AdvisingSystemGuidelines2009-1114

Version 2009-1115

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1959 NE Pacific Street, D770 Seattle, Washington 98195 206.543.5948 FAX 206.543.7783 www.dental.washington.edu

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Restorative Dentistry Student Advising/Patient Treatment Management Process

Contents

This document is organized under the following headings:

*Overall Goals *Description of Advising System and Treatment Planning Process *Faculty Responsibilities *Student Responsibilities *Evaluations *Appendix A: Current Faculty Advising Groups *Appendix B: Guidelines for Oral Conditions Appropriate for Care by Predoctoral Students *Appendix C: Patient Oral Conditions Requiring Advising System Management *Appendix D: Treatment Planning Competency Form *Appendix E: Informed Consent Competency Form *Appendix F: Student Evaluation Form (by Faculty) *Appendix G: Faculty Evaluation Form (by Student) (*Appendix H: Outcomes Assessment Form)-under development

Overall Goals

Restorative Dentistry (ResD) maintains a system to assure that students have a resource for planning and implementing restorative care of patients with more advanced needs. This system provides the best learning for students, the best treatment for patients, and the lowest risk of problems for the patient, the student, and the school.

The goals of the advising system are to ensure that:

(1) students learn how to plan, implement, and manage treatment of more complex cases.

(2) patient treatment is planned and sequenced properly, and approached comprehensively and with continuity.

(3) clinical competency is achieved in the areas of patient treatment planning and informed consent for treatment.

(4) the student learns to integrate restorative treatment with other dimensions of dentistry and medicine.

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Description of Advising System and Treatment Planning Process

Advising Groups: Restorative (ResD) faculty are organized into 5 faculty advising groups with three or more faculty per group. Faculty advising groups are selected (Appendix A) to provide sufficient expertise within each group to administer and coordinate comprehensive treatment of patients seen at the predoctoral level. Each group is responsible for approximately thirteen (13) D3 (including RIDE students) and eleven (11) D4 students. Students will be assigned to their faculty advising group by the Advising System Director at the beginning of their 3rd year, and will retain that group for the duration of their time at the school. Transfers of students among advising groups will be considered, but discouraged, and administered by the Director and Chair of ResD as necessary. D4 RIDE students will obtain advising via their mentors in Eastern Washington.

Treatment in the Predoctoral Restorative Clinic: To be treated at the School of Dentistry by predoctoral students, a patient’s clinical needs must meet certain global guidelines (see Appendix B). These guidelines protect both the patient and the student. The student should be aware that patients who do not meet the guidelines in Appendix B will be rejected by Advising teams for treatment in the predoctoral program. At the time of the initial restorative assessment, many patients will have treatment needs that meet predoctoral guidelines, but require a comprehensive, strategic approach for appropriate management. For these patients, the student is required to coordinate treatment through their faculty advising group. Examples of these types of patients are shown in Appendix C, but the faculty member present at the initial restorative appointment has the discretion to request involvement or oversight of the advising group for any patient or student. The Director (currently Dr. Verhoef) will have the ultimate decision about the appropriateness of patients (both comprehensive and limited care) for the predoctoral program. If the patient’s needs are appropriate for predoctoral care, the student will proceed with the initial Restorative appointment (next section).

Sequence of Events in the Initial Restorative Comprehensive Care Appointment (Figure next page): A determination will be made by the student and faculty covering clinic as to the complexity of the needs of the patient. A periodontal assessment of the patient’s needs will also be made by the periodontist on the floor to determine if the periodontal needs are routine or more advanced. If the patient’s needs (perio and restorative) are routine, the student should propose a treatment list and the faculty will confirm the treatment and approve the plan in axiUm. Treatment may then proceed to completion (usually beginning with prophylaxis). Routine restorative cases generally involve direct fillings and no more than a single crown; most patients will be administered by this route. However, other factors, such as a medical condition, behavioral needs, rampant disease, or other factors may make use of the advising system appropriate—at the discretion of the faculty covering the clinic (perio or restorative).

