ENDODONTICS SAUDI BOARD PROGRAM SAUDI BOARD FINAL CLINICAL EXAMINATION OF ENDODONTICS (2018)

Transcription

1 ENDODONTICS SAUDI BOARD PROGRAM SAUDI BOARD FINAL CLINICAL EXAMINATION OF ENDODONTICS (2018)

2 I Objectives a. Determine the ability of the candidate to practice as a specialist and provide consultation in the general domain of his/her specialty for other health care professionals or other bodies that may seek assistance and advice. b. Ensure that the candidate has the necessary clinical competencies relevant to his/her specialty including but not limited to history taking, physical examination, documentation, procedural skills, communication skills, bioethics, diagnosis, management, investigation and data interpretation. c. All competencies contained within the specialty core curriculum are subject to be included in the examination. II General Rules a. Saudi board final specialty clinical examination will be held once per year within 2-8 weeks after Final written examination. b. Specialty clinical examinations shall be held on the same day and time in all centers, however if consecutive sessions are used, suitable quarantine arrangements must be in place. c. If examination is conducted on different days, more than one exam version must be used. IV Exam Format a. The Endodontic final clinical examination shall consist of 8 graded stations each with 15 minute encounters. b. The 8 stations consist of 4 Objective Structured Clinical Exam (OSCE) stations with 1 examiner each and 4 Structured Oral Exam (SOE) stations with 2 examiners each. c. All stations shall be designed to assess integrated clinical encounters. d. SOE stations are designed with preset questions and ideal answers. e. Each OSCE station is assessed with a predetermined performance checklist. A scoring rubric for postencounter questions is also set in advance.

3 V Final Clinical Exam Blueprint* DIMENSIONS OF CARE Endodontic Surgery 1±1 Station(s) Trauma 1±1 Station(s) Pain and emergency treatments 1±1 Station(s) Diagnosis 1±2 Station(s) # Stations DOMAINS FOR INTEGRATED CLINICAL ENCOUNTER Patient Care 3±1 Station(s) Patient Safety & Procedural Skills 1±1 Station(s) Communication & Interpersonal Skills 2±1 Station(s) Professional Behaviors 1±1 Station(s) 1 1 3± ± Total Stations ±1

4 VI Definitions Dimensions of Care Pain and emergency treatments Trauma Medically compromised or surgery Diagnosis Focus of care for the patient The process of enabling people to increase control over their pain & its determinants, thereby improve their health. Emergency treatments covers measures not only to prevent the occurrence of illness such as risk factor reduction but also arrest its progress & reduce its consequences once established. This includes but is not limited to screening, periodic health exam, health maintenance, diagnosis and treatments, and management. Episode trauma, within the time span defined by initial presentation through to transition of care. This dimension includes but is not limited to urgent, emergent, & life-threatening conditions, management of complications. Illness of long duration that includes but is not limited to illnesses with slow / fast progression, failure RCT which can be treated only by surgery, management of surgery Presentations rooted in the social & psychological determinants and management of the Problems of health that include but are not limited to the treatments challenges, difficulty, management, & the impact of the patient`s health. Domains Patient Care Patient Safety & Procedural Skills Communication & Interpersonal Skills Professional Behaviors Reflects the scope of practice & behaviors of a practicing clinician Exploration of illness & disease through gathering, interpreting & synthesizing relevant information that includes but is not limited to history taking, physical examination & investigation. Management is a process that includes but is not limited to generating, planning, organizing care in collaboration with patients & health care professionals (e.g. finding common ground, agreeing on problems & goals of care, time & resource management, roles to arrive at mutual decisions for treatment) Patient safety emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. Procedural skills encompass the areas of clinical care that require physical and practical skills of the clinician integrated with other clinical competencies in order to accomplish a specific and well characterized technical task or procedure. Interactions with patients, families, caregivers, other professionals, communities, & populations. Elements include but are not limited to active listening, relationship development, education, verbal, non-verbal & written communication (e.g. patient centered interview, disclosure of error, informed consent). Attitudes, knowledge, and skills based on clinical &/or medical administrative competence, ethics, societal, & legal duties resulting in the wise application of behaviors that demonstrate a commitment to excellence, respect, integrity, accountability & altruism (e.g. self-awareness, reflection, life-long learning, scholarly habits, & physician health for sustainable practice).

