logbook computer
TRANSCRIPT
CLINICAL EXPERIENCE LOG - ORAL SURGERY, ORAL PATHOLOGY & ORAL MEDICINE
Patient’s Name : Registration Number :
Supervisor’s name : Date patient first seen :
Type of Cases : Date case completed :
*Please tick () where applicable
Clinical Competency Management
*Observe (O) / Assist (A) /Conduct (C) Date Notes
(in brief)O A C
Patient clerking
History: Present complaint Medical Dental Examination: General Extra-oral Intra-oral Diagnosis & treatment plan Differential Definitive Treatment plan
Inpatient management
AdmissionInvestigation(s)
Non Invasive Invasive
Informed consentTreatment(s)Medication(s)
Discharge & follow up
1
Log-OSOMOP
Log-OSOMOP
*Please tick () where applicable
Clinical Competency Management
*Observe (O) / Assist (A) /Conduct (C) Date
Notes(in brief)
O A C
Outpatientmanagement
Investigation(s) Non Invasive Invasive
Treatment(s)PrescriptionFollow up
Management of medical & dental emergencies
Emergency treatmentReferralBasic life support
Pain & anxiety control
Parenteral: IM / IV PCAOral medication: Sedation Analgesic
Local Anesthesia: Infiltration TopicalAssurance
Others (specify):
Minor oral surgery (Dento-alveolar surgery and others)
Exodontia: Tooth/Retained rootsSurgical Removal of: Retained root(s) Impacted tooth Toilet & suturing Incision and drainage
Infected / dry socketOthers
*Please tick () where applicable
Clinical Competency Management *Observe (O) / Date Notes2
Log-OSOMOP
Assist (A) /Conduct (C) (in brief)
O A C
Management of maxillofacial trauma
Hard tissue injuries
Soft tissue injuries
Management of soft and hard tissue pathology
Role of dental officers
Management of oral oncology
Combine clinics
Surgical Management
Referral system / follow up / rehabilitationRole of dental officer
Early detection and prevention of oral pre-cancer and oral cancerOthers (please specify)
Management of medically compromised patient
Optimizing patient’s condition prior to treatment
Ver 01- 020511
Name of FYDO/SYDO :
Supervisor’s signature :
Name & Official Stamp of Supervisor : Date :
EVALUATION OF CLINICAL PERFORMANCE - ORAL SURGERY, ORAL PATHOLOGY & ORAL MEDICINE
3
EP-OSOMOP
Name of FYDO/SYDO :Date of Attachment :Place of Attachment : Grade of competency level: 1, 2, 3 or 4 =Below Average; 5 or 6 = Average; 7 or 8 = Good; 9 or 10 = Outstanding
*Please tick () where applicable
Area of competency
Level of Competency at the BEGINNING of Attachment
(Perception by FYDO of own’s competency)
Level of Competency at theEND of Attachment
(to be filled up by Supervisor) Comments
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10Patient clerking
Inpatient Management
Outpatient Management
Management of medical & dental emergencies
Pain & anxiety control
Minor oral surgery
Management of maxillofacial trauma
Management of soft and hard tissue pathology
Management of oral oncologyManagement of medically compromised patient
Ver 01- 020511
4
EP-OSOMOP
Total marks achieved at the end of attachment ( / *100) points*Denominator depends on number of competencies involved X10
Other comments (if any):
………………………………………………………………………………………………………………………………………………………………………………………………………………
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………………………………………………………………………………………………………………………………………………………………………………………………………………
Supervisor’s signature :
Name of Supervisor :
Date :
Official Stamp of Supervisor :
CLINICAL EXPERIENCE LOG - PAEDIATRIC DENTISTRY
5
Log-PaedDent
Patient’s Name : Registration Number :
Supervisor’s name : Date patient first seen :
Type of Cases : Date case completed :
*Please tick () where applicable
Clinical Competency Management
*Observe (O) / Assist (A) /Conduct (C) Date Notes
(in brief)O A C
Patient clerking
History: Present complaint Medical Dental Examination: General Extra-oral Intra-oral Diagnosis & Treatment plan Differential Definitive Treatment plan
Inpatient management
AdmissionInvestigation(s)
Informed consentTreatment(s)
Medication(s)Discharge
Follow up
*Please tick () where applicable
Clinical Competency Management *Observe (O) / Assist (A) /
Date Notes(in brief)
6
Log-PaedDent
Conduct (C)O A C
Outpatientmanagement
InvestigationTreatment(s)PrescriptionFollow up
Medical & dental emergencies
Emergency treatment
Behavioural management-pharmacological-Non pharmacological
Pharmacological-Oral sedation-Inhalation sedation-LA (infiltration/topical)-GA Non pharmalogical-Behavioural technique
Pulp therapy(if applicable)
Pulpotomy / Pulpectomy
Apexification / RCT
Management of trauma / Oral surgery
Toilet & suturing
Splinting (if applicable)
Crown fracture
Root fracture (if applicable)
Displacement & luxation injuriesIncision and drainage
Removal of teeth
Dento alveolar fracture (if applicable)
*Please tick () where applicableClinical Competency Management *Observe (O)/
Assist (A)/Conduct (C)
Date Notes(in brief)
7
Log-PaedDent
O A CMandibular fracture (if applicable)
Maxillary fracture (if applicable)
