted limits? ___ ___ ___ _________ 4. Are margins smooth and overhangs eliminated? ___ ___ ___ _________ 32
  33. 33. Follow-up Procedure Yes No N/A & Date G. Prosthetics (RPD’s) 1. Does the patient have an understanding of the care and limits of a removable prosthesis? ___ ___ ___ _________ 2. Is the prosthesis well polished and finished ___ ___ ___ _________ 3. Is the occlusion within acceptable limits ___ ___ ___ _________ 4. Have all pressure areas been eliminated ___ ___ ___ _________ 5. Is the removable prosthesis framework seated and retentive and of functional design ___ ___ ___ _________ H. Pedodontics/Orthodontics 1. Are fixed or removable appliances stable and ___ ___ ___ _________ functional? 2. Were any management problems adequately dealt with? ___ ___ ___ __________ 3. Was a stable orthodontic result achieved? ___ ___ ___ __________ I. Infection Control 1. Have necessary sterilization, isolation and barrier techniques bee followed in: a. patient treatment? ___ ___ ___ _________ b. laboratory procedures ___ ___ ___ _________ 2. Have infectious disease screening procedures been followed? ___ ___ ___ _________ 33
  34. 34. Sample 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. they have collected for review. 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. 34
  35. 35. Example of Monthly Production Report Provider Revenue Actual Budget Revenue Actual Budget YTD YTD YTD Budget Revenue Variance Budget Charges Variance Budget Actual Budget March March March Revenue Variance Resident $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 $184 $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 $3,613 $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) 35
  36. 36. 36
  37. 37. 37
  38. 38. Advanced 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 pg. 38). 4. The faculty will provide a reading list for the seminar. Each resident will be responsible for : a. Reading all assigned materials b. Abstracting one article assigned by the chairperson and providing copies as required. c. Discussing the articles in relation to clinical practice. Abstract Form 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. Statement of the problem b. Purpose of the study c. Methods and materials d. Results e. Conclusions f. Comments - personal evaluation: 1. Are the problem and purpose clearly stated? 2. Is the subject population appropriate for the study? 3. Is research methodology reliable and valid? 4. Does article suggest lines of further research? 5. Are the conclusions consistent with the materials and methods and results? 38
  39. 39. Abstract Example February 5, 1991 Dr. El-Fayez 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. Most teeth with fractures of the enamel and dentin which were vital immediately after the trauma, remained vital. 2. Some teeth that test vital initially will develop pathologic changes and should be examined at 3 months, then every 6 months. 3. 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. 4. 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. 39
  40. 40. 40
  41. 41. General Dentistry Introduction To Treatment Planning Technical Criteria I. History (S) A. Chief Complaint (CC) 1. It should be a symptom - record the patients’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 II. Examination - Findings; list problems requiring attention, all of these must be addressed in TX sequence; charting must be complete - (O) A. List general observations and systemic findings - age, vital signs, skin, limbs, development nutrition. B. 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 mucosa, palate, pharynx, tongue and floor of mouth 3. Gingivae - color, texture, consistency, contour, amount of keratinized tissue, bleeding; details of periodontal condition on appropriate form 4. Occlusion/musculature - a general statement of condition; details on appropriate form 5. Dentition - a general statement of condition; details on appropriate form 41
  42. 42. 6. Oral hygiene - a general statement of condition; details on appropriate form 42
  43. 43. 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 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. V. 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 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: 43
  44. 44. 44
  45. 45. 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 goo 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 f. Endodontic therapy if pulpal and/or periapical lesions have developed or not resolved g. Replacement of restorations which no longer satisfy health, function or esthetic requirements h. Make new occlusal splints when old ones are broken down, worn out or lost VI. Prognosis 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. 45
  46. 46. University of Maryland, Baltimore Dental School Request for Patient Date: __________________ I request a patient with the following primary and secondary needs (in order of resident’s needs): 1. ______________________________________ 2. ______________________________________ 3. ______________________________________ Signature: __________________________________ Printed Name: ___________________________________ Provider: _________________________________ GPC # ________________ ---------------------------------------------------------------------------- Your request for a new patient of the above type has been: ____ denied (reason(s) checked below: ____ excessive patient load ____ overdue treatment plan(s) ____ other: ___________________________________________________________ ____ delayed due to lack of such cases at this time. If you still need this type of patient, return this form to the “Request for New Patient Bin” located at the main reception desk. ____ file as follows: Chart#: _______________ Date: ________________________ Note: This form should be completed in duplicate. 46
  47. 47. Advanced Education in General Dentistry Implantology Progress Form Patient: __________________________________ Densyst #: __________________________________ Date: __________________________________ Date Dentist Signature Resident Signature Comment Consult Wax up and stint Final Treatment Plan Financial Plan Placement Surgery Stage 2 Surgery Fixture/Component Order Site Quantity Catalog Number Description Used/Returned Grafting Supplies Quantity Item Description Appliance: Completion Date: Quality Assessment Audit Date: Signatures: Dentist Resident Date 47
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  49. 49. M E M O R ANDUM 10/16/2001 TO: All AEGD Residents FROM: Douglas M. Barnes Director RE: Leave Policy AEGD residents are expected to be present for all clinic and seminar sessions throughout the academic year. Allowed vacations are listed in the orientation booklet. As a courtesy, 10 days of annual leave are permitted with prior approval of the director. Note that these 10 days are for any reason (interviews, illness, etc). After the 10 days have been exhausted, leave will not be granted except in emergency situations and the director must be contacted immediately. Resident Signature Date cc: Dr. Hasler Dr. Cohen 49
  50. 50. I have reviewed and understood the orientation manual and Clinic manual and will adhere to the guidelines set forth. Signature: Print: 50
  51. 51. Interoffice MEMORANDUM TO: Dr. John Hasler Associate Dean for Clinical Affairs FROM: Dr. Douglas M. Barnes Director SUBJECT: AEGD Discount to Employees and Immediate Family DATE: 10/16/2001 In response to your request at our last meeting, I am submitting to you our policy on Employee Discounts. Employees of the School who work in the AEGD Program receive a 50% discount off of the published AEGD fee schedule. Immediate family members of the AEGD Program employees and Dental School employees receive a 20% discount off of the published AEGD fee schedule. If you need any additional information please contact me at x6-0741. 51