5 VII Passing Score a. The pass/fail cut off for each OSCE/SOE station is determined by the exam committee prior to conducting the exam using a Minimum Performance Level (MPL) Scoring System. b. Each station shall be assigned a MPL based on the expected performance of a minimally competent candidate. The specialty exam committee shall approve station MPLs. c. At least one examiner marks each OSCE station and two examiners independently mark each part of the SOE. d. To pass the examination, a candidate must attain a score > MPL in at least 70% of the number of stations and 60% in each component (OSCE and SOE). VIII Score Report a. All score reports shall be issued by the SCFHS after approval of the Specialty Examination Committee. IX Exemptions a. SCFHS at present has no reciprocal arrangement with respect to this examination or qualification by any other college or board, in any specialty.

6 X OSCE Station Sample** Endodontic Clinical Exam Station 1 Instructions to Resident Scene: Emergency Room You are called to see a patient named; Ali Saeed, a 19-year-old male who presented with pain and bleeding from the upper anterior area and the tooth was in his hand. YOU HAVE 15 MINUTES TO INTERVIEW THE PATIANT AND DO THE FOLLOWING: 1. How do you take the history of dental traumatic injury in general? 2. What are the types of radiographs you will request for this case? 3. Based on the image shown which teeth were involved? Mention the type of injury? 4. What should your clinical examination be in the case? 5. Pulpal responses to traumatic injuries are affected by the degree of injury to the neurovascular supply. What is the possible outcome of the pulp? 6. Tooth #11 was diagnosed with necrotic pulp and acute apical abscess and tooth #21 was necrotic pulp with symptomatic apical periodontits. What are the treatment modalities of managing immature tooth (#11)? 7. Tooth # 11 is intruded, how do you bring it back to the previous position?

7 Performance Evaluation: Station 1 ENDODONTIC SAUDIBOARD PROGRAM - MANAGEMENT OF TRAUMA Question/Ideal Answers 1. How do you take the history of dental traumatic injury in general? The following questions are intended to elicit essential information about the traumatic event. When did the injury occur? Time factors are important especially in avulsion and displacement injuries. Also, treatment delay may signal possible child abuse, if the patient is a minor. Where did the injury occur? For legal and insurance purposes, this information is important to be recorded in the patient file. How did the injury occur? Answers to this question may guide evaluation of the extent of trauma, for example, a blow to the chin may transmit to the condyles. Has the patient been unconscious? If so, medical attention must be sought, but that does not preclude urgent immediate dental care such as replantation of an avulsed tooth. Are there previous injuries to the teeth? Some children are accident prone, and participants in various sports will frequently show radiographic indication of previous trauma. Such information can affect treatment options. Is there a change in the bite? Changes in occlusion following an injury would indicate possible tooth luxation, alveolar/jaw fracture, or condylar fracture. 2. What are the types of radiographs you will request for this case? Is there increased sensitivity to temperature changes? This is typically observed in teeth with crown fractures exposing the dentin. It is recommended that 1. One steep occlusal exposure along. 2. Three periapical bisecting angle exposures in different angle. 3. One radiograph to examine the presence of impacted foreign bodies in penetrating soft tissue wounds. 4. CBCT 3. Based on the image shown which teeth were involved? Mention the type of injury Tooth #11: Intrusive luxation with uncomplicated crown fractures. Tooth #21: Uncomplicated crown fractures. 4. What should your clinical examination be in the case? Begin with evaluation of any soft tissue wounds, including examination for the presence of impacted foreign bodies. Teeth are examined for fractures or infractions, if the pulps are exposed and the extent. Any displacement of teeth must be noted. Mobility test. Percussion test Pulpal sensibility test. 5. Pulpal responses to traumatic injuries are affected by the degree of injury to the neurovascular supply. What is the possible outcome of the pulp? Three possible outcomes exist: a) Pulpal healing. b) Pulpal necrosis. c) Pulp canal obliteration. 6- Tooth #11 was diagnosed with necrotic pulp and acute apical abscess and tooth #21 was necrotic pulp with symptomatic apical periodontits. What are the treatment modalities of managing immature tooth (#11)? a. Obturation of the tooth. b. Surgical intervention. c. Apexification. d. Artificial barrier. e. Revascularization 7- Tooth # 11 is intruded, how do you bring it back to the previous position? Orthodontic intervention, due to the time of trauma (before 3 months) and pulp necrosis of the tooth. Total 0 Mark /20 /15 /20 /15

