2006 – 2007 AEGD Competency and Proficiency Statements

The following statements describe the graduates of the LMC Advanced Education in General Dentistry (AEGD) programs. They are intended to communicate the expectations of the faculty to the resident and serve as the basis for evaluation of resident’s satisfactory completion of the program.

h3.Definitions

In order to facilitate reading this list of statements, certain terms have been defined so they could be used in the manual without repetitive definition. These definitions are listed at the end of the competency and proficiency statements. 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 may perform some treatment but is more likely to oversee treatment or refer, the term “manage” is used. The term “appropriate” is not used in these statements to eliminate repetitive verbiage. It is assumed that all knowledge, skills, and procedures described will be performed for appropriate reasons, in appropriate circumstances and in an appropriate manner. In this manual each statement is designated as either an area ofcompetency© 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.

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.

A graduate of the LMC AEGD program will: In regard to planning and providing comprehensive multidisciplinary oral health care:

1. Function as a patient’s primary and comprehensive, oral health care provider as part of an interdisciplinary health care team. —(Proficiency)

2. Explain and discuss with patients, or parents or guardians of patients, findings, diagnoses, treatment options, realistic treatment expectations, patient responsibilities, time requirements, sequence of treatment, estimated fees and payment responsibilities in order to establish a therapeutic alliance between the patient and care provider. —(Competency)

3. Integrate multiple disciplines into an individualized, comprehensive, sequenced treatment plan using diagnostic and prognostic information for patients with complex needs. —(Competency) Page 1 of 6

4. Perform dental consultations and request medical consultations for outpatients in assigned health care settings. —(Competency)

5. Participation in the management of a system for continuous quality improvement in a dental practice—(Proficiency)

In regard to health care delivery:

6. Treat patients efficiently in a dental practice setting—(Competency)

7. Support the program’s mission statement by acting in a manner to maximize patient satisfaction in a dental practice—(Competency)

8. Use and implement accepted sterilization, disinfections, universal precautions and occupational hazard prevention procedures in the practice of dentistry. —(Competency)

9. Provide patient care by working effectively with allied dental personnel, including performing sit down, four handed dentistry—(Competency)

10. Provide dental care as a part of an interdisciplinary health care team (Competency)

11. Practice and promote ethical principles in the practice of dentistry and in relationships with patients, personnel, and colleagues—(Proficiency)

In Regard to Patient Assessment and Diagnosis:

12. Select and use assessment techniques to arrive at a differential, provisional and definitive diagnosis for patients. —(Competency)

13. Obtain and interpret the patients chief complaint, medical, dental, and social history, and review of systems—(Competency)

14. Obtain and interpret clinical and radiographic data and additional diagnostic information from other health care providers or other diagnostic resources—(Competency)

15. Use the services of clinical, medical, and pathology laboratories and refer to other health professionals for the utilization of these services—(Proficiency)

16. Perform a limited history and physical evaluation and collect other data in order to establish a risk assessment for dental treatment and use that risk assessment in the development of a dental treatment plan—(Proficiency)

17. Maintain a patient record system that facilitates the retrieval and analysis of the process and outcomes of patient treatment. (Competency)

18. Treat patients with a broad variety of acute and chronic systemic disorders and social difficulties including patients with special needs—(Competency)

19. Develop and carry out dental treatment plans for patients with special needs in a manner that considers and integrates those patients medical, psychological, and social needs—(Competency)

In Regard to Obtaining Informed Consent:

20. Inform patients of alternative treatment options available and/or risk of potential complications prior to performing invasive, surgical and/or high risk dental procedures that will allow patients to determine risk vs. benefit for the proposed treatment and arrive at a decision towards treatment. (Proficiency)

21. Obtain and/or document written approval from patients to perform those specific dental procedures requiring consent. (Proficiency) Page 2 of 6

In regard to promoting oral and systemic health and disease prevention:

22. Participate in community programs to prevent and reduce the incidence of oral disease—(Competency)

23. Use accepted prevention strategies such as oral hygiene instruction, nutritional education, and pharmacologic intervention to help patients maintain and improve their oral and systemic health—(Proficiency)

24. Diagnose and manage oral manifestations of systemic disease—(Competency)

25. Diagnose and manage common oral pathological abnormalities—(Proficiency)

In regard to sedation, pain and anxiety control:

26. Provide control of pain and anxiety in the conscious patient through the use of psychological interventions, non pharmacologic, behavior management techniques, local anesthesia, and other pharmacologic agents using at least one of the following delivery methods (IV sedation, inhalation, or oral).-(Competency)

27. Prevent, recognize, and manage complications related to use and interactions of drugs, local anesthesia and/or conscious sedation. —(Competency)

In regard to restoration of teeth:

28. Restore individual, vital teeth using a wide range of materials and methods that will enhance patient’s esthetics and/or function.—(Competency)

29. Restore endodontically treated teeth. —(Competency)

In regard to placement of teeth using fixed and removable appliances:

30. Treat patients with missing teeth requiring removable appliances.—(Competency)

31. Treat patients with missing teeth requiring uncomplicated fixed restorations. —(Competency)

32. Communicate case design with laboratory technicians and evaluate the resultant prostheses. —(Competency)

In regard to periodontal therapy:

