development of a system to assess students' … ·  · 2017-03-30transitional rpd “points...

Thisinitialreportonthesuccessfulimplementationoftheproposedpointsystemtoassessdentalstudents'clinicalperformancesuggeststhattheconcepthasthepotentialforwidespreadutilizationbydentalschools,afteradaptationofthekeyconceptstothespecificcontextoftheschoolandtheoverarching healthcaresystem5.Thissystemalsoencouragesstudentstoachievespecificpatientcareorclinicaleducationalgoalswhilemeetingtheneedsofthecommunity(Figure3).Thissystemprovidesauniversalapproachtostudentassessmentinotherhealthcaredisciplines.Forexample,itcouldbeadaptedtodentalassistingprograms,iftheprocedurescoveredwithintheirscopeofpracticearerelativelyweightedtoeachotherbasedontheamountoftimeandskillsneededtocompletetheprocedure.Thesystemissimple,practical,andcanbeeasilyintegratedwiththeschool’spatientcaresystem6.

Preliminaryreportsindicatethattheproposedsystemenhancesstudentclinicalproductivity.Namely:thenumberofcasesand pointsaccumulatedhaveincreasedfollowinginitialimplementationofthesystemasshowninFigure2.Qualitativedataobtainedinfocusgroupmeetingswiththestudents,indicatethatstudentsarenowmoremotivatedtotacklecomplexcaseswithconfidence.Moreover,initialdataindicatespatientsatisfactionwiththeserviceprovided.Quantitativeanalysisofstudents’motivation,levelofconfidencetoinitiateandstabilizecomplexcases,andreferraldecisionswillbe assessedinafollow-upreport.Thusdescribed,thesystemcarriesadvantagesforthemultiplestakeholderinvolvedinthecomprehensivecareprogram.Foreducators,itprovidesobjectivemeansforevaluatingandmonitoringstudents’performance.Students’performancecanbetrackedandunderperformingstudentscan beidentifiedandremediated.Forprogramdirectors,thesystemprovidesasystematicandfairmethodforthedistributionofcasesamongststudents.Forstudents,itencouragesthemtomaximizeclinicalproductivitywithoutoverlookingtheneedtoexcelinproceduralskills,andassuringqualityofcare. Fortheindividualpatient,thesystemhelpstrackpatients’progressontheoutlinedtreatmentplan,providesclearstabletargetforcaseneedswhileservingtheneedsofthecommunity,andestablishesareliablereferralsystembetweenundergraduatelevelandpostgraduate/specialtytrainingprograms.

This system was initiated in 2015 at the Faculty of Dentistry, King Abdul-AzizUniversity (KAUFD). The system builds on a validated framework for theassessment of the degree of case complexity using UCU. UCU is based on theaverage amount of clinical time needed by the average, mid-trained, student tofinish a clinical procedure and the level of skill required to complete thisprocedure. UCU are relatively weighted across the variant dental disciplines(Tables 1-5). UCU are awarded for the initial preparation stage of treatment toencourage students to control the disease and motivate the patient tomaintain good oral hygiene and prevent further disease. Additional weightedUCU are also awarded for difficulty factors complicating the case, such asbehavioral issues or medical conditions (Table 6). The system is linked to thedental school Electronic Health Record (HER) system, which generates anautomated summation of the total UCU after approval of the definitivetreatment plan by the students’ clinical mentor. The granted commutative UCUfor each case determines the weight the case will contribute to the student’sclinical grade and determines the number of cases to be completed, using apredetermined equation. The process of validation of this system will beoutlined in a subsequent report.Many problems with current systems of assessing case difficulty in casecompletion curricula are avoided using this framework. For instance, the threecases displayed in Figure 1 are classified as Type 4, according to the newHarvard School of Dental Medicine Clinical Case Classification System, whichcategorizes cases by case type and typical procedures required for each.However, UCU profiling of these case show the great variation in their UCU,and hence, the skills and time required to manage the case, and subsequently,the grades awarded.The UCU also determines the weight for each discipline in determining thequality grade for the case. Further, the UCU helps the student, with guidance,determine the realistic goals for treatment of each case, appropriate to his/herlevel, in order to provide the patient with a stable, hygienic, and disease freeoral environment. It is important to state that completion of phase I therapydemonstrated by achievement of a stable, dental disease free, and hygienicoral environment, in a medically controlled patient, is an importantcornerstone of this system, with emphasis on the importance of referral andconsultation skills.The preliminary assessment of student outcomes, following theimplementation of this system will be presented by comparing students’productivity before and after the initiation of this system.

