Competencies for the new practitioner
This document establishes the standards for new graduates of the UBC DMD program as they enter the dental profession. These competencies are intended to provide a framework for us to educate and train a biologically oriented, technically competent, socially sensitive practitioner of dental medicine who adheres to the highest standards of professional conduct and ethics, and who can function effectively as a member of the nation's health care delivery system. In order to meet that purpose, it is necessary to identify the knowledge and skills our graduates must possess to be able to promote the oral health of patients. These competencies identify and organize the knowledge and skills UBC graduates must acquire to become competent, curious, and caring dental practitioners who treat the whole patient.
The value and usefulness of these competencies are directly related to two applications. The first application is defining the core content of our pre-doctoral curriculum. By stating publicly what graduates must know and be able to do after completing our program, we establish a basis for the content of all courses. This definition sets standards for identifying relevant content and provides guidance in making decisions related to our pedagogy and course sequencing. The degree to which our pre-doctoral curriculum is relevant, complete, educationally sound, and well organized will be a direct reflection of this document.
A second application is related to the issue of outcomes assessment. The quality of any curriculum must be judged by its results. UBC has established the individual competencies which a student must demonstrate to qualify for graduation and entry into the profession. For these educational standards to be of real value, the Faculty must have methods in place to measure the degree to which a student has acquired and can demonstrate the competencies needed to care for patients.
Competencies for the New Practitioner should be viewed as dynamic standards which must be responsive to any clear need for change. The competencies are intended to serve as the "blueprint" for our pre-doctoral curriculum. It is recognized and understood that this education plan will require regular review in the interest of continual improvement.
Competency as an Educational Concept
The term “competent” is defined by Chambers as "the behavior expected of the beginning practitioner. This behavior incorporates understanding, skill, and values in an integrated response to the full range of requirements presented in practice". There is a level of skill beyond competency known as proficiency which is acquired through advanced training, leading to specialization. Competencies are:
- a typical part of the general practice of dentistry.
- a combination of knowledge, attitude, and skills.
- performed in a clinical context.
- the continued performance at or above the defined standard of care.
Development of the Competencies
Competencies, as defined above, are acquired in a clinical setting or in the context of patient care. A competency is the demonstrated ability to perform a clinical task or to explain and discuss a clinical concept. Because competencies are outcomes of clinical training and experience clinicians, therefore, had the greatest responsibility in identifying the initial list of essential competencies.
Preamble to the ACFD “COMPETENCIES FOR A BEGINNING DENTAL PRACTITIONER IN CANADA” document (2005)
A competent beginning dental practitioner in Canada must be able to provide oral health care for the benefit of individual patients and communities in a culturally sensitive manner.
Competency assumes that all behaviours are supported by foundation knowledge and skills in biomedical, behavioural and clinical dental science and by professional behaviour. Beginning dental practitioners in Canada must be able to apply foundation knowledge and skills to justify their decisions and actions and to evaluate outcomes. Therefore, foundation knowledge, skills and professional behaviour are understood to be a part of every competency.
Competency also assumes that all behaviours are performed to an acceptable level and that the practitioner can evaluate their quality and effectiveness. Competency cannot be achieved without the ability to self-evaluate. Moreover, there are no degrees of competence: a dentist is either competent or not competent. The competencies below refer to general dental practice and include the management of patients of all ages including those with special needs. It is assumed that all oral health care is provided in an ethical manner, in accordance with legal requirements at the national and provincial level.
The general organization of this document (and ultimately our curriculum) is structured from the general to the more specific. Six "Domains" have been identified. These represent broad categories of professional activity and responsibilities which occur in the general practice of dentistry. The concept of Domains is intended to encourage an eventual structure and process in the pre-doctoral curriculum that is more interdisciplinary and not departmental. In this document, the Domains are indicated I-VI (see detail following Organization section).
Within each Domain, each Competency Statement is identified as relating to that Domain's activity or concern. Competence is the ability to perform or provide a particular, but complex, service or task. For example, "The new dentist must be able to perform an examination that collects biological, psychological, and social information needed to evaluate the medical and oral condition, for patients of all ages." The complexity of this service suggests that multiple and more specific abilities are required to support the performance of any Competency.
