Predoctoral Education Self-Study Report

Transcription

1 UTHSCSA Dental School CODA Self Study Report Predoctoral Education Self-Study Report Commission on Dental Education Site Visit: February 21 23, 2012 The University of Texas Health Science Center at San Antonio Dental School 7703 Floyd Curl Drive San Antonio, Texas

2 UTHSCSA Dental School CODA Self Study Report Table of Contents Volume 1: Self-Study Report Page(s) Administrator Verification Site Visit Recommendations and Response to Suggestions 7 Compliance with Commission Policies 8-10 Forward UTHSCSA Dental School Activities and Milestones Since Process for Conducting the Self-Study and Timeline Membership of Self-Study Task Forces and Sub-Committees Recommendations Emerging From the Internal Self-Study Process and Associated Action Plans Standard 1 Institutional Effectiveness Standard 2 Educational Program 2-1 and 2-2: Student Admissions and 2-4: Instruction and Due Process through 2-11: Curriculum Management through 2-15: Biomedical Sciences : Behavioral Sciences : Multicultural Patient Care and 2-19: Oral Health Delivery Models and Practice Management and 2-21: Ethics and Professionalism : Life-long Learning and Self-Assessment and 2-24: Critical Thinking and Information Management : Clinical Sciences : Special Needs Patients : Life Support and Medical Emergencies Standard 3 Faculty and Staff Standard 4 Educational Support Services 4-1: Facilities and Resources : Student Services , 4-4, 4-5: Student Financial Aid , 4-7, 4-8: Health Standards and Services

3 UTHSCSA Dental School CODA Self Study Report Standard 5 Patient Care Services Standard 6 Research Program Table of Contents for CODA Tables 1 16 CODA Title Page Table 1 Persons Responsible for Each Standard (Appendix F-7) 32 2 UTHSCSA Dental School Outcomes Assessment Report (Appendix 1-2b) 40 3 Schedule of UTHSCSA Dental School Courses (Appendix 2-5a) 75 4 List of Biological Science Courses (Appendix 2-9c) 92 5 List of Behavioral Science Courses (Appendix 2-9d) 92 6 List of Clinical Science Courses (Appendix 2-9e) 92 7 Roster of Department Chairs and Program Directors (Appendix 3-1a) Roster of Full-time Faculty Members (Appendix 3-1b) Roster of Part-time Faculty Members (Appendix 3-1c) Departmental Listing of Faculty Members (Appendix 3-1d) Basic Science Faculty Members (Appendix 3-1e) Clinical Science Faculty Members (Appendix 3-1f) Behavioral Science Faculty Members (Appendix 3-1g) Dental School Committee Members (Appendix 3-3b) Research Grants: Federal and Non-federal Support (Appendix 6-2a) Clinical Faculty Research Information (Appendix 6-2b) 279 Basic Science Faculty Research Information (Appendix 6-2c) Roster of Faculty Publications Since 2006 (Appendix 6-2d) Table of Contents for Volumes in the UTHSCSA Dental School Self-Study Report Volume Contents 1 UTHSCSA Dental School 2012 Self-Study Report 2 Appendices: Forward Section Standard 1 Standard 2-1 through 2-7, except 2-3b 3 Appendices: Standards 2-8 through Appendices: Standards 3, 4, 5 and 6 5 Appendix 2-3b: Basic Science Course Syllabi and Rotations 6 Appendix 2-3b: Clinical and Behavioral Science Syllabi 4

4 UTHSCSA Dental School CODA Self Study Report Standard One STANDARD 1: INSTITUTIONAL EFFECTIVENESS 33

5 UTHSCSA Dental School CODA Self Study Report Standard One Mission Statement Standard The dental school must develop a clearly stated purpose/mission statement appropriate to dental education, addressing teaching, patient care, research and service. Compliance: The UTHSCSA Dental School is in compliance with Standard 1-1. A. Description for Standard 1 1 Appendix 1-1a presents the Dental School Mission, Goals and Objectives. This document describes the Mission of the Dental School in clear and concise terms as being the acquisition, dissemination and use of knowledge toward the enhancement of oral health. The statement further describes that the Dental School Mission is addressed through six inter-related action components: education, research, patient care, community, faculty and staff, and infrastructure. As required in Standard 1-1, this statement is appropriate to dental education and addresses teaching (education), patient care, research and service to both the community and the profession. The Dental School Mission, Goals and Objectives are consistent with the Mission of our parent institution, the University of Texas Health Science Center at San Antonio (Appendix 1-1b) and serves as the roadmap for all Dental School programs. Programmatic outcomes assessment is an integral part of the Dental School s strategic planning process and is based upon attaining the goals and objectives identified in Appendix 1-1a. The Dental School strategic planning process is described in Standards 1-2 and 1-3. The Dental School s Mission, Goals and Objectives are communicated to faculty, staff, students, patients and other communities of interest through several mechanisms: 1. distribution to new Dental School faculty and staff members; 2. posting on the Dental School website for access by faculty, staff and students; 3. all new patients receive a welcome letter from the Dental School, delineating patients rights and directing them to the Dental School website (dental.uthscsa.edu/missiongoals. php) to access the School s mission and goals; 4. posting in the clinic staff lounge; and, 5. presentation during orientation for all enrolled dental students and during the interview day for dental school applicants. B. Supportive Documentation for Standard 1-1: 1. Appendix 1-1a: UTHSCSA Dental School Mission, Goals and Objectives 2. Appendix 1-1b: Mission of the University of Texas Health Science Center at San Antonio 34

6 UTHSCSA Dental School CODA Self Study Report Standard One Strategic Planning and Outcomes Assessment Standards 1-2 and Planning for, evaluation of and improvement of educational quality at the dental school must be broad-based, systematic, continuous and designed to promote achievement of institutional goals related to education, patient care, research and service. 1-3 The dental school must demonstrate the effectiveness of its programs and units using a formal and ongoing outcomes assessment process to include measures of student achievement. Compliance: UTHSCSA Dental School is in compliance with Standards 1-2 and 1-3. A. Description for Standards 1-2 and 1-3 The responses for Standards 1-2 and 1-3 are combined because strategic planning and outcomes assessment are integrated at the UTHSCSA Dental School. The 2011 Dental School Strategic Plan appears in Appendix 1-2a. The Dental School s strategic planning process provides the operational framework to promote achievement of Dental School goals in education, research, patient care, community service, faculty and staff development, and infrastructure. The Dental School conducts a formal process for measuring achievement of the goals articulated in the school s Mission, Goals and Objectives Document (Appendix 1-1a). For each goal, multiple measures, including indicators of student performance, are analyzed to determine performance. Appendix 1-2b (CODA Table 2) depicts the Dental School's 2011 outcomes assessment plan including delineation of goals/objectives, outcome measures, expected and actual results, distribution of performance data, and actions taken in response to findings. A description of the strategic planning process appears in the following paragraphs. Dr. William Dodge, Vice Dean, and Chair of the Strategic Planning Committee, is the school s compliance office for strategic planning and outcomes assessment. The Strategic Planning Committee manages the overall process of planning. The membership of this committee is broadbased and includes all of the Dental School program directors (Dean, Vice Dean and Associate Deans listed below), five appointed Dental School faculty members, and a basic science faculty member from the School of Medicine. The school s program directors play key roles in the strategic planning and outcomes assessment process. These programmatic areas are based on the structure of the Strategic Plan. Programs, persons responsible and the primary faculty committees for each component of the Strategic Plan are indicated in Table

7 UTHSCSA Dental School CODA Self Study Report Standard One Table 1-2: Strategic Plan Components and Responsibility Program Responsibility Committees Education Associate Dean for Academic Affairs Dr. Birgit Glass Research Patient Care Community Service Faculty/Staff Development Infrastructure Associate Dean for Student Affairs Dr. Adriana Segura Associate Dean for Research Dr. Bjorn Steffensen Vice Dean Dr. William Dodge Associate Dean for External Affairs Dr. Elaine Neenan Dean / Vice Dean Drs. Ken Kalkwarf and William Dodge Vice Dean Dr. William Dodge Curriculum Committee Curriculum Management Committee Admissions Committee Academic Performance Committee Student / Faculty Relations Committee Research Committee Clinical Quality Assurance Committee Instruments and Materials Committee Curriculum Management Committee Clinical Quality Assurance Committee Faculty Development Committee Faculty Assembly Strategic Planning Committee Faculty Council Strategic planning at UTHSCSA Dental School has been fully integrated into the academic framework of the Dental School since the mid-1980s when the school s initial strategic plan was created as part of the planning process for a Pew Grant. Over the past 25 years, the school has continually reviewed existing strategic plans, made revisions based on the process described in this standard and developed new plans on a periodic basis. Dental School strategic planning incorporates the commonly accepted elements of environmental assessment, analysis of external and internal strengths, weaknesses, opportunities and threats (SWOT) and outcomes assessment of school, department, and program performance. Over the past 15 years, strategic plans were developed in 1996, 1997, 1999, 2001, 2003, 2005, 2007 and The 2005 and 2007 Dental School Strategic Plans will be on file during the February 2012 Site Visit in the office of the Vice Dean. The 2011 Strategic Plan is in Appendix 1-2a. Recent Initiatives and Changes Resulting from Strategic Planning Process Examples of initiatives and changes since the 2005 CODA Site Visit that were outcomes of the Dental School s strategic planning process include: implementation of incentive strategies designed to increase total compensation for faculty members and enhance recruitment and retention (see description of the XYZ compensation plan in Standard 3-4); establishment of an International Dentist Education Program (IDEP) to improve student body diversity and increase revenues (see description below and in Standard 2-1); development of a plan for a new Dental School Clinical Building; 36

8 UTHSCSA Dental School CODA Self Study Report Standard One implementation of a curricular emphasis on evidence-based practice and critical appraisal (see descriptions in the Forward section and Standard 2-22); development of a semester-long orientation for new faculty members to facilitate transition into the Dental School (See description in Standard 3-2); implementation of required student rotations in community health centers in South Texas (See description in Standards 1-8 and 2-17); restructuring of predoctoral clinic revenue distribution that has produced additional revenue for the Dental School; restructuring of Dental School departments to facilitate efficient use of resources and promote collaborative planning of both educational and patient care programs; revision of Dental School Bylaws to reflect the new organizational structure, the 2010 Strategic Plan, and outcomes of an analysis of committee effectiveness and utility; creation of a 2,000 square foot dental student lounge to facilitate on-campus study, meetings of student organizations, and provide a dedicated study space; and, renovation of 2,500 square feet of new laboratory space for the Department of Oral and Maxillofacial Surgery. This laboratory is designed to enhance the Dental School research theme: Pain, Inflammation and Wound Healing, as described in Standard 6-1. Description of Strategic Planning Initiatives The following expanded descriptions of strategic planning initiatives for faculty incentive plans and community-based education are provided as examples of how the process stimulates new programs within the School. Faculty Compensation: The implementation of strategies to grow revenue for faculty incentive payments is one example of how the strategic planning process has worked to improve the Dental School s ability to respond to reductions in state funds and maintain its ability to recruit and retain faculty. The trail of this activity began in 1999 with the recommendation by the Strategic Planning Committee to seek approval to change the manner by which the predoctoral clinics are funded. The intent of this strategy was to stimulate clinic productivity to generate new revenue that could be used for expanded faculty compensation. Approval for a new model of clinic revenue distribution was obtained from the UTHSCSA administration in 2003 and an incentive plan implemented in As this process was moving forward, the School continued to experience reductions in state funding. The 2003 Strategic Plan recommended the exploration of additional sources of new funds. This recommendation was repeated in 2005 with the result that faculty compensation became the top priority on the Dean s Work Plan for that year. In May 2005, a task force was formed to determine the feasibility of starting an advanced standing program for international dentists with goals to enrich the diversity of the student body and generate additional tuition revenue. In February 2006, the task force completed its work and recommended 37

9 UTHSCSA Dental School CODA Self Study Report Standard One appointment of a director for the international dentist program, and the first class of international students was admitted in Continuing efforts to increase funds for faculty compensation have remained a high priority as noted in the 2007 and 2010 Strategic Plans and the Dean s Work Plan. The high strategic priority placed on development of additional funding to support faculty compensation led to a recent proposal calling for a significant tuition increase for predoctoral education. Some of the expanded revenue from increased tuition will be used to address the critical need for enhanced faculty compensation, which is essential for faculty retention. Community-Based Education: Required extramural training in South Texas is another result of the strategic planning process. The School has a long history of providing voluntary community-based educational experiences for students, in which a high percentage of students participated. However, the voluntary aspect made scheduling and logistics difficult for both students and faculty, and was noted as a weakness of the Dental School in the 2003 and 2005 Strategic Plans and became a priority on the Dean s 2005 Work Plan. The inauguration of the International Dentist Education Program and its impact on clinic space, and moving the start of the junior and senior years into early July, thus expanding time available for off-campus rotations, provided a structure to make community-based education mandatory for all dental students and was implemented in August Strategic Planning Process Dental School strategic planning is an on-going process that follows the process described below. The Strategic Planning Committee (SPC) conducts an assessment of the internal and external environment, reviews program outcomes as reflected in the Dental School Outcomes Assessment Report (Appendix 1-2b), and updates the table of strengths and weaknesses in the existing Strategic Plan. Based on this review, the SPC identifies potential action items and submits a preliminary report to the Dean, which includes new or updated recommendations. The Dean reviews the preliminary report and identifies which recommendations are of most immediate importance to the School; these strategic plan priorities are incorporated into the Dean's Annual Work Plan for top priority projects, programs and initiatives, which is shared with UTHSCSA administration. The new Strategic Plan is finalized based on input and prioritization by the Dean and is shared with faculty at faculty meetings and other mechanisms. The Dean, in consultation with the Faculty Council (Chairs, Associate Deans and faculty representatives) assigns responsibility for new initiatives that are proposed in the Strategic Plan to the appropriate Associate Dean for assessment of feasibility, and development of action plans in conjunction with appropriate committees. When a Strategic Plan recommendation crosses areas of responsibility, the Dean may appoint a special Task Force to conduct an assessment and plan implementation. 38

10 UTHSCSA Dental School CODA Self Study Report Standard One Each Associate Dean manages implementation to achieve Strategic Plan goals and objectives within their areas of responsibility. During weekly meetings of the senior Dental School administrative team (Dean, Vice Dean, Associate Deans), the Associate Deans provide updates on assessment or implementation of new initiatives, share information related to accomplishment of Strategic Plan goals and objectives, and identify emerging issues and problems pertinent to any of the Strategic Plan components (education, research, patient care, community service, faculty / staff development and infrastructure). Methods for evaluation and resolution of emerging issues are identified by direct communication among the senior administrative team and with department chairs. Task forces or ad hoc committees may be assigned to address time sensitive issues as described later in this Standard. At meetings of the senior administrative team near the conclusion of each academic year, the Associate Deans summarize activities over the past year for their areas of responsibility including assessments of progress toward goals, objectives and new initiatives. Based on feedback and recommendations from the Associate Deans, review of the Dental School Outcomes Assessment Report (Appendix 1-2b; CODA Table 2), and the outcomes of new environmental scans, the Strategic Planning Committee develops a modified Strategic Plan at the culmination of the two-year cycle. The modified/updated Strategic Plan is submitted to the Dean for review, and the process starts over again culminating in a new Strategic Plan. As noted previously, this process has occurred 8 times between 1996 and Curriculum Evaluation and Planning Curriculum evaluation and planning are described in Standard 2-10, but this process is intimately tied to the strategic planning and outcomes assessment process. Education is a central mission of the UTHSCSA Dental School and is a major focus for outcomes assessment during each strategic planning cycle. Predoctoral dental education is the responsibility of the Associate Dean for Academic Affairs who functions as the Program Director for Education. The Dental School s Curriculum Committee and the Curriculum Management Committee create and oversee policies and procedures for predoctoral dental education. These committees report to the Associate Dean for Academic Affairs, who includes progress toward Dental School objectives in the educational area in the Biennial Program Outcomes Report. This report also includes an environmental assessment related to factors that may influence predoctoral dental education. Student achievement is an important part of the outcomes assessment process for educational programs. Measures of student achievement for predoctoral education and indicators of the quality of the educational environment include: students' performance in didactic, lab and clinical courses; percentage of students who graduate in four years and percentage who ultimately graduate; analysis of student attrition rate and reasons for departure; percentage of students who need remediation; students' performance on clinical skill assessments and competency examinations; 39

11 UTHSCSA Dental School CODA Self Study Report Standard One students' performance in the General Practice Groups (i.e., clinical teams) as assessed by the GPG Leaders and faculty; students' performance on National Dental Boards Parts 1 and 2; students' performance on the Western Regional Board Licensure Exam; faculty peer review of courses; analysis of students' course evaluations; senior students' perceptions of the educational environment; and, surveys of students who graduated five years previously (alumni) to obtain their retrospective perceptions of educational environment and learning experiences. Departmental Planning Annual departmental reports include Departmental Goals and Objectives. Dental School policy stipulates that Departmental Goals and Objectives must be keyed to the Dental School Goals and Objectives, which are in turn keyed to the Health Science Center Mission Statement. Departmental reports are submitted annually to the Dean for review. Subsequently, the Dean provides guidance and feedback to each Departmental Chair, maintaining an effective linkage between departmental planning and the Dental School s strategic planning process. Special Planning Processes Special planning processes are used during times of urgency or to respond to time-sensitive opportunities when the two-year strategic planning cycle may require too much time to address a newly arising opportunity or issue. In these situations, the Dean appoints ad hoc committees or task forces to study the issue and develop recommendations, which are submitted to the SPC for review. B. Supportive Documentation for Standards 1-2 and 1-3: 1. Appendix 1-1a: UTHSCSA Dental School Mission, Goals and Objectives 2. Appendix 1-2a: UTHSCSA Dental School 2010 Strategic Plan 3. Appendix 1-2b: 2011 Outcomes Assessment Report for UTHSCSA Dental School (CODA Table 2) 40