Others: (Specify)
Oral Medicine and Oral Pathology
Common oral infections
Acute oro-facial infections
Oral manifestations of systemic infections / disease
Children with special needs
Management of physical handicap
Management of mental handicap
Management of medically compromised
Dental AnomaliesDiagnosis and management
*Please tick () where applicable
Clinical Competency Management*Observe (O)/
Assist (A)/Conduct (C)
DateNotes
(in brief)
8
Log-PaedDent
O A C
Early Childhood Caries
Diagnosis
Prevention
Intervention
Health promotion &disease prevention
Oral health education
Preventive Therapy
Ver 01- 020511
Name of FYDO/SYDO :
Supervisor’s signature :
Name & Official Stamp of Supervisor : Date :
9
EVALUATION OF CLINICAL PERFORMANCE - PAEDIATRIC DENTISTRY
Name of FYDO/SYDO :Date of Attachment :Place of Attachment :
Grade of competency level: 1, 2, 3 or 4 =Below Average; 5 or 6 = Average; 7 or 8 = Good; 9 or 10 = Outstanding
*Please tick () where applicable
Area of competency Level of Competency at the BEGINNING of Attachment
(Perception by FYDO of own’s competency)
Level of Competency at the END of Attachment
(to be filled up by Supervisor)
Comments
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10Patient clerking
Inpatient managementOut patient managementMedical and dental emergencyBehavioral management -pharmacological-non pharmacologicalManagement of trauma / Oral surgeryOral Medicine and Oral PathologyChildren with special needs
Dental anomalies
Early childhood cariesHealth promotion and disease prevention
Ver 01- 020511
10
EP-PaedDent
Total marks achieved at the end of attachment ( / *110) points *Denominator depends on number of competencies involved X10
Other comments (if any):
Supervisor’s signature :
Name of Supervisor :
Date :
Official Stamp of Supervisor :
11
EP-PaedDent
CLINICAL EXPERIENCE LOG - ORTHODONTICS
*Please tick () where applicable
Clinical Competency Management
*Observe (O) / Assist (A) /Conduct (C) Date Notes
(in brief)O A C
Patient clerking
History Present complaint Medical Dental
Patient’s Name Registration No. Date seen Type of case
::::
Examination General Extra-oral
Intra-oral
Clinical investigation(s) Type of malocclusion IOTN index
Diagnosis
Treatment plan
Patient management
Impression taking for study model
Patient’s Name Registration No. Date seen Type of case
::::
Further investigation(s)
Informed consent
Cephalometric tracing
Initial photoshots
Treatment(s)
12
Log-ORTHO
*Please tick () where applicable
Clinical Competency Management
*Observe (O) / Assist (A) /Conduct (C) Date Notes
(in brief)O A C
Emergency management
Loose bands Patient’s Name Registration No. Date seen Type of case
::::
Loose brackets
Fractured / Sharp archwires
Broken removable appliances
Others (Specify)
Interceptive orthodontics with removable appliance
Purpose of interception Patient’s Name Registration No. Date seen Type of case
::::
Type of appliance (Specify)
Design of appliance
Impression taking for working modelIssue of appliance and appropriate instructionsActivation of appliance
Review and monitoring progress (OH reinforcement, assessment of patient’s compliance)Relevant photo shots
Interceptive Orthodontics with functional appliance
Purpose of interception Patient’s Name Registration No. Date seen Type of case
::::
Type of appliance (Specify)
Design of appliance
Impression taking for working modelIssue of appliance and appropriate instructionsActivation of appliance
13
Log-ORTHO
Clinical Competency Management
*Observe (O) / Assist (A) /Conduct (C) Date Notes
(in brief)O A C
Review and monitoring progress (OH reinforcement)
Relevant photo shots
Assessment of patients’ compliance
Fixed appliance
Placement of separators Patient’s Name Registration No. Date seen Type of case
::::
Banding and bonding
Tying in with ligatures or elastomeric modulesChange of archwire and activationAnchorage consideration (as necessary)Review and monitoring progress (OH reinforcement)Others (Specify)
Debanding and debonding of fixed appliance
Stage photo shots
Cases of retention (Retainer)
Type of retainer (Specify) Patient’s Name Registration No. Date seen Type of case
::::
Design of retainer
Impression taking for working model
14
*Please tick () where applicable Log-ORTHO
Clinical Competency Management
*Observe (O) / Assist (A) /Conduct (C) Date Notes
(in brief)O A C
Issue of retainer and appropriate instructions
Review and monitoring progress (OH reinforcement)
Stage photo shots
Multidisciplinary cases (Opportunistic)
Cleft lip and palate Patient’s Name Registration No. Date seen Type of case
::::
Orthognathic surgery
Hypodontia cases
Others (Specify)
Ver 01- 020511
Name of FYDO/SYDO :
Supervisor’s signature :
Name & Official Stamp of Supervisor : Date :
15
Log-ORTHO*Please tick () where applicable
EVALUATION OF CLINICAL PERFORMANCE - ORTHODONTICS
Name of FYDO/SYDO :Date of Attachment :Place of Attachment :
