The following statements describe the graduates of Pacific's AEGD program. 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.
In order to facilitate reading this list of statements, certain terms have been predefined to avoid repetitive definition. In general, the definitions proposed by Chambers and Gerrow have been followed, albeit with some additions and modifications.
In situations where it is expected that the 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.
To avoid repetition, the term "appropriate" is not used in these statements. It is assumed that all knowledge, skills, and procedures described will be performed for appropriate reasons, in appropriate circumstances, and in an appropriate manner.
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.
The following are competency and proficiency statements that describe the additional areas, beyond those of the first year program, that apply to residents completing the second year program. 1. Integrate all aspects of dentistry in the treatment of patients with complex dental, medical and social situations. (P)
Adapted from Chambers and Gerrow1
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. [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 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.
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.
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. ["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. 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. [Caution should be used with this term. Valuing alone is not a competency; it must be blended with skill and understanding.]