COMPETENCY IN DENTISTRY DR. MUZAMMIL MOIN AHMED

Assistant Professor Division of Periodontics

Department of Preventive Dental SciencesBuraydah College of Pharmacy and Dentistry

Buraidah, KSA.

COMPETENCY

• It is “the behavior expected of the beginning practitioner”.

• A “competency” is a complex behavior or ability essential

for the general dentist to begin independent, unsupervised

dental practice.

(American Dental Education Association - ADEA)

COMPETENCE VS COMPETENCY • Competence is the ability to do a task to a predetermined

standard.

• Competency is the series of abilities that together make up a

competent person.

(BDJ 2001; 190(7):343-46)

STAGES OF COMPETENCE

NOVICE• Mimicking of instructors in the simulation laboratory or diagnostic clinic.

BEGINNER• With further instruction and practice, students gain some control of

parts of a competency • become able to demonstrate in ideal, simulated situations when asked

to do so.

COMPETENT• Now able to understand the basis for their decisions• Possess appropriate professional values • Ability to provide the dental needs of most patients.

(BDJ 2000; 189(6):324-26)

DOMAINS OF COMPETENCY

ADEA has identified Six “Domains in the general practice of dentistry

1. Patient Care : Includes assessment, diagnosis, treatment planing, establishment and maintenance of oral health.

2. Communication and interpersonal skills: Skills to interact with patients and their families and supporting staff.

3. Professionalism:Appropriate ethical and legal standards in providing patient centered care.

4. Practice management: Demonstrating practice management skills and quality assurance principles.

5. Information management and critical thinking: Integration of scientific research with clinical expertise and patient values for optimum evidence-based care.

6. Health promotion: Appropriate means of prevention, intervention, and educational strategies for all patients at risk of disease.

COMPETENCIES IN DENTISTRY

CORE COMPETENCIESOPERATIONAL NON-OPERATIONAL

Positioning of the patient and infection control

Patient – dentist discourse

Local anesthesia Handling of medically compromised patients

Cavity filling Patient Care, oral education & post-operative explanations.

Root canal therapy Communication skillsScaling and root planing Treatment planningSimple extractions and suturing Ethics Fabrication of fixed and removable prosthesis

Informing patient of diagnosis & how to avoid medical conflicts.

Radiographic technique Dealing with difficulties immediately

(J Dent Sciences 2015; 10:161-66)

(J Dent Edu 2008; 72(12):1405-35)

COMPETENCIESINDEPENDENT NON-INDEPENDENT

Professionalism Periodontal surgical procedures

Health promotion and maintenance Placement of endosseous implants

Basic treatment procedures Treatment for complex orofacial trauma and advanced intraoral infections

Communication skills Complex restorative and prosthetic therapies

ESSENTIAL SKILLS FOR DENTAL GENERAL PRACTITIONER

GENERAL SKILLS  1 History taking and examination  2 Ethics and law, consent and professionalism 3 Communication skills 4 Health and safety  5 Infection control 6 Dental public health measures 7 Medical emergencies including therapeutics  8 Pharmacological management of pain and anxiety  9 Behavior management of anxious adult and child

patient  10 Dental radiology  11 Prevention and interception  12 Patient referral  13 Isolation and moisture control  14 Impression making

DISCIPLINE SPECIFIC SKILLS  1 Dental material science 2 Pediatric dentistry  3 Orthodontics  4 Operative Dentistry  5 Periodontology  6 Endodontics  7 Prosthodontics – Removable & fixed 8 Oral surgery  9 Oral Medicine  10 Oral Pathology

INTERGRATED SKILLS  1 Integrated dental care

EVALUATION OF COMPETENCE

WHY DO WE HAVE TO ASSESS?

• Increase self-awareness by encouraging self-evaluation and learning

• Encourage achievement of competent core skills.

• Identify and help individuals who are not achieving or progressing

satisfactorily at an early stage.

(BDJ 2001; 190(7):343-46)

HOW DO WE ASSESS COMPETENCE ?

• Knowledge

• Skills

• Attitude (interaction with patients and relatives, ethics, reliability, professional development, teamwork, image or appearance.)

(General Dental Council, UK)

ELEMENTS OF EVALUATION

Intellectual competence

physical-technical competence

Interpersonal competence

(BDJ 2000; 189(6):324-26)

EVALUATION OF COMPETENCE CONVENTIONAL METHODS CURRENT METHODS

Paper Based

Essays, Short Notes, MCQs

Viva Voce (Oral Examination)

Clinical, Practical, Patient Diagnosis

Treatment Outcome

Online Discussions, Group Seminars,

Reflective Portfolios, Academic

Feedback.

OSCE’s and Patient case managed

Peer assessment, Self-reflection and

Patient Feedback.

Clinical Chair Side Assessment

facilitated by patient management

clinical software

Learning Management Systems (LMS)(Int J Dent Clin 2011; 3(2):33-

39)

(J Dent. Edu. 2008; 72(12):1405-35)

(J Dent. Edu. 2008; 72(12):1405-35)

(J Dent. Edu. 2008; 72(12):1405-35)

• It is the point where responsibility for learning is transferred from

teachers to learners.

• Once basic competency has been achieved, the dental graduate

must take the continuum to higher levels of competency, through

continuing education and postgraduate dental programs.

COMPETENCY CONTINUUM

(BDJ 2000; 189(6):324-26)

Evaluated both subjectively and objectively in all clinical areas by:Non-graded clinical evaluation of chairside

performanceProgress examinations

Comprehensive care program group leaderconferences

Competency examinations

Progress summary reports Professional performance

A “relative value point” system, Program requirements

EVALUATION OF GRADUATING DENTAL STUDENT

(J Den Edu 2006; 70(5):500-10)

• Student performance and deficiencies are noted and

summarized daily.

• Provides on-demand feedback and tracking of student which can

be used for continuous quality improvement.

Non-graded clinical evaluation of chairside performance

• Students are divided into groups and assigned to a faculty member who

serves as their group leader.

• That faculty becomes the student’s mentor, advocate, cheerleader,

disciplinarian, and remedial resource director.

• Regular meetings are held monthly (and as otherwise needed) between

group leaders and each student to review performance and other issues that

arise.

Comprehensive Care Program (CCP) Group Leader Conferences

• Group leaders receive weekly summaries of the assessment sheets

and arrange conferences/meetings as needed with each student.

• At least once a month a general conference is completed and recorded.

• Student conference results are then summarized in progress reports

and students receive a copy of their progress reports.

• Students failing to meet the standards are remediated by their group

leader and additional patients and/or laboratory exercises may be

assigned.

Progress Reports

• Students are accountable for all clinic hours.

• Students are required to maintain a minimum “overhead factor”

of particular points per available hour of clinic time.

• Every procedure or activity is assigned a relative value that students

“earn” by participation.

• Relative value point (RVP) deductions may be incurred for errors,

time management faults, and other minor infractions.

A “relative value point” system

• These periodic laboratory and clinical examinations comprise

particular percent of the final grade and cover all the specialties.

Competency Examinations • Structured competency exam is administered cover all the

specialties within the allotted time and without faculty assistance.

Progress Examinations

• The requirements for certification for graduation are competency confirmation

from all departments and

1) Completed treatment of all assigned patients as verified by group leaders

2) Minimum production of particular value points per hour of available clinic

time.

3) Successful participation in all remedial, progress, and competency

examinations.

4) Satisfactory percent of attendance in available clinic hours.

Program Requirements

THANK YOU