12 UTHSCSA Dental School CODA Self Study Report Standard One Financial Resources Standard The financial resources must be sufficient to support the dental school s stated purpose/mission, goals and objectives. Compliance: The UTHSCSA Dental School is in compliance with Standard 1-4. A. Description for Standard 1-4 Funds for the operating budget of the UTHSCSA Dental School come from six sources: 1. appropriations from the State of Texas; 2. income from predoctoral students patient care activities; 3. income from faculty and postdoctoral residents patient care activities; 4. research/foundation support; 5. differential tuition and fees; and, 6. private philanthropic support. Appropriations from the State of Texas The state s contribution to the budget process begins when the UTHSCSA Administration submits an allocation request through the University of Texas System (UT System) to the Legislative Budget Board and the State Legislature. An appropriation is allocated by the Legislature to the Health Science Center (HSC) and is distributed to the schools. General tuition (set by the UT System), paid by dental students, does not go directly to the School. Rather, it is placed in a HSC account and is considered part of the state allocation. Income from Predoctoral Students Patient Care Activities Clinical revenue derived from the predoctoral program is first used to cover the costs of supplies and small equipment in the predoctoral clinics. The balance is distributed, by formula, to the departments to be used for part of faculty incentive payments. Income from Faculty and Postdoctoral Residents Patient Care Activities The postdoctoral clinics and the faculty practice function under the umbrella of the Dental Service, Research and Development Plan (DSRDP). This plan operates under the auspices of the University of Texas and revenues generated by the plan are used under the guidelines established by the UT Board of Regents. With the reduction in state funding, this source of revenue has taken on increasing importance for the Dental School. DSRDP revenues over the past six years have increased by 54.6% ($6,822,852 in FY2006 vs. $10,548,919 in 2011). Revenues are distributed by formula with transfers occurring to the Office of the President, the Dean s Office, the Faculty Practice Clinic for overhead cost, the Central Billing Office, and the departments. By agreement with the UTHSCSA President, a portion of his funds are allocated to the Dental School for use by the Dean to support research start-up packages, innovative teaching grants, and faculty development. Departmental transfers comprise the largest component of DSRDP revenues and 41

13 UTHSCSA Dental School CODA Self Study Report Standard One are used by the chairs to support graduate education and specialty clinics, faculty compensation, and for other departmental needs. A portion of the postdoctoral clinic revenues is diverted to an account managed by the Dean for support of renovation, capital investment projects, and other initiatives of school-wide importance. Research and Foundation Grant Support Research revenues depend on faculty member s grant success and funding levels. Departments manage their faculty member s grants and awarded funds are accounted separately from other funds. State salaries offset by grants return to the Dean s Office. Requests may be made for these funds to support coverage of a research oriented faculty member s other responsibilities, research infrastructure, or incentive compensation. Research revenues, faculty grants, publications and national ranking are described in Standard 6 with documentation in the appendices for Standard 6. Indirect dollars associated with research grants are accumulated at the institutional (UTHSCSA) level. A small portion of these dollars is returned each year to the Dental School to support research infrastructure, as well as provide incentives for continued research productivity. Differential Tuition and Fees Differential Tuition is approved biannually by the University of Texas (UT) System. Twenty-five percent of tuition and fees is retained by the UTHSCSA for scholarships and 75% is transferred to the Dental School to cover operational expenses of the educational program, support infrastructure and contribute to faculty incentive payments. Fees approved by the UT System, are collected annually from students and are used to cover specific costs of their education program. Private Philanthropic Support The Dental School receives private philanthropic funding from a variety of sources including alumni, friends and grateful patients. Over the past five fiscal years, the Dental School has averaged $1.2 million in philanthropic gifts annually. During the same five-year period, 87% of the Dental School s gifts were provided by individuals including 51% from alumni and 36% from friends of the school in the community. The remaining 13% of gifts were provided by corporations, foundations and other entities. Revenues and Expenditures Appendix 1-4a displays projected revenues and expenditures for the Dental School for fiscal years 2012 to Appendix 1-4b provides an analysis of Dental School revenues and expenditures for the past five fiscal years, 2007 to The Dental School develops its priorities for capital investment and renovation based upon input from departments and the Associate Deans. As displayed in Appendix 1-4c, the Dental School has invested approximately $8 million for infrastructure enhancement, renovation and replacement during 2005 to

14 UTHSCSA Dental School CODA Self Study Report Standard One Physical Plant Renovations Since 2005, significant renovation and equipment upgrades have occurred within the Dental School including the following projects: Preclinical Simulation Laboratory: described in the Forward and Standard 4-1; Dental Student Lounge: described in the Forward and Standard 4-1; and, Classroom Upgrades: described in the Forward and Standard 4-1. Sterilization Unit: In 2010, a Castle-Getinge instrument wash unit was installed. The Dental School has developed plans for a new central sterilization facility that will contain multiple automated preparation and sterilization systems as well as Ethylene Oxide. The anticipated initiation of construction is spring 2012 if funding for a new dental clinic building is not forthcoming. Front door for main patient entrance to Dental School clinic: The Dental School was originally constructed in the early 1970s with an open floor plan for the main patient entrance to the clinical area of the facility. This space eventually became the primary patient registration and cashier area. With significant increases in patient traffic as the school's clinical activities developed, temperature control in the reception/cashier area became increasingly challenging. In 2000, a multiple entry/exit door system was installed, but this system was problematic for functionality and temperature control. In 2008, the Dental School invested $100,000 to install a commercial grade, large-scale revolving door that can be collapsed in case of an emergency requiring rapid evacuation. Accounts Management All department funds are reconciled on a monthly basis by the Accounting Coordinator. The reports are delivered to the Administrator, the Chair, and to the Principal Investigators by the last day of each month. Reconciled reports include forecasted information, documentation (back-up), as well as any information that may assist the Principal Investigator, Administrator, clinical Division Director, and Chairman in the prudent and timely expenditure of funds. Dental School Account Reconciliation The Manager of Financial Operations and/or the Assistant Dean for Administration meet with the Administrator of each of the five academic departments, as well as the Outpatient Clinic, Continuing Dental Education, and the Faculty Practice Plan, on a quarterly basis, to review the departments account reconciliation and review process. B. Supportive Documentation for Standard 1-4: 1. Appendix 1-4a: Projected Revenues and Expenditures, FY Appendix 1-4b: Revenues and Expenditures, FY Appendix 1-4c: FY Dental School Capital and Infrastructure Investments 43

15 UTHSCSA Dental School CODA Self Study Report Standard One External Support 1 5 The sponsoring institution must ensure that support from entities outside of the institution does not compromise the teaching, clinical and research components of the program. Compliance: The UTHSCSA Dental School is in compliance with Standard 1-5. A. Description for Standard 1-5 The Dental School is in compliance with the policies of the UTHSCSA and the University of Texas System, which ensure that financial and/or in-kind support from entities outside the institution do not compromise the integrity of the teaching, clinical or research components of our programs. The University has a Conflict of Interest policy that covers all real and/or perceived academic/business conflicts for faculty members, staff members and students. Chapter 10 in the UTHSCSA Handbook of Operating Procedures describes institutional policies for Ethics, Standards of Conduct, and Relationships with External Entities. These policies include conflict of interest in scholarly, research and clinical activity, conflict of commitment, outside activities for pay and relationships that may involve conflicts of interest, and guidelines for interactions of clinicians and researchers with industry (Appendices 1-5a, b, c and d). The UTHSCSA Office of Legal Affairs advises the University and the Dental School regarding interpretation of conflict of interest. Faculty members are required to sign a conflict of interest statement that discloses any personal financial interest with entities that could be interpreted as a conflict. The UTHSCSA has a competitive bid system for all major equipment, materials or services that are purchased in support of our facility or programs. This process of accountability is mandated both by the State of Texas and the UT System. Any sole source purchases must be justified and approved by the University Purchasing Department consistent with State of Texas rules and regulations. The UTHSCSA, through the Office of Sponsored Programs, reviews all grants and contracts prior to submission to verify compliance with all University policies and procedures. When research funding involves human subjects, the grant and research design must meet the strict requirements of the UTHSCSA Institutional Review Board. B. Supportive Documentation for Standard 1-5: Documentation for Standard 1-5 can be accessed in the UTHSCSA Handbook of Operating Procedures. A print copy of the Handbook of Operating Procedures will be available during the February 21-23, 2012 Site Visit. Specific sections in the Handbook of Operating Procedures pertinent to Standard 1-5 are provided in the appendices. 1. Appendix 1-5a: UTHSCSA Handbook of Operating Procedures, Chapter Conflict of Interest in Scholarly, Research and Clinical Activity 2. Appendix 1-5b: UTHSCSA Handbook of Operating Procedures; Chapter Conflict of Commitment for Faculty and Administrative and Professional Staff 44

16 UTHSCSA Dental School CODA Self Study Report Standard One 3. Appendix 1-5c: UTHSCSA Handbook of Operating Procedures, Chapter Outside Activities for Pay and Relationships Which May Involve Potential Conflicts of Interest 4. Appendix 1-5d: UTHSCSA Handbook of Operating Procedures, Chapter Guidelines for Interactions of Clinicians and Researchers With Industry 5. Appendix 1-5e: UTHSCSA Institutional Review Board website [Screenshot] Authority and Final Responsibility for Administrative Matters Standard The authority and final responsibility for curriculum development and approval, student selection, faculty selection and administrative matters must rest within the sponsoring institution. Compliance: The UTHSCSA Dental School is in Compliance with Standard 1-6. A. Description for Standard 1-6 The UTHSCSA Dental School has the sole authority and final responsibility for curriculum development and approval, curriculum implementation, student selection, faculty selection and administrative policies, processes and decisions as stipulated in the document Academic Organization and Bylaws of the UTHSCSA Dental School (Appendix 1-6a). All matters pertaining to curriculum, student selection and faculty selection are handled by either standing or ad hoc (appointed by the Dean or department chairs) committees of the Dental School. Responsibilities of the standing committees of the Dental School are described in the Academic Organization and Bylaws of the UTHSCSA Dental School. Mechanisms of faculty participation in School governance are described in Standard 3 3. All administrative matters are managed by the Dean with consultation from the Faculty Council that is comprised of the department chairs, vice dean, associate deans, assistant deans, program directors and elected faculty representatives. The Faculty Assembly, comprised of all full-time faculty members, is also advisory to the Dean. Curriculum Development, Assessment and Implementation As described in Standards 1-2, 1-3 and 2-10, the Dental School s Curriculum Committee and Curriculum Management Committee are responsible for planning and assessment of the predoctoral educational program for dental students in collaboration with the Associate Dean for Academic Affairs. These committees are composed of full-time faculty members selected by the Dental School s Committee on Committees. The faculty of the Dental School are also responsible for the delivery of didactic, pre-clinical and clinical course content. Part-time clinical faculty members assist in the education of our students and function in accordance with the School s Bylaws and the rules and regulations of the UTHSCSA as stipulated in the UTHSCSA Handbook of Operating Procedures. 45

17 UTHSCSA Dental School CODA Self Study Report Standard One Student Selection As described in Standards 2-1 and 2-2, the assessment and selection of predoctoral dental students are the responsibility of the Dental School Admissions Committee, the Associate Dean for Student Affairs and the Admissions Review Panel, working in coordination. The Admissions Committee is a standing committee appointed by the Dean and chaired by the Associate Dean for Student Affairs. The Admissions Committee is comprised of full-time faculty members, community dentists and dental students. The Associate Dean for Student Affairs selects the applicants for interviews based on criteria established by the Admissions Committee. Each applicant is interviewed by a faculty member and a dental student. The Admission Review Panel (ARP) reviews each candidate s application and assigns a score from 0 to 400. Applicants are accepted in accordance with their score. The Admissions Review Panel is compromised of five faculty members and the Associate Dean for Student Affairs. The Admissions Committee selects candidates for admission to the Dental School who have applied through the Texas Medical and Dental Application Center and through the American Dental Education Association Application Service. Recruitment and Selection Process for Faculty Faculty members at the UTHSCSA Dental School are recruited, selected and appointed in a manner consistent with UTHSCSA rules and regulations as described in the Handbook of Operating Procedures; Chapter Faculty Recruitment Procedures (Appendix 1-6b). Faculty recruitment and credentialing are managed by the five Dental School departments. Recruitment for open and unfilled faculty positions is initiated by the department in conjunction with the UTHSCSA Office of Faculty and Academic Equal Employment Opportunity and Affirmative Action (EEO/AA). A Search Committee within the department is formed and an EEO/AA staff member serves as a member of the Search Committee. Announcements are placed in appropriate journals as part of a national search. The Search Committee reviews the applicants for the faculty position and recommends names to the Department Chair for the interview process. The top candidates are selected for the interviews. These candidates are then interviewed by the Search Committee and other faculty members. Evaluations are completed and recommendations are made to the Department Chair based on the credentials of the prospective candidates and other factors, including interviewers' assessment and recommendations and review of the candidates resume, publications, academic and other employment history, letters of recommendation, teaching experience, and scholarship record. Procedures for certification of faculty credentials are described in Chapter 3.5.1, Faculty Credentialing Procedures, in the UTHSCSA Handbook of Operating Procedures (Appendix 1-6c). An example of the credentialing documentation maintained in one Dental School department appears in Appendix 1-6d. Credentialing documents from the other four departments will be available on site during the February Site Visit. Upon completion of the credentialing process, the Department Chair writes a detailed letter outlining the qualifications of the prospective faculty and submits this document to the Dean, who makes final approval of the appointment within the Dental School, and then submits the recommendation to the UTHSCSA President s Office. Initial appointments to the ranks of Associate Professor, Professor, Tenure Track and/or appointments at 75 percent or above are contingent on 46

18 UTHSCSA Dental School CODA Self Study Report Standard One approval from the UTHSCSA Faculty Promotions, Tenure, and Appointments Committee. Final approval of faculty appointments is granted by the Executive Vice Chancellor for Health Affairs of the University of Texas System and the University of Texas Board of Regents. Recruitment and Selection Process for Department Chairs The University of Texas Board of Regents delegates to the Executive Vice Chancellor for Health Affairs who, in turn, delegates to the UTHSCSA President, the responsibility for the permanent or acting appointment of department chairs, department heads, and their equivalents. The selection process for Department Chairs is initiated by the Dental School Dean. The Dean appoints a Search Committee that includes an official from the UTHSCSA Office of Faculty and Academic Equal Employment Opportunity and Affirmative Action, and appoints the Chairman of the Search Committee. The Chair convenes the Committee; and the charge and timeframe to the Committee are issued by the Dean. The Search Committee meets to discuss the process and develop the criteria required for the position. Announcements are placed in appropriate journals as part of a national search. The Search Committee reviews the applicants for the Chairmanship position and recommends names to the Dean for the interview process. The top candidates are selected for the interview process and applicants are interviewed by the Search Committee and other UTHSCSA and Dental School administrators and faculty members. Evaluations of interviews and submitted supportive materials are completed and recommendations are made to the Dean based on the overall portfolio of credentials of the prospective candidates. Prior to extending a formal offer to the candidate, the offer letter is reviewed by the UTHSCSA Office of Faculty and Academic Equal Employment Opportunity and Affirmative Action and approved by the President s Office. Pending completion of the credentialing process, the Dean formalizes a request in writing to the UTHSCSA President for Chairmanship appointment. Final appointment is granted by the Executive Vice Chancellor for Health Affairs and the University of Texas Board of Regents. Chairs serve without fixed terms and continuation is subject to the discretion of the UTHSCSA President. The recruitment of the Vice Dean, Associate and Assistant Deans and Program Directors is initiated by the Dean. Candidates for these administrative positions are generally sought internally in accordance with the academic position advertisement, recruitment and selection policies of the UTHSCSA. Recruitment and selection proceeds in a manner similar to that described for department chairs. The recruitment and selection of Division Heads is conducted by the Chairs of the respective Departments in consultation with the Dean in accordance with the academic position advertisement, recruitment and selection policies of the UTHSCSA. An electronic announcement of the position and job description is distributed to all faculty and nominations for consideration are received. Recruitment and selection of Division Heads proceeds in a manner similar to that described for department chairs. Administrative Policies, Processes and Decisions The administration of the Dental School consists of the following components: 1. The Dean is responsible for identifying and delegating to specific individuals the administrative responsibilities necessary for program planning, management and assessment within the Dental School. 47

19 UTHSCSA Dental School CODA Self Study Report Standard One 2. The Faculty Council of the Dental School is composed of Departmental Chairs and administrators (Associate Deans and Program Directors), and includes elected faculty members. The Faculty Council is advisory to the Dean for matters concerning the operation of the Dental School and the implementation of its missions. 3. Standing committees of the Dental School are composed of faculty, staff and administrators, and in many instances, student representatives. Methods and structure for faculty governance and participation in decision-making is described in Standard 3-3. Appendix 1-6e displays the organizational chart of the UTHSCSA Dental School. B. Supportive Documentation for Standard 1 6: 1. Appendix 1-6a: Academic Organization and Bylaws of the UTHSCSA Dental School 2. Appendix 1-6b: Handbook of Operating Procedures, Chapter 3.3.1: Faculty Recruitment 3. Appendix 1-6c: Handbook of Operating Procedures, Chapter 3.5.1: Academic Credentialing 4. Appendix 1-6d: Example of Faculty Recruitment and Credentialing Documentation from One Department 5. Appendix 1-6e: Organizational Chart of the UTHSCSA Dental School 48

20 UTHSCSA Dental School CODA Self Study Report Standard One Component of Higher Education Institution Standard The dental school must be a component of a higher education institution that is accredited by a recognized accrediting agency. Compliance: The UTHSCSA Dental School is in compliance with Standard 1-7. A. Description for Standard 1-7 The UTHSCSA is a component of the University of Texas System, which is comprised of 17 campuses, including six health science centers. The Dental School is one of five components of the UTHSCSA: Dental School, School of Medicine, School of Nursing, School of Health Professions, and Graduate School of Biomedical Sciences. The organizational chart for the University of Texas Health Science Center at San Antonio appears in Appendix 1-7a. This organizational chart shows the relationships among UTHSCSA components. The UTHSCSA is accredited to award Bachelor s, Master s, and Doctoral degrees by the: Southern Association of Colleges and Schools (SACS) Commission on Colleges 1866 Southern Lane Decatur, Georgia The UTHSCSA was initially accredited by the Southern Association of Colleges and Schools Commission on Colleges in The most recent SACS accreditation site visit occurred in 2009, when the UTHSCSA received full accreditation for a period of ten years (Appendix 1-7b). B. Supportive Documentation for Standard 1-7: 1. Appendix 1-7a: Organizational Chart of UTHSCSA 2. Appendix 1-7b: 2009 SACS Accreditation Letter 49

