BFACA Mid-Year Meeting 2013 New (2013) CODA Standards .

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ADEA Sections on Business and Financial Administration and Clinic AdministrationBFACA Mid-Year Meeting 2013New (2013) CODA Standards: OverviewSource:2012-2013 ADEA RegionalAccreditation Workshop Series:“What’s New In CODA 2013”Bill Hendricson MS, MA, MEdAssistant Dean, Education & Faculty DevelopmentUTHSCSA Dental [email protected]

Trauma, cancer, TMJ, speech deficits, infection, crowding alignmentissues, facial pain, cosmetics secondary to facial reconstruction,complicated orthodontics

GoalProvide context for changes in the 2013 CODApredoctoral accreditation standards likely to haveimplications for clinical education and patient careprograms of dental schools. Std 2-23h Implant education Stds 5-1, 5-2, 5-3, 5-4 Patient – centered care &evidence-based practice (also 2-21)

Radar Screen Context for This Morning:What’s New & Noteworthy in CODA 2013?1. Stds 1-3 & 1-4: Assessment of culture, environment, diversity2. A general dentist is the “product” of predoctoral education &delineation of 27 general dentistry components3. Stronger CODA commitment to actual competency-basedassessment4. How to provide stronger evidence of student competency for the“other” non-procedural curriculum standards5. Std 2-23: How to provide evidence of students’ “overall readiness”for general dentistry practice6. Std 2-23h: How to provide learning experiences & assessment for allstudents pertinent to “dental implant prosthodontic therapy”7. Stds 5-1, 2, 3 & 4: Practices & issues related to patient-centeredcare & evidence-based practice (also Std 2-21: EBP)

Focus on Dental School Environment

LearningEnvironmentHumanisticWorkCultureAcceptance &AchievementOf Diversity

A “General Dentist” is the educational productProfessionalDental competenceEducationis morethan demonstration of isolatedHistorically focused oncompetencies.specific components ofWhen we see the whole, we seedental practiceits parts differently than whenwe see them in isolation.Bedrock CBE Principle:Above all else, assess trainees’ capacity forEraut. Professional Knowledge &functioning in the role for whichthey are beingCompetence.trained. London. Falmer Press. 1994.Grant, 1979Domain ofOverallGeneralCompetenceDentistryComponents of General Dentistry

What is a “General Dentist”?What is your school’s definition of General Dentistry?UTHSCSA Dental School Definition of A General DentistA General Dentist is the primary oral health care provider for patientsin all age groups supported by dental specialists, allied dentalprofessionals and other health care providers. (ADEA Competenciesfor the New General Dentist, JDE, July 2009). General dentists providediagnosis, treatment, management and overall coordination oftherapeutic services to meet patients’ oral health needs including riskIf you don’tknow wheregoing, General nd education.responsibilitiesto someplacetheir patients else.”include referral to, and consultationyou’ll end upor collaboration with, physicians and other health care providers forYogiemergentBerra systemic medical issues, medicaldetected and/oremergencies and trauma.

CODA 2013 Stipulates that Dental SchoolGraduates Must be Competent in 27 Componentsof General DentistryProfessional Role, Thinking, Patient Care / Clinical SkillsFunctional Context, Values(N 15; 56%)(N 12; 44%)

StdRole, Thinking, Context, Values (12)2-09Use critical thinking in patient care, inquiry and research2-10Use self-assessment to develop competency; learning plans2-14Apply biomedical science knowledge in patient care2-15Apply behavioral sciences & patient-centered approaches topromote, improve & maintain oral health2-16 Manage a diverse patient population Skills for multicultural work environment & culture comp2-172-18 Practice Mgmt: regulatory, principles Health care delivery models Function as oral health care team leader2-19IPE: Collaborate with other health care team members2-20Apply ethical decision-making & professional responsibility2-21EBP: Access, critically appraise, apply, communicate2-22Provide oral health care to patients in all life stages2-24Assess Tx needs of patients with special needsAssessment

To Date, The Evidence Bar Has Been Lowfor the “Other” Educational StandardsStds 2-09, 2-10, 2-14, 2-15, 2-16, 2-18, 2-19, 2-20, 2-21, 2-22, 2-24