The competency statements in this document come directly from the document entitled “ACFD Competencies For A Beginning Dental Practitioner In Canada”, approved in 2005. These statements of competency are also used by the Commission on Dental Accreditation of Canada and the National Dental Examining Board of Canada.
A note about the word “manage” in Competency Statements: Managing the oral health care needs of a patient may include providing education, advice, treatment by the dentist, treatment by the dentist after consultation with another health care professional, or referral of a patient to another health care professional, monitoring treatment provided, and also may include providing no treatment or observation. “Manage” assumes the use of the least invasive therapy necessary to gain a successful outcome in accordance with patient wishes.
Foundational ability consists of knowledge, skills, and attitudes that are prerequisite for satisfactory attainment of Competencies. Foundational knowledge is the ability to acquire and use information and correctly answer specific questions when asked, for example, in a tutorial or in an examination. Foundational skill is the ability to produce acceptable results in standardized situations, for example, creating a satisfactory full crown preparation on an artificial tooth. Foundational attitudes are positive intellectual and behavioral actions, such as scheduling appointments in the patient's best interest and not at the student's convenience.
The basic medical and dental sciences, behavioral sciences, and clinical sciences all provide instruction at the foundational level. Lecture, small group, seminar, and laboratory instruction provide information and psychomotor experiences that enable students to acquire and demonstrate competence in the clinical setting or context. The inclusion of any specific foundational ability in the curriculum should be based on the direct support of one or more of the Competencies. These "Foundational Abilities" are defined by Objectives.
THE DOMAINS AND RELATED COMPETENCIES
The competent new practitioner provides skilled care based on contemporary knowledge and therapeutics and is capable of discerning and managing ethical issues and problems in dental practice. The dental profession holds the benefit of the patient as its primary goal (CDA Code of Ethics). The practice of dentistry occurs in a rapidly changing environment where benefits to the patient are influenced by ethical issues and problems created by regulatory actions, economics, social policy, cultural diversity and gender, and health care reform.
New practitioners should participate in professional and personal development activities that enhance their contribution to their communities and equip them with the knowledge and skills to provide the highest standards of dental practice. These activities should provide a thorough knowledge of community resources and expectations that will bear upon their practice of dentistry, either in private practice or in a public dental program.
The general practice of dentistry includes regular involvement with large and diverse amounts of information. Patient care, office management, and professional renewal are all highly dependent upon the capacity to obtain and process information, and the ability to make decisions or take action. The competent practitioner must be prepared to practice in this dynamic environment.
Related ACFD Competency Statements
3. evaluate the scientific literature and justify management recommendations based on the level of evidence available.
4. communicate effectively with patients, parents or guardians, staff, peers, other health professionals and the public.
45. apply accepted principles of ethics and jurisprudence to maintain standards and advance knowledge and skills.
47. demonstrate professional behaviour that is ethical, supersedes self-interest, strives for excellence, is committed to continued professional development and is accountable to individual patients, society and the profession.
II. PRACTICE ORGANIZATION
The principal goal of the pre-doctoral program is to produce graduates who will function as general practitioners in the general practice of dentistry. In addition to clinical knowledge and skills, the general dental practitioner is also required to manage a sound business operation which facilitates the delivery of quality oral health care to patients. In order to manage a general practice, the dental graduate must be able to establish a professional practice by developing practice goals and plans; implement effective office systems; make sound business decisions; manage the business aspects of practice; evaluate outcomes; manage personnel; manage patient care; and understand the legal ramifications of patient care.
Related ACFD Competency Statements
27. recognize and institute procedures to minimize occupational hazards related to the practice of dentistry.
46. apply basic principles of practice administration, financial and personnel management to a dental practice.
OF THE PATIENT AND THE ORAL ENVIRONMENT
Patients seek the care of a dentist to maintain a level of oral health which is comfortable, functional and esthetically acceptable to the patient, as well as for treatment of oral disease. In order to confirm or establish, and then maintain, the oral health of their patients, the general dentist must first be competent to evaluate the patient, diagnose existing conditions, and develop a treatment plan. Assessment must precede any treatment and enables the general dentist to provide appropriate primary oral health care.
Related ACFD Competency Statements
5. identify the patient’s chief complaint/concern and obtain the associated history.
6. obtain and interpret a medical, dental and psychosocial history, including a review of systems as necessary, and evaluate physical or psychosocial conditions that may affect dental management.