If the patient’s needs are more complex (perio, or restorative as outlined in Appendix C), no treatment plan will be formulated at the initial appointment. Rather, the goal of the appointment will be to collect sufficient data for presentation to the student’s Advisor, so that treatment options can be constructed for the patient. Clinical findings and data collection may include: alginate impressions, current radiographs, pulp testing, facebow transfer and bite registration

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records, periodontal charting, photographs (hard copy, disk, or AxiUm). Special attention should be paid to assess teeth that have a guarded prognosis (e.g., restorability is borderline). The perio faculty also may require more advanced charting, tests, or special photographs as needed for complex perio cases. The faculty members on duty will guide the student as to the appropriate data collection. The patient will be advised that they may need to return for a separate treatment planning appointment. In rare cases, a second diagnostic appointment might be necessary as well. In general referral from Endodontics, Orthodontics, or Oral Surgery should be deferred until the student has met with the advising team.

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Treatment Planning Session with the Advisor: For patients whose treatment requires the advising system, the student should arrange appointments with whomever in their advising group is best equipped to answer questions/address issues (determined by faculty in the advising group). The faculty advising group will consult among themselves as necessary to assure coordination of treatment and appropriate student advising.

In preparation for the appointment with the advising team, the student will pour and trim alginate impressions and mount casts, and then depending on the experience of the student, formulate preliminary treatment options and treatment sequences. It is the student’s professional responsibility to be fully prepared for the session with the advising team, bringing all records needed and familiarizing themselves with the patient’s needs and history (for example, being aware of all medications and what they are for). Students will be evaluated on their preparation for and performance during these sessions (see section below).

At the advising appointment, the student and Faculty Advisor will formulate treatment options and potential treatment sequences for the patient. If the periodontal needs also are complex, the student will meet with the periodontal Advisor (Appendix A) who will be retained for a given patient throughout treatment). The Restorative Advisor may require input from the Perio Advisor prior to formulating restorative options. The Restorative Advisor also will help the student to plan consultations from Endondontics, Oral Surgery, or Orthodontics as needed. Consultations will be obtained after the treatment plan is finalized.

At this point, the Faculty Advisor will determine how the treatment plan will be presented to the patient.

(i) If the proposed plan can be addressed only as one logical option, the Advisor may allow the student to schedule the patient into the Restorative clinic and present the treatment plan without the Faculty Advisor.

(ii) If the proposed plan contains more than one logical option, but each option is straight forward and should require little discussion, the Advisor my determine that the student should schedule the patient into the Restorative Clinic when the same faculty (or another member of the Advisory Team) is present to finalize the approval of the treatment plan.

(iii) If the proposed treatment plan is more complex with several options requiring patient input and faculty consultation, the Advisor will ask the student to schedule the patient into the treatment planning chair.

Treatment Planning Chair: The following ideas will guide the administration and use of the treatment planning chair. Note that treatment of patients will not commence until the advising faculty approves the final treatment plan and treatment is accepted by the patient.

a. Students are responsible for coordinating a treatment planning session with their patient and Faculty Advisor. Faculty is responsible for suggesting available times for students to schedule their patients.

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b. Appointments must be made through the clinic coordinator (currently Shirley Sampson) at least 3 days in advance, and students must confirm the appointment 24 hours in advance. Most days there will be 3 chairs available for treatment planning. The appointment need not be at 9:30 or 1:30, but cannot be scheduled after 10:30 or 2:30. If 2 patients are scheduled on the same day, they should be staggered at 9:30 and 10:30, or 1:30 and 2:30.

c. Treatment planning sessions are independent from regularly blocked sessions. They may be scheduled during one of their open session, or at the time of a regularly scheduled blocked session. Students must cancel their regular session in order to schedule the Treatment Planning Chair.

d. Faculty may facilitate the session by any means at their discretion. They may choose to be present at all times, or allow the student to present the treatment options, and then be present to answer questions and to approve the treatment plan.

e. At the end of the appointment, the patient should either: 1) approve the plan; 2) decline any of the treatment plan options; or 3) consider the proposed plan for a period of time (suggest 2 weeks). Normally the student and Faculty Advisor should not need to meet with the patient a second time, but the student and Advisor should discuss questions that the patient may still have after the clinical appointment.

f. If the patient approves one of the treatment plan options, the plan as well as any referrals must be entered into axiUm at the end of the appointment. No significant changes can be made to this plan without consent from the Advisor. It may be revised following the results of any consultations. The patient will be required to sign acceptance of the treatment plan and cost estimates in AxiUm, and a disclaimer that treatment options may change depending on therapeutic outcomes and that costs estimates expire on year from the date of signature. For some treatment options (for example ICD’s) the patient will read and sign a consent form at this point. An informed consent competency will be administered as part of this appointment once the Faculty Advisors believe that the student is ready.

g. The treatment planning session will be graded in the normal manner. Students will be expected to: know the treatment options available; to recommend the options that are ideal, and the options that may be consistent with the patients chief concern; be able to present approximate fees for the proposed treatments; communicate clearly, effectively and with confidence; and, be able to properly complete charting and enter the treatment plan and referrals into the axiUm system.