Leveling the Playing Field forCompetency AssessmentSolution in the other health professions: OSCE Objective Structured Clinical Evaluation Objective Structured Competency Evaluation

abcdefghijklmPatient assessment, dx, comprehensive TxP, prognosis & informed consentnoMalocclusion & space managementScreening and risk assessment of head & neck cancerRecognize complexity of patient Tx & identify when referral is indicatedHealth promotion & disease preventionAnesthesia, and pain & anxiety controlRestoration of teethCommunicate & manage dental lab procedures in support of patient careReplacement of teeth: fixed, removable & dental implant prosth therapyPeriodontal therapyPulpal therapyOral mucusal & osseous disordersHard & soft tissue surgeryDental emergenciesIntent Statement for 2-23h:“At a minimum, grads must becompetent in providing oral healthcare within the scope of generaldentistry, as defined by the school,including Evaluation of Tx outcomes, recall strategies & prognosis

CODA 2013 Standard 2-23 “Programs should assess overall competency, not simplyindividual competencies in order to measure thegraduate’s readiness to enter the practice of generaldentistry.” DEP Standards, 2013; pg. 45

Standards 5-1, 5-2, 5-3, 5-4What is your school’s philosophy related to theprimary function of the clinic & patients?What is your school’s commitment to patientcentered care?

“Deeply Conflicted”Clinic & patients are first& foremost for studenttrainingClinic is first & foremosta health care facilityStudent needs come 1stPatient needs come 1st

2 Sides to the Coin7 “Ps” of Skill Acquisition “I’ve spent 3 appointmentsPreparation/PrecursorsPrompted Practice (Reps)Perform Personally (Solo)Persistent PerformancePerfecting (Refining)PlateauPersonal ePiphanySchijven, et al. Surg Endosc.2004; 18: 121-127.Ericsson. Acad Med. 2004; S70S81doing stuff for you that don’tbenefit me. I need you show upwhen you are supposed to, so Ican start work on you that willearn points for me that I needor I’m going to have to dropyou.”

Comparing Std 2-5 in 2008 & 20132008: Quantitative criteria for student advancement &graduation must not compromise delivery ofcomprehensive patient care. Describe the school's philosophy on comprehensive patient care. How are patients assured of receiving comprehensive care?2013: The use of quantitative criteria for studentadvancement and graduation must not compromise deliveryof comprehensive patient care.

5-4 The use of quantitative criteria for studentadvancement & graduation must not compromise thedelivery of comprehensive patient care. (2013)A. Description:Describe the school's philosophy on comprehensive patient care.How are patients assured of receiving comprehensive care?Describe how patients are assured of best practices care and not carerelated to quantitative requirements.Comment on the effectiveness of the system in place to ensure thatall students encounter the specified types of patient/clinicalconditions needed for the clinical objectives to be met.B. Supportive Documentation:List of clinical requirements & clinical competency exams requiredfor graduation.

Full Disclosure – We Have TheseRequirements & DeadlinesProcedureAcademic YearRequiredUnitsDeadlinesXYZXYZEtcDS3DS463Dec 1Feb 1

UTHSCSA-DS Table 2-25-3 (2012 SSR)Major Examinations of Competencies Screen shot

5 – 4 Narrative (4 pages)ItemHow training & assessment system worksvis-à-vis patient careComprehensive Care PolicyStandards of CarePatient screening and selectionHow are patients scheduled and by who?Policy on patient transfer among studentsPatient outcome assessment data;patient completion dataPatient satisfaction dataDocuments(Append)Narrative1/2 pgYes½ pgYesYesTables½ pg½ pg½ pg½ pg½ pgTable½ pgFlowchartFlowchart

Assessment Checklist for 5-4

Std 5 – 4 Self Assessment1. What criteria/process do you use to determine if Tx is consistentwith best available evidence? Who assesses and how?2. Is patient selection & scheduling managed by faculty?3. Is patient scheduling based on the patients’ TxP, unless in aemergency situation?4. Is Tx based on an approved TxP that is accessible in the patientmanagement system for inspection?5. Is TxP or sequence altered to benefit students’ acquisition ofrequirements or to facilitate conducting an assessment?6. Are students’ assessments based on Tx needs of patients at thatpoint in time?7. After initiation of Tx, are patientsdiscontinued when they no longermeet the training needs of students?

A Long, Arduous JourneyBut Successful,Thanks To YouBill HendricsonAssistant Dean, Education & Faculty DevelopmentUTHSCSA Dental [email protected]

New (2013) CODA Standards: Overview . Bill Hendricson MS, MA, MEd . Assistant Dean, Education & Faculty Development . UTHSCSA Dental School . [email protected] Source: 2012-2013 ADEA Regional . Accreditation Workshop Series: “What’s New In CODA 2013” ADEA Sections on Business and Financial Administration and Clinic Administration .