MASSACHUSETTS GENERAL HOSPITAL GENERAL PRACTICE RESIDENCY IN DENTISTRY

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1 MASSACHUSETTS GENERAL HOSPITAL GENERAL PRACTICE RESIDENCY IN DENTISTRY OVERVIEW The Massachusetts General Hospital General Practice Residency is a one-year program accredited by the Commission on Dental Accreditation with a status of approval without reporting requirements. It is structured to provide experience in all phases of ambulatory and inpatient dental care. To provide a broad educational experience, the training program combines the resources of several Harvard-affiliated institutions: Massachusetts General Hospital, Brigham and Women s Hospital (BWH), and BWH Faulkner Hospital. In addition, residents have required rotations in oral and maxillofacial surgery, anesthesiology, and internal medicine. Lectures, literature reviews, and case presentations are scheduled throughout the year. Our goal is to create an environment for learning that will enable each resident to develop not only clinical dental skills, but also the intellectual skills needed to face the challenges of the future. GOALS AND OBJECTI VES The program will prepare graduates to be able to: 1. Act as the primary care provider by providing training experiences which refine and advance their knowledge and skills in clinical dentistry, with emphasis on diagnosis, treatment planning and comprehensive dental care. 2. Treat a broad range of patients by providing training experiences which refine their skills in the management of medically-compromised patients, including physical evaluation, risk assessment and understanding of how various medical disorders affect dental treatment planning and care. 3. Function effectively in a hospital setting by providing training experiences in hospital protocol, management of patients in the hospital setting, inpatient rounds and interaction with other hospital professionals. 4. Manage dental day surgery patients in the operating room. 5. Manage a broad range of acute dental problems. 6. Manage oral pathologic conditions including those associated with cancer therapy. 7. Apply scientific principles to learning and health care by providing residents with experiences which refine and advance their skills in critical review of dental literature. 8. Understand the dental professional s role in community service by providing a variety of experiences on and off the hospital campus. SPECIFIC COMPETENCIES PATIENT MANAGEMENT 1. Function as a patient's primary and comprehensive oral health care provider. 2. Explain and discuss with patients, parents or guardians of patients, findings, diagnoses, treatment options, realistic treatment expectations, patient responsibilities, time requirements, sequence of treatment,

2 estimated fees and payment responsibilities in order to establish a therapeutic alliance between the patient and care provider. 3. Treat patients efficiently in a dental practice setting. 4. Act in a manner to maximize patient satisfaction in a dental practice. 5. Provide dental care as a part of a multidisciplinary health care team such as that found in a hospital, institution, or community health care environment. 6. Practice and promote ethical principles in the practice of dentistry and in relationships with patients, personnel, and colleagues. 7. Integrate multiple disciplines into an individualized, comprehensive, sequenced treatment plan using diagnostic and prognostic information for patients with complex needs. 8. Modify the treatment plan, if indicated, based on unexpected circumstances or patient's individual needs. 9. Perform a limited history and physical evaluation and collect other data in order to establish a risk assessment for dental treatment and use that risk assessment in the development of a dental treatment plan. 10. Use accepted prevention strategies such as oral hygiene instruction, nutritional education, and pharmacologic intervention to help patients maintain and improve their oral and systemic health. 11. Treat patients with a broad variety of acute and chronic systemic disorders and social difficulties including patients with special needs. 12. Develop and carry out dental treatment plans for patients with special needs in a manner that considers and integrates those patients medical, psychological, and social needs. PRACTICE MANAGEMENT 13. Use scheduling systems and insurance and financial arrangements to maximize production in dental practice. 14. Use and implement accepted sterilization, disinfection, universal precautions and occupational hazard prevention procedures in the practice of dentistry. 15. Provide patient care by working effectively with allied dental personnel, including performing sit down, four-handed dentistry. 16. Participate in organized dentistry. 17. Evaluate scientific literature and other sources of information to determine the safety and effectiveness of medications and diagnostic, preventive, and treatment modalities, and to make appropriate decisions regarding the use of new and existing medications, procedures, materials, and concepts. 18. Demonstrate the application of the principles of ethical reasoning, ethical decision making and professional responsibility as they pertain to patient care, practice management, academic environment, and research. 19. Maintain a patient record system that facilitates the retrieval and analysis of the process and outcomes of patient treatment.

