Program Educational Philosophy
The education philosophy of the AEGD program is to provide General Dentistry Resident education in a multidisciplinary environment that enhances and refines skills and knowledge obtained in dental school and provides practical experiences serving underserved communities. An emphasis on professional ethics and community care will be at the forefront of every education opportunity.
Program Goals & Competency Statements
Definitions
The following statements describe the graduates of the AEGD program. These statements are intended to communicate the expectations of the faculty to the resident and serve as the basis for evaluation of resident’s satisfactory completion of the program.
In order to facilitate reading this list of statements, certain terms have been defined so they could be used in the application without repetitive definition. These definitions are listed in the next section of this manual. In general, the definitions proposed by Chambers and Gerrow have been followed, although some new definitions have been added and some definitions modified. In situations where it is expected that the AEGD program graduate will be able to, and likely to, actually perform the necessary procedures, the terms “perform”, “provide”, “restore”, or “treat” have been used. In circumstances where the graduate mayperform some treatment but is more likely to oversee treatment or refer, the term “manage” is used. The term “appropriate” is not used in these statements to eliminate repetitive verbiage. It is assumed that all knowledge, skills, and procedures described will be performed for appropriate reasons, in appropriate circumstances and in an appropriate manner. In this application each statement is designated as either an area of competency (C) in which graduates are expected to have little experience at the beginning of their programs, or as an area of proficiency (P) in which graduates are expected to be competent at the beginning of their programs and gain further experience, skill and judgment as the program progresses.
Competency: Behavior expected of the beginning practitioner. This behavior incorporates understanding, skill and values in an integrated response to the full range of requirements presenting in practice. The level of performance requires some degree of speed and accuracy consistent with patient well-being but not performance at the highest level possible. It also requires an awareness of what constitutes acceptable performance under the circumstances and desire for self-improvement. Graduates are expected to have little experience at the beginning of their program.
Proficiency: A level of practice that exceeds competency. Proficiency entails slightly greater speed and accuracy of performance, ability to handle more complicated and unusual problems, and problems presenting under less than ideal circumstances, and greater internalization and integration of professional standards.
Graduates are expected to be competent at the beginning of their program and gain further experience, skill and judgment as the program progresses.
Competencies. Written statement describing the levels of knowledge, skills, and values expected of residents completing the program.
Program Goals
Graduates of our program will be able to function as a highly-trained primary oral health care provider, demonstrating compassionate care for diverse populations of individuals and communities and capable of multidisciplinary treatment modalities. Specifically, graduates of this program will:
Demonstrate the ability to develop a comprehensive definitive treatment plan or limited limited plan which considers a patient’s chief complaint, disease condition, and medical considerations and results in a state of oral health.
Function as a member of a multi-disciplinary team to provide high-quality and sophisticated dental care for patients, including patients with special needs.
Use didactic knowledge, technology, and scientific evidence to guide oral health care decisions, with emphasis on best practices, outcomes assessment, and preventative care.
Demonstrate positive and ethical relationships with patients, peers, staff, and program.
Engage in community service.
Clinical Competency Statements
In regards to providing primary oral health care:
Provide episodic and comprehensive multidisciplinary oral health care that is coordinated by the general dentist.
Understand and obtain informed consent.
Treat patients who present with a broad variety of acute and chronic systemic disorders and social difficulties, including patients with special needs.
Promote oral health through disease prevention activities.
Maintain a patient record system that facilitates the retrieval and analysis of the process and outcomes of patient treatment.
Obtain and interpret relevant clinical data to develop a logical, sequenced and comprehensive treatment plan to restore health, function, and esthetics to patients.
Practice and promote ethical principles of dentistry in relationship to patients, colleagues, institutions, and staff.
Treat patients efficiently in a dental health care setting.
Provide compassionate service to the community with empathy towards others, especially patients with limited access to oral health care.
Use effective sterilization techniques, workplace controls, and other universal precautions to prevent the spread of disease in the health care setting.
Evaluate outcomes of treatment to develop a prognosis and plan for long-term maintenance of oral health.
In regards to the restoration of teeth:
Provide direct and indirect restorations for single teeth using a variety of functionally acceptable materials and techniques.
Understand the materials used to fabricate dental restorations.
Restore endodontically treated teeth.
In regards to periodontal therapy:
Use clinical data to develop an appropriate diagnosis and prognosis of the periodontium; develop a plan for intervention when necessary.
Treat patients presenting with mild and moderate periodontal disease using non-surgical interventions.
Manage severe periodontitis patients.
Provide adjunctive periodontal soft/hard tissue procedures to improve periodontal health, enhance esthetics, or facilitate restorative procedures.
Evaluate the results of periodontal treatment to establish/monitor a periodontal maintenance program.
In regards to endodontic therapy:
Treat anterior and posterior teeth with endodontic therapy.
Use relevant clinical information to test and diagnose teeth demonstrating pulpal pathology.