Treatment of Restorative Needs/Adjustment of Treatment Plan: After the treatment plan is finalized, treatment will occur at normal Restorative or Periodontal clinic sessions. Students must ensure that they seek faculty approval for specific steps at critical points in the treatment process that are required by the advising group. The advising group also may require that students confirm (with their Advisors) the quality of work going into or back from dental laboratory. In the event that something does not go as planned in the patient’s treatment plan that threatens the viability of the plan, the student must return to the advising group to discuss

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and approve an alternative plan. Faculty on the clinic floor will not be responsible for significant adjustments to treatments plans of patients with complex dental needs.

Outcomes Assessment Examination: To teach and ensure outcomes assessment, all complex treatment plans will contain a final exam/prophylaxis appointment. Once the treatment plan is complete, the student will see the patient for a final exam and prophylaxis. At this appointment the patient will be examined to ensure that the treatment plan as been completed to the degree the patient desires, that all treatment has acceptable clinical quality, that there are no additional problems that have developed over the course of treatment, that final prophylaxis/management instructions have been given, and that the patient is admitted into the recall system. The outcomes assessment sheet will be completed by the student, signed by the faculty member, and made part of the patient’s chart.

Evaluations of Faculty-Student Performance: Faculty advising groups may be asked to provide evaluation of students periodically and students will have the opportunity to evaluate their Advisors. In addition, the student will be required to take and pass competency examinations in formulation of a treatment plan and in providing informed consent to a patient (see next section). These examinations and evaluations will be managed by the Director and administered by the Faculty Advisors.

Adjudication: In general the each group will be self-regulating as much as possible. The concept of the group is that they can cover and compensate for each other to assure adequate guidance for students. If irreconcilable problems occur among group members, the Chair of ResD will adjudicate. The Chair/Director are the overall administrators of the advising system and will adjudicate other issues as necessary. They will coordinate the composition of the groups and any assessment of group and faculty performance. Results of group performance will be reported to the Chair (see below).

Evaluations

During their third and fourth years, students will be required to complete two competency examinations. In addition both faculty and students will be evaluated for performance.

Treatment planning competency exam: A competency examination in treatment planning will be required in the fourth year, after the student has completed at least 5 (five) treatment plans with their advising group, but then at the discretion of the advising group. RIDE students will take their treatment planning competency exam in Eastern Washington. The advising group will assess and pre-approve the patient to be used for the competency--the treatment required must be sufficiently complex to warrant use on the competency exam. Once approved, the student will obtain all the appropriate records and consults, then will formulate a written treatment plan for the patient with appropriate options. The student will present this plan, without aid, to at least one member of the advising group, then answer questions and defend the choices and strategies in the plan. The Advisor(s) will then complete the treatment plan competency form (see Appendix D); students must receive at least 70% of total points to pass. If the student does not pass, s/he must retake the exam on another patient when the advising group feels

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they are ready. Regardless of the final score on the examination, the student and faculty member will discuss strengths and weakness of the student’s ability to formulate treatment options for a patient. Scores will be reported to the Director.

Informed consent competency exam: Each student also will be required to take a competency in obtaining appropriate informed consent from a patient. This competency may be completed in either the third or fourth years, but may only be completed after the student has presented at least 3 (three) treatment plans to patients in treatment planning appointments. At the treatment planning appointment, the student will present treatment options to the patient and, without aid, inform the patient of the risks and benefits of various treatment options, then arrive at a finalized treatment plan. The presentation will be observed and graded by a covering faculty member, who will grade the student using the informed consent evaluation form (see Appendix E). The student must receive an 70% or better to pass the competency. If the student does not pass, s/he must retake the exam on another patient. Regardless of the final score on the examination, the student and faculty member will discuss strengths and weakness of the student’s presentation and informed consent process. Scores will be reported to the Director.