Grade of competency level: 1, 2, 3 or 4 =Below Average; 5 or 6 = Average; 7 or 8 = Good; 9 or 10 = Outstanding
*Please tick () where applicable
Area of competency
Level of Competency at the BEGINNING of Attachment
(Perception by FYDO of own’s competency)
Level of Competency at theEND of Attachment
(to be filled up by Supervisor) Comments
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10Patient clerking
Patient management
Emergency managementInterceptive orthodontics with removable appliance
Functional appliance
Fixed appliance
Case of retention (retainer)Multidisciplinary case (opportunistic)Ver 01- 020511
16
EP-ORTHO
Total marks achieved at the end of attachment ( / *80) points *Denominator depends on number of competencies involved X10
Other comments (if any):
Supervisor’s signature :
Name of Supervisor :
Date :
Official Stamp of Supervisor :
17
EP-ORTHO
CLINICAL EXPERIENCE LOG - PERIODONTICS
Patient’s Name : Registration Number :
Supervisor’s name : Date patient first seen :
Type of Cases : Date case completed :
*Please tick () where applicable
Clinical Competency Management
*Observe (O) / Assist (A) /Conduct (C) Date Notes
(in brief)O A C
Patient clerking
History: Present complaint
Medical
Dental
Medical problem (Specify)
Examination: General Extraoral
Intraoral
Clinical investigation(s): X-ray, vitality test & others
Diagnosis
Treatment plan
18
Log-PERIO
*Please tick () where applicable
Clinical Competency Management
*Observe (O) / Assist (A) /Conduct (C) Date Notes
(in brief)O A C
Patient management
Full mouth six point charting
CPITN Index/BPE
Further investigation(s)
Informed consent
Oral hygiene instruction / education
Correction of patients’ brushing technique with emphasis on dentogingival junction
Explanation of alveolar bone loss with picture guide
Full mouth scaling
Subgingival debridement
Splinting
Occlusal adjustment
Others (Specify)
19
Log-PERIO
*Please tick () where applicable
Clinical Competency Management
*Observe (O) / Assist (A) /Conduct (C) Date Notes
(in brief)O A C
Surgery
Flap surgery
Gingivectomy
Root amputation / root resectionCrown lengthening
Guided tissue regeneration
Guided bone regeneration
Implant
Others (Specify)
Ver 01- 020511
Name of FYDO/SYDO :
Supervisor’s signature :
Name & Official Stamp of Supervisor : Date :
20
Log-PERIO
EVALUATION OF CLINICAL PERFORMANCE - PERIODONTICS
Name of FYDO/SYDO :Date of Attachment :Place of Attachment :
Grade of competency level: 1, 2, 3 or 4 =Below Average; 5 or 6 = Average; 7 or 8 = Good; 9 or 10 = Outstanding
*Please tick () where applicable
Area of competencyLevel of Competency at the BEGINNING
of Attachment (Perception by FYDO of own’s competency)
Level of Competency at the END of Attachment
(to be filled up by Supervisor)
Comments
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10Patient Clerking
Patient management
SurgeryVer 01- 020511
21
EP-PERIO
Total marks achieved at the end of attachment ( / *30) points*Denominator depends on number of competencies involved X10
Other comments (if any):
Supervisor’s signature :
Name of Supervisor :
Date :
Official Stamp of Supervisor :
22
EP-PERIO
CLINICAL EXPERIENCE LOG - RESTORATIVE DENTISTRY
Patient’s Name : Registration Number :
Supervisor’s name : Date patient first seen :
Type of Cases : Date case completed :
*Please tick () where applicable
Clinical Competency Management*Observe (O) /
Assist (A) /Conduct (C)
Date Notes(in brief)
O A C
Patient clerking
History: Present complaint Medical
Dental
Examination: General Extraoral
Intraoral
Occlusal analysis
Clinical investigation(s): X-ray/EPT/Bite test etc Diagnosis
Treatment plan
Patient management
Informed consent
Oral hygiene instruction / education
Direct Restorations
Class I, II, III, IV, V
Direct composite veneers
23
Log -RESTO
Clinical Competency Management
*Observe (O) / Assist (A) /Conduct (C) Date Notes
(in brief)O A C
Others (Specify):
Fixed prosthodontics
Onlays
¾ metal crown
Full metal crown
Porcelain-fused to metal crown
Indirect composite veneers
Porcelain veneer
All ceramic crown
Fixed-fixed bridge
Cantilever bridge
Resin-retained bridge
Root canal treatmentAnteriors
Posteriors
Root canal retreatment
Management of complex endodontic cases Eg: Curved roots, Perforation, Separated instruments (Specify):
24
*Please tick () where applicable Log -RESTO
Clinical Competency
Management
*Observe (O) / Assist (A) /Conduct (C) Date
Notes(in brief)
O A C
Bleaching
Bleaching discoloured endodontically treated teethExternal bleaching of discoloured vital teeth
Removable prosthodontics or prosthetics (Complex cases)
Sectional dentures /Cobalt-chrome partial dentures
Partial Dentures with precision attachment (eg: magnetic attachment)
Complete denture (Difficult cases)Overdenture
Others Eg: Obturators, Oro-maxillo facial prostheses (Specify):
Management of complex cases
Moderate to severe tooth wear
Extensive root caries