33. Diagnose and treat early and moderate periodontal disease using appropriate therapies and procedures.—(Competency)

34. Manage advanced periodontal disease.—(Competency)

35. Evaluate the results of periodontal treatment and establish and monitor a periodontal maintenance program.—(Competency)

In regard to pulpal therapy:

36. Diagnose and treat pain of pulpal origin.—(Competency)

37. Perform uncomplicated non-surgical anterior Endodontic therapy.—(Competency)

38. Perform uncomplicated non-surgical posterior Endodontic therapy.—(Competency)

39. Treat non-complex Endodontic complications.—(Competency)

40. Manage complex Endodontic complications.—(Competency)

In regard to hard and soft tissue surgery:

41. Perform uncomplicated intra-oral surgical procedures, including surgical extraction of teeth.—(Competency)

42. Perform non-surgical extraction of teeth.—(Competency) Page 3 of 6

In regard to treatment of dental and medical emergencies:

43. Treat patients with intra-oral dental pain and infections.—(Competency)

44. Treat patients with non-complex, post-operative complications to dental treatment.—(Competency)

45. Manage patients with complex, post-operative complications to dental treatment.—(Competency)

46. Anticipate, diagnose and provide initial treatment and follow-up management for medical emergencies that may occur during dental treatment. —(Competency)

47. Treat intraoral hard and soft tissue lesions of traumatic origin.—(Competency)

Second Year AEGD Competency and Proficiency Statements:

1. Integrate all aspects of dentistry in the treatment of patients with complex dental, medical and social situations. —(Proficiency)

2. Perform advanced procedures in the selected Area of Concentration. —(Proficiency)

3. Use proper health center protocol when treating and managing patients in a health center environment. —(Proficiency)

4. Perform dental consultations and request medical consultations for outpatients in assigned health care settings. —(Proficiency)

5. Participate in programs within the AEGD program to prevent and reduce the incidence of oral disease. —(Proficiency)

6. Participate in the management of a system of continuous quality improvement in a dental practice. (Proficiency)

7. Teach undergraduate dental students (externs) in selected clinical and didactic disciplines when and/or where applicable at those sites that allow for undergraduate externships.—(Competency)

Definitions – 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 evaluation findings. Diagnosis is a more inclusive term that 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 and understanding of disease etiology and natural history.

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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 termsthe other party understands. (Caution should be exercised with using these verbs to ensure that the communication is between the practitioner and the patient. Communication between the student and faculty is language reminiscent of the old instructional objectives and is not evidence of competency).

Document

Making, organizing and preserving information in standardized, usable and legally required format.

Manage

Management refers to the selection of treatment-including: no intervention; choice of specific care providers including hygienist, and medical and dental specialists; timing and evaluation of treatment success; proper handling of sequelae; andinsurance of patient comprehension of and appropriate participation in the process. In circumstances where the graduate mayperform some treatment but is more likely to oversee treatment or refer, the term “manage” is used. In some situations where it is expected that the 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 the results and takes needed corrective action. All preparatory and collateral procedures are assumed to be 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 discussthe risk and necessary precautions and skill in carrying out the precaution. Because preventing future damage is of necessity a response to an internalized stimulus rather than a present one, additional emphasis is placed on supportive values.

Proficiency

A level practice that exceeds competency. Proficiency entails slightly greater speed and Page 5 of 6

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accuracy of performance, ability to handle more complicated and unusual problems, and problems presenting under less than ideal circumstances, and greater internalization and integration of professional standards.

Provide care (see perform).

Recognize (differentiate, identify).

Identify the presence of an entity or pattern that appears to have significance for patient management. Recognition is not a broad as assessment -assessment requires a 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 used in 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 discussionof the necessity for the referral and of alternatives with the patient, discussionand 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 are incorporated into competency. The importance of this skill is more than speed and accuracy: it is the coordination of performance patterns into an organized competency whole.

Treat (see perform).

Use

This term refers to a collateral performance. In the course of providing care, precautions and specialized routines may be required. For example, infection control and rapport building communication are used. Understanding the collateral procedure and its relation to overall care is assumed. It is often the case that supporting values are especially important for procedures that are needed. They are usually mentioned specifically because their value requires reinforcement. (“Utilize” is a stylistic affectation that should be avoided.)

Understanding

The residual cognitive foundation knowledge that is incorporated into competency. Understanding is more than broad knowledge of details: it is organized knowledge that is useful in performing the competency. (Caution should be used with this term. Understandingalone is not a competency; it must be blended with skill and values.)

Values

Preferences for professional appropriate behavior in the absence of compelling or on constraining forces. Values can only be inferred from practitioner’s behavior when alternatives are available. “Talking about” values reflects a foundation knowledge; valuing can be inferred by observing the practitioner’s attempts to persuade others. (Caution should be used with this term. Valuing alone is not a competency; it must be blended with skill and understanding.)

References

Chambers DW, Gerrow JD, Manual for Developing and Formatting Competency Statements. J. Dent Educ 1994: 58:361-6