Student evaluation by faculty: Faculty advising groups will provide student evaluations on students’ ability to plan and manage patient treatment. Each student will be evaluated on a quarterly basis, but a formal grade will only be issued at the end of years 3 (as part of ResD 630 and Pros 630) and 4 (as part of ResD 640 and Pros 640). This frequency of grading accommodates the possibility that not all students will have sufficient experience with the advising team in any quarter to permit a fair assessment. In the event that student performance is not adequate (grade in ResD 630 or Pros 630 of < 3.0), the student also will be evaluated at the end of Summer quarter (grade in ResD 535). Evaluations will be provided on a form (see Appendix F) at the end of each quarter, which will be combined into a single evaluation at year’s end. All members of the faculty advising group will contribute to the final year-end assessment for each student.

Faculty evaluation by students: Students will provide faculty evaluations of members of their advising group at the end of years 3 and 4. These evaluations will be done anonymously and will be required to receive a grade in ResD 630/640 and Pros 630/640. Students will provide feedback using a form (see Appendix F) or equivalent in the school’s online evaluation system. The Director will manage administration of the evaluations; the Chair will monitor and distribute results to the faculty.

Faculty Responsibilities

(1) Participate fully and equitably in their group. (2) Provide and keep adequate appointment times for student advising. (3) Ensure/arrange for coverage for student advising in their absence (sick, professional

travel, vacation) in cases where necessary. On occasion, faculty from other advising groups may be enrolled to help (e.g., a specific case where expertise is required that other members of the group cannot meet).

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(5) Communicate effectively within the group to ensure consistent advising for students and appropriate treatment of patients. This communication can happen via email or periodic meetings. Meet at least once per quarter to evaluate students.

(6) Treat students as professional participants in the process of planning and implementing treatment.

(7) Seek advise/help if cases require more expertise than the faculty member has, or a group has.

(8) Provide constructive evaluation of student performance when requested by course director. Administer competency examinations in treatment planning and informed consent.

(9) Report problems to the Director/Chair of ResD if students are not fulfilling their responsibilities, are acting unprofessionally, or are not able to appropriately manage and coordinate the treatment of their patients.

Note: Faculty advising groups will have the authority to limit student treatment of a patient, manage patient transfers, recommend that students be removed as providers for a patient, assign grades as requested/required by course directors, or report on student performance to the Director, ResDChair, Associate Dean for Clinics, or Dean as requested or needed. Chair/Vice-Chair(s) will have ultimate authority over restorative patient care management, in coordination with other departments or school leadership as required.

Student Responsibilities

(1) Maintain close communication with their faculty advising group on a regular basis for each patient, as requested by their advising group.

(2) Come to appointments with the Faculty Advisors on time, with all relevant materials needed, and intellectually prepared to discuss treatment.

(3) Ensure that they do not proceed with treatment without approval from the faculty advising team for specific checkpoints (which are procedure dependent and patient dependent).

(4) Manage their laboratory cases in a timely manner. (5) Pass competency examinations in treatment planning and informed consent. (6) Not be intrusive on faculty members’ time outside of appointment times without

permission or advanced arrangements. (7) Treat Faculty Advisors with professional courtesy and respect. (8) Provide constructive evaluations of Faculty Advisors periodically. (9) Contact the Chair if faculty are not fulfilling their responsibilities as Advisors.

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Appendix A-Current Student Advising Groups (Restorative (above) and Perio (below) (2009-0123)

Restorative Advisors Group 1

Dr. Mats Kronström Dr. Andy Marashi Dr. Glen Johnson

Group 2 Dr. Ricardo Schwedhelm Dr. Marty Anderson Dr. John Wataha Dr. Sami Dogan

Group 3 Dr. Xavier Lepe Dr. John Townsend Dr. Kavita Shor

Group 4 Dr. Hai Zhang Dr. Albert Chung Dr. Gabriela Ibarra

Group 5 Dr. Tom Helbert Dr. Tar-Chee Aw Dr. Doug Verhoef

Perio Advisors

Mondays: Dr. Robert O’Neal Tuesdays: Dr. Thomas Flemmig Wednesdays: Dr. Johnny Wang Thursdays: Dr. Frank Roberts Fridays: Dr. Manoj Muthukuru

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Appendix B-Guidelines for Oral Conditions Appropriate for Care by Predoctoral Students (2009-0901)

Operative and Fixed Prosthodontics

These “Guidelines” suggest limitations on the abilities of undergraduate dental students to maintain a standard of care which should include the ability to complete quality comprehensive treatment in a reasonable period of time. Extremely complex treatment plans, those with a guarded or poor prognosis, or those that typically should be treated by dental specialists, should not be assigned to the undergraduate Restorative Clinic.