7. maintain accurate and complete patient records in a confidential manner.
8. prevent the transmission of infectious diseases by following current infection control guidelines.
9. perform a clinical examination.
10. differentiate between normal and abnormal hard and soft tissues of the maxillofacial complex.
11. prescribe and obtain the required diagnostic tests, considering their risks and benefits.
12. perform a radiographic examination.
13. interpret the findings from a patient's history, clinical examination, radiographic examination and from other diagnostic tests and procedures.
14. recognize and manage the anxious or fearful dental patient.
15. recognize signs of abuse and/or neglect and make appropriate reports.
16. assess patient risk (including, but not limited to, diet and tobacco use) for oral disease or injuries.
17. develop a problem list and establish diagnoses.
18. determine the level of expertise required for treatment and formulate a written request for consultation and/or referral when appropriate.
19. develop treatment options based on the evaluation of all relevant data.
20. discuss the findings, diagnoses, etiology, risks, benefits and prognoses of the treatment options, with a view to patient participation in oral health management.
21. develop an appropriate comprehensive, prioritized and sequenced treatment plan.
22. present and discuss the sequence of treatment, estimated fees, payment arrangements, time requirements and the patient’s responsibilities for treatment.
23. obtain informed consent including the patient’s written acceptance of the treatment plan and any modifications.
24. modify the treatment plan as required during the course of treatment.
IV. HEALTH PROMOTION
The dental profession serves the community in both private and public practice settings. Public health is concerned with promoting health and preventing disease through organized community efforts, as well as education of individuals and family groups. These are important components of any interdisciplinary approach. Whether acting as the community advocate or serving as a resource or change agent, the dental professional should be competent to interact with others to promote activities that protect, restore and improve oral health and the quality of life.
Related ACFD Competency Statements
1. recognize the determinants of oral health in individuals and populations and the role of dentists in health promotion, including the disadvantaged.
25. provide education regarding the risks and prevention of oral disease and injury to encourage the adoption of healthy behaviors.
AND MAINTENANCE OF A HEALTHY ORAL ENVIRONMENT
Treatment is based on patient assessment. Thus, where oral conditions are healthy and stable, the goals are disease prevention and health maintenance. Active oral disease requires management of risk factors and control of the disease processes. In order to maintain or establish a healthy oral environment, the general dentist must be competent in the provision of preventive, therapeutic and continued oral health care.
Related ACFD Competency Statements
2. recognize the relationship between general health and oral health.
26. provide therapies for the prevention of oral disease and injury.
28. achieve local anesthesia for dental procedures and manage related complications.
29. determine the indications and contraindications for the use of drugs used in dental practice, their dosages and routes of administration and write prescriptions for drugs used in dentistry.
30. manage dental emergencies.
31. recognize and manage systemic emergencies which may occur in dental practice.
32. manage conditions and diseases of the periodontium, provide periodontal treatment when indicated and monitor treatment outcomes.
33. assess the risk, extent and activity of caries and recommend appropriate non-surgical and surgical therapy.
35. manage patients with orofacial pain and/or dysfunction.
36. manage surgical procedures related to oral soft and hard tissues and their complications
37. manage trauma to the orofacial complex.
38. manage conditions and pathology of the pulp and provide endodontic treatment when indicated.
39. manage abnormalities of orofacial growth and development and treat minor orthodontic problems.
OF FORM, FUNCTION AND ESTHETICS
A desirable dentition is comfortable and effective in function, and socially pleasing in appearance. Dental disease, congenital deformity, pathosis or traumatic incidents may compromise any or all of these qualities to varying degrees. In order to rehabilitate a compromised dentition, the new dentist must be competent to provide treatment which restores form, function, and esthetics of defective and/or missing teeth for patients of all ages.
Related ACFD Competency Statements
34. manage dental caries, tooth defects and esthetic problems and, when restoration is warranted, use techniques that conserve tooth structure and preserve pulp vitality to restore form and function.
40. recognize and manage functional and non-functional occlusion.
41. select and, where indicated, prescribe appropriate biomaterials for patient treatment.
42. manage partially and completely edentulous patients with prosthodontic needs including the provision of fixed, removable and implant prostheses.
43. make records required for use in the laboratory fabrication of dental prostheses and appliances.
44. design a dental prosthesis or appliance, write a laboratory prescription and evaluate laboratory products.