Combination of fixed and removable prostodontics
Others (Specify):
Ver 01- 020511
Name of FYDO/SYDO :
Supervisor’s signature :
Name & Official Stamp of Supervisor : Date :
25
*Please tick () where applicable Log -RESTO
EVALUATION OF CLINICAL PERFORMANCE - RESTORATIVE DENTISTRY
Name of FYDO/SYDO :Date of Attachment :Place of Attachment :
Grade of competency level: 1, 2, 3 or 4 =Below Average; 5 or 6 = Average; 7 or 8 = Good; 9 or 10 = Outstanding
*Please tick () where applicable
Area of competency
Level of Competency at the BEGINNING of Attachment
(Perception by FYDO of own’s competency)
Level of Competency at theEND of Attachment
(to be filled up by Supervisor) Comments
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10Patient clerking
Patient management
Direct Restorations
Fixed prosthodontics
Root canal treatment
Bleaching
Removable prosthodontics or prosthetics (Complex cases)Management of complex casesVer 01- 020511
26
EP-RESTO
Total marks achieved at the end of attachment ( / *80) points*Denominator depends on number of competencies involved X10
Other comments (if any):
Supervisor’s signature :
Name of Supervisor :
Date :
Official Stamp of Supervisor :
27
EP-RESTO
CLINICAL EXPERIENCE LOG - PRIMARY ORAL HEALTHCARE
Service: Out-patient / SDS / Antenatal / Elderly / Special Needs (Please STRIKEOUT where non applicable)
Patient’s Name : Registration Number :
Supervisor’s name : Date patient first seen :
Type of Cases : Date case completed :
*Please tick () where applicable
Clinical competency Management
*Observe (O) / Assist (A) / Conduct (C)
Notes(in brief)
O A C
Patient examination & diagnosis
Complaint / medical / dental /social history taking
Intra & extra-oral examinations
Diagnosis
Radiographs / special investigation
Referral if necessary
Treatment planning & patient management Treatment plan
Health promotion / disease prevention(chairside)
Dental health education / Tobacco cessation & Anticipatory guidanceFissure sealant / topical F application / others
Medical & dental emergencies Emergency treatment
Anaesthesia & pain control Local anaesthesia administration
28
Log-PRIMARY
Clinical competency
Management
Observe (O) / Assist (A) / Conduct (C)
Notes(in brief)
O A C
Management of periodontal & soft tissue
Periodontal status examination
Scaling & polishing
Management of oral lesions
Soft or hard tissue lesions / Oral cancer screening
Restoration of teeth
Amalgam restoration
Composite / GIC restoration
Root canal treatment
Pulpotomy / Pulpectomy / Apexification
Non-surgical management
Drug prescribing - analgesic, antibiotic, mouthwash
Hard & soft tissue surgery
Extraction of teeth
Extraction of retained roots
Simple surgical procedures / MOS
Post-extraction complications
Management
Replacement of teeth
Removable / Fixed
Reline / rebase / repair denture
Review Customized recall interval
Ver 01- 020511
Name of FYDO/SYDO :
29
Log-PRIMARY*Please tick () where applicable
Supervisor’s signature : Name & Official Stamp of Supervisor : Date :
EVALUATION OF CLINICAL PERFORMANCE - PRIMARY ORAL HEALTHCARE
Name of FYDO/SYDO :Date of Attachment :Place of Attachment :
Grade of competency level: 1, 2, 3 or 4 =Below Average; 5 or 6 = Average; 7 or 8 = Good; 9 or 10 = Outstanding
*Please tick () where applicable
Area of competency
Level of Competency at the BEGINNING of Attachment
(Perception by FYDO of own’s competency)
Level of Competency at theEND of Attachment
(to be filled up by Supervisor) Comments
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10Patient examination & diagnosisTreatment planning & patient managementHealth promotion / disease preventionMedical & dental emergenciesAnaesthesia & pain controlManagement of periodontal & soft tissue Management of oral lesionsRestoration of teeth Non surgical managementHard & soft tissue
30
EP-PRIMARYEP-PRIMARY
surgery
Area of competency
Level of Competency at the BEGINNING of Attachment
(Perception by FYDO of own’s competency)
Level of Competency at theEND of Attachment
(to be filled up by Supervisor)
Comments
1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10Post-extraction complications
Replacement of teeth
Review
Ver 02- 070911
Total marks achieved at the end of attachment ( / *130) points*Denominator depends on number of competencies involved X10
Other comments (if any):
Supervisor’s signature :
Name of Supervisor :
31
EP-PRIMARY
Date :
Official Stamp of Supervisor :
DENTAL PUBLIC HEALTH LOG
Name of FYDO/SYDO : Placement :Name of Supervisor :
*Please tick () where applicable
Competency Activities Notes(Specify date / place / provider)
Clinical prevention
Conduct / involvement in fissure sealant programme
Conduct /involvement in topical fluoride application activities
Conduct / involvement in caries risk assessment in school children (refer Incremental Dental Care School Programme Guideline)
Involvement in oral cancer screening programme, smoking cessation.