21 UTHSCSA Dental School CODA Self Study Report Standard One Interaction with Other Higher Education Components Standard The dental school must show evidence of interaction with other components of the higher education, health care education and/or health care delivery systems. Compliance: The UTHSCSA Dental School is in compliance with Standard 1-8. A. Description for Standard 1-8 The Dental School has extensive educational, research and patient care/clinical service interactions with other UTHSCSA schools and programs, community health centers, and community agencies within Texas with focus on South Texas and Mid Rio Grande Border Region. Collaborations Within UTHSCSA Campus The Dental School s principal interaction with other higher education components occurs on the UTHSCSA campus. Dental School faculty members have appointments in several other UTHSCSA component schools. These cross-appointments are processed by the Dental School s Assistant Dean for Administration and appointment documents are kept on file in the respective departments. Faculty cross appointments provide opportunities for participation in educational, research and service programs across institutional component lines and contribute to improved communications throughout our educational and health care delivery systems. Dental School faculty members also play significant roles within the UTHSCSA by their participation on campus wide committees (Appendix 1-8a). Dental School Dean s Role and Responsibilities The Dental School Dean is responsible to and reports to the UTHSCSA President. The Dean serves at the pleasure of the President, without fixed term, and performs such duties as are assigned by the President, including a number of activities and responsibilities in support of the overall mission of the UTHSCSA. Within the Dental School, the Dean is responsible for all educational programs and associated activities in the school, including continuing education and other instructional programs, research programs, or academic support services as may be assigned by the President. Specific duties of the Dental School Dean s position include: recommending appropriate budgets and budget policies affecting the Dental School, as well as effectively administering the approved budget; recommending appointment, promotion, retention, non-retention, or dismissal of department chairs and other administrative positions; and appointment, promotion, retention, non-retention, or dismissal for cause of faculty and staff of the Dental School; recommending appointment to tenure of qualified faculty, when deemed appropriate, upon receipt of certification of faculty qualifications by the department chairs; developing and evaluating research and academic programs and teaching methods and 50

22 UTHSCSA Dental School CODA Self Study Report Standard One curricula, and developing long-range plans for the academic programs of the school; recommending additions and alterations to facilities necessary for academic purposes; chairing the Faculty Council of the Dental School, chairing meetings of the faculty called by the Dean, and establishing procedures for meetings of other faculty organizations; establishing and appointing (or authorizing the election/selection of) ad hoc committees or councils for the Dental School as needed for program planning and monitoring; executing the academic regulations and procedures of the Dental School, including admission and dismissal of students; and, certifying, upon the recommendation of the faculty, students for graduation and honors. In addition to administrative responsibilities within the Dental School, the Dean is actively engaged in the UTHSCSA, including the following roles: representing the Dental School and/or the UTHSCSA at the direction of the President, before accrediting bodies, educational and professional associations, legislative bodies, the University of Texas System, and appropriate health and regulatory agencies; representing the Dental School on the Executive Committee of the UTHSCSA and other policymaking bodies of the HSC and the University of Texas system; chairing campuswide UTHSCSA task forces appointed by the President; and, chairing search committees for Dean s positions at the UTHSCSA. Educational Collaborations Interactions between the Dental School and the UTHSCSA Graduate School of Biomedical Sciences are many and varied. Graduate School faculty members are appointed as faculty members of the Dental School and teach many of the basic science courses conducted for dental students. These basic science courses require planning and input from dental clinical faculty. Both basic science faculty members and dental clinical faculty members serve on Dental School Committees responsible for planning and evaluating curricular offerings. The Dental School offers a combined DDS-PhD Program for selected students in conjunction with the Graduate School for Biomedical Sciences, which is described in Standard 6. The Dental School also offers a public health certificate program in conjunction with the University of Texas-Houston, School of Public Health (SPH), San Antonio Regional Campus. This program allows dental students to obtain a certificate in public health by completing five online courses offered by the SPH. These credits can be applied toward an MPH. 51

23 UTHSCSA Dental School CODA Self Study Report Standard One The Dental Early Admissions Program (DEAP) enhances recruitment of highly qualified students from institutions having high percentages of underrepresented minority students. The DEAP is a Dual Degree Program implemented in conjunction with 20 cooperating undergraduate institutions in Texas (Appendix 1-8b: DEAP Partner Institutions). In DEAP, participating students earn both a bachelor's degree and a dental degree in a reduced period of time. Students participating in this program gain early acceptance by the Dental School and shorten their number of college years and associated costs by 1 year. Final acceptance of DEAP participants is dependent upon academic performance and DAT achievement that meet predetermined benchmarks. Community Service, Patient Care and Clinical Education Collaborations A major focus of the UTHSCSA mission is service for South Texas. Consequently, the Dental School outreach program includes clinical education at numerous affiliated sites in South Texas. Appendix 1-8c is a cooperative agreements table indicating the Dental School s affiliations with numerous cooperating sites and institutions including federally qualified health centers, local health departments, homeless shelters, hospitals and public school districts / schools. The Dental School s interaction with other components of health care education and health care delivery systems in South Texas takes place through a series of required and selective communitybased clinical education rotations that have been developed for dental students. (Appendix 1-8d: Outreach Education and Service Programs Summary). Infrastructure capacity is essential to provide community-based educational experiences for our students at affiliated sites. To achieve this capacity, the Dental School established a clinical training network, Dental Education Outreach Network (DEON), comprised of community and migrant health centers in South Texas to accommodate student rotations and link affiliates to the Dental School (Appendix 1-8e: Map of South Texas DEON clinic network; Appendix 1-8f: Map of Alamo Area DEON clinic network). The majority of our community-based training is provided in designated Dental Health Professional Shortage Areas (HPSA) in South Texas (Appendix 1-8g: Dental HPSA map for the South Texas Border Region; Appendix 1-8h: Licensed dentist Per 100,000 Population). Students community-based education is primarily focused on four geographic regions Alamo Area (San Antonio and surrounding counties), Lower Rio Grande Valley (e.g., Harlingen, Texas), Mid Rio Grande Border Area (e.g., Laredo, Texas), and the Winter Garden Border Area (e.g., Eagle Pass, Texas) (Appendix 1-8i: Map of Dental School s Training Sites in South Texas). Examples of representative program affiliation agreements with South Texas clinics, hospitals and schools appear in Appendix 1-8j. All affiliation agreements will be available for inspection during the February 21-23, 2012 Site Visit. In 2000, the Texas Legislature established the Laredo Regional Campus. In the past decade, the Dental School has implemented a number of dental educational programs in Laredo and along the San Antonio-Laredo corridor, including required dental student clinical training in preventive and primary dental care provision. The Dental School also provides an on-campus service-learning program in which San Antonio public school children come to the School to receive clinical 52

24 UTHSCSA Dental School CODA Self Study Report Standard One preventive services provided by students. Appendix 1-8k is a report summarizing the Dental School s community activities for FY Research Collaborations Dental School faculty members have established numerous research collaborations with other components of the UTHSCSA. Several prominent initiatives are described in Standard 6. International Collaborations The Dental School also has international affiliations with institutions of higher education. A Japanese Exchange Program was initiated in 1995 with two dental schools in Japan: Meikai University, School of Dentistry in Sakado, Saitama Asahi University College of Dentistry in Hozumicho, Motosu-gun, Gifu Dental students and faculty members from two schools in Japan visit the UTHSCSA Dental School for one week annually. The Japanese dental students are paired up with host dental students in San Antonio and attend classes with their UTHSCSA student partner. Each year, ten UTHSCSA dental students travel to Japan accompanied by two faculty members. Students and faculty visit Meikai University, School of Dentistry and Asahi University College of Dentistry. The Dental School recently renewed its long-standing affiliation agreement and supplemental Research program agreement with La Universidad Mariano Galvez De Guatemala in Guatemala City, Guatemala. The focus of the agreements is on collaboration in population-based research projects. The Dental School has established an affiliation agreement with the Saudi Arabian Cultural Mission (SACM) to provide advanced dental education programs for SACM postgraduate students who will return to Saudi Arabia upon completion of their respective training programs. B. Supportive Documentation for Standard 1 8: 1. Appendix 1-8a: Dental School Faculty Serving on UTHSCSA Committees 2. Appendix 1-8b: Dental Early Admission Program (DEAP) Partner Undergraduate Institutions 3. Appendix 1-8c: Dental School s Affiliations with Cooperating Institutions (Cooperative Agreement Table) 4. Appendix 1-8d: Summary of Dental School s Outreach Education and Service Programs 5. Appendix 1-8e: DEON South Texas Clinic Network 6. Appendix 1-8f: DEON Alamo Area Clinic Network (Bexar County) 7. Appendix 1-8g: Map of Federally Designated Dental Health Professional Shortage Areas in the South Texas Region 8. Appendix 1-8h: Dentist to Population Ratios in South Texas 9. Appendix 1-8i: Map of Dental School s Educational Outreach Training Sites in South Texas 53

25 UTHSCSA Dental School CODA Self Study Report Standard One 10. Appendix 1-8j: Examples of Program Affiliation Agreements with Clinics, Hospitals and Schools 11. Appendix 1-8k: UTHSCSA Dental School s Community Activity Reports for FY

26 STANDARD 2: EDUCATIONAL STANDARD PROGRAM 2: EDUCATIONAL PROGRAM 55

27 Student Admissions Standards 2-1, 2-1.1, and Specific written criteria, policies and procedures must be followed when admitting predoctoral students Admission of students with advanced standing must be based on the same standards of achievement required by students regularly enrolled in the program Transfer students with advanced standing must receive an appropriate curriculum that results in the same standards of competence required by students regularly enrolled in the program. 2-2 Admissions policies and procedures must be designed to include recruitment and admission of a diverse student population. Compliance: The UTHSCSA Dental School is in compliance with Standards 2-1, 2-1.1, and 2-2 Note: Standards 2-1 and 2-2 will be addressed first, followed by Standards and A. Description for Standards 2-1 and 2-2 Standards 2-1 and List the admission criteria for the dental program. Are the criteria weighted? If so, explain. Admissions criteria for the regular four-year predoctoral dental education program are described first followed by admissions criteria for the International Dentist Education Program. Admission Criteria for the Regular Four Year Predoctoral Dental Education Program Applicants are considered on a competitive basis with attention given to the undergraduate grade point average, DAT scores, evaluation by pre-professional advisors and/or university professors, extramural achievements and interviews conducted by members of the Admissions Committee. Admission criteria for the Predoctoral Dental Education at UTHSCSA appear in the UTHSCSA Catalog on page 114 (Appendix 2-1a). The UTHSCSA Catalog will be available onsite during the February 2012 Site Visit. Dental Admissions Test (DAT): DAT scores are considered on an individual basis as part of the overall evaluation of the candidate s entire academic record. The highest score from the last three exams is used to assess candidate performance. DAT scores older than five years at the time of application are not accepted. Transcript of College Credit: The minimum requirement for admission into the predoctoral dental education program is 90 semester hours of credit from a regionally accredited university. The 56

28 following courses, completed with a minimum grade of C, must be documented on the candidate's transcript: English Biology Physics Chemistry One year of college-level English Two years as required for college science majors, including one year of formal laboratory work One year as required for college science majors, including one year of formal laboratory work One year of general chemistry and one year of organic chemistry as required for college science majors, including two years of formal laboratory work. Biochemistry One semester (3 semester hrs.) * Statistics One semester (3 semester hrs.) * * Effective for the matriculating class of All applications are reviewed and considered for an invitation to interview on a competitive basis, using the objective component of the Dental School s Admissions Management Model Score derived from the overall GPA, the science GPA, and the academic average score from the DAT. No single criteria carry a specific weight. The formula for the Management Model Score is: (Science GPA x DAT-Academic Score/30 x 4 + Overall GPA) x 50 = Overall Score. The Associate Dean for Student Affairs considers the following factors in determining which applicants to invite for an interview: academic and personal background, including high school, parents education, extenuating circumstances affecting academic qualifications; socioeconomic situation and barriers to achievement; work experience, campus/community involvements and personal accomplishments; geographic issues, including South Texas and home in rural or underserved area; letters of evaluation/recommendation; personal essay in the application and evidence of commitment to dentistry; component scores on the DAT, especially the scores for the Biology, Inorganic and Organic Chemistry sections; and, course loads and upper division science preparation, university/college attended and time frame for university enrollment. 57

29 Letters of Evaluation: Letters of Evaluation are required from applicants. If a student is attending a school that has a health professions advisory committee, a letter of evaluation from the Committee is required. If a student is attending a school that does not have a health professions advisory committee, three letters of evaluation are required. Two of these must be from science faculty who can evaluate the applicant s performance and potential for success in dental school. The third can be from another faculty member (any field) or from a health professional who knows the student well. Criminal Background Check and Drug Testing: The dental school requests criminal background checks for accepted students. A criminal background check is part of the final acceptance process at UTHSCSA. Details concerning the background check policies of the Dental School are provided on pages of the UTHSCSA Catalog (Appendix 2-1a). Out-of-State Admission The total number of out-of-state students who are accepted for enrollment at the UTHSCSA Dental School is limited to 10% of the possible enrollment per class as stipulated by the Texas State Legislature. 2. Describe the process for selecting dental students. The selection process for the regular four-year predoctoral dental education program is described first followed by the selection process for the International Dentist Education Program. Selection Process for Regular Four-Year Predoctoral Dental Education Program The Texas Medical and Dental Student Application Services accept applications May 1 through October 1 of each year. Dental school applicants are interviewed between August and January of each year. Applicants who are selected for interviews are determined by the Associate Dean for Student Affairs, Dr. Adriana Segura, based on review of the applicants portfolios including the objective and subjective factors previously described. There are two separate but inter-related committees involved in the student selection process: the Admissions Committee and the Admissions Review Panel (ARP). The respective roles of the Admissions Committee and the ARP are described in the following paragraphs. The Admission Committee is composed of 16 faculty members and 6 dental students who are appointed by the Dental School s Committee on Committees. The Admissions Review Panel consists of six faculty members, who have diverse backgrounds and roles within the school, and all have experience with admissions matters. The members of the ARP for are: Dr. Adriana Segura, Associate Dean for Student Affairs, Dr. David Cox, Professor of Comprehensive Dentistry, Dr. Juanita Pineda, Assistant Professor; Director of Predoctoral Community Outreach Programs, Dr. Michael Huber, Associate Professor of Comprehensive Dentistry, Dr. Vidal Balderas, Assistant Clinical Professor, Comprehensive Dentistry, and Dr. John Gildersleeve, Professor of Comprehensive Dentistry. 58

30 Interviews are conducted each Monday during the fall semester. Applicants are first oriented to campus life at UTHSCSA, receive an overview of the curriculum and are provided financial aid information. Applicants then participate in interviews conducted by faculty and student members of the Admissions Committee as well as by other faculty members. The interview day culminates with a lunch with second, third and fourth-year dental students and a tour of the Dental School, also conducted by dental students. Appendix 2-1b is the Interviewer Evaluation Form used by faculty and students to summarize impressions of candidates after interviews. All applicants who are interviewed are then reviewed by the Admissions Review Panel (ARP), and are assigned a point total from 0 to 400 based on the factors indicated in Admission Review Panel Application Evaluation Sheet (Appendix 2-1c) which is used by the ARP to assign scores to candidates. The ARP then creates a rank ordered list of applicants. Prior to December 1st, the Admissions Committee reviews the rank ordered list and determines how many first round acceptance letters will be sent and to whom. After the first round of acceptance letters goes out, admission becomes a rolling process. In February, the Admissions Committee develops an alternate list. When the alternate list is set, rejection letters go out to those applicants who were not interviewed and those who did not make the alternate list. Offers of admission are made in the rank order approved by the Admissions Committee. The Admissions Committee can modify the ranking if new information about the candidate or extenuating circumstances arise. Examples of new information include, but not limited to: new course grades that do not meet the level of performance specified and new letters of evaluation that are inconsistent with other letters. Offers of acceptance are provided in writing by the Dean. In the event that the Dean is not available, the Associate Dean for Student Affairs may sign the letters. Selection Process for the International Dentist Education Program (IDEP) The UTHSCSA Dental School annually admits ten internationally trained dentists with advanced standing. These students enter dental school as third years and graduate with the DDS degree two years later upon successful completion of all courses and demonstration of competency. Applicants obtain information concerning the International Dentist Education Program (IDEP) admission criteria, policies and procedures through the Dental School s IDEP website. The IDEP Application Packet can be downloaded from the website. The application, interview/skills testing, and acceptance phases of the IDEP Admissions Process occur annually from August-December. Applicants also must successfully complete a 15-week IDEP Prematriculation Curriculum that takes place from March through June in order to be placed in into the 3rd year DDS class in July. The IDEP Pre-matriculation Curriculum is subsequently described in this standard. Admissions Criteria for the International Dentist Education Program (IDEP) The IDEP admission criteria require submission of the following documents from the applicant, and from testing, accrediting and educational institutions directly to the IDEP Office: fully completed, signed, and dated IDEP Application Packet; foreign dental school diploma confirming graduation date and award of dental degree (notarized copy); 59

31 foreign dental school transcripts (official school certified copy); course-by-course report of dental school transcript (original certified document) from Educational Credentials Evaluators (ECE) with a U.S. GPA of 2.5 or above; NBDE Part I score report (original certified document) with an overall score of 75 or above; TOEFL report (original certified document) with an Internet-based test score of 92 or above. The IDEP admission criteria include an evaluation of the applicant s foreign dental school curriculum, course grades, score reports, letters of recommendation, continuing dental education experiences, recent dental related activity, professional goals, and current dental knowledge and skills. After review of completed applications that meet the minimum IDEP admission criteria, applicants are selected by the IDEP Director, Dr. David Bohnenkamp, and scheduled for interviews and for knowledge and skills assessment in late October through mid-december. Acceptance into IDEP is based on an overall appraisal rating considering all admission criteria. The IDEP Director makes recommendations to the Vice Dean of the Dental School for rolling acceptance of the most qualified candidates from among those individuals who participated in the interviews and skills assessments. The IDEP Director establishes an alternate pool and rejection letters are sent to those applicants who were not interviewed and did not make the alternate pool. An ad hoc committee of faculty who served as IDEP applicant interviewers approves the acceptance of the entering class of ten IDEP students. Awarding of advanced standing credit is a function of the UTHSCSA Registrar, the Vice Dean, and the IDEP Director. Once accepted, IDEP students must successfully complete a 15-week Prematriculation Curriculum that provides a condensed review of the first 2 years of dental school at UTHSCSA. This course includes graded online review assignments, lectures, preclinical laboratory, and simulated clinical exercises to allow the IDEP students to demonstrate that they have the knowledge, skills, and values to begin treating patients under faculty supervision. Appendix 2-1d displays the IDEP Prematriculation Curriculum. The curriculum followed by IDEP students after prematriculation training is the same as that for students enrolled in the regular DDS degree program. This includes didactic lecture courses, written examinations, progress skills assessments, clinical competency examinations, supervised patient care in a General Practice Group (i.e., a clinical team), departmental rotations, and community-based clinics. IDEP students are fully integrated into the DDS class and must meet the same standards of competence for knowledge, skills, and values as those students in the regular program. 3. To what extent does the administration and faculty participate in the modification of admission criteria and procedures? Administrators, faculty and students are represented on the Admissions Committee. This committee reviews the admissions criteria and procedures and makes modifications as needed. In May of 2010, at the annual Dental School Faculty Advance, faculty reviewed the admission process, criteria for acceptance, applicant evaluation form and a new applicant evaluation form for use by interviewers. The new applicant evaluation form was structured around a series of 60