3 20. Understand the role of a dentist in community service as a health care provider and educator. HOSPITAL DENTISTRY 21. Use proper hospital protocol when treating and managing patients in a hospital environment. 22. Provide dental treatment in an operating room 23. Provide comprehensive management and care for individual inpatients or same day surgery patients from the beginning to the end of a patient s hospital experience. 24. Perform dental consultations and request medical consultations. 25. Select and use assessment techniques to arrive at a differential, provisional and definitive diagnosis for patients with complex needs. 26. Use the services of clinical, medical, and pathology laboratories or refer to other health professionals for the utilization of these services. EMERGENCIES 27. Manage intraoral soft tissue lesions of non-traumatic origin. 28. Treat patients with intra-oral dental emergencies and infections. 29. Anticipate, diagnose and provide initial treatment and follow-up management for medical emergencies that may occur during dental treatment. 30. Treat intraoral hard and soft tissue lesions of traumatic origin. 31. Perform initial treatment and management of facial trauma. PHARMACOLOGY/ANESTHESIA 32. Use pharmacologic agents in the treatment of dental patients. 33. Provide control of pain and anxiety in the conscious patient using techniques involving psychological interventions, behavior management, local anesthesia, oral sedation or nitrous oxide. 34. Prevent, recognize, and manage complications related to the use or interaction of drugs, local anesthesia, or conscious sedation. 35. Monitor and manage the airway of a semi- or fully unconscious patient. ORAL SURGERY/ORAL PATHOLOGY 36. Diagnose and manage common oral pathological abnormalities. 37. Diagnose and manage oral manifestations of systemic disease. 38. Perform surgical and nonsurgical extraction of teeth.

4 39. Recognize uncomplicated temporomandibular disorders and orofacial pain, making a differential diagnosis, and managing treatment. CLINICAL DENTISTRY RESTORATIVE 40. Restore single teeth with a wide range of materials and methods. 41. Place restorations and perform techniques to enhance patient's facial esthetics. 42. Restore endodontically treated teeth. 43. Diagnose and manage a patient's occlusion. CLINICAL DENTISTRY PROSTHODONTICS 44. Treat patients with missing teeth requiring removable restorations. 45. Treat patients with missing teeth requiring uncomplicated fixed restorations. CLINICAL DENTISTRY PERIODONTICS 46. Diagnose and treat periodontal disease using surgical or nonsurgical procedures. 47. Manage periodontal disease in medically complex patients. CLINICAL DENTISTRY ENDODONTICS 48. Diagnose and treat pain of pulpal origin. 49. Perform uncomplicated non-surgical anterior endodontic therapy. 50. Perform uncomplicated non-surgical posterior endodontic therapy. 51. Treat uncomplicated endodontic complications. QUALITY IMPROVEMENT 52. Understand the purpose, design, and implementation of quality improvement plans. 53. Participate in a quality improvement plan. SUPERVISION AND EVALUATION All resident activity is supervised by attending staff either directly with the attending physically present with the resident and patient or indirectly with the attending in the same clinic or hospital, available immediately to supervise directly. Evaluation of residents occurs after each rotation. In addition, the director of the program holds formal

5 evaluation sessions with each resident four times per year. Residents provide formal evaluations of the staff and program at the end of the year. Based on resident feedback, the program will implement improvements and changes as needed. DESCRIPTION OF ROTATIONS MASSACHUSETTS GENERAL HOSPITAL COMPREHENSIVE DENTAL CARE The Massachusetts General Hospital was founded in 1811 and is renowned for the care it provides to patients from around the world. The hospital has over 900 beds and offers postdoctoral training programs in most medical and surgical specialties and subspecialties. The Massachusetts General Hospital Division of Dentistry is part of the Department of Oral and Maxillofacial Surgery. Dental residents rotate through the two practices of the Division of Dentistry - one in Boston on the main hospital campus (link to ) and one in Danvers, (link to which is a suburb 19 miles north of Boston. For this reason, access to a car is advised for residents. The Boston office is an 11-chair facility with digital radiographs and electronic medical records. Specialists are available in endodontics, periodontics, prosthodontics, pedodontics, orthodontics, facial pain, and oral and maxillofacial surgery. Dental residents spend most of the day for six months treating regularly scheduled outpatients for comprehensive care, and the rest of the day seeing inpatients on consultation. These consultations may be requested by a wide variety of hospital services, including cardiac surgery, hematology/oncology, and neurology. In addition, residents manage adult and pediatric dental rehabilitation cases in the operating room under direct supervision of an attending dentist. The Danvers dental office is a 10-chair facility located in an MGH satellite facility that also houses primary care medicine, pediatric surgery, cardiology, radiation oncology, urology, and obstetrics/gynecology. The dental practice utilizes electronic medical records and digital radiographs, including CBCT. Specialists are available in periodontics, endodontics, pedodontics, orthodontics, facial pain, and oral and maxillofacial surgery. In addition, adult and pediatric dental rehabilitation is performed on a day surgery basis. In this community setting, residents will spend most of their time, two days each week for five months, providing comprehensive dental care for regularly scheduled outpatients. Residents are expected to: Gain experience in four-handed dentistry Learn the daily operations of a dental practice Gain experience in advanced general dentistry Learn the financial management aspect of patient care Gain expertise in oral diagnosis, oral pathology, and the management of medically-compromised patients Develop skills in communicating with physicians and other health care professionals Become skillful in writing consultation notes and presenting clinical patients for discussion Gain experience in OR dentistry, including review of history, prescribing and performing treatment, and documentation.