Personal & practice organisation
Critical appraisal of published paper (clinical & public health related / HMIS / survey reports etc.)Acquire basic knowledge on the following topics through briefing, discussions, presentations, dialogues, talks, etc
1. Role & function of Oral Health Care System and MDC
2. Oral healthcare programmes
3. Plan of Action & Achievements
32
Log-DPH
Competency Activities Notes(Specify date / place / provider)
Involvement in organizing training / CPD session (staffs, health nurses, preschool / PERMATA teachers) / others
Fluoridation programme (e.g. analysis of water samples, monitoring of NIA indicator, visits to local water treatment plant, etc)
Ethics & legislative
To attend briefing on :1. Safety & Health in Dental Practice:
Related guidelines and policies,
infection control,
safety in dental laboratory,
mercury hygiene,
radiation safety
Ver 01- 020511
Supervisor’s signature :
Name & Official Stamp of Supervisor : Date :
33
Log-DPH
EVALUATION OF PERFORMANCE - DENTAL PUBLIC HEALTH
Name of FYDO/SYDO : Placement :Name of Supervisor :
*Please tick () where applicable
Competency Area of involvement
Level of Competency at the End of Attachment
CommentsBelow Average Average Good Outstanding
1 2 3 4 5 6 7 8 9 10
Clinical prevention
Fissure sealant programme
Topical fluoride application activities
Caries risk assessment in school children
Pre-cancer and Oral Cancer screening programme, smoking cessation programme
Personal & practice organization
Critical appraisal of published papers
Roles and functions of Oral Health Care Delivery System
Oral health promotion activities
CPD session
Fluoridation programme
Ethics & legislative
Safety & Health in Dental Practice
Ver 01- 020511
34
EP-DPH
Total marks achieved ( / *100) points *Denominator depends on number of competencies involved X10
Other comments (if any):Other comments (if any):
Supervisor’s signature :
Name of Supervisor :
Date :
Official Stamp of Supervisor :
35
EP-DPH
MANAGEMENT PRACTICE LOG
Name of FYDO/SYDO : Placement :Name of Supervisor :
*Please tick () where applicable
Competency Activities Notes(Specify date / place / provider)
Organization / Management practice
Acquire basic knowledge on the following topics through briefing, discussions, presentations, dialogues, talks, etc1. Client charter at dental clinic2. Corporate culture3. QA initiatives (innovation, ISO, NIA, HSA / DSA, KPI, QCC)4. Relevant circulars and oral healthcare guidelines 5. Treasury Instructions Attend briefing on Financial Management1. Fee schedule : Provisions; procedures for exemption;
responsibility for collection2. Budgetary system & allocation to cost centre3. Authority, control & responsibility4. Vot book / e-SPKB / e-perolehan5. Local purchase order (LPO)6. Petty cash7. Programme agreement8. Exceptions report9. Audit10. E-reporting10.Others (please specify)Focus group discussion on :1. Client satisfaction 2. Management of complaints 3. Asset management
36
Log-MP
4. Others
Competency Activities Notes(Specify date / place / provider)
General Management :1. Staff2. Vehicles3. Dental Equipments
Ethics & legislative
To attend briefing on : Dental Act Code of Professional Conduct Private Health Care Facilities Act & Regulations
Communication & leadership
Communication with other personnel
Communication with patients, carers / family
Briefing on appropriate dress code protocol at work
Ver 01- 020511
Supervisor’s signature : ……………………………………………………………
Name& Official Stamp of Supervisor : Date :
37
Log-MP
EVALUATION OF MANAGEMENT PRACTICE
Name of FYDO/SYDO : Placement :Name of Supervisor :
*Please tick () where applicable
Competency Area of involvement
Level of Competency at the End of Attachment
CommentsBelow Average Average Good Outstanding
1 2 3 4 5 6 7 8 9 10
Organization /management practice
Understanding of client’s charter, general orders treasury instruction, service circular requirement
Understanding the concept of quality initiatives
Basic financial management awareness
Ability to handle complaints
Efficient management of time and resources on daily work
Ethics & legislative
Understanding of the Dental Act 1971, Private Healthcare Facilities & Services Act 1996 & Regulations 2006; and relevant acts Understanding the principles of consent, confidentiality, security (Adherence to Code of Professional Conduct)
Communication & leadership
Demonstrate effective leadership within the healthcare team, where appropriateCommunication with patient, carers & family
Personality and appearance
Ver 01- 020511
38
EP-MP
Total marks achieved ( / *100) points *Denominator depends on number of competencies involved X10
Other comments (if any):
Supervisor’s signature :
Name of Supervisor :
Date :
Official Stamp of Supervisor :
39
EP-MP
REFLECTION FORM
Name of FYDO/SYDO : Placement :
Supervisor Name : Date :
Please give description on e.g. cases encountered, competencies/domains* or activities reflected upon.
Please conduct self assessment on what went well? What were the challenges? What didn’t go well?
Please describe evidence considered during reflection e.g. feedback from assessment? Unexpected outcome? Own feeling?
40
Reflection
Please analyse and describe why: e.g. identifying cause and effect for unexpected case outcomes or identifying reason why progress is slow in one competency and fast in another.
Describe any improvement / change: e.g. learning outcome from this exercise.