Manage complex endodontic complications.
In regards to oral surgery:
Demonstrate proficiency in exodontia.
Manage or treat patients with oro-facial pain and infections.
Manage post-operative pain with appropriate pharmacological approaches.
Identify and manage soft tissue lesions and pathology.
Manage temporomandibular disorders and other facial pain disorders.
Treat or manage patients demonstrating complications from oral surgery.
Be familiar with techniques to manage patients with traumatic injuries to the face or dentition.
Be familiar with the diagnosis and management of oral mucosal diseases and soft tissue biopsy.
In regards to evaluation and treatment of emergencies:
Perform limited evaluation exams to collect clinical information and diagnose causes of dental pain.
Anticipate, diagnose and provide initial treatment and follow-up management for medical emergencies that may occur during dental treatment.
Prevent emergencies through coordination and communication with physicians and other health care providers to understand patient medical conditions and suitability for dental care.
In regards to pain and anxiety control:
Use nitrous oxide to alleviate anxiety for patient care.
Use parenteral moderate sedation to alleviate anxiety for patient care.
Use other methods for pain control and anxiety relief, such as local anesthesia, behavior management techniques, and communication skills.
Perform medical, social, and dental history review and physical exam to identify and manage patients with complex medical presentations.
In regards to managing the edentulous space:
Treat patients with complete and partial removable dentures.
Use dental laboratories to develop fixed and removable indirect restorations; communicate effectively with these laboratories.
Place single implants in abundant bone.
Restore dental implants to provide function and esthetics for patients.
Use site development techniques to preserve and restore anatomic bone contours.
Service Goals and Objectives
One of our major goals of our program is to engage residents in community service. This is represented by goal 5, Residents will engage in community service.
Community service for us is defined as serving members of the community without access to traditional forms of providing dental care. This is typically due to lack of sufficient finances to pay for treatment, but can also be associated with lack of transportation, lack of mobility, or other special needs.
Our program provides several opportunities for service and service learning. In fact, our clinic is focused on service, as we are seeing community patients that are not able to access traditional care. Additionally, we have the MOM project in Southwest Virginia. Our residents travel there and provide free services for three days. Also, we close our clinic two days per year to provide free care to homeless persons in Bessemer. Residents are encouraged to pursue other service opportunities.
The objectives of community service are to expose residents to service for two purposes. First, residents are providing direct care to people in need. Second, we hope that this pattern of service will establish attitudes and understanding of service that will continue into a resident’s community service in the future, hopefully providing similar care to those in need.
Objectives:
Engage in service activities in the clinic, such as giving away “Foundry Bucks” to persons in need.
Participate in MOM project in Southwest Virginia.
Participate in the annual UAB Cares day.
Provide free care at the dental center 2 days per year.
Write and submit for review a self-reflection on service, and how it has impacted the resident personally.
Complete surveys following graduation which document service activities.
*Adapted from Chambers and Gerrow.
Assess: Evaluation of physical, written, and psychological data in a systematic and comprehensive fashion to detect entities or patterns that would initiate or modify treatment, referral, or additional assessment. Assessment entails understanding of relevant theory, and may also entail skill in using specialized equipment or techniques. But assessment is always controlled by an understanding of the purpose for which it is made and its appropriateness under the present circumstances. Recognition is a more limited term that does not subsume the notion of evaluating findings. Diagnosis is a more inclusive term which relates evaluated findings to treatment alternatives.
Competency: Behavior expected of the beginning practitioner. This behavior incorporates understanding, skill, and values in an integrated response to the full range of requirements presenting in practice. The level of performance requires some degree of speed and accuracy consistent with patient well-being but not performance at the highest level possible. It also requires an awareness of what constitutes acceptable performance under the circumstances and desire for self-improvement.
Diagnose: Diagnosing means systematically comparing a comprehensive database on the patient with an understanding of dental and related medical theory to identify recognized disease entities or treatable conditions. The concept of diagnosis subsumes an understanding of disease etiology and natural history.
Discuss (communicate, consult, explain, present): A two-way exchange that serves both the practitioner's needs and those of patients, staff, colleagues, and others with whom the practitioner communicates. The conversation, writing, or other means of exchange must be free of emotional or other distorting factors and the practitioner must be capable of expressing and listening in terms the other party understands.
Document: Making, organizing, and preserving information in standardized, usable, and legally required format.
Manage: Management refers to the selection of treatment-including: no intervention; choice of specific care providers-including hygienists, and medical and dental specialists; timing and evaluation of treatment success; proper handling of sequela; and insurance of patient comprehension of and appropriate participation in the process. In circumstances where the graduate may perform some treatment but is more likely to oversee treatment or refer, the term "manage" is used. In situations where it is expected that practitioners will be capable of and likely to provide treatment as well as oversee it, the terms "treat", "provide", or "perform", will be used.