6 ORAL AND MAXILLOFACIAL SURGERY The MGH Oral and Maxillofacial Surgery Department (link to ) has a combined six-year OMFS/MD program and very active outpatient and inpatient services. The oral surgery clinic is an 11-chair facility including 2 IV sedation rooms. The scope of patient care is very broad, including odontectomy, implant placement, biopsy and management of tumors, orthognathic surgery, and oral and maxillofacial reconstruction. There are resident-run outpatient clinics every day, attending private patient clinics and IV sedation clinics. Patients who are referred by or seen in the ED present with a wide range of problems, from odontogenic infection to facial trauma. OR cases, whether private or house cases are attended by OMFS residents and faculty, as well as GPR residents. GPR residents spend the greater part of two months on the oral surgery service as an active member of the surgical team. To gain experience in the oral and systemic evaluation and management of the routine and medically compromised surgery patient To gain experience and develop confidence in simple and surgical exodontia To learn operating room protocol To gain experience in the management of intraoral infections, post operative complications, and other oral surgical emergencies BRIGHAM AND WOMEN S HOSPITAL ORAL MEDICINE The Brigham and Women's Hospital is one of the largest tertiary care hospitals in New England offers training programs in nearly all medical and surgical specialties and subspecialties. The Division of Oral Medicine and Dentistry (link to ) is a regional center for oral medicine and mucosal diseases. The rotation on this service is part time over the course of a month and emphasizes oral medicine and oral pathology. Residents will learn: To evaluate, diagnose, and manage oral mucosal diseases, atypical facial pain, and malignancy To diagnose and treat oral manifestations of systemic disease and oral complications of cancer therapy ANESTHESIA Residents are assigned to the Department of Anesthesia of the Brigham and Women's Hospital for two weeks. Residents receive instruction on the principles and techniques of general anesthesia from a pharmacological, theoretical and practical standpoint.

7 To become knowledgeable in the preoperative evaluation of the general anesthesia patient To gain exposure to venipuncture To gain exposure to intubation of an unconscious patient To become knowledgeable in airway management and monitoring the unconscious patient To become knowledgeable in the prevention of anesthetic emergencies To assist in the supervising of patient recovery from anesthesia To become knowledgeable in the use and effects of pharmacological agents INTERNAL MEDICINE The Internal Medicine Rotation is a required two-week rotation on the inpatient Medicine service at the Brigham and Women s Faulkner Hospital in Jamaica Plain. There is a shuttle bus that runs between Brigham and Women s Hospital and Brigham and Women s Faulkner Hospital. Dental residents participate as members of the medical team in the clinical management of patients under the supervision of medical residents and attending physicians. Dental residents also attend all teaching sessions, inpatient rounds, and conferences. To gain experience in history taking, physical diagnosis, and appropriate laboratory testing To learn to assess medical problems requiring an inpatient admission To learn risk assessment and medical management of systemic illness HEAD AND NECK CANCER Residents participate part time for a month on the Head and Neck Oncology team of the Massachusetts General Hospital, which consists of an ENT specialist, a medical oncologist, and a radiation oncologist. The team sees newly diagnosed patients, follow up patients and patients actively undergoing cancer treatment. To learn the multi-disciplinary nature of head and neck cancer management To learn the basic approach to medical workup, diagnosis, staging, and treatment planning of head and neck cancer To gain exposure to the medical and oral complications of head and neck cancer therapy and their management To learn to be part of the multi-disciplinary team in evaluating patients, educating patients on the oral complications of head and neck cancer therapy, and advising patients on dental management pre- and post- therapy and during therapy.