Suggestions on how the attachment programme can be further improved (To be filled by FYDO/SYDO and supervisor):
By FYDO/SYDO
By Supervisor
Please refer to page 5 of the Dental Professional Development Programme - User Guide.Ver 02- 070911
FYDO/SYDO’s Signature: ……………………………………… Supervisor’s Signature: ……………………………………………
41
MULTISOURCE FEEDBACK(to be distributed and collected by supervisor)
Name of FYDO/SYDO :
Placement : Date :
Assessor(please tick () where necessary)
Supervisor Dental Technologist Dental Officer Dental Surgery Assistant Dental Nurse
Grading Code:
1, 2, 3 or 4 = Below Average;
5 or 6 = Average; 7 or 8 = Good; 9 or 10 = Outstanding
No Attitude and / or Behaviour 1 2 3 4 5 6 7 8 9 10 Comments on any behaviourcausing concern
1
Maintaining trust / professional relationship with patients(Listen, polite & caring, shows respect for patients’ opinions, privacy, dignity & confidentiality. Is unprejudiced)
2
Verbal communication skills(Give understandable information. Speaks fluently and knows the level of patient’s acceptance)
3
Team work(Respect others’ roles, work constructively in the team. Hands over effectively & communicates well. Is unprejudiced, supportive & fair)
4
Accessibility(Accessible. Take proper responsibility. Only delegates appropriately. Does not shirk duty. Responds when called. Arranges cover for absence)
5 Work ethics - punctuality, abide by the rules, patience)
6 Appropriate dress code protocol at work
Ver 02- 070911
42
MSF
Total marks achieved ( / *60) points *Denominator depends on number of competencies involved X10
Other comments (if any):
Supervisor’s Signature:
Name of Supervisor :
Office Stamp : Date :
43
MSF
PENILAIAN RAKAN SEKERJA(untuk diedar dan dikembalikan kepada penyelia)
Pegawai Pergigian :
PTempat Bertugas : Tarikh :
Penilai(Sila tanda () di ruangyang berkenaan)
Penyelia Juruteknologi Pergigian Pegawai Pergigian Pembantu Pembedahan Pergigian Jururawat Pergigian
Kod Gred :
1, 2, 3 atau 4 = Kurang Memuaskan; 5 or 6 = Memuaskan; 7 or 8 = Baik; 9 or 10 = Cemerlang
No Sikap dan/atau Kelakuan 1 2 3 4 5 6 7 8 9 10Komen terhadap
sikap/tingkahlaku yang memerlukan perhatian
1
Mengekalkan kebolehpercayaan / hubungan professional dengan pesakit (Mendengar, jujur & prihatin, menghormati pendapat pesakit, menjaga privasi, menjaga kerahsiaan dan maruah pesakit)
2
Kemahiran komunikasi verbal (menyampaikan maklumat yang boleh difahami. Bercakap dengan jelas dan memahami tahap penerimaan pesakit)
3
Kerja berpasukan(Menghormati peranan pihak lain dan bekerjasama dalam kumpulan/pasukan. Menjalankan tugas dengan efektif dan berkomunikasi dengan baik. Tidak prejudis, adil dan memberi sokongan / galakan).
4
Mudah diakses (Bertanggungjawab). Membahagikan tugasan mengikut kesesuaian. Tidak mengelak apabila diberi sesuatu tugasan. Memberi respon apabila dipanggil. Mengaturkan pegawai pengganti apabila tidak hadir bertugas.
5 Etika kerja - menepati masa, berdisiplin, sabar
6 Mematuhi protokol pakaian yang sesuai di tempat kerja
Ver 02- 070911
44
MSF-BM
Jumlah markah yang dicapai ( / *60) mata *Denominator bergantung pada jumlah kompetensi yang terlibat X10
Komen-komen lain (jika ada):
Tandatangan penyelia : ……………………………………………………………
Nama penyelia :
Tarikh :
Cop Rasmi Pejabat :
45
CbD
MSF-BM
CASE-BASED DISCUSSION ASSESSMENT FORM(to be filled up by the Supervisor)
Please use this format to write notes and record the questions you will ask during or following the case presentation in order to assess the Dental Officer’s clinical judgement in this case:
Topic of presentation: Date of presentation:
No ItemBelow Average Average Good Outstanding
1 2 3 4 5 6 7 8 9 10
1
Content of Presentation:
a) Introduction
b) Method
c) Result
d) Discussion
e) Conclusion
2 Presenter’s skillful use of MS Powerpoint or other methods to enhance the presentation
3Presenter’s style of presentation and the command of language used during the presentation
4 Presenter have the appropriate knowledge and ability to answer the question posed
Ver 01- 020511
* Case may refer to a particular patient / population / programme For clinical case presentation, the case history, relevant investigation and differential diagnosis should be discuss and presented.
46
Evaluator Notes:
Total mark achieved ( / *80) points *Denominator depends on number of competencies involved X10
Supervisor signature :
Date :
Official Stamp of Supervisor:
47
CbD
DENTAL HEALTH EDUCATION ASSESSMENT FORM(to be filled up by the supervisor)
Please use this format to write notes and record the questions you will ask during or following the Dental Health Education / Talk in order to assess the Dental Officer’s approach in this case:
Topic of presentation: Date of presentation:
No ItemBelow Average Average Good Outstanding
1 2 3 4 5 6 7 8 9 10
1 Content of Presentation
2. Presenter’s skillful use of MS Power Point or other methods to enhance the presentation
3.Presenter’s style of presentation and the command of language used during the presentation
4. Presenter have the appropriate knowledge and ability to answer the question posed
Ver 01- 020511
Evaluator Notes:
48
DHEA
Total marks achieved ( / *40) points *Denominator depends on number of competencies involved X10
Area of good performance:
Area for development before completion of placement:
Supervisor’s signature : ……………………………………………………………
Date :
Official Stamp of Supervisor :
49
DHEA
BORANG SOAL-SELIDIK OLEH PESAKITQUESTIONNAIRE ASSESSMENT by PATIENT (QAbP)
(To be filled up during Primary Healthcare Attachment)
NO.BAGAIMANAKAH PEMERHATIAN ANDA TERHADAP PEGAWAI
PERGIGIAN HARI INI?HOW WAS THE DENTIST YOU SAW TODAY AT …...
TAHAP PENILAIAN / RATINGTIDAK MEMUASKANNOT SATISFACTORY
1
SEDERHANAMODERATE
2
MEMUASKANSATISFACTORY
3
BAIKGOOD
4
1Menyapa anda dengan ramah, tidak merungut atau berkelakuan biadap.Greeting you in a friendly way, not being grumpy or rude to you.
2
Bertanya sebab mengapa anda ke sini dan memberi perhatian kepada jawapan anda. Asking you questions about the reasons for your visit and listening carefully to your responses.