8 Questioning Skills (ONE choice only) Awkward, exclusive use of closed-ended or leading questions and jargon Somewhat awkward; inappropriate terms; minimal use of open-ended questions Borderline unsatisfactory; moderately at ease; appropriate language; uses different types of questions Borderline satisfactory; moderately at ease; appropriate language; uses different types of questions At ease; clear questions; appropriate use of open and closed-ended questions Confident; skillful questioning Professional Behavior with Patient (ONE choice only) Offensive or aggressive; frank exhibition of unprofessional conduct Negative attitude toward patient Borderline unsatisfactory; does not truly instill confidence Borderline satisfactory; manner inoffensive, but does not necessarily instill confidence Attempts professional manner with some success Overall demeanor of a professional; caring, listens, communicates effectively Overall Organization of Patient Encounter (ONE choice only) No logical flow; scattered, inattentive to patient's agenda Counsels patient before taking history or doing physical Minimal organization; scattered approach Appropriate approach to patient Skillful approach to patient Skillful, professional approach to patient and effective use of time Facilitation of Informed Decision Making (ONE choice only) No attempt or inappropriate attempt at information sharing (e.g., deception, slanting of facts, incorrect information) Incomplete and / or biased information; overuses jargon; does not ensure understanding of issues Attempts to share information; omits some critical facts; uses some jargon; attempts to ensure understanding Gives some information on most important facts; may use jargon; attempts to ensure understanding Gives clear information; supports patient decision making (e.g., alternatives, risks / benefits); appropriate language; ensures understanding Organized; optimizes patient decision making; significant effort to make information relevant; clear language; attentive to patient understanding

9 XI SOE Station Sample** Instructions to candidate: STATION 2 A 20 year old man is referred to the endodontic clinic for evaluation of chronic right extra-oral swelling, Patient under many medications. Patient Care/Treatment Planning 1. What are the required examination tools would you perform in the first visit? Endo-Ice test, percussion test, palpation test, periodontal probing and mobility Mark 2. What is the pulpal diagnosis in the first visit? Asymptomatic irreversible pulpitis 3. What is the pulpal and periapical diagnosis in the second case? Previously initiated therapy and acute apical abscess 4. List 2 possible mechanisms for the Flare-up? a. Apical extrusion of debris and microorganism b. Change in the microbiota or environmental conditions 5. What is the emergency treatment plan? c. drainage establishment, d. relief of occlusion, e. intracanal medication f. systemic medication. 6. If you planning to prescribe antibiotic, what are the microorganisms that might be present in the first and second case? In the first case gram negative anaerobes and gram positive anaerobes in the second case. 7. Describe in 4 steps your management for in the ER visit (the second visit)? a. Good patient commination and reassurance b. Establish drainage through the tooth by passing size 25 file through apical foramen c. Complete cleaning and shaping d. Ca(OH)2 intracanal medication followed by temporary filling 8. During treatment in the emergency visit, the patient loses consciousness. Mention tow possible causes? Syncope, MI, Stroke, hyperglycemic coma, 9. What is the definite treatment plan for this tooth? NSRCTX 10. What is the prognosis of this case? Favorable Total marks: 0 /16 /16 /8 /5 /5

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