Authors:ImamA,B.D.S,MSc.,FRCDC.andAgou S,B.D.S,MSc.CH[HPTE],M.Ed (c),Ph.D,ABODiplomatAffiliations:FacultyofDentistry,KingAbdulaziz University

AIM

RESULTS

CONCLUSIONS

MATERIALS&METHODS

Procedure Unit Value

Oral hygiene instructions 1Supragingival scaling and prophylaxix 0.5

SRP anterior (per sextant) 0.5SRP posterior (per sextant) 0.75

Maximum point for 6 sixtants SRP 4Re-Evaluation of Phase I 1.5

Maintenance 2Assisting in Implant/periodontal surgery 2

Observing implant placement 1Re-evaluation of a case with a

comprehensive periodontal examinationfull mouth (CPEFM)

4

Table1:PeriodontalProceduresPoints

Procedure Unit Value

Simple Class II “ No Adjacent tooth” 0.5Occ. Proximal Class II “OM or OD” 1.5

MOD Class II 2Class I simple occlusal Amalgam/

composite 0.5

Buccal/ lingual extentions of Class I 0.25Class V (composite) 0.5

Simple Proximal Class III 0.5Class III Lingual approach 1.5

Class III through and through 2Class IV 2

Large buildup Amalgam/ large anterior build up/ or composite veneers

2

Bleaching Session 2Caries Control restoration “ GI” 0.5

Root caries 0.5

Table2:OperativeDentistryProceduresPoints:

Procedure Unit Value

Endodontic emergency/ Case 0.5

Access Cavity preparation/tooth 0.5

Working Length Determination/Canal 0.5

Cleaning and Shaping or obturation/ Canal 0.5

Re-evaluation of own previous RCT 1

Additional points for re-treatment/ canal 0.5

Apexogenesis procedure “MTA”/ canal 0.5

Apexification procedure anterior tooth/canal 0.5

perforation repair/ site 0.5

Table3:EndodonticProceduresPoints:

Procedure Unit Value

Crown/Veneer/Onlay or FPD (points added when required)/ tooth

Primary Impression/ Arch 0.5abutment preparation/ tooth 1.5

Final impression/ tooth 1.5Provisional crown/ tooth 1Provisional Pontic/ pontic 0.5

Metal try-in 1Soldering 1

Porcelain try-in 1Final Cementation 1

Pontic For Final FPD/ pontic 2Post and cores (points added when required)/ tooth

Post space preparation 0.5Core Buildup/or GC Pattern 0.5

Metal try-in 1Final Cementation 1

Repair of existing fixed prosthesis 1

Table4:FixedProsthodonticsProceduresPoints:

Procedure Unit Value

Definitive RPD (free-end saddle)

1ry Impression/Arch 0.5Surveying and designing 1Rest preparation/ tooth 0.5

Peripheral Molding 1.5Final impression 1.5Framework try-in 1.5

Jaw Relation/prosthesis 0.75Teeth set-up try-in/ Arch 0.75

Insertion 1Altered cast 1 1.5

Complete Denture

1ry Impression/Arch 0.5Peripheral Molding/arch 1.5

Final Impression/arch 1.5Jaw relation/ Arch 0.75Teeth try in/Arch 0.75

Denture delivery/Arch 1Transitional RPD “points are considered when indicated”

1ry Impression/Arch 0.5Peripheral Molding/arch 1.5

Final Impression/arch 1.5Jaw relation/ Arch 0.75

Teeth try in 1Delivery 1

Overdenture/coping/attachment/locator 1Immediate CD relining and Follow up 1Follow-up of complete denture/ Arch 0.5

Implant Tx planning (including RG and surgical stent) 1

Table5:RemovableProsthodonticsProceduresPoints:

Figure1:TheUCUforthreecomprehensivecarecases,classifiedasHarvardType4case.