Good or Acceptable Cases:

1. Obvious caries or defective restorations expected to be restorable with direct restorations. 2. Failing amalgam or composite restorations where crowns might be indicated. 3. Patients whose potential treatment plan could normally progress fast enough for a student to

control the disease process without continued deterioration of the remaining dentition. 4. Patients requesting esthetic procedures, i.e., veneers or anterior C&B. Requests for bleaching

will only be acceptable if other restorative services are clearly indicated. 5. One or two edentulous spaces in any quadrant that might be indicated for bridges or implants. 6. Implant cases involving single tooth or two adjacent tooth restorations. Potential implant cases

involving more than 3 implants are normally not suitable for under-grad teaching, but may be considered as a part of a more comprehensive plan. Patients should never be told that implants will be provided until after treatment planning by both restorative and surgical departments.

7. Combination cases involving multiple disciplines, are encouraged, but only to the extent that the previous indications are met.

Patients must understand that we are here to provide comprehensive dental care, and not treatments for selected procedures only.

Patients should demonstrate adequate financial means or dental insurance which would allow for reasonable treatment planning options, and an ability to make schedule appointments.

Patients must understand that work will progress much more slowly than in a private office.

Poor or Unacceptable cases:

1. Multiple “bombed out” teeth with rampant caries, unless expected to be extracted and treated with Removable Prosthodontics.

2. Extreme occlusal wear demonstrating short, flat occlusal and incisal surfaces, and expected to require restoration at an increased vertical dimension of occlusion or “full-mouth” reconstruction. Undergraduate cases will NEVER be allowed to restore dentition at an increased vertical dimension of occlusion.

3. Multiple missing teeth in both arches where condition of occlusal plane is not easily correctable. 4. Not more than 2-3 obviously failing crowns (recurrent caries or other defect). 5. No more than a total of 10 existing crown and bridge units (intact or defective). Replacement of

multiple defective crowns is not predictable; can take an excessive amount of time; and, is not a good teaching experience.

6. Extensive root caries (more than 3-4 teeth). 7. Multiple implants. More than 2 in the same quadrant. Final approval to be made by Dr.

Kronstrom or implant advisor. 8. Crown and bridge units will not be covered by DSHS. Patients should be advised before

assignment to student for comprehensive care.

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9. Patients “demanding” that specific treatments be accomplished or who have unrealistic expectations. (I want “caps” on all of my teeth to make me look younger”, or, “I want all of my amalgam fillings replaced with white fillings”)

Common Problems During the Treatment Phase

1. Conditions that are so extensive that caries control cannot keep up with continued deterioration of the dentition. Students are only able to work on one or two teeth at a time. Teeth are lost – possibly unnecessarily. Patient complaints.

2. Patients do not understand that there are many things that we cannot or will not do, despite treatment plans generated by “outside” dentists. For example, we will not attempt to place a crown on what we consider to be a non-restorable tooth.

3. Patients do not understand that although our fees are lower, we cannot propose a logical treatment plan that would meet all of their needs and still be affordable to them. (Patients desire all edentulous spaces restored with bridges, and will not accept a removable prosthesis.)

4. Patients expect that all teeth can be restored. Not all teeth are restorable. Many teeth might only be restorable with expensive specialty care – and then with an unpredictable prognosis. It is not practical to spend time and money on one tooth while the rest of the dentition is ignored. UG students cannot be expected to spend all of their time with one patient, while others are neglected.

5. Many teeth with radiographically identified deep caries may be non-restorable. A referral to the Department of Endodontics does not guarantee that RCT will be performed or that the Department of Restorative Dentistry will place a crown.

6. The restorative treatment plan is determined to be too complex. This may include: too many defective crown and bridge units; severe occlusal wear necessitating extensive occlusal rehabilitation or increase in the vertical dimension of occlusion; extensive root caries on more than a few teeth; medical or behavioral conditions that would be best treated in Fears, DECOD, GPR, or Faculty Practice. Very few patients are accepted to Graduate Prosthodontics.