32 standardized interview questions to enhance calibration among interviewers, replacing a previous form that largely left questions to the discretion of the interviewer. Mock interviews were held at the Advance to pilot-test the new assessment form and the faculty also provided feedback on the new standardized interview questions. During the 2010 Advance, faculty also developed recommendations for objective assessment of the non-academic qualifications of applicants. Faculty input was incorporated into the two new forms: the interviewer Evaluation Form (Appendix 2-1b) and the Admission Review Panel Application Evaluation Sheet (Appendix 2-1c). Beginning in 2010, student and faculty interviewers were able to submit their applicant evaluation forms online, which has increased overall compliance and promptness dramatically. 4. How are applicants informed about the program s criteria and procedures for admission? Potential applicants can obtain information concerning admissions criteria and policies, program goals and curriculum, and information about the admission process from several sources including: Dental School Website at the Admissions and Student Affairs section; Office of the International Dentist Education Program; UTHSCSA Catalog; Office of the Registrar at UTHSCSA; ADEA Official Guide to Dental Schools: Admission Requirements of United States and Canadian Dental Schools; Texas Medical and Dental Student Application Service website; American Association of Dental Schools Application Service website; Predental and health professions association meetings at universities; Open house events for prospective applicants are conducted throughout the year; and, Presentations and exhibits by the Dental School at recruiting fairs and career days. Additionally, admissions criteria and procedures are provided annually to student advisors and coordinators of predental organizations at universities. The Office of Student Affairs coordinates visits annually with predental clubs throughout the state, educating students about dental careers and the application process. Each year, the Dental School sponsors a Summit meeting for the officers of predental organizations. A central application center processes applications to all medical and dental schools of The University of Texas System. Texas residents are required to apply through the UT Application Service system. Information about application procedures for Texas residents is available on the website of the Texas Medical and Dental Schools Application Service where students can apply online. Application information for non-texas residents is available through the American Association of Dental Schools Application Service (AADSAS) website. 61

33 5. If students who do not meet the program s admission criteria are admitted, what academic strengthening is provided in the area(s) of deficiency? Students are only admitted if they have met the specified criteria. The Admission Review Panel reviews each application to assure that students have the necessary prerequisites for successful participation in the predoctoral dental education program. 6. Describe how the program monitors and evaluates both attrition rates and performance of students in relation to admission criteria. Table 2-1 displays UTHSCSA dental student graduation and attrition statistics for regular admission classes matriculating For the six classes matriculating during this period, 94% of all students (518/551) have graduated from UTHSCSA Dental School. A total of 477 of 551 (87%) graduated on time in four years. Thirty-four students (6%) graduated 3 to 12 months late. Seven students (1%) with delayed graduation are still enrolled and on track to graduate in Thirtythree students (6%) who matriculated during departed the school, either through selfinitiated withdrawal (22) or school-initiated dismissal (11), and did not graduate. The Associate Dean for Academic Affairs, in conjunction with the Academic Performance Committee, annually analyzes reasons for student attrition. All 11 students dismissed by the Academic Performance Committee over the past six years were because of extensive academic deficiencies including cumulative GPA below standards and failure of multiple courses. One of these 11 students was dismissed after failing a remediation attempt and one student was dismissed for a combination of academic deficiencies and sub-standard professionalism. Four students were dismissed after the first year, four were dismissed after the second year and three were dismissed after the third year. The Admission Committee on a yearly basis reviews the admission process and admission criteria in conjunction with reasons for student attrition. As described above in the response to item 3, the new Admissions Review Panel Application Evaluation Form in Appendix 2-1c has facilitated thorough assessment of the weakness and strengths of candidates. 62

34 Table 2-1: UTHSCSA Dental Student Graduation and Attrition Statistics for Regular Admission Classes Matriculating Matriculation Year Number of students Withdrew Dismissed Graduated on time: 4 yrs 3 79 (88%) 1 80 (88%) 0 80 (87%) 2 75 (82%) 5 76 (81%) Graduated late still enrolled 0 87 (94%) Projected 6 still enrolled Total grads % 82 (91%) 85 (93%) 88 (96%) 84 (92%) 86 (91%) 93 (100%) Projected IDEP Dental Student Graduation and Attrition Statistics for Classes Entering the Junior Year in 2009, 2010 and 2011 Ten IDEP students entered into the junior (third) year in 2007, 2008 and 2009 respectively for a total of 30. To date, all students in the IDEP have graduated; 29 IDEP students graduated on schedule (97%) and one student graduated three months late (3%). The 20 IDEP students entering the third-year in 2010 and 2011 are currently on track for on-time graduations. Standard Briefly describe the institution s policies on admitting disadvantaged and/or minority students. In what documents are these policies stated? The Dental School is committed to recruiting and admitting students who reflect multiple perspectives and experiences. In recent years, competition for the relatively small numbers of minority students and for the most academically qualified students has become more intense in Texas. The Dental School feels a responsibility to maintain a vigorous recruitment effort to ensure matriculation of the best qualified students, and that each incoming class is diverse in many ways, including racially, culturally, socially and by gender. Recruitment is aimed at colleges and health careers high schools throughout Texas, and includes trips to colleges and universities with traditionally high minority enrollments. The recruitment strategy of the Dental School is designed to capitalize on HSC programs that bring high school and college students to campus for exposure to health careers opportunities. These programs include utilization of the Recruitment and Science Outreach Coordinator, and the Med Ed UTHSCSA program, described in the next paragraph. The Recruitment and Science Outreach Coordinator 63

35 serves as a point of contact between the UTHSCSA and secondary and post-secondary institutions, and facilitates visits to the HSC by school groups. The Med Ed program, offered through the School of Medicine, provides college preparatory seminars, offers SAT preparation classes, conducts career fairs and field trips to the HSC and provides counseling to high school students in the South Texas region. Med Ed staff help arrange visits to the Dental School and also for Dental School staff to visit the Valley to meet students and discuss the opportunities. Additionally, the Office of Student Affairs coordinates recruiting visits to high school, college and university campuses so that students of all types, backgrounds, and cultures are reached. Finally, the Office of Student Affairs coordinates visits with predental clubs throughout the state, educating students about dental careers and the application process. The annual Predental Summit is designed to seek interest from many Universities. Efforts are being made to increase scholarship funds available for recruiting a highly qualified and diverse class. The Dental School has an admissions policy that evaluates applicants in a comprehensive manner, giving consideration to academic credentials and to non-cognitive factors, including hometown, work experience, campus and community involvement and leadership experience, bilingual abilities, obstacles overcome, parents education and socioeconomic background. The school strives to matriculate a diverse class each year. This encompasses many types of diversity, and goes beyond only racial or ethnic diversity. Every year the Texas Higher Education Coordinating Board requests that public colleges, universities and health related institutions update the matriculation targets for underrepresented minority students (URM). The Dental School strives to meet the state s target goals for African American and Hispanic students. The University of Texas Health Science Center at San Antonio does not discriminate on the basis of race, color, national origin, religion, handicap or sexual orientation in any of its policies. The following statement appears in the UTHSCSA Catalog; Page 81: It is the policy of The UT Health Science Center San Antonio to provide an educational and working environment that provides equal opportunity to all members of the university community. In accordance with federal and state law, the university prohibits unlawful discrimination on the basis of race, color, religion, sex, national origin, age, disability, citizenship, and veteran status. Discrimination on the basis of sexual orientation is also prohibited pursuant to university policy. Matriculation data for is displayed in Table 2-2. Underrepresented minority students comprised 16% of the past six matriculating classes (88/567), with total ethnic diversity (URM, Asian and multiple ethnicity) representing approximately 41% of these classes (234/567). Analysis of the diversity of the entering class of identified no discernable reason for the lower enrollment of URM students (n = 7) in that class. First year enrollment of URM students doubled to 15 in the following academic year, , and further increased to 20 in class entering during the academic year, suggesting that 2007 may have been an aberration. Across the sixyear time frame, females comprised 47.4% (269/567) of the first year matriculating students. 64

36 Table 2-2: Entering Dental Class Diversity Characteristics, Year Total Enrolled Females URM Students African American American Indian / Alaska Native Hispanic * Total URM Asian Multiple ethnicity Unknown Caucasian Total Ethnic Diversity URM, Asian, Multiple 29 31% 21 23% 45 46% 45 48% 47 49% * Notes on Table 2-2: URM = African American, American Indian, Alaska Native and Hispanic Asian Americans are not designated as URM students per University of Texas guidelines. Additionally, the Dental Early Admissions Program (DEAP) is implemented in collaboration with 20 participating colleges in Texas to allow selected college students to enter Dental School after three college years, and earn a bachelor s degree following the first year of Dental School (Appendix 1-8b). A number of the participating DEAP colleges have high minority enrollments. The DEAP saves the selected students time and money, without having to give up the bachelor s degree. DEAP students must obtain a 3.4 overall GPA, 3.4 science GPA and a DAT score of 18 to matriculate into dental school. Data for the , and applicants and acceptances are displayed below. In the past three years, 12 underrepresented minority students have matriculated into the Dental School. Applications Total Accepted African American Accepted Hispanic Accepted Average GPA 48 49% Average DAT

37 Standards and Admission of students with advanced standing must be based on the same standards of achievement required by students regularly enrolled in the program Transfer students with advanced standing must receive an appropriate curriculum that results in the same standards of competence required by students regularly enrolled in the program. 8. Does the dental program admit students with advanced standing and/or transfer students? If yes, describe the policies and methods for awarding advanced standing/transfer credit. International Dentist Education Program Through the International Dentist Education Program (IDEP), the UTHSCSA Dental School annually admits ten internationally trained dentists with advanced standing into the predoctoral education program leading to the D.D.S. degree. The admissions criteria and selection process were previously described in Standard 2-1 on pages IDEP applicants who are admitted after thorough review of their academic credentials and who successfully complete the 15 week IDEP Prematriculation Curriculum enter into the third year of dental school and are fully integrated into the 3 rd year class. IDEP students must meet the same standards of competence for knowledge, skills, and values as students admitted into the regular four-year predoctoral program. Transfers in Regular Predoctoral Education Program Outside of the IDEP, the regular predoctoral dental education program very infrequently admits students via transfers for advanced standing. The policies for Admission by transfer and a list of the required documents for a completed application are available on the Dental School website (Appendix 2-1e). Applications for transfer matriculation are due January 1st of each year. Only outstanding applicants are invited for interviews by the Admissions Committee. The number of applicants interviewed is limited by the quality of the applicants and by the number of positions available. Accepted transfer students are placed into a class in the regular curriculum, at a level designated by the Associate Dean for Academic Affairs based on a recommendation of the Admissions Committee. 9. How many applicants, i.e., individuals who have submitted required credentials: a. Were there for the most recently admitted class? b. Met minimum admission criteria? c. Were offered admission? d. Were enrolled? e. Were enrolled with advanced standing? f. Were enrolled as a transfer student? Table 2-2a indicates applications and admissions for the UTHSCSA Dental School class matriculating in For the regular predoctoral education program, 1050 applicants submitted credentials and 315 met admissions criteria. A total of 145 were offered admission, and of these, 66

38 98 enrolled. For the 2011 admissions into IDEP, 281 applicants submitted full sets of credentials and 48 met admissions criteria. A total of ten were offered admission, and of these, ten enrolled. Table 2-2a: Application and Admissions Data for Dental School Class Matriculating in 2011 In-State Out-of- Totals for IDEP State Transfer Predoctoral Program Advanced Standing Applications Met Criteria Offered Admission Enrolled C. Supportive Documentation for Standards 2-1, 2-1.1, and Appendix 1-8b: Dental Early Admission Program (DEAP) Partner Undergraduate Institutions 2. Appendix 2-1a: UTHSCSA Catalog (Hard copy available onsite at Site Visit) 3. Appendix 2-1b: Interviewer Evaluation Form 4. Appendix 2-1c: Admissions Review Panel Applicant Evaluation Sheet 5. Appendix 2-1d: IDEP Prematriculation Curriculum 6. Appendix 2-1e: Guidelines for Transfer Admissions Instruction Standard In advance of each course or other unit of instruction, students must be provided written information about the goals and requirements of each course, the nature of the course content and the method(s) of evaluation to be used. Compliance: The UTHSCSA Dental School is in compliance with Standard 2-3. A. Description for Standard 2-3 A syllabus is provided to students in advance of each course containing written information that communicates course goals, objectives, competencies addressed, content and methods of evaluation. In recent years, students have either received a written syllabus, or an electronic version of the syllabus is made available at the Blackboard (online course management system) site for the course. Dental students are informed at the orientation for each academic year that they must be provided with a syllabus for each course and they are encouraged to inform the Office of Academic Affairs if they fail to receive it. 67

39 The Curriculum Management Committee of the UTHSCSA Dental School developed a Syllabus Template (Appendix 2-3a) that identifies required components, including: Official course number and course title Name of course director, contact phone number, address, and room number Overview of the course Goals and objectives UTHSCSA Dental School Competencies that are addressed by this course Methods of evaluation used Grading Policy Attendance policy Missed exam policy Remediation program List of required and recommended textbooks List of topics that are addressed in each session of the course Description of how values, professionalism and professional development will be evaluated In quarterly Course Director Forums and through other mechanisms, the Associate Dean for Academic Affairs communicates the roles and responsibilities of course directors to the UTHSCSA Dental School faculty. Faculty who assume course director roles are informed that it is their responsibility to provide students with appropriate course details, as identified above, in a timely fashion prior to the initiation of a course, or prior to the start of a clinical course or rotation. Matriculating students also receive the document entitled UTHSCSA Dental School Competencies for Predoctoral Dental Education Program (described in Standard 2-7 and appears in Appendix 2-7a) during the orientation at the beginning of year one, and these competencies are posted on the Dental School intranet. Enhancements to Dental School Syllabi The syllabus template is distributed to all course directors annually and is available at the Dental School Blackboard site called Faculty Resources. In 2011, a menu-driven electronic (online) syllabus template was developed to allow faculty to enter information pertinent to each of the required syllabus components directly into the template. Beginning with the fall 2012 semester, all syllabi will be created using this online template, which will increase standardization of format. The Self Study Review process also identified that syllabi components were sometimes merged into laboratory or clinic manuals rather than being independent documents that can be easily accessed by students. This hindered students ability to identify course assignments, understand expectations for course elements such as attendance, missed exams and remediation, and understand assessment methods. At the October 2010 Faculty Development Day, faculty endorsed the proposal that course syllabi and lab or clinic manuals for the same course should be distinct and separate entities. During , course directors are revising their course documents as an outcome of this decision. The Self-Study Review process also determined that syllabi did not uniformly exist for all clinical rotations, including experiences in community-based clinics, where students have learning activities away from the General Practice Groups (GPGs). During , syllabi were developed for all student rotations. 68

40 B. Supportive Documentation for Standard 2-3: 1. Appendix 2-3a: Dental School Syllabus Template 2. Appendix 2-3b: Syllabi for Dental School Courses and Rotations Due Process Standard If students do not meet the didactic, behavioral and/or clinical criteria as published and distributed, individual evaluations must be performed that lead to an appropriate decision in accordance with institutional due process policies. Compliance: The UTHSCSA Dental School is in compliance with Standard 2-4. A. Description for Standard 2-4 The due process policies, appeal and disciplinary procedures for all UTHSCSA students, including dental students, are described in the UTHSCSA Catalog ; pages (Appendix 2-1a). Due process policies are also described in the UTHSCSA Handbook of Operating Procedures; section (Appendix 2-4a: Procedures and Regulations Governing Student Conduct and Discipline). These academic policies are intended to promote timely student progression through the curriculum; ensure due process; and facilitate monitoring of student performance. These policies are designed to ensure that when students fail to meet the academic standards established by the faculty in all didactic, laboratory and clinical courses and/or fail to meet the standards for professional conduct, assessments are performed that lead to appropriate decisions in accordance with institutional due process policies. Academic Standards and Assessment The academic standards that define successful completion of a course, assessment methods and grade assignment are established by the department or faculty group under which the course is administered. In arriving at a final grade for a student, consideration is given to written, oral and practical examinations as well as clinical performance when applicable. Non-cognitive factors, including professionalism, are part of course expectations and are also evaluated and used to determine the student s course grade. Non-cognitive factors include: performance under stress, integrity, initiative, interpersonal relations and personal and professional characteristics. Appendix 2-4b indicates the Dental School s professionalism expectations for students. A copy of the assessment standards and grading policy for each course is given to students at the beginning of the course as part of the syllabus. A student may appeal a course grade directly with the Course Director. If the student is not satisfied with the decision by the Course Director, he/she may appeal the grade to the Chair of the Department in which the course is given. 69

41 All students must meet the Dental School's Standards for Promotion and Graduation of Dental Students (Appendix 2-4c), which are periodically reviewed and updated by the Dental School faculty with the most recent modification occurring in These 2011 modifications consist primarily of updates based on changes in the Dental School organizational structure, but not of the core academic standards. Students are informed of the critical components of the standards during the curriculum orientation at the beginning of year one and are reminded each year to review the standards posted on the Dental School intranet. At the end of fall semester in December, students who are not meeting the academic standards are notified, at which time students may be placed on academic probation. All students receive notification of their academic performance, as recommended by the Academic Performance Committee, from the Associate Dean for Academic Affairs at the end of each spring semester. Academic Performance Committee The Dental School Academic Performance Committee (APC) is charged with assessing each student s performance and making recommendations pertaining to students continuation in the predoctoral dental education program. The charge to the APC, committee membership and areas of responsibility are described in the document: Academic Organization and Bylaws of the UTHSCSA Dental School (Appendix 1-6a). The APC makes recommendations for promotion from year to year, graduation and other decisions for students in academic difficulty. The protocol for student assessment and decision-making by the APC appears in Appendix 2-4d. Students are recommended for promotion to the subsequent academic year if a grade point average of 2.0 or above is achieved in both the Group A and Group B courses (Appendix 2-4e) and a passing grade has been achieved in all courses in the year's curriculum. Group A courses include basic science and dental didactic courses and Group B courses include pre-clinical laboratory and clinic courses. Course Directors may assign a grade of I (incomplete) if they accept the reason for a student's failure to satisfactorily complete required work. A grade of "I" that is not corrected prior to the end of the academic year must be corrected during the summer remediation period in most cases. Exceptions are made for special circumstances on a case-by case basis. For students experiencing academic difficulty, the APC can make one of four recommendations: 1.) remediation of a specific course or courses; 2.) repetition of the entire academic year; 3.) academic dismissal; or, 4.) placement on an altered curriculum. A student receiving a GPA below 2.0 in Group A and/or Group B courses of a year's curriculum will be considered for dismissal. However, after reviewing the student's entire academic record and any extenuating circumstances and interviewing appropriate faculty, the APC may recommend repetition of the year or remediation of a course in lieu of dismissal. A recommendation to remediate a specific course in the summer, or to repeat the year may be made for students with one or more F grades, but with a GPA above 2.0. An altered curriculum may be offered to a student who successfully completes the third year curriculum but has failed the National Board Dental Examination (NBDE) Part 1 three times and is required to wait an entire year before 70