Monitor: Systematic vigilance to potentially important conditions with an intention to intervene should critical changes occur. Normally monitoring is part of the process of management.
Obtain (collect, acquire): Making data available through inspection, questioning (patients, physicians, relatives), review of records etc., or capturing data by using diagnostic procedures. Health histories, radiographs, casts, and consults are obtained. It is always assumed that the procedures for obtaining data are performed accurately so that no bias is introduced, are appropriate to the circumstances, and no more invasive than necessary, and are legal.
Patients with Special Needs: Those patients whose medical, physical, psychological, or social situations make it necessary to modify normal dental routines in order to provide dental treatment for that individual. These individuals include, but are not limited to, people with developmental disabilities, complex medical problems, and significant physical limitations.
Perform (conduct, restore, treat): When a procedure is performed, it is assumed that it will be done with reasonable speed and without negative unforeseen consequences. Quality will be such that the function for which the procedure was undertaken is satisfied consistent with the prevailing standard of care and that the practitioner accurately evaluates the results and takes needed corrective action. All preparatory and collateral procedures are assumed to be a part of the performance.
Practice: Used to describe a general habit of practice, such as "practice consistent with applicable laws and regulations."
Prepare (see Perform):
Present (see Discuss):
Prevent [the effects of]: The negative effects of known or anticipated risks can be prevented through reasonable precautions. This includes understanding and being able to discuss the risk and necessary precautions and skill in carrying out the precaution. Because preventing future damage is of necessity a response to an internalized stimulus rather than a present one, additional emphasis is placed on supportive values.
Provide care (see Perform):
Recognize (differentiate, identify): Identify the presence of an entity or pattern that appears to have significance for patient management. Recognition is not as broad as assessment -- assessment requires systematic collection and evaluation of data. Recognition does not involve the degree of judgment entailed by diagnosis. [Caution is necessary with these terms. They are often use in the old instructional objectives literature to refer to behavior students perform for instructors. They can only be used for competencies when practitioners recognize, differentiate, or identify for patients or staff.]
Refer: A referral includes determination that assessment, diagnosis, or treatment is required which is beyond the practitioner's competency. It also includes discussion of the necessity for the referral and of alternatives with the patient, discussion and cooperation with the professionals to whom the patient is referred, and follow-up evaluation.
Restore (see Perform):
Skill: The residual performance patterns of foundation skills that is incorporated into competency. The importance of the skill is more than speed and accuracy: it is the coordination of performance patterns into an organized competency whole.
Treat (see Perform):
Use: This term refers to a collateral performance. In the course of providing care, precautions and specialized routines may be required. For example, infection control and rapport building communication are used. Understanding the collateral procedure and its relation to overall care is assumed. It is often the case that supporting values are especially important for procedures that are needed -- they are usually mentioned specifically because their value requires reinforcement.
Understanding: The residual cognitive foundation knowledge that is incorporated into competency. Understanding is more than broad knowledge of details: it is organized knowledge that is useful in performing the competency. [Caution should be used with this term. Understanding alone is not a competency; it must be blended with skill and values.] Values. Preferences for professional appropriate behavior in the absence of compelling or constraining forces. Values can only be inferred from practitioner's behavior when alternatives are available. "Talking about" values reflects a foundation knowledge; valuing can be inferred by observing the practitioner's attempts to persuade others.
Reference
Chambers DW, Gerrow JD, Manual for developing and formatting competency statements. J Dent Educ 1994;58:361-6.
Minimum Clinical Expectations
While our program is competency-based, educators recommend several foundational exercises to display and document clinical competencies adequately. Please find the minimum number of cases expected below.
PGY1 Expectations
Clinical Item or Procedure Minimum Expectations
Diagnostic
Treatment plans……………………………………………………………………………………………………………………………….20
Patient evaluations…………………………………………………………………………………………………………………………...20
Informed consent……………………………………………………………………………………………………………………………..20
Operative Dentistry
Crowns………………………………………………………………………………………………………………………………………………5
Direct restorations……………………………………………………………………………………………………………………………20
Periodontal Therapy
Sc/Rp/QDS………………………………………………………………………………………………………………………………………...8
Soft tissue surgery (including implant uncovery)…………………………………………………………………………………..2
Implant site development…………………………………………………………………………………………………………………...2
Endodontics
Anterior RCT……………………………………………………………………………………………………………………………………….2
Posterior RCT…………………………………………………………………………………………………………………….………………..2
Oral surgery
Extractions………………………………………………………………………………………………………………………………………20
Pre-prosthetic surgery………………………………………………………………………………………………………………………..2
Dentures
Conventional complete…………………………………………………………………………………………………………….…………2
Implants
Implant placement……………………………………………………………………………………………………………………….…..10
Implant restoration, crown…………………………………………………………………………………………………………………5
Implant restoration, overdenture……………………………………………………………………………………………….…….....2