3 Menerangkan apa yang akan dilakukan sebelum memeriksa anda. Explaining what she is going to do before starting to examine you.
4
Memaklumkan hasil daripada pemeriksaan yang telah dijalankan,; tidak berselindung atau mengelirukan anda. Letting you know what she finds after examining you; not keeping you in the dark or confusing you.
5
Berbincang mengenai pelbagai pilihan (jika ada) untuk rawatan dan tidak bergegas untuk membuat pilihan untuk anda. Talking through the different options for your treatment helping you to choose; not rushing ahead or telling you what to do.
6
Memberitahu anggaran kos yang mungkin terlibat dan tidak membiarkan anda menunggu sehingga invois/resit dikemukakan. Indicating the likely cost of the chosen course of treatment at the outset; never waiting until you are presented with the bill.
7
Merawat anda dengan sopan dan rasa hormat; tidak merendahkan atau membuat anda merasa bodoh. Treating you with courtesy, respect and as an equal; never belittling you or making you feel stupid.
8Peka, memahami, bersabar dan bersimpati; tidak mengasari anda. Being sensitive, understanding and patient with you, never rough, unsympathetic or impatient.
50
QAbP
NO.BAGAIMANAKAH PEMERHATIAN ANDA TERHADAP PEGAWAI
PERGIGIAN HARI INI?HOW WAS THE DENTIST YOU SAW TODAY AT …...
TAHAP PENILAIAN / RATINGTIDAK MEMUASKANNOT SATISFACTORY
1
SEDERHANAMODERATE
2
MEMUASKANSATISFACTORY
3
BAIKGOOD
4
9
Memberitahu kemungkinan adanya rasa sakit dan memberi nasihat untuk mengurangkan kesakitan Forewarning you of any likely pain involved and offering you ways of reducing pain.
10
Bercakap dalam bahasa yang mudah, menggunakan perkataan yang boleh difahami tanpa menjadi terlalu teknikal atau sukar. Talking in plain language, using words you can understand, never being too technical or complicated.
11
Meraih kepercayaan dan keyakinan anda; tidak nampak gementar dan tidak yakin. Inspiring your trust and confidence; never appearing nervous or unsure of himself / herself.
12 Menasihati anda cara bagaimana untuk menjaga gigi dan gusi di rumah. Advising you on how to look after your teeth and gums at home.
13
Mendengar sebarang pertanyaan dan menjawab anda dengan jelas; tidak mengelak atau mengabaikan kemusykilan anda. Listening to any questions you have and answering you clearly; not avoiding or ignoring your questions.
Ver 02- 070911
51
QAbP
Jumlah markah / Total Marks( / 52) points
DENTAL PROFESSIONAL DEVELOPMENT PROGRAMME REPORT - STATE LEVEL(to be filled up by State Coordinator)
State :: Date completed :
No Name of Dental Officer
MARKSGradeA > 75
B 50-74C < 50
*Requirement fulfilled
(Yes / No)
a b c d e f g h i
OS, OM & OP
PaedDent ORTHO PERIO RESTOSubtotal
(∑ a-e) / 5PRIMARY
Total (f+g)
Average( h /2 )
1
2
3
4
5
6
*The dental officer is considered to have fulfilled the requirements if he / she achieves a minimum of 50 marks for each discipline Ver 02- 170611
Signature of Coordinator : ……………………………………………………………
Name of Coordinator :
Date :
Official stamp :
52
DP2-State
OE-OSOMOP
OVERALL EVALUATION OF PERFORMANCE
Name of Dental Officer: Placement/Discipline: ORAL SURGERY, ORAL PATHOLOGY AND ORAL MEDICINE
No.
Type of Assessment Weight Factor Weighted Marks
1 EP 50 X 60 = 100*
2 CbD 30 X 30 =80*
3 MSF 20 X 10 = 60*
Ver 02- 070911
*Denominator depends on number of competencies involved X10 Total Marks :
Grade :
Note: The dental officer is considered to have fulfilled the competency level requirement of the respective discipline if he / she achieves a minimum of 50 marks (This form to be sent to State Coordinator)
Signature of Supervisor : ……………………………………………………………
Name of Supervisor :
Official stamp of Supervisor :
53
GradeA > 75B 50 – 74C < 50
OVERALL EVALUATION OF PERFORMANCE
Name of Dental Officer: Placement/Discipline: PEDIATRIC DENTISTRY
No.
Type of Assessment Weight Factor Weight Marks
1 EP 60 X 60 = 110*
2 CbD 30 X 30 = 80*
3
MSF 10 X 10 = 60*
Ver 02- 070911
*Denominator depends on number of competencies involved X10
Total Marks
Grade
Note: The dental officer is considered to have fulfilled the competency level requirement of the respective discipline if he/she achieves a minimum of 50 marks(This form to be sent to State Coordinator)
Signature of Supervisor : ……………………………………………………………
Name of Supervisor :
Official stamp of Supervisor :
54
OE-PaedDent
GradeA > 75B 50 – 74C < 50
OVERALL EVALUATION OF PERFORMANCE
Name of Dental Officer: Placement/Discipline: ORTHODONTICS
No.