Removable Prosthodontics

General Guidelines

1. Be sure that patient is available for many lengthy appointments and in some cases treatment may take up to a full year.

2. Be sure financing is available. 3. We need relatively healthy patients; patients with compromised health are too difficult for

undergrads.

4. We need patients with a relatively good occlusion and interarch relationship where students will not struggle to set denture teeth.

5. Patients who want or need many implants should be referred to Grad Pros, Faculty Pros or to PP. 6. Be sure the patient is truly interested in a removable treatment option. Ask them directly “Are you interested in a removable appliance to replace your missing teeth?” 7. If the patient has large Tori/Exostosis that will interfere with the fabrication of a CD or RPD be

sure the patient is healthy enough and willing to undergo surgical removal.

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Complete Dentures 1. Excessive resorption of ridges is OK, if patient has reasonable expectations.

Ask yourself, are patient’s expectations reasonable? Ask patient if they will consider and if they can afford 2 mandibular implants for retention. 2. Good ridges but unrealistic expectations, the patient is not a good candidate. Ask yourself, “Do I want this person as a patient?” 3. ICD patients that require general anesthesia should be referred to Hospital Dentistry for both the

extractions and the dentures.

Removable Partial Dentures 1. Patient may first have to undergo initial care and take care of urgent needs, perio, and caries

control before we can commit to treat the patient. 2. CONTRAINDICATION: Patient with rampant caries who will not or can not improve home care. 3. CONTRAINDICATION: Kennedy Class IV with large edentulous area. 4. CONTRAINDICATION: RPD patient with supra-erupted teeth and inadequate room for denture

teeth. 5. EXPECTATION: Food will collect under a RPD. This is a sure thing when chewing food. 6. Swinglock RPD’s may not be possible if less than 5 anterior teeth remaining, should have at least

1 canine and patient should accept the appearance and possibly showing the bar. Also patient must be able to lock and unlock RPD bar.

7. RPD’s designs with attachments should be referred to Grad Pros, Faculty Pros or to PP. 8. RPD patients who will need an Increase in Vertical Dimension should be referred to Grad Pros,

Faculty Pros or to PP.

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Appendix C-Patient Oral Conditions Requiring Advising System Management (2009-0123*)

Oral Condition/Treatment involves: Comment Fixed partial dentures. **All bridges (regardless of # of units). Specific

check points at discretion of advising group. **More than 4 individual crowns or more than 2

adjacent individual crowns. **Failing crowns or bridges. **Involves change in or restoration of excursive

mandibular guidance. Note, cannot involve change in vertical dimension.

**Single crowns as abutments for removable partial dentures.

**PFM crowns in upper anterior, any number of units.

Implants **All treatments involving new or existing

implants. Note: specific Advisor in each advising group must manage these treatments.

Esthetic cases, particularly in the upper anterior, and particularly

those that cross the mid-line **All in-house bleaching. Note: specific Advisor

in each advising group must manage these treatments.

**All-ceramic crowns, any number of units. **All veneers, ceramic or composite

Complete dentures **All types. Removable Partial dentures **All types. Periodontal conditions that complicate restorative treatment **Note: may require coordination of advising

group with a perio faculty member. Patients with Special Problems **Systemic disease (physical or mental) that

complicates treatment or increases risk of treatment failure.

*Note: Exceptions may occur and will be determined by the advising group and the Chair/Vice Chair(s) of the Department. A conservative approach (error on the side of closer student advisement is encouraged), particularly for less experienced students. Advising faculty may give more experience greater latitude in independently managing cases, depending on the student’s past performance, the patient’s needs, and the best judgment of the advising group.

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Appendix D- Treatment Planning Competency Evaluation Form (in progress 2009-0801)

Area Assessment Comments Collection of data is accurate and complete to arrive

at a diagnostic list and formulate a comprehensive plan of treatment -all patient queries made (eg chief complaint) -needed records obtained -complete histories obtained (including medical) -quality of records allow proper diagnosis -needed consults identified and obtained

0* 10 15 20 25

Synthesis of Information from all sources and all diagnoses considered in development of treatment plan -medical (health hx, consults) -behaviorial (limitations, coping ability) -esthetic (patient’s needs/desires) -radiographic -soft-tissue (periodontal and intraoral) -skeletal (as appropriate) -TMJ -occlusal (including parafunction)

0

10 15 20 25

Treatment options consider and account for the patient’s diagnoses, needs, and desires -medical -behavioral -functional -speech -nutrition -esthetics

0

10 15 20 25

Sequencing of treatment considers impact on the patient’s: -safety/well-being -achieving goals, satisfying patient concerns -stability of treatment -convenience -financial impact

0

10 15 20 25

Total Points

*Grading Criteria; 70 points or greater required to pass, with NO critical errors.