8 FACIAL PAIN ROTATION Residents will work with attending staff in the MGH Facial Pain Clinic one afternoon a week for several weeks. The vast array of patients includes those with TMD, MPDS, OSA, atypical facial pain, trigeminal neuralgia, and burning mouth syndrome. Residents will work up and assist in the care of patients. To learn the work up, diagnosis, and treatment of various facial pain entities, including the distinction between TMD vs. neuropathic pain, and the distinction between the TMD pathologies of MPDS vs. arthralgia To learn the medical and psychological disorders that may complicate diagnosis or be a concomitant diagnosis To learn how ancillary services may be helpful in treatment, such as physical therapy and mindbody medicine To learn when to refer to or work with other specialties such as neurology, psychiatry, sleep medicine, and pain medicine To gain exposure to the outcomes of treatment, possible complications of treatment and management of those complications ELECTIVE If scheduling allows, a short elective rotation directed by resident professional interest may be arranged. Examples of elective rotations include shadowing dental specialists, working with oral public health organizations, and shadowing other medical professionals such as ENT surgeons, radiation oncologists, and speech pathologists. EMERGENCY ON-CALL Dental residents are on-call for emergencies for patients of record at the MGH Division of Dentistry s two practices. Emergency calls are taken from home and therefore, it is recommended that residents live within a 30-minute commute to the MGH. There is always an assigned attending on back up call in the event that residents need consultation. Emergency call coverage by dental residents for the MGH Division of Dentistry is every other week throughout the entire year. In addition, general practice residents will assist oral surgery residents on emergency call during the dental resident s 2-month oral surgery rotation. The emergency call duty is in-house and not taken from home. There are call rooms available for resident use in the hospital. The range of experience will include odontogenic infection, facial infection, and facial trauma. To learn emergency diagnosis and management of acute dental problems To learn emergency workup, diagnosis, and management of facial infection and trauma

9 RESOURCES AND BENEFITS 1. Full house-staff privileges at the Massachusetts General Hospital 2. Housing search and financial assistance 3. Access to Harvard University academic and athletic facilities, including Countway Library, one of the largest medical libraries in the world 4. For information on Massachusetts General Hospital resident salary and benefits, click here. (link to Benefits/default.aspx ) COSTS Because the MGH GPR program is affiliated with Harvard University, the University charges residents mandatory approximate annual fees of $1,620 for facilities usage and $1,088 for health coverage. APPLICATION INFORMATION The residency program is highly competitive and continues to attract applicants who have performed well in dental school and have passed Part I of the National Board of Dental Examinations. The program also considers letters of recommendation, extracurricular activities, and undergraduate performance. Results of the Advanced Dental Admission Test are accepted. A limited number of applicants are offered interviews, and desirable candidates are rank listed in the Postdoctoral Dental Matching Program. Applicants are notified of their status if they are offered interviews and if they are matched to the program. All applicants are welcome to contact the office for interim status checks. The program encourages interested individuals to apply early. The program will not discriminate with regard to age, color, gender, national origin, race, religion, sexual orientation, disability, or veteran status. The program only accepts graduates of US or Canadian dental schools. STEP 1 PASS The program participates in the ADEA Postdoctoral Application Support Service (PASS), an information clearinghouse. Applicants must submit a completed application by October 19 of the year before the residency is to begin. See the PASS website for information. IMPORTANT Our program requires applicants to submit the following in the PASS application: Essay Dental school transcript Curriculum vitae Institution Evaluation Form (IEF), which includes NBDE results

10 FOUR Professional Evaluation Forms (PEFs) Advanced Dental Admission Test (ADAT) score, if taken STEP 2 Additional Application Materials Required In addition to submitting the PASS application, applicants are required to forward the following directly to our program: Undergraduate transcript sent directly from the college or university to the program 2 x2 photo These materials should be sent to: Agnes Lau, DMD Director, General Practice Residency in Dentistry MGH Division of Dentistry 165 Cambridge Street Suite 401 Boston, MA STEP 3 The Match Program The residency program participates in the Postdoctoral Dental Matching Program. In order to be considered for the residency program, candidates must register with the Match via the PASS website during the application process.