Type of Assessment Weight Factor Weight Marks
1 EP 60 X 60 = 80*
2 CbD 30 X 30 = 80*
3
MSF 10 X 10 = 60*
Ver 02- 070911
*Denominator depends on number of competencies involved X10
Total Marks
Grade
Note: The dental officer is considered to have fulfilled the competency level requirement of the respective discipline if he/she achieves a minimum of 50 marks(This form to be sent to State Coordinator)
Signature of Supervisor : ……………………………………………………………
Name of Supervisor :
55
OE-ORTHO
GradeA > 75B 50 – 74C < 50
Official stamp of Supervisor : ……………………………………………………………
OVERALL EVALUATION OF PERFORMANCE
Name of Dental Officer: Placement/Discipline: PERIODONTICS
No.
Type of Assessment Weight Factor Weight Marks
1 EP 60 X 60 = 30*
2 CbD 30 X 30 = 80*
3
MSF 10 X 10 = 60*
Ver 02- 070911
*Denominator depends on number of competencies involved X10
Total Marks
Grade
Note: The dental officer is considered to have fulfilled the competency level requirement of the respective discipline if he/she achieves a minimum of 50 marks(This form to be sent to State Coordinator)
Signature of Supervisor : ……………………………………………………………
Name of Supervisor :
56
OE-PERIO
GradeA > 75B 50 – 74C < 50
Official stamp of Supervisor :
OVERALL EVALUATION PERFORMANCE
Name of Dental Officer: Placement/Discipline: RESTORATIVE DENTISTRY
No.
Type of Assessment Weight Factor Weight Marks
1 EP 60 X 60 = 80*
2
CbD 30 X 30 = 80*
3 MSF 10 X 10 = 60*
Ver 02- 070911
*Denominator depends on number of competencies involved X10
Total Marks
Grade
Note: The dental officer is considered to have fulfilled the competency level requirement of the respective discipline if he/she achieves a minimum of 50 marks(This form to be sent to State Coordinator)
Signature of Supervisor : ……………………………………………………………
57
OE-RESTO
GradeA > 75B 50 – 74C < 50
Name of Supervisor :
Official stamp of Supervisor :
OVERALL EVALUATION OF PERFORMANCE
Name of Dental Officer: Placement/Discipline: PRIMARY ORAL HEALTHCARE
No.
Type of Assessment Weight Factor Weight Marks
1 EP 30 X 30 = 130*
2 CbD 10 X 10 = 80*
3 MSF 10 X 10 = 60*
4 DPH 20 X 20 = 100*
5MP 10
X 10 = 100*
6 DHEA 10 X 10 = 40*
7 QAbP 10 X 10 = 52*
Ver 02- 070911
Note: The dental officer is considered to have fulfilled the competency level requirement of the respective discipline if he / she achieves a minimum of 50 marks(This form to be sent to State Coordinator)
58
OE-PRIMARY
Total Marks
Grade
GradeA > 75B 50 – 74C < 50
Signature of Supervisor : ……………………………………………………………
Name of Supervisor :
Official stamp of Supervisor :
DURATION OF FYDO/SYDO ATTACHMENT(to be completed by FYDO/SYDO)
Name of Dental Officer : MDC Number :
DISCIPLINEDURATION(MONTHS)
DATE OF ATTACHMENTREMARKS
COMMENCE COMPLETE DURATION (MONTHS)
Oral Surgery &Oral Medicine & Oral Pathology
4
Paediatric Dentistry 2
Orthodontics 2
Periodontics 2
Restorative Dentistry 2
Dental Public Health & Primary Oral Healthcare
12
Ver 01- 020511
59
60
CHECKLIST OF ASSESSMENTPlease tick (√) when the assessment is done.
Name of Dental Officer : MDC Number :
Duration (Month)
Specialty Assessment Frequency Done ()
Dental Specialist Attachment: Hospital Based (Oral Surgery, Oral Medicine & Oral Pathology, Paediatric Dentistry)
4Oral Surgery, Oral Medicine & Oral Pathology
EP (Beginning) 1x
Log-OSOMOP Min 5x
CBD 1x
Reflection Min 1x
MSF 1x
EP (End) 1x
2 Paediatric Dentistry
EP (Beginning) 1x
Log-PaedDent Min 5x
CBD 1x
Reflection Min 1x
MSF 1x
EP (End) 1x
Duration (Month)
Specialty Assessment Frequency Done ()
Dental Specialist Attachment: Non-Hospital Based (Orthodontics, Periodontics, Restorative Dentistry)
2 Orthodontics
EP (Beginning) 1x
Log-ORTHO Min 5x
CBD 1x
Reflection Min 1x
MSF 1x
EP (End) 1x
61
2 Periodontics
EP (Beginning) 1x
Log-PERIO Min 5x
CBD 1x
Reflection Min 1x
MSF 1x
EP (End) 1x
2 Restorative Dentistry
EP (Beginning) 1x
Log-RESTO Min 5x
CBD 1x
Reflection Min 1x
MSF 1x
EP (End) 1x
Duration (Month)
Specialty Assessment Frequency Done ()
General Dentistry Attachment: (Primary Oral Health Care)
12
Dental Public Health Specialist &
Primary Healthcare
Log-PRIMARY Min 5x
CbD 1x
DHEA 1x
Reflection 1x
Log-MP 1x
Log-DPH 1x
CbD 1x
DHEA 1x
Reflection 1x
MSF 1x
QAbP 1x
62
EP-Primary 1x
EP-MP 1x
EP-DPH 1x
Ver 01- 020511
*EP (Beginning) to be filled up by FYDO/SYDO as a form of self assessment. The rotation of specialist attachment shall be determined at State level according to local requirements.
63