42 retesting. Students may not be promoted to the fourth year without successfully completing NBDE Part 1 (see promotion standards in Appendix 2-4c). The Registrar s Office is responsible for recording grades and calculating students grade point average (GPA). A report is sent to the APC by the Registrar s Office at the end of the fall semester identifying students who have failed a fall course or do not meet the GPA requirements for both Group A and B courses. Students who fail a course are placed on academic probation and are informed of this status by that is followed up by a written memorandum from the Associate Dean for Academic Affairs. The report sent to the APC at the end of the spring semester is the one that is used for decisions for promotion and graduation. If a motion is made by the APC to dismiss a student, the motion is tabled, the student is informed and is given the option of appearing before the committee before a final vote is taken. There is an interval of several days between the tabled motion and the time the student meets with the committee. This interval allows the student to prepare his/her statement and to find faculty who may speak on his/her behalf. The Associate Dean for Student Affairs offers assistance to the student during this process. Decisions concerning students in academic difficulty are generally made by the APC at the end of the spring semester when the students entire academic record can be evaluated for the year. There are three exceptions to the policy of waiting until the end of the spring semester for the APC to make decisions, which are described below. 1.) Seniors who fail a course that ends before the conclusion of the year may be allowed to remediate the course during the academic year, if time and faculty supervision is available. 2.) A student who is repeating the year and is already on academic probation, and who fails to maintain academic standards, may be dismissed before the end of the academic year. 3.) Students may lose clinic privileges during the third or fourth year if patient safety is a concern. In this event, the core faculty of the GPGs that monitor students progress in years three and four may recommend a failing grade in INTD 7020 Clinical Patient Management, the primary third year clinical course (Appendix 2-4f) or GEND 8077 General Dentistry Clinic (Appendix 2-4g), the primary fourth year clinical course. Both of these courses cannot be remediated. The course director conducts an investigation into the problems identified by the supervising clinical faculty. If, as an outcome of this investigation, an F grade is submitted, the student is informed and reminded of the appeal process. The student can submit an appeal for a review of the grade to the Chair of the Comprehensive Dentistry Department, which is responsible for implementation of INTD 7020 and GEND 8077, after the failing grade is assigned. If the F grade remains on the student s transcript after departmental review of a student-initiated appeal, the student is requested to appear before the Academic Performance Committee as soon as the committee can convene to determine what should occur next: dismissal or development of an altered curriculum. 71

43 Student Appeal of Decision by the Academic Performance Committee A student may appeal the decision by the Academic Performance Committee that recommends remediation, repetition of the year, or academic dismissal by submitting a written request to appeal to the Dental School Dean within five days following receipt of written notification of the recommendation. The Dean consults with appropriate individuals and renders a decision to uphold or overturn the recommendation of the Academic Performance Committee. The student receives written notification of this decision. Procedural appeal may be made to the UTHSCSA President in accordance with UTHSCSA Policy (Appendix 2-4a: UTHSCSA Handbook of Operating Procedures; section Procedures and Regulations Governing Student Conduct and Discipline). Support for Academic At-Risk Students During each semester, Dental School course directors communicate students examination grades and other indicators of academic progress (such as skill assessments in laboratory courses and in the clinic) to the Associate Dean for Academic Affairs who shares them with the Associate Dean for Student Affairs. Students at risk may be contacted by the Associate Dean for Academic Affairs or Associate Dean for Student Affairs and requested to make an appointment to discuss progress and potential consequences of continued poor performance. Students experiencing academic difficulty are informed that student tutors may be available for assistance. They are also advised to visit with their faculty advisors and/or counselors available at the UTHSCSA Office of Student Services, depending upon factors contributing to their academic difficulty. National Board Policy Students must pass Part I of the National Board Dental Examination for promotion to the senior year. Subsequently, students must pass Part II of the National Board Dental Examination (NBDE) to graduate. Third-year students who fail the NBDE Part I a total of three times and thus are required to wait one year for retesting, cannot progress into the senior year. An altered curriculum may be developed to allow the student to concentrate on preparation for the NBDE Part I while maintaining a level of clinical skills that would be consistent with an entry level senior if the student passes NBDE Part I at the end of the one-year waiting period. Fourth-year students who are unable to pass NBDE Part II before graduation can remain on campus as students until the end of the current academic year, which provides them with access to all normal school-related educational resources. Fourth-year students who have not passed NBDE Part II before the start of the next academic year can be enrolled as a special student, with a reduced tuition, in order to have access to the Dental School resources. Certification for Graduation To be recommended for graduation, student candidates must have satisfactorily fulfilled the academic requirements of the dental school curriculum, have a cumulative GPA of 2.0 or above, have passed Parts I and II of the National Board Dental Examinations, be in good professional standing, and comply with all necessary legal and financial requirements as described in the document Standards for Promotion and Graduation of Dental Students (Appendix 2-4c). Final certification of senior students for graduation is made by the Dental School Faculty Council that is comprised of the Dean, Vice Dean, Associate Deans, Dental School department chairs, two chairs of Basic Science Departments in the UTHSCSA School of Medicine, two full-time faculty 72

44 representatives from the Dental School, and one full-time representative from among the School of Medicine s Basic Science faculty members who teach in the Dental School. All of the aforementioned members of the Faculty Council whom are voting members. Thus, certification of fourth-year students for graduation is based on a broad based panel of administrators and faculty members. B. Supportive Documentation for Standard 2 4: 1. Appendix 1-6a: Academic Organization and Bylaws of the UTHSCSA Dental School 2. Appendix 2-1a: UTHSCSA Catalog (Hardcopy available onsite during Site Visit) 3. Appendix 2-4a: UTHSCSA Handbook of Operating Procedures; Chapter Procedures and Regulations Governing Student Conduct and Discipline 4. Appendix 2-4b: Professional Development Expectations for UTHSCSA Dental Students 5. Appendix 2-4c: Standards for Promotion and Graduation of Dental Students 6. Appendix 2-4d: Protocol for Student Assessment and Decision-making by the Academic Performance Committee 7. Appendix 2-4e: Dental School Courses in Group A and Group B 8. Appendix 2-4f: Course Syllabus for INTD 7020 Clinical Patient Management 9. Appendix 2-4g: Course Syllabus for GEND 8077 General Dentistry Clinic Curriculum Management Standard The curriculum must include at least four academic years of instruction or equivalent. Compliance: The UTHSCSA Dental School is in compliance with Standard 2-5. A. Description for Standard 2-5 The Dental School has a four-year curriculum comprising a total of 4787 hours of scheduled curricular activity as displayed in Table 2-5. The total hours and allocations for curricular components are consistent with national means reported by the ADA for all U.S. dental schools (Source: ADA, Survey Center. Survey of Dental Education: ; Volume 1). Pages of the UTHSCSA Catalog (Appendix 2-1a) provide a year-by-year overview of the curriculum and pages of the Catalog list and describe each core course and each selective course. Appendix 2-5a (CODA Table 3) displays the Dental School courses by class year including the number of hours per course and hours per instructional format. Appendix 2-5b provides class schedules for each academic year. 73

45 NOTE: For Appendix 2-5a and 2-5b and other appendices and listings for this Self Study Report, numbering for courses follows this format: 5000 numbers First year courses 6000 numbers Second year courses 7000 numbers Third year courses 8000 numbers Fourth year courses Table 2-5: UTHSCSA Dental School Curriculum Overview Curriculum Component Hours % Biomedical Sciences % Dental / Clinical Sciences % Behavioral, social, information and research sciences % Total % Each academic year consists of two semesters (fall and spring) and a summer term. Students register for the entire year. The fall semester begins during the first full week of July and concludes in mid December. The spring semester begins the first week of January and ends the last week of April for seniors, and the middle of May for all other students, at which time all core courses are concluded. The summer term is from mid-may to June 30. This period is reserved for remediation and for selective courses to enhance and diversify the students overall educational experience. There is a two-week break in December, and a one-week spring break is scheduled to coincide with the ADEA and AADR meetings to allow participation by students and faculty members. Selective Program A summer selective program provides students with opportunities to diversify their learning experiences and supplement the core curriculum. Appendix 2-5c indicates selective courses available to UTHSCSA dental students. The summer selective program was created to address several concerns. 1. For years, many students used the summer for curriculum augmentation with clinical electives, but often through informal processes in which students made their own arrangements for projects and learning experiences with individual faculty members. Prior to 2006, the fall semester started the third week of July, and the spring semester ended in mid-may, which created issues regarding student enrollment status and institutional liability. 2. For the informally arranged programs, there was no way to document on the students transcripts what had been accomplished. 3. As a consequence of the two-month hiatus, it was noted by faculty that students skills deteriorated requiring catch-up activities at the start of the fall semester, which contributed to a slow start in the clinic for some students. 4. The predoctoral clinics were underutilized during the extended summer hiatus. 74

46 To address these issues, a faculty task force recommended use of the mid-may to mid-july period for a summer comprehensive care clinic for both juniors and seniors. A pilot was implemented in 2006 and 2007 for a four-week summer clinic using half days for both rising juniors and seniors. Based on feedback from faculty and students, this pilot was discontinued in favor of beginning the fall semester two weeks earlier in July. After discontinuation of the summer comprehensive care clinical pilot, selectives were scheduled mid-may through June 30 including South Texas Rotations, Hospital Dentistry, Oral and Maxillofacial Surgery and Pediatric Dentistry. The Dental School Faculty Council encouraged faculty to develop additional summer selective courses, especially in the specialty areas, so that students could select from a menu of courses. Currently, for students transitioning from the third to the fourth year, the summer is divided into three two-week blocks. With the exception of the DDS/PhD students, each rising senior is required to enroll in one approved clinical selective, during one of these blocks. The DDS/PhD students complete a 6-week research program during the summer. Rising second and third year students are required to complete at least one selective during the summer. Students may enroll in other selectives based on personal interests after it has been certified that all students are enrolled in at least one selective. There also are a limited number of selective courses in the fourth year that seniors may take in conjunction with the regular curriculum, again designed to allow students to customize their curriculum and pursue special interests. B. Supportive Documentation for Standard 2 5: 1. Appendix 2-1a: UTHSCSA Catalog ; Pages ; (Available onsite) 2. Appendix 2-5a: Schedule of Courses (CODA Table 3) 3. Appendix: 2-5b: Class Schedules for First, Second, Third and Fourth Years 4. Appendix 2-5c: List of Selective Courses Goals of Dental Education Program Standard The goals of the dental education program must include the preparation of graduates who possess the knowledge, skills and values to begin the practice of general dentistry. Compliance: The UTHSCSA Dental School is in compliance with Standard 2-6. A. Description for Standard 2-6 Educational goal 3 of the Dental School Mission, Goals and Objectives (Appendix 1-1a) is to graduate competent dentists who demonstrate that level of skill, knowledge, attitudes, behaviors, ethical practices, and experiences necessary to make the transition from faculty supervision to the unsupervised practice of general dentistry. As described in the response for standard 2 7, the competencies that our students are required 75

47 to attain for graduation are based on the knowledge, skills and values needed for entry-level professional performance as a general dentist. The Dental School Competencies are periodically evaluated and revised by the faculty to ensure focus on professional roles and capacities that are consistent with the contemporary practice of general dentistry. The most recent comprehensive review of the competencies, coordinated by the Curriculum Committee, started in 2008 and concluded in February, General Practice Groups A core focus of the curriculum for UTHSCSA dental students is the two year clinical education experience within a General Practice Group (GPG) a clinical practice team, where students (12/13 juniors and 12/13 seniors) on each GPG are coached and mentored on a daily basis by a core of four faculty in a comprehensive care model. Each GPG is directed by a general dentist and each assistant group leader is also a general dentist. Thus, the students primary role models during their clinical education are general dentists. The other core GPG faculty function as a restorative dentist and a Prosthodontist, and supported by faculty consultants from the other dental specialties as needed for treatment planning and delivery of patient care. The GPG experience also includes seminars and conferences that address issues pertinent to the practice of general dentistry. The GPG format for the clinical curriculum is further described in standards 2-8 and 2-9. B. Supportive Documentation for Standard 2 6: 1. Appendix 1-1a: UTHSCSA Dental School Mission, Goals and Objectives Competencies and Educational Outcomes Standard The dental school must define the competencies needed for graduation, which must be focused on educational outcomes. Compliance: The UTHSCSA Dental School is in compliance with Standard 2-7. A. Description for Standard 2-7 The UTHSCSA Dental School Competencies for Predoctoral Dental Education are in Appendix 2-7a. This document also includes a preamble that discusses the Dental School s concept of competency-based education, presents seven guiding principles for the design of the curriculum, and provides an explanation of the format and definitions. The competencies describe the knowledge, values and skills expected of graduates as identified by the faculty of the Dental School. To demonstrate readiness for entry into the practice of general dentistry, UTHSCSA dental students must demonstrate that they can accomplish the competencies described in this document, which indicate the knowledge, values and skills that new graduates need to begin their professional roles in society. It is recognized that these competencies 76

48 represent only a starting point for the dentist s life-long professional journey, a journey which must include ongoing developmental activity to enhance, refine and maintain patient care skills, and to develop new capabilities needed to serve the evolving oral health needs of the public. The competencies are periodically reviewed and updated by the faculty with broad-based input from all departments. The most recent review began in 2008 when the Curriculum Committee was charged with revising the competencies. The Dean charged the Curriculum Committee to analyze the recommendations that were being made at that time for modification of the CODA predoctoral accreditation standards to ensure that the Dental School s newly updated competencies would be contemporary and consistent with CODA directions. After several months of modification, the competencies document was critiqued at the Dental School Faculty Advance in May 2009 and again at the annual Faculty Development Day in October 2009 for additional feedback. Final approval of the newly updated competencies by the Dental School Faculty Council occurred in February Format for UTHSCSA Dental School Competencies The UTHSCSA Dental School has 20 competency domains. Each domain is a description of an essential patient care skill or professional role that the entry-level general dentist must be able to perform satisfactorily and independently. Each competency is supported by several educational outcomes that identify the biomedical knowledge, technical/procedural skills, patient management skills, communications skills and professional behaviors that students must perform to demonstrate competency. The educational outcomes are indicators of the student s capacity to attain the overall competency. The competencies apply to the assessment, management and treatment of dental patients at all life-stages: infant, child, adolescent, adult and the elderly and also apply to individuals with special needs including medically compromised, elderly and underserved and vulnerable populations. The Dental School Competencies are explained to matriculating first year students during their orientation period prior to the initiation of coursework. Course syllabi identify the competencies addressed in that particular course and display the relationship of course objectives to specific competencies. The competencies are also posted on the Dental School intranet. As described in Standards 2-8 and 2-25, the monthly comprehensive progress assessments that third and fourth year students receive from their General Practice Groups (GPGs) are based on the 20 domains to help both students and faculty monitor progress toward attainment of competency in these dimensions of general dental practice. The students comprehensive, end-of-year assessment (year 3) and competency attainment certification (year 4) are also based directly on the school s competency domains, which are linked directly to specific CODA educational standards. The assessment process and forms used for end-of-year assessments are described in Standard 2-8. B. Supportive Documentation for Standard 2-7: 1. Appendix 2 7a: UTHSCSA Dental School Competencies for Predoctoral Dental Education 77

49 Competency Evaluation Methods Standard The dental school must employ student evaluation methods that measure the defined competencies. Compliance: The UTHSCSA Dental School is in compliance with Standard 2-8. A. Description for Standard 2 8 The UTHSCSA Dental School definition of competency is: That level of knowledge, values, judgment, skill and experience required by the new dental school graduates to begin the independent and unsupervised practice of general dentistry (Page 3 of Appendix 2-7a: UTHSCSA Dental School Competencies for Predoctoral Dental Education). Competency" includes knowledge, experience, critical thinking and problem-solving skills, professionalism, ethical values, and technical and procedural skills. The competencies that UTHSCSA dental students are expected to attain are indicated in the UTHSCSA Dental School Competencies for Predoctoral Dental Education in Appendix 2-7a. Twenty competencies are defined by a set of educational outcomes that can be measured in one or more of three areas: knowledge, skills and values. The Dental School s assessment model has two purposes: (1) monitor students progression toward designated competencies (in other words, are students attaining appropriate developmental milestones along the path to competency) and, (2) certify students attainment of both individual competencies and overall COMPETENCY (readiness for unsupervised, entry-level general dental practice in the public domain). The assessment model is a three - step process that spans the curriculum: 1. evaluation of students acquisition of foundation concepts, skills and values that provide the framework for competency; 2. evaluation of students progression toward each of the UTHSCSA Dental School competencies pertinent to CODA standards 2-16 through 2-27, as well as progression toward overall competency (hitting appropriate developmental milestones); and, 3. final certification of each student s attainment of UTHSCSA Dental School competencies pertinent to CODA standards 2-16 through 2-27, as well as certification of OVERALL COMPETENCY, which is the students capacity to put it all together consistently over an extended period of time when functioning in an approximation of a general dentistry practice model as implemented in the school s General Practice Group format). The responses for Standards 2-16 through 2-27 distinguish these levels of assessment in the descriptions of evaluation methods. The following section provides an overview of how each of these levels of evaluation are implemented. 78