5*

2015

4*

2015

3*

2015

6*

2016

5*

2016

4*

20160

50

100

150

200

250

300

350

400

Astudents Bstudents Cstudents

Figure2:BarchartcomparingthecumulativeUCUforA,B,andCstudentsintheacademicyear2015and2016

While comprehensive care curricula are becoming a cornerstone requirement in dental schools aspiring to meet accreditation standards, the implementation of this concept remains a struggle1-3. One of the important challengestypically presented when a case completion approach is employed, is determining the degree of case complexity, given the scarcity of solid objective and validated methods to evaluate the difficulty of cases presented4. This isparticularly important for millennial students demanding transparent, objective assessment, and explicit guidelines for evaluation4. This poster aims to outline the development and outcomes of an objective system forevaluating and monitoring dental students’ clinical performance in a comprehensive care course. The system builds on a validated framework for the assessment of the degree of case complexity, based on UniversalComprehensive dental care Unit value (UCU). We here propose that UCU lays the ground for an objective method for case allocation and case grading, that encourages students to provide high quality comprehensive care forcases, within their scope of practice, despite the varying degree of complexity of these cases. Solutions to issues encountered in case completion curricula are suggested.

*Averagenumberofcasescompletedbythestudents

Development of a System to Assess Students' Comprehensive Care Performance

Procedure Unit Value Procedure Unit Value Procedure Unit Value

Consultation/Referral/Interpretation

1 Handling a medical condition 2 Behavioral management 2

Table6:HolisticPatientCarePoints:

Case1:50UCU Case2:160UCUCase3:80UCU

1. Al-Alawi,H.,Al-Shayeb,M.,Al-Jawad,A.,Al-Ali,A.,&Mahrous,A.(2015).EvaluationofacomprehensiveclinicaldentistrycourseatdentalschoolsinSaudiArabia.JournalofDentalResearchandReview,2(1),5.2. Adibi,S.S.,Chaluparambil,J.,Chambers,S.K.,Estes,K.,Valenza,J.A.,&Walji,M.F.(2012).Assessingthedeliveryofcomprehensivecareatadentalschool.Tex DentJ,129(12),1267-1275.3. Nulty,D.D.,Short,L.M.,&Johnson,N.W.(2010).Improvingassessmentindentaleducationthroughaparadigmofcomprehensivecare:Acasereport.Journalofdentaleducation,74(12),1367-1379.4. Teich,S.T.,Roperto,R.,Alonso,A.A.,&Lang,L.A.(2016).DesignandOutcomesofaComprehensiveCareExperienceLevelSystemtoEvaluateandMonitorDentalStudents’ClinicalProgress.Journalofdentaleducation,80(6),662-669.5. Park,S.E.,Timothé,P.,Nalliah,R.,Karimbux,N.Y.,&Howell,T.H.(2011).Acasecompletioncurriculumforclinicaldentaleducation:replacingnumericalrequirementswithpatient-basedcomprehensive care.Journalofdentaleducation,

75(11),1411-1416.6. Albino,J.E.,Young,S.K.,Neumann,L.M.,Kramer,G.A.,Andrieu,S.C.,Henson,L.,...&Hendricson,W.D.(2008).Assessingdentalstudents’competence:bestpracticerecommendationsintheperformanceassessmentliteratureand

investigationofcurrentpracticesinpredoctoral dentaleducation.JournalofDentalEducation,72(12),1405-1435.

REFERENCES

Figure3:Thegoalsofthecomprehensivecareprogramat

KAUFDACKNOWLEDGMENTWewouldliketothankDr.Noha A.Alkurdi forhervaluableassistanceindesigningthisposter…