0 Lack of judgment that would result in failure of treatment or significant or irreversible harm to a patient; Critical error. 10 Gap in judgment which would hinder the successful treatment of patients condition or patient’s safety, but is correctible,

albeit at higher cost or time or discomfort. 15 Errors that cause increases costs, inconvenience, or time to the patient but do not compromise patient health or well

being. 20 Minor errors that do not compromise treatment or patient well being, but incur slightly longer treatment times or higher

costs. 25 No significant errors, patient-centered, comprehensive clinical judgments and insights.

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Appendix E- Informed Consent Competency Evaluation Form (in progress 2009-0801)

Area Assessment Comments Preparation for the case presentation

-all records needed are available -records are organized -records are professionally prepared and presented -demonstration aids are available as needed

0* 10 15 20 25

Presentation of the treatment options -organized -pace good and spoken clearly -consideration for patient’s level of intellect -student maintains professional appearance/demeanor -student shows respect and compassion for the patient’s view

0

10 15 20 25

Presentation of risk-benefits of treatment options -are discussed thoroughly and accurately -are balanced accurately based on evidence based knowledge -are presented without bias -address patient concerns and questions -leads to ability of patient to select a treatment option and sign consent form.

0

10 15 20 25

Student’s intellectual grasp/ability to answer questions -student comprehends the treatments and the issues -able to answer questions accurately, and without help -admits when does not know, seeks answers -answers are not defensive

0

10 15 20 25

Total Points

*Grading Criteria; 70 points required to pass, with NO critical errors.

0 Poor presentation that lacked balance, professional quality, organization, clarity, or contained biases that if uncorrected by faculty would lead patient to an uniformed or inappropriate treatment choice; Critical error.

10 Poor presentation of treatment options, leading to patient confusion and numerous questions; multiple attempts by student were necessary to clearly inform patient...

15 Presentation was fair, some patient questions required to clarify, or explanations were not efficient or organized or lacked needed records or aids--lead to some confusion of patient.

20 Good presentation, but minor errors that did not compromise the patient’s ability to choose, but made the choice less efficient or required additional questions and explanations.

25 No errors that compromised patient’s understanding or ability to make an informed choice about treatment..

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Appendix F- Form for evaluation of student by Faculty Advising Team (in progress 2009-0801)

Area Assessment Comments Preparation for Sessions

-on-time -comes with appropriate documents -organized -

1.5* 2.0 2.5 3.0 3.5 4.0

Ins Exp**

Level of Knowledge -knows relevant facts -looks up what s/he doesn’t know -recalls information required

1.5 2.0 2.5 3.0 3.5 4.0

Ins Exp

Synthesis/integration of information -able to apply principles -draws from all sources of information -considers alternatives -plans for contigencies -finds inconsistencies in data

1.5 2.0 2.5 3.0 3.5 4.0

Ins Exp

Interpersonal Behaviors -shows respect for Advisor -takes criticism well -shows respect for patient situation -respects instructor’s time -professional/ethical attitude

1.5 2.0 2.5 3.0 3.5 4.0

Ins Exp

Final Grade * Grades are UW SOD grading system scale ** Insufficient Experience during this interval

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Appendix G- Form for Faculty Advisor by Student (in progress 2009-0801)

Area Assessment Comments Availability

-

1* 2 3 4 5

Level of Expertise -knows relevant facts -refers if s/he does not know

1* 2 3 4 5

Quality of explanations -

1* 2 3 4 5

Interpersonal Behaviors -shows respect for student -respects questions/challenges -shows respect for patient situation -respects student’s time -professional/ethical attitude

1* 2 3 4 5

*1 = poor, 2 = fair, 3= satisfactory, 4 = good, 5 = outstanding

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Appendix H- Form for Treatment Outcomes Assessment (under development)

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