50 Assessment of Foundational Knowledge and Skills and Initial Progress Toward Competency in Years One and Two: In years one and two of the curriculum, students are evaluated on their acquisition of foundational knowledge and skills for basic, behavioral and clinical sciences, and preliminary progress toward competency by several methods including but not limited to: written examinations in several formats; written reports, analyses and reflection papers; critical analyses and summaries of the biomedical literature; individual and group (team) projects, typically involving investigation of topics and issues and development of proposals and reports; timed preclinical skill assessments performed independently without faculty assistance in simulation laboratory courses; and, objective structured clinical examinations (OSCEs), and other types of station exams. Specific assessment methods are described in the responses to standards 2-16 through 2-27 for acquisition of foundational knowledge and skills, and measuring progress toward competency. Assessment of foundational knowledge is also determined by satisfactory (Pass) performance on the National Board Dental Examination, Part I, which most students complete during the summer term of the second academic year. To be certified for advancement into the third year, students must pass all courses in years one and two and meet other expectations that are stipulated in the school s Standards for Promotion and Graduation of Dental Students (Appendix 2-4c) as described in Standard 2-4. Competency Assessment in Years Three and Four The assessment strategy employed in years three and four to evaluate progression toward, and ultimate attainment of individual competencies and overall competence (readiness for independent practice) is based on three interconnected elements consistent with assessment best practices described in the health professions education literature, and recommendations by the American Dental Education Association (ADEA), the Joint Commission on National Dental Examinations (JCNDE) and the Commission on Dental Accreditation. These three elements are depicted in Figure and described below. 79

51 Figure 2-8-1: Elements of UTHSCSA Dental School Competency Assessment Model Assess component & overall competency multi-source assessment Longitudinal assessment over 2 yrs by GPG faculty Certification of Graduation Readiness Assess Component Competencies and Overall (Readiness for Practice) Competency During years three and four, student assessment focuses on: (1) demonstration of competency for individual skills that comprise components of an entry-level general dentist s overall professional toolkit, and (2) assessment of overall, or general, competency, which is the students ability to put it all together, consistently, over an extended period of time (Figure 2-8-2). Assessment in year three primarily focuses on student s progress toward competency in specific components of general dentistry, while assessment in year four focuses primarily on overall readiness for entry-level general dentistry. 80

52 Figure 2-8-2: General Competence and Component Competence Source: Albino, Young, Neumann, Kramer, Andrieu, Henson, Horn, Hendricson. Assessing Dental Students Competence: Best Practice Recommendations in the Performance Assessment Literature and Investigation of Current Practices in Predoctoral Dental Education. J Dent Educ. 2008; 72(12): The preamble to the 2008 ADEA Competencies for the New General Dentist states that a competency is a complex behavior or ability essential for the general dentist to begin independent, unsupervised dental practice. Competency includes knowledge, experience, critical thinking and problem-solving skills, professionalism, ethical values, and technical and procedural skills. These components become an integrated whole during the delivery of patient care by the competent general dentist (ADEA. J Dent Educ 2008; 72(7): 823 6). The highlighted sentence is the fundamental concept that underlies assessment in competency-based education, and is at the core of the Dental School s assessment model. This concept is stated in the Guiding Principles section of the school s Competencies for Predoctoral Dental Education document (Appendix 2-7a; preamble; page 3), and is the basis for the school s definition of competency. The revised CODA predoctoral education standards to be implemented in July 2013 also advocate this model of assessment in the intent statement for the new Standard 2-23: Programs should assess overall competency, not simply individual competencies, in order to measure the graduate s readiness to enter the practice of general dentistry (Accreditation Standards for Dental Education Programs; July 1, 2013; page 27). As articulated by Eraut in one of the seminal texts on competency assessment: Professional Knowledge and Competence, Professional competence is more than demonstration of isolated competencies. When we see the whole, we see its parts differently than when we see them in isolation (Eraut M. Professional Knowledge and Competence. London: Falmer Press, 1994). 360 O Multi-Source Assessment Thirteen different assessment data sources are analyzed to develop a comprehensive 360 O assessment of each student s progress toward and ultimate attainment of specific competencies associated with CODA Standards 2-16 to 2-27, and each student s overall readiness for 81

53 independent, unsupervised practice after graduation. All of the assessment data sources identified in Table are reviewed and considered by each student s GPG faculty to reach an appraisal of the student s progress, and in the second semester of the senior year to certify the student s acquisition of all designated competencies. The assessment system includes four steps that form a continuum of assessment. 1. daily, formative assessments of student s performance during every patient care situation that occurs within the GPG, which are analyzed to guide development of. 2. monthly progress evaluations covering 25 dimensions of performance including all Dental School Competencies, which are analyzed to guide development 3. end-of semester and end-of-year comprehensive evaluations; and then 4. all data sources across years 3 and 4 are considered to develop an end-of-program competency attainment certification and assessment of readiness for independent practice. Each step is subsequently described and forms are provided in the appendices. Table 2-8-1: Multiple Types of Evaluation Data Used in 360 O Assessment of Students By GPGs Data Source Description Evaluations of performance on 62 independently performed clinical skill evaluations in years 3 and 4. Evaluations for all rotations during yrs 3 and 4 including the South Texas Rotation, rotation at homeless shelter, oral surgery rotations, and pediatric dentistry rotations at community clinics Table shows independently performed clinical skill & linkage to Standard 2-25 a-n Table Appendix 2-3b Performance in 3 rd year Oral Surgery Course Standard 2-25k Grades in discipline-based clinical courses in 3 rd year Standard 2-25 f - m Case presentations and patient portfolio Standard 2-23 Participation in selectives and honors programs Various standards; Appendix 2-5c Mock WREB Exam Standard 2-8 Professionalism evaluations Standard 2-20 and 2-21 Productivity points Appendix 2-4g (Syllabus for GEND8077) Evaluation of treatment outcomes Standard 2-25n Daily formative assessment Standard 2-8 Monthly progress evaluation Standard 2-8 End-of semester comprehensive 360 O evaluation Standard 2-8 Longitudinal Assessment Over Two Years by Same Set of GPG Faculty The prevailing recommendation in the competency assessment literature for measuring general competence is a pre-graduation internship of at least several months duration that approximates, as much as feasible, the work environment, tasks, and responsibilities of entry-level practitioners. During this extended internship, students work under daily supervision by a small group of the 82

54 same faculty, for coaching and assessment consistency, who observe and assess reproducibility of skills, seamless transition between elements of patient care, problem-solving, nature of the student s fund of knowledge (is it superficial or deep?), punctuality, decorum, appearance, stress management, and capacity for self-assessment and self-correction. This assessment best practice was endorsed in the comprehensive review of dental education evaluation methods written by a task force representing the Joint Commission on National Dental Examinations, the ADA Testing Center and ADEA (Albino, et al. Assessing Dental Students Competence: Best Practice Recommendations in the Performance Assessment Literature and Investigation of Current Practices in Predoctoral Dental Education. J Dent Educ. 2008; 72). As described in Standard 2-6, the clinical education system at the UTHSCSA Dental School is based on a group practice format where third and fourth year students are assigned to one of eight GPGs under the supervision of a small group of faculty who work with the same students for two years to provide consistent mentoring and assessment. Each GPG is directed by a Leader and Assistant Leader who function as general dentists. A major responsibility of the GPG Leaders and Assistant Leaders is to monitor each students level of progress, provide counseling and support when indicated, design learning experiences to redress any deficiencies, and ensure that each student has opportunities to develop skills in all facets of patient care consistent with contemporary general dentistry as stipulated in the school s 20 competency domains, and also CODA standards 2-12 to Thus, the GPGs play a central role in implementing the school s assessment model. Operational Structure and Grade Assignment The GPGs are the operational arm (primary educational experience) for the following courses: Clinical Patient Management INTD 7020 in the third year, and General Dentistry Clinic GEND 8077 in the fourth year. As described at the end of this standard, students grades are assigned through these courses for learning activities that occur within the scope of the GPGs. Other concurrent clinical courses occur in the third year where students accomplish patient care tasks within the GPGs that are evaluated assignments in these other courses and which are evaluated by the prosthodontic or restorative dentistry representative on each GPG and count toward the grade in these discipline-specific courses. Third year students are also evaluated by faculty from endodontics, oral surgery and pediatric dentistry when students are in clinical courses and rotations within these disciplines. General Dentistry Clinic GEND 8077 is designed to be the fourth year course in which final assessment of students attainment of competency and readiness for graduation occurs. As stated frequently in the narrative responses for Standards 2 16 through 2-27, fourth year students cannot be certified for graduation without passing all components of GEND How Does the GPG Assessment System Work? In years three and four, students apply knowledge, skills and professionalism during the oral health care of a family of patients and in discipline specific rotations. As described in Standard 2-11, the GPG faculty provides an initial family of patients to each student that may be augmented by the students' own screening activities throughout the year. A typical third year student begins the year with 15 patients, which grows to approximately 25 patients by the end of the year and approximately 40 patients during year four. The goal is to provide each student with a family of 83

55 patients needing a full scope of general dentistry services and in sufficient numbers to allow the student to progress toward, and ultimately demonstrate, that they have attained the School s competencies and are ready for unsupervised general practice. With approval of GPG faculty, patients among a student's family of patients may be occasionally treated by other students to expedite timely and convenient care. Expectations for Progression of Students' Learning In terms of learning expectations for the two-year GPG continuum, third year students are expected to demonstrate progress toward competency in specific areas of dentistry (endodontics, oral surgery, pediatric dentistry, periodontics, prosthodontics, restorative dentistry) via participation in clinical courses and rotations that occur during their GPG experience. By successfully completing unassisted clinical skill evaluations in each of these areas, junior students are expected to demonstrate sufficient mastery of core clinical skills necessary for entry into the fourth year where they will work more independently. During year four, students continue to treat patients with various complexities and treatment needs within the GPG. As the year progresses, students are expected to progressively become more responsible for treatment decisions. The expectation is that GPG faculty will continue to supervise patient treatment by senior students, but there will be progressively less need to intervene, until at the end of the year, the student has demonstrated capacity for independent decision-making and care delivery. Daily, Monthly, Semester and End-of-Year Assessments For every patient seen by a student for any type of oral health care, GPG faculty complete a student assessment form, displayed in Appendix 2-8a, known as the Daily Assessment of Student Technical Development and Professionalism / Ethics. This assessment is used to guide the provision of end-of-appointment feedback to the student and is not recorded as a grade or rating. All daily assessment forms are placed into the student s file and are reviewed by the GPG Leader and other GPG faculty as one of the data sources, per Table 2-8-1, used to assemble the next step in the assessment process: the Monthly Assessment of Professionalism, Ethics and Progress Toward Competency. The form used to communicate this assessment is in Appendix 2-8b. The monthly assessment is a summative evaluation of a student s strengths and weaknesses in professionalism, communication skills, assessment and treatment planning, capacity for selfassessment, surgical and procedural skills, and extent of progress toward the Dental School s 20 competency domains. The GPG Leader meets with students to discuss their monthly evaluation and students receive a copy of this progress assessment. The purpose of the Monthly Assessment is to provide students with an overall, composite picture of their performance and identify areas that need additional attention. The monthly assessments are used, along with other data sources, to develop the End-of-Semester and End-of-Year Progress Toward Competency Evaluations which students receive near the end of the fall and spring semesters in the junior year and at mid-year during year four. The third and fourth year progress-toward-competency forms appear in Appendix 2-8c. During these evaluations, students receive assessments of their progress toward 25 dimensions of general dentistry (the 20 competencies plus five other areas), and an assessment of progress toward overall competence in general dentistry. For students with areas of sub-standard progress, the GPG Leader and Assistant Leader develop individualized plans to help students acquire clinical and other learning experiences that will facilitate growth. 84

56 Junior students cannot advance to the fourth year with any deficiencies on the end-of-year comprehensive assessment. The final comprehensive evaluation in this sequence of progress assessments occurs during the spring semester of the senior year with the Assessment and Certification of Competency. The form used for this evaluation is in Appendix 2-8d. Fourth year students cannot be certified as ready for graduation with any deficiencies on this assessment. The End-of-Semester and End-of-Year Progress Toward Competency Evaluations, and the fourth year Assessment and Certification of Competency are new assessments being implemented for the first time in to provide each student with specific appraisals of where they stand in regard to each competency. Feedback by the Mock Site Visit Team indicated that additional documentation was needed for the assessment system. Format of Forms Used by GPG Faculty to Record Student Assessments The daily assessments (Daily Assessment of Student Technical Development and Professionalism / Ethics; Appendix 2-8a) which are compiled and analyzed to develop the students monthly progress evaluation during years three and four (Monthly Assessment of Professionalism, Ethics & Progress Toward Competency; Appendix 2-8b) both contain four rating scale points that comprise passing : excellent, satisfactory, minor improvement indicated, needs improvement (definite improvement indicated), and one rating scale point that represents substandard (no pass) performance labeled as unsatisfactory. The End-of-Semester and End-of-Year Progress Toward Competency Evaluations for Year three (Appendix 2-8c) and End-of Fourth Year Assessment and Certification of Competency (Appendix 2-8d) contain two rating scale points: Yes and No. A rating of YES indicates that the student is making satisfactory progress toward competency or has attained competency. A rating of NO indicates the student has not made satisfactory progress. Evaluation of Students Capacity to Perform Patient Care Skills, Procedures and Processes In addition to the daily, monthly, end-of-semester and end-of-year progress assessments provided by GPG faculty in years three and four, there are numerous graded evaluations of the students ability to perform a wide range of patient care skills, procedures and processes in the clinical disciplines that each student must perform independent of faculty assistance (unassisted). Table in Standard 2-25 indicates approximately 60 evaluations of clinical skills in years three and four that students must perform unassisted (independently) and at a satisfactory level based on criterion for each evaluation. The primary evaluation forms used by supervising faculty to assess students performance on these assessments of clinical skills and other patient care capacities appear in Appendix 2-8e. Table indicates the specific evaluations of clinical skills that are associated with each domain of Standard 2-25; a n. Site Visit Consultants can click on this sentence to go directly to this table. Third year students cannot progress to the fourth year if they have not passed each of the third year clinical evaluations identified in Table Fourth year students cannot graduate if they have not passed each of the fourth year clinical evaluations identified in Table

57 Mock Board Examination Fourth year students also independently complete and must pass a Mock Board Examination conducted the second or third week of March of the spring semester to support preparation for the WREB licensure exam and provide both students and their supervising faculty with a diagnostic assessment of student readiness. The Mock Board is a component of GEND 8077 and is a factor in determination of the student s final grade in this course. Planning, organization and time management are critical components of the Mock WREB. Students receive individualized schedules and are expected to complete the Mock Board component examinations at designated times during the week dedicated to this important evaluation. The Dental School s Mock Board Examination consists of five components: 1.) Two Independently Performed Clinical Skill Evaluations: a) One restorative procedure: Class III composite, Class II composite or Class II amalgam, and b) Periodontal treatment: One quadrant of scaling and root planing. If a clinical examination is not attempted or a second examination is needed, based on appraisal of student performance, a make-up or re-make examination must be successfully completed during usual clinic hours. 2.) Laboratory Endodontic Exam consisting of pulpal therapy in an extracted tooth mounted in a manikin. The endodontic exam is pass/fail and must be retaken until passed. 3.) Patient Assessment and Treatment Planning exam* 4) Prosthodontic exam on Blackboard (online assessment)* 5.) Periodontal exam on Blackboard (online assessment)* *These Mock Board components are given only once and are pass/fail. Evaluation of Student Professionalism Assessment of students professionalism is an integral component of Clinical Patient Management INTD 7020 in year three (the major umbrella course for the third year clinic; Appendix 2-4f) and General Dentistry Clinic GEND 8077 in year four, a similar umbrella course for students clinical education in the fourth year. The syllabus for the GEND 8077 course is in Appendix 2-4g. Both INTD 7020 and GEND 8077 encompass the students clinical education within the GPGs as well as other clinical rotations. The professionalism evaluations on the monthly, end-of-semester and end-of-year progress assessments must be satisfactory to pass both of these courses. INTD 7020 in year three cannot be remediated in the summer if failed due to professionalism or other performance deficiencies. Fourth year students cannot graduate if GEND 8077 is failed due to professionalism or other academic difficulties. Grade Assignment In year four, to receive a passing grade in General Dentistry Clinic GEND 8077, senior students must accomplish all of the following: 86

58 obtain satisfactory evaluations on independently performed evaluations of clinical skills; pass the fourth year mock WREB board exam; obtain positive monthly and end-of-semester progress reports; ameliorate any deficiencies identified on the monthly progress reports; successfully complete all rotations; obtain point production standards for patient care identified in the GEND 8077 syllabus (Appendix 2-4g); demonstrate values required of a health care professional as determined by GPG faculty; and, have no deficiencies on the end-of-senior year Assessment and Certification of Competency. Students cannot graduate if they have an F or incomplete in any course at the end of the senior year (Standards for Promotion and Graduation of Dental Students; Appendix 2-4c). Monitoring of Student Progress Student progress is monitored on a regular basis by the Associate Dean for Academic Affairs, Academic Performance Committee, directors of discipline based clinical courses, and the GPG Leaders. Problematic trends in student performance, including academic, technical and professional, are addressed with remediation or other appropriate interventions until competence is achieved or the student is dismissed or withdraws from UTHSCSA Dental School. B. Supportive Documentation for Standard 2-8: 1. Appendix 2-3a: UTHSCSA Dental School Course Syllabus Template 2. Appendix 2-4c: Standards for Promotion and Graduation of Dental Students 3. Appendix 2-4f: Syllabus for INTD 7020 Clinical Patient Management 4. Appendix 2-4g: Syllabus for GEND 8077 General Dentistry Clinic 5. Appendix 2-7a: UTHSCSA Dental School Competencies for Predoctoral Dental Education 6. Appendix 2-8a: Daily Assessment of Student Technical Development and Professionalism / Ethics; Years Three and Four 7. Appendix 2-8b: Monthly Assessment of Professionalism, Ethics & Progress Toward Competency 8. Appendix 2-8c: End-of-Semester and End-of-Year Progress Toward Competency Evaluations 9. Appendix 2-8d: Form for Fourth Year Assessment and Certification of Competency 10. Appendix 2-8e: Evaluation Forms Used for Evaluations of Clinical Skills 87

59 Curriculum Integration Standard Biomedical, behavioral and clinical science instruction must be integrated and of sufficient depth, scope, timeliness, quality and emphasis to ensure the achievement of the curriculum s defined competencies. Compliance: The UTHSCSA Dental School is in compliance with Standard 2-9. A. Description for Standard 2-9 The curriculum of the UTHSCSA Dental School is designed to integrate the biomedical, behavioral and clinical sciences to enable graduates to attain the competency needed to function as general dentists in the community. To achieve this educational goal, graduates must recognize and comprehend the interrelationships of the biomedical, behavioral and clinical sciences within the specific contexts of oral health and disease, and also the broader context of general health, wellness and systemic disease. These foundational interrelationships are introduced to students in year one and reinforced throughout subsequent years. To ensure appropriate scheduling of courses to accomplish integration goals, the Curriculum Management Committee (CMC), in collaboration with the Associate Dean for Academic Affairs and in consultation with individual course directors, monitors and coordinates the sequencing of courses to ensure that the various components of biomedical, behavioral and clinical science instruction are coordinated to promote students understanding of the core concepts that provide building blocks for subsequent learning. The Curriculum Management Committee also coordinates the course evaluation process including students feedback about courses and the faculty peer review process. A major goal of the course assessment process, accomplished by faculty peer review, is to assess the depth and currency of subject matter communicated to dental students within each course. Outcomes from both of these review mechanisms contribute to the CMC's assessment of the sequencing, focus and depth of courses in relation to the overall educational mission and goals of the Dental School. The responsibilities and membership of the Curriculum Management Committee are described in Appendix 1-6a: Academic Organization and Bylaws of the UTHSCSA Dental School. The Dental School Curriculum Committee focuses on overall educational policy including future directions, special projects (such as updating the competencies), promoting innovation and critiquing proposals for new courses. In this capacity, The Curriculum Committee contributes to course and topic sequencing by conducting periodic broad-based and comprehensive assessments of the overall predoctoral education program for purposes of identifying issues and potential solutions. The most recent comprehensive review, conducted in 2010, identified several enhancements to the students sequence of learning including a recommendation to implement a hand skill development component in the first year to better prepare students for second year 88

60 preclinical technique laboratory courses. This recommendation was implemented in spring 2011 as a rotation in the Introduction to Patient Care INTD 5030 course. The responsibilities and membership of the Curriculum Committee are described in Appendix 1-6a: Academic Organization and Bylaws of the UTHSCSA Dental School. Dental School courses are presented by faculty members from a variety of backgrounds including basic sciences, clinical dentistry, behavioral sciences, public health, biostatistics/epidemiology, nutrition and psychology. Clinically relevant information is introduced in first and second years of the curriculum, augmented and reinforced by more than 200 hours of clinical experiences, to allow students to associate the importance of the basic sciences to their future clinical training and development. The scheduling of the curriculum is designed to allow students to integrate the study of disease and the study of the patient, and to acquire knowledge, skills, and values essential to successful patient care in a logical sequence. Overview of Curriculum Sequencing The following paragraphs summarize the general sequencing of dental students learning experiences for years one through four of the curriculum. Year One As a fundamental building block for all competencies, UTHSCSA dental students are introduced to the ethical principles that define professional behavior as a health care provider, and learn the foundations of normal human structure and function moving from cellular, to gross tissues, to organ systems. Students also study Pharmacology to provide the foundation for pathology and therapy. Structure and function of the orofacial region is emphasized including a strong focus on anatomy of dentition. Students also begin to acquire foundation skills in patient assessment including radiographic techniques and physical examination. Students develop skills in oral health risk assessment and prevention and begin their study of periodontal disease and therapy that prepares them for competency in these aspects of dental practice. A critical component of year 1 is the students introduction to the perceptual and fine-motor skills needed for competency in many types of dental therapy. First-year students are introduced to the clinical environment, including community-based prevention, and begin to acquire clinical support skills that allow them to serve as assistants to upper class students. During Introduction to Patient Care INTD 5030 (Appendix 2-9a), students rotate through a variety of pre-clinical and clinical activities in small groups, including multiple opportunities to assist upperclassmen during patient care in the clinic. These experiences allow students to correlate the clinical, behavioral and basic sciences, and gain an orientation to subsequent stages in their learning process in preclinical labs and in the patient care clinic. In INTD 5030, the primary focus of student assessment is on basic elements of professionalism, for example, being on time and being prepared for assignments, which is intended to introduce students to the responsibilities of patient care. Year Two Building on the foundations of normal human structure and function developed in year one, second-year students analyze the causes and clinical presentations of oral abnormalities and diseases of the major organ systems. This learning process, moving from normal to recognition of 89

61 abnormal conditions, provides the cognitive groundwork for competency in patient evaluation and diagnosis. A major focus of the sophomore year is development of procedural skills in preclinical simulation laboratories. Specific preclinical skills, linked to various patient care competencies, must be mastered, via unassisted skill demonstrations, to certify that students are ready for progression to the clinical phase of the curriculum. Second-year students also assist upper class students in the clinic and receive additional experience in patient evaluation to provide a transition into the junior year clinical experience. These activities are part of Clinic Introduction INTD 6088 (Appendix 2-9b), which is a continuation of INTD 5030, giving students opportunities in small groups to develop different patient care skills and correlate the clinical, behavioral and basic sciences. During INTD 6088, second year students receive extensive exposure to oral health risk assessment, oral cancer screening, tobacco cessation strategies and nutritional counseling as later described in Standard In INTD 6088, dental students also participate in rotations to an elementary school to provide sealants for second graders, to the sealant clinic in the Dental School that occurs twice per year to provide sealants for elementary school children, to the Head Start Center to apply fluoride varnishes to pre-school children, to several community clinics to experience full patient care of infants and young children, and to the oral surgery clinics where they administer their first local anesthetics and assist in oral surgery procedures. Student assessment in INTD 6088 also focuses primarily on professionalism. As described in Standards 2-22 and 2-23, students begin an extensive learning experience for evidence-based dentistry during the second year beginning with the Evidence Based Dentistry Course, INTD 6010, where they acquire skills for critical appraisal of the biomedical literature in the fall semester, and then use these skills in the spring semester to review and critique the evidence for a selected topic in collaboration with a faculty mentor. Year Three The third year has a strong clinical focus as students apply the knowledge, skills, and values acquired in years one and two to the oral health care of patients. Junior students join one of eight General Group Practices (GPGs) and remain in that GPG throughout their third and fourth years. A team of faculty, headed by a general dentist, guides each GPG and work closely with students in their group to provide hands-on coaching and feedback. The GPGs provide students with an environment where they have continuous contact with a small group of instructors and also provide a forum for conferences, faculty demonstrations, case reviews, and other learning activities to enrich the students clinical education and help them blend together many aspects of their education. Learning experiences, derived from the process of patient assessment and treatment, are orchestrated to facilitate students acquisition of the 20 competencies. Third-year students also receive instruction and patient care experiences during discipline-specific rotations. An important component of the GPG experience is evaluation of students professionalism, which occurs via the Clinical Patient Management INTD 7020 course (Appendix 2-4f). Students cannot progress to the senior year if they are deficient in professionalism. Summer Session between Years Three and Four The summer between the junior and senior years allows students to enrich their education with 90

62 selectives and clinical rotations. A minimum of a two-week clinical selective is required for all rising fourth year students except those who enroll in a full summer research selective. Students may continue selective courses into the senior year (Appendix 2-5b). Year Four Students continue their acquisition of clinical competency through extensive patient care experiences within the GPG framework. Seniors are expected to demonstrate increasing capacity for independent functioning with less reliance on GPG faculty for guidance and assistance. Through the patient assignment function of the GPGs, seniors receive opportunities to provide care for patients with a wider variety of oral health needs and to treat dental problems that are more complex. To enrich and diversify their education, seniors participate in focused rotations in pediatric dentistry, oral surgery, dental emergencies, oral medicine and at various community locations. Appendices 2-9c, 2-9d and 2-9e provide rosters of all behavioral, biological science and clinical science courses respectively (CODA Tables 4, 5 and 6). Examples of Vertical Integration Several courses in years one, two, three and four of the curriculum provide opportunities for students to apply basic and behavioral science knowledge to the assessment and treatment of dental patients. Syllabi for courses described in the following paragraphs appear in Appendix 2-3b. In Clinical Oral and Maxillofacial Pathology PATH 7023, conducted in year three, the students are taught how to apply their basic science knowledge, acquired in the prerequisite didactic pathology courses, to simulated patient care situations. In Pharmacotherapeutics PHAR 8009, conducted in year four, the students review general principles of pharmacology and pharmacotherapy that they might be exposed to in their clinical practice, and apply these principles to patient care scenarios in addition to receiving updates on state-of-the art treatment of various diseases that general dentists now routinely see in their practices. An Oral Medicine clinic rotation is a component of PHAR 8009 and must be successfully completed to pass PHAR In years one and two, behavioral sciences are offered in two courses, Oral Health Promotion and Disease Prevention for Individuals and Populations COMD 5017, and Patient-Centered Oral Health Care: Behavioral, Social, and Cultural Dimensions COMD COMD 5017 provides the student with the basis and application of evidence-based practices to prevent oral diseases and promote oral health among groups living in communities. COMD 6048 provides an in-depth engagement of cultural competency, transcultural health care, and the contexts of culture, family, and community in oral health care. In the second part of COMD 5017, a clinical psychologist introduces students to the etiology of patient fear and anxiety, and reviews strategies that can be used to help patients be more comfortable and at ease during dental treatment. A rotation to an elementary school in School-Based Prevention COMD 5015 (See Standard 2-16) allows first year students to teach children the basics of oral health care and prevention of disease. Introduction to Patient Care INTD 5030, Clinic Introduction INTD 6088, Clinical Medicine DIAG 6011, and Clinical Patient Management INTD 7020, where students participate in more than 200 hours of clinically-related activities including support of patient care, are incorporated into the curriculum concurrently with the students study of the foundational biomedical, behavioral and 91

63 clinical sciences to facilitate integration. For example, in Practical Infection Control DIAG 5049, first year students learn a protocol for effective infection control. This course is followed with indepth exploration of organisms and diseases in Microbiology MICR In another example, development of professional behaviors is a key goal for INTD 5030 and INTD 6088, which are foundational courses designed to prepare students for General Dentistry Clinic GEND 8077, where students capacity to integrate professionalism into the delivery of oral health care is evaluated for all patient encounters. B. Supportive Documentation for Standard 2 9: 1. Appendix 1-6a: Academic Organization and Bylaws of the UTHSCSA Dental School 2. Appendix 2-4e: Dental School Courses in Group A and Group B 3. Appendix 2-5b: Class Schedules for First, Second, Third and Fourth years 4. Appendix 2-5c: List of Selective Courses 5. Appendix 2-9a: Syllabus of INTD Introduction to Patient Care 6. Appendix 2-9b: Syllabus for INTD Clinical Introduction 7. Appendix 2-9c: Biological Science Courses (CODA Table 4) 8. Appendix 2-9d: Behavioral Science Courses (CODA Table 5) 9. Appendix 2-9e: Clinical Science Courses (CODA Table 6) Curriculum Management Plan Standard The dental school must have a curriculum management plan that ensures: a) an ongoing curriculum review and evaluation process that includes input from faculty, students, administration and other appropriate sources; b) evaluation of all courses with respect to the defined competencies of the school to include student evaluation of instruction; and c) elimination of unwarranted repetition and outdated / unnecessary material, incorporation of emerging information and achievement of appropriate sequencing. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Description for Standard 2-10 Curriculum planning and evaluation is a key component of the overall strategic planning and outcomes assessment process for the UTHSCSA Dental School. As described in standards 1-2 and 1-3, as part of the school s strategic planning and outcomes assessment process, the Associate Dean for Academic Affairs conducts an assessment of the outcomes of predoctoral education and 92

64 submits a report to the Strategic Planning Committee, at the conclusion of each two-year review cycle. The Associate Dean's report is derived in part from reports submitted by the committees, described below, which manage curriculum planning, implementation and review. The UTHSCSA Dental School has two standing committees charged with management of predoctoral education (Curriculum Management Committee; CMC), and educational planning (Curriculum Committee; CC). Both committees work in close collaboration with the Associate Dean for Academic Affairs to implement curriculum planning and review processes. Faculty and students are members of both committees. The responsibilities and membership of the CC and CMC are described in Appendix 1-6a: Academic Organization and Bylaws of the UTHSCSA Dental School. Curriculum Management Committee (CMC) A major goal of the Curriculum Management Committee (CMC) is to ensure appropriate scheduling of courses to facilitate a logical sequence of learning for students. To accomplish this goal, the CMC, in collaboration with the Associate Dean for Academic Affairs and in consultation with course directors, coordinates and conducts a course review process that monitors the content and sequencing of courses to ensure that the various components of biomedical, behavioral and clinical science instruction are coordinated to promote students understanding of the core concepts that are building blocks for subsequent learning. Course Review Process The curriculum management plan includes an on-going review of all courses. The course review process is based on four sources: 1. outcomes data (student achievement) including student performance on assessments in each course, and other outcomes such as number of students requiring remediation, percentage of students who fail courses, student attrition, results of National Boards, and WREB results; 2. course assessment by faculty and student teams which focuses on the relationship of course objectives, content, teaching/learning strategies and evaluation techniques to UTHSCSA Dental School competencies, as well as appraisal of the syllabus, examinations and course outcomes; 3. students' perceptions of courses including organization, clarity, adherence to stated objectives, presentation, workload and teaching/learning methods as measured by the course evaluations completed online; and, 4. students' perceptions of the overall learning environment assessed in two formats: (a) annual end-of-year assessments (end of year one, end of year two, and end of year three), and (b) graduating seniors' overall appraisal of the curriculum across several dimensions and selfassessment of competency attainment. Each component of the course review process is described in the following pages. 93

65 Outcomes data Student achievement is a critical component of the outcomes assessment process for the UTHSCSA Dental School curriculum. Measures of student achievement that are reviewed by the Associate Dean for Academic Affairs and submitted to the Curriculum Management Committee as needed or requested include: students' performance in UTHSCSA Dental School core courses including didactic, simulation laboratory and clinical learning environments; percentage of matriculated students who graduate in four years and percentage who ultimately graduate from UTHSCSA Dental School; analysis of student attrition rate and reasons for student departure; percentage of students who need remediation; students' overall performance in the General Practice Groups; percentage of students who graduate with distinctions in research or teaching; students' performance on National Board Dental Exams Parts 1 and 2; students' performance on clinical mock boards administered in the fourth year; students' performance on the Western Regional Board Licensure Exam; and, percentage of graduating students who are accepted into postdoctoral programs. Course assessment by faculty and student teams The Curriculum Management Committee (CMC) in the fall of 2010 critiqued the existing course evaluation process which focused on five primary data sources: external measures (WREB results and National Boards), issues brought to the CMC by students and faculty, issues identified through the Course Directors Forum, results of the senior exit surveys, and students evaluations of courses and rotations. The later source received heavy emphasis. The CMC felt that this course review methodology might not address how well courses met their objectives or supported the school competencies. Therefore, a new review system was developed in 2010 to facilitate in-depth critique of courses by faculty members. This new process evaluates courses in a four-year cycle, with each cycle of reviews concentrating on one academic year. Teams composed of faculty and student members of the CMC conduct the reviews, with support from students in the Teaching Honors Program. Courses completed in the fall semester are reviewed in the spring, while spring courses or those spanning both semesters are reviewed during the summer and fall. The review process is guided by a protocol developed by the CMC (Appendix 2-10a) and data entry forms, which appear in Appendix 2-10b. Review teams have access to a variety of data sources including the course syllabus, examinations and other assessment instruments, students evaluation of the course, results of the annual senior exit survey, and the course director s selfassessment and appraisal of educational outcomes. The following questions are assessed by the course review teams: are the competencies supporting the course identified? are the course goals and objectives supportive of the competencies? does course content reflect stated goals/objectives? 94

66 do the instruction methods enable students to achieve the stated course objectives/goals? do the evaluation methods measure student s attainment of these objectives? how do the students perceive the course and are negative comments warranted? are course outcomes being self-assessed by the course director? The review team meets with the course director for input and to discuss findings prior to submission of a summary report to the entire CMC. If the CMC concurs with the recommendations, the department chair and course director receive the final summary report. Follow up is conducted by the CMC for critical items. Because this review system is new and evolving, the process will be evaluated by the CMC and modified over the next several years. Appendix 2-10c identifies courses that were reviewed / are being reviewed by faculty-student teams in and Students' perceptions of courses Students complete online evaluations of all courses to provide their assessments of organization, clarity of communication concerning objectives, assignments, readings, and assessments, quality of presentations by faculty, quality and usefulness of syllabi and other learning materials, and relationship of assessments to course objectives. Appendix 2-10d displays the core items that are included on each of the students' course evaluation forms that are tailored to classroom, laboratory and/or clinical teaching. The Associate Dean for Academic Affairs is responsible for monitoring the student course evaluation system, which is implemented by the UTHSCSA Academic Center for Excellence in Teaching (ACET), an educational support unit serving all schools at UTHSCSA. Administering student evaluations through ACET separates course directors from the process to promote student candor. ACET staff members tabulate summaries of each course evaluation, and communicate these summaries in a timely manner to course directors, their Chairs, and the Associate Dean for Academic Affairs. Students' perceptions of the overall learning environment Appraisal of students' level of satisfaction with the learning environment is an important component of curriculum assessment. Four sources of data comprise this assessment: year-end review by first, second and third year students' for the just concluded academic year, focusing on issues of topic coordination, course sequencing, workload, and program strengths and weaknesses, as well as students self-assessment of their progress toward each of the competencies; seniors' perceptions of the UTHSCSA Dental School educational environment and learning experiences obtained by the annual Graduating Senior Questionnaire; seniors' responses to the ADEA "Senior Survey"; and, surveys of alumni who graduated five years previously to obtain perceptions of educational environment, learning experiences and curriculum relevancy to dental practice. 95

67 The End of Year Questionnaires for first, second and third year students with are in Appendix 2-10d. Appendix 2-10e is the class of 2011 Graduating Senior Exit Questionnaire and Appendix 2-10f is the Class of 2005 Alumni Survey. Summaries of the results of these surveys will be available onsite during the February 2012 Site Visit for inspection. Monitoring Unwarranted Repetition and Outdated Material The curriculum monitoring activities by the CMC, including faculty peer review of courses, is an important strategy to detect unwarranted repetition within and between courses and identify curricular gaps. The CMC periodically recommends actions to eliminate the unnecessarily repetitive, outdated, or unnecessary components from the students' educational experience as demonstrated by the recent recommendations for the community dentistry and biochemistry courses, subsequently described. Changes Resulting From Review by the Curriculum Management Committee As an outcome of the course review process implemented by the CMC, several program changes and enhancements have been implemented in recent years, which are described below. Additional curriculum changes in recent years were stimulated by reviews conducted by the Curriculum Committee as described subsequently. Re-sequencing of courses To reduce redundancy and provide more timely presentation of concepts, the second and third year oral pathology courses were consolidated into one course now conducted in the spring semester of the second year, and the former fourth year oral pathology course, which focuses on clinical assessment and diagnosis, was relocated to the spring semester of the third year to better address students' learning needs at that point in their clinical education. Additionally, courses in community oral health were consolidated and relocated to minimize redundancy as subsequently described in this section. Temporomandibular Dysfunction RESD 6108 was relocated from the spring semester of the third year to the spring semester of the second year to provide students' with more timely preparation for the junior year clinic and also reduce the didactic course load in the third year. Movement of RESD 6108 facilitated relocation of Oral and Maxillofacial Pathology Clinicopathologic Conference PATH 7023, previously conducted in the fall semester of year 4 into the spring semester of the third year, a transition requested by students. In the fall semester of 2012, Jurisprudence COMD 8032 in the fourth year spring semester will be moved to the fall semester to support students preparation for the NBDE Part II, which includes jurisprudence. Modification of student scheduling policies As a consequence of the dramatic expansion of off-campus community-based rotations including the two-week South Texas rotation, conflicts arose with regard to student participation in scheduled didactic courses during the third and fourth years while they were participating in these rotations. The Curriculum Management Committee reviewed and modified scheduling policies to clarify where students should be on days when they are scheduled for community-based rotations that occurred while on-campus didactic courses were scheduled (Appendix 2-10g: Student Scheduling Conflict Policy). 96

68 Developed video archive process to facilitate student access to lectures while on community rotations Related to the preceding item, the Curriculum Management Committee recommended the videotaping and archiving of all classroom lectures that occurred while fourth year students participated in the two-week South Texas Rotation. Because all fourth year students complete the South Texas experience on a rotational basis throughout the year, some senior students are always away from campus and do not have the opportunity to attend parts of several didactic courses conducted in the senior year. This recommendation has been implemented and now all students away from campus can access missed lectures online via a portal on the Blackboard course management system. Faculty access to course information A concern identified by faculty was that they did not know what was being taught in other courses and there was no easy way to review the objectives and content of other courses. This was especially true for clinical faculty who were not involved in all preclinical courses. To address this problem, the CMC recommended that all faculty members should have access to every course Blackboard site to allow convenient review of syllabi and other course materials. The Faculty Council approved faculty access to all courses in spring Beginning with the fall semester 2011, all faculty members are enrolled as auditors for each dental school course on Blackboard. Community oral health courses Students identified concerns about overlapping, redundant and excessive material in a sequence of courses that addressed community oral health, prevention and wellness principles, and public health and epidemiology concepts. Based on a recommendation from the CMC and with support from this committee, the department reorganized this component of the curriculum resulting in fewer courses and hours. Biochemistry course Based on course review, the CMC identified that the freshman Biochemistry course, BIOC 5013, provided excessive depth related to basic biological principles for the needs of dental students, most of whom have taken one or more biochemistry courses as undergraduates. The CMC proposed substantial revisions for the course so that it provided students with better focus on application of biochemistry concepts to the assessment of oral health disorders, and also proposed that the topic should become an admissions prerequisite. These proposals were forwarded to the Curriculum Committee, which recommended that biochemistry should be established as a prerequisite for dental school admission, and also recommended that the existing course should be modified to focus on concepts directly applicable to oral health care with expansion of clinical cases. This recommendation was approved by the Faculty Council and will go into effect with the entering class of 2013 Curriculum Committee (CC) The Dental School Curriculum Committee focuses on overall educational policy including future directions, special projects, and promoting innovation. In this capacity, the Curriculum Committee conducts periodic comprehensive assessments of the overall predoctoral education program for 97

69 purposes of identifying issues and potential solutions. The most recent comprehensive review of the curriculum was implemented in 2010 to identify curricular concerns that might affect students' attainment of the Dental School s competencies (Appendix 2-7a). These issues were identified through meetings and focus groups with students and faculty. The list was discussed at the 2010 Faculty Advance (annual end-of-the-year school wide meeting described in Standard 3) where faculty reached consensus that following curricular goals were desirable: provide first year students with a hand skill lab with focus on learning how to use handpieces; provide year two students with enhanced preparation for initial patient encounters, including diagnosis and treatment planning, use of axium, and awareness of clinical operation; enhance the occlusion curriculum; develop mechanisms to facilitate students attainment of a new implant educational outcome; expand clinical experiences for first and second year students; and, re-distribute basic science and clinical coursework so that the first half of the curriculum is less heavily front-loaded with biomedical science material that is difficult for students to appreciate prior to substantial patient care experiences in the clinic Progress was made during on the first four goals as described below. The creation of an integrated Comprehensive Dentistry Department has facilitated planning pertinent to these goals. The remaining two goals (early clinical experiences and re-distribution of basic and clinical sciences) require coordinated planning among basic science and dental school clinical departments. The Curriculum Committee is pursuing strategies to achieve the remaining goals. Development of hand skill laboratory for first year students In the spring semester 2011, a hand skill development laboratory was implemented for first year students to enhance preparation for the second year preclinical technique laboratory courses. This lab rotation was implemented as a component of Introduction to Patient Care INTD Students from the Honors in Teaching Program were recruited to assist the faculty with 14 laboratory sessions. Half of the first year class attended each lab, so freshman students each participated in seven sessions. Feedback from first year students was very positive and as a result of the successful roll out of this rotation, a task force within the new Comprehensive Dentistry Department is now developing plans for a more formalized course. Enhanced preclinical preparation for initial patient encounters (diagnosis and treatment planning) The Department of Comprehensive Dentistry appointed a task force to address several issues related to students preparation for initial patient encounters. A primary charge was to review the current diagnosis and treatment planning curriculum. As an immediate outcome of this task force, axium training was incorporated into the Clinical Introduction INTD 6088 course so the preclinical laboratory courses could include axium as part of their course content. Beginning in September, 2011, second year students receive an orientation to AxiUm. Additionally, the photography 98

70 module in this course was modified to enable second year students to take a complete series of clinical photographs of a patient as an assignment during one of their clinical experiences. Enhanced occlusion curriculum There has been a pendulum shift in the emphasis on occlusion in the curriculum from too much emphasis to perhaps too little in recent years. The 2010 curriculum review revealed that students were not consistently assessed on their comprehension of occlusal problems and the potential effect of these problems on TMD. To address this shortcoming and develop a standardized approach, a "Rapid TMD and Occlusal Assessment," was implemented, as part of General Dentistry Clinic GEND 7001, during the third year, which students complete on each new patient as part of the comprehensive examination. The Rapid TMD and Occlusal Assessments performed by students are evaluated by GPG faculty. Students attainment of a new implant educational outcome Restoration of dental implants, in a scope that includes single implant crowns and implant supported overdentures, is now routine in general dental practices. Additionally, enhanced training in implant dentistry has been the curricular enhancement most frequently requested by fourth year students on the Senior Exit Survey for the past several years, and by alumni on the annual past graduates surveys. Faculty and students both pressed for inclusion of implant restorations in the school s predoctoral education competencies, and as a response, an educational outcome for Competency Domain 12 (Replacement of Missing Teeth) will be modified to include implants as a therapeutic option. A three to five year year timeline was established for fully implementing this new educational outcome into the curriculum. One strategy that was implemented in as a beginning step was to provide second year students with in-depth instruction for just one single implant system, versus the previous approach of introducing several systems, without providing much detail on any system. The new focused strategy for second year students has provided a better foundation prior to their entry into the clinic. The school is fortunate to have several faculty, who work with fourth year students on the GPGs, who have obtained advanced implant training and can function as implant educators for seniors, guiding exploration of alternative systems. The second strategy to enhance implant education involved finances. The biggest barrier for predoctoral implant training is the cost to the patient. A large NIH-funded diabetes study at the Dental School subsidizes the cost of implants for diabetic patients. Implants are placed by dental students as part of this study, which has provided the predoctoral program with a substantial group of patients who require implant restorations. Identification and Addition of Emerging Biomedical and Clinical Information The primary responsibility for monitoring new advances in biomedical, behavioral and clinical science lies with the course directors who are expected to continually update courses to reflect contemporary knowledge and dental practice. To support and augment this on-going review, the Curriculum Committee solicits suggestions from faculty, students, or administration for new courses and subject matter additions to current courses. During many of the Annual Dental School Faculty Advances over the past decade, faculty have participated in curriculum analysis to 99

71 identify strategies for incorporating emerging information and new therapeutic approaches into the curriculum. Other Curriculum Assessment and Planning Mechanisms Curriculum planning is not restricted to the Curriculum Management Committee and Curriculum Committee. Issues or concerns that affect the curriculum may be brought forward from various sources including the Strategic Planning Committee, Faculty Development Committee, Academic Performance Committee as well as other committees that deal with pre-clinical and clinical education issues. Curricular issues identified by these committees are discussed with the Associate Dean for Academic Affairs, who in consultation with others may charge either the Curriculum Committee or the Curriculum Management Committee to study the issue and make recommendations. As described in Standards 1-2 and 1-3, the Dean may appoint special Ad Hoc Task Forces to address urgent and time dependent issues, including curricular problems or unique opportunities for enhancement of the educational program. For educational issues, these Task Forces are appointed in consultation with the Associate Dean for Academic Affairs. Recommendations from these ad hoc groups are submitted to the Curriculum Committee and the Associate Dean for Academic Affairs for feedback and additional recommendations. The membership of these Ad Hoc Committees or Task Forces are broad-based and include faculty who would be directly affected by recommended actions. All curricular recommendations, from either standing curriculum committees or ad hoc task forces, are forwarded to the Dean, who may charge individuals or committees to implement proposed initiatives. B. Supportive Documentation for Standard 2 10: 1. Appendix 1-6a: Academic Organization and Bylaws of the UTHSCSA Dental School 2. Appendix 2-10a: Instruction for Course Review Forms and Summary Statement 3. Appendix 2-10b: Course Review Forms 4. Appendix 2-10c: Schedule of Course Reviews for and Appendix 2-10d: End-of-Year Questionnaires for Years One, Two and Three 6. Appendix 2-10e: 2011 Graduating Senior Exit Questionnaire 7. Appendix 2-10f: Class of 2005 Alumni Survey 8. Appendix 2-10g: Student Scheduling Conflict Policy 100

72 Adequate Patient Experiences for Competency Standard The dental school must ensure the availability of adequate patient experiences that afford all students the opportunity to achieve its stated competencies within a reasonable time. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Description for Standard Provide a definition of the patient category system used by the program. Patient Category System The patient treatment categories used at UTHSCSA Dental School are indicated in Table The categorization system is based on care levels. Table 2-11: Patient Categories at UTHSCSA Dental School Level Description 0 Individuals seen for non-invasive screening or diagnostic imaging 1 Patients receiving diagnosis and treatment limited to one problem, usually the present complaint (i.e., an emergent problem). 2 Patients receiving diagnosis and treatment for more than one problem, but short of comprehensive care. 3 Patients receiving diagnosis and treatment for all dental problems that have been agreed to by the patient and the School. Although called comprehensive care, this level may not include every desirable therapeutic regimen. Pediatric patients Special needs patients Pediatric patients are defined as infants and children up to the age of 13 years unless there are special needs considerations. Special needs patients include patients whose medical, physical, psychological, or social situations may make it necessary to modify normal dental routines in order to provide dental treatment for that individual. These individuals include, but are not limited to, people with developmental disabilities, complex medical problems, and significant physical limitations. 2. Summarize the students' patient care experiences. Students' Patient Care Experiences The competencies at UTHSCSA Dental School are designed to ensure that students have sufficient exposure to the types of patient experiences that qualify them to practice general dentistry at a competent level. As described in Standard 2-8, different types of evaluation methods are employed to assess students progression toward and ultimate attainment of competence in the 101

73 20 domains defined in the UTHSCSA Dental School Predoctoral Competencies (Appendix 2-7a). These assessments include timed practical examinations in preclinical simulation courses, skill assessments in the third year to determine mastery of specific clinical capacities and techniques, graded clinical examinations in the fourth year to assess students capacity to independently provide patient care, daily formative feedback in years three and four, monthly progress assessments in years three and four, professionalism evaluations in both years, assessment of students case presentations in both years, mock boards in year four, and comprehensive mid-year and end-of-year progress toward competency in year three and attainment of competency assessments near the conclusion of year four (See description in Standard 2-8). Both quality and experiential thresholds must be accomplished by students to achieve competence. For academic year , 5,830 adult patients were screened through the normal screening process for the predoctoral patient pool and their information was entered into a database. Individuals may also apply to become patients of the Dental School through an on-line application process that attracted more than 8,000 applications in The Dental Emergency Care Clinic is another source of new patients for the predoctoral program. Many patients enter the Dental School system as a result of referrals from satisfied patients. In , 4,743 of the 5,830 screened patients were assigned to students (81%). On average, each third and fourth year student provided care for 42 patients during the year. During , a total of 34,347 patient visits were made to the UTHSCSA Predoctoral Clinic. Appendix 2-11a is the Dental School patient admissions process flow chart. The GPG Leader, with the guidance of other GPG faculty and support from the patient care coordinator (PCC), assigns a family of patients to each student. A typical third year student begins the year with 15 assigned patients. This number grows to approximately 25 patients during the third year and increases further during the fourth year to approximately 40 patients. Patients are selected based on how the patient s needs complement the educational needs of the students. Patients are assigned to a specific student in the GPG, but at the discretion of the GPG faculty, the patient may be treated by other students to expedite timely care or to provide students with experiences with procedures that are in short supply such as fixed partial dentures and endodontic therapy. The objective is to provide each student with a family of patients needing a full scope of general dentistry services and in sufficient numbers to allow the student to progress toward, and ultimately demonstrate, that they have attained the Dental School s competencies and are ready for unsupervised general practice. Students acquire new patients as existing patients are completed, discontinued, placed on recall, and also as deemed necessary by the GPG faculty so each student can maximize learning experiences and fulfill the School s patient care mission. Pediatric dental experiences are obtained during rotations in the School s Pediatric Dental Clinic, the Frank Bryant Clinic and the Ricardo Salinas Clinic. The latter two are extramural clinics staffed by the faculty in the Department of Developmental Dentistry. All students receive extensive patient care experiences during their two-week clinical rotations in South Texas affiliated sites. 102

74 Reports will be available for inspection during the February 21-23, 2012 Site Visit documenting the average number of dental procedures and other clinical tasks in various categories that have been completed by UTHSCSA dental students in recent years. 3. Document, for the past 5 classes, the number of students who have graduated on the scheduled graduation day. Of those that have failed to do so when did they graduate? As indicated in Table 2-1 displayed in Standard 2, 86% of students (477/551) who matriculated during into the regular admission four-year predoctoral program graduated on schedule during Thirty-four students over these six years (6%; 34/551) graduated 3 12 months late. Seven students originally scheduled to graduate in 2011 are still enrolled and on track to graduate in For the first three classes of the International Dentists Education Program (IDEP; 2009, 2010, 2011), 97% of students graduated on schedule (29/30) and one IDEP student required three additional months to graduate. B. Supportive Documentation for Standard 2 11: 1. Appendix 2-11a: Patient Admissions Process Flow Chart at UTHSCSA Dental School 103

75 Biomedical Sciences Standards 2-12, 2-13, 2-14 and Biomedical science instruction in dental education must ensure an in-depth understanding of basic biological principles, consisting of a core of information on the fundamental structures, functions and interrelationships of the body systems The biomedical knowledge base must emphasize that the oro-facial complex is an important anatomical area existing in a complex biological interrelationship with the entire body In-depth information on abnormal biological conditions must be provided to support a high level of understanding of the etiology, epidemiology, differential diagnosis, pathogenesis, prevention, treatment and prognosis or oral and oral-related diseases Biomedical science knowledge must be of sufficient depth and scope for graduates to apply advances in modern biology to clinical practice and to integrate new medical knowledge and therapies relevant to oral health care. Compliance: The UTHSCSA Dental School is in compliance with Standards 2-12, 2-13, 2-14 and A. Description for Standards 2-12, 2-13, 2-14 and 2-15 The UTHSCSA Dental School curriculum includes the 11 biomedical science courses indicated in Table Overall, 923 hours of the total curriculum of 4787 hours (19%) are devoted to biomedical science foundational topics and clinical applications of biomedical foundations. Of the total number of hours focusing on foundational biological principles, 828 hours are provided by 11 biomedical science courses listed in Table 2-12 and the remaining hours are devoted to clinical application of biomedical concepts in clinically oriented courses, which are listed in Table Class schedules for years one and two of the Dental School curriculum appear in Appendix 2-5b. Syllabi for the biomedical sciences courses are in Appendix 2-3b. With the exception of Pharmacotherapeutics PHAR8009 in the fourth year, the biomedical science foundation courses are conducted by faculty members with academic appointments primarily in the UTHSCSA School of Medicine. However, course directors for basic science courses participate on standing committees of the school, including admissions, academic promotion, the curriculum committees, the strategic planning committee and the faculty development committee as well as task forces periodically appointed by the Dean. 104

76 Table 2-12a: Biomedical Science Foundation Courses at UTHSCSA Dental School Course Title Year Credit Hours Clock Hours Biochemistry BIOC5013 First Dental Histology CSBL5031 First Gross Head and Neck Anatomy CSBL5016 First Dental Neuroscience CSBL5020 First Microbiology MICRO5013 First Physiology PHYL5013 First Pharmacology PHAR5001 First General Pathology PATH6019 Second Oral Pathology PATH6021 Second Clinical Oral and Maxillofacial Pathology Conference PATH7023 Third Pharmacotherapeutics PHAR8009 Fourth Other courses (See Table 2-14) Years 2-4 N/A 97 Total Many Dental School competencies address Standards as indicated in Table 2-12b. Table 2-12b: Competencies and Educational Outcomes that Address Biomedical Sciences UTHSCSA DS Competency Domain Competency Graduates must be competent in: Educational Outcomes 4: Biomedical Sciences Application of biomedical sciences to the assessment and treatment of patients 01. Demonstrate comprehension of the structure, function and pathology of cells, tissues, organs and systems, and apply for assessment and treatment of patients. 02. Recognize diseases in these categories, and explain presentation, pathophysiology and implications for dental treatment: a. diseases of head, neck & oral cavity; b. systemic diseases with oral manifestations; and, c. systemic diseases without oral manifestations 5: Patient Assessment and Diagnosis Patient assessment and diagnosis. 01. Obtain and interpret dental, medical and social patient histories. 02. Identify the presence of systemic disease with oral manifestations or implications for dental care, and manage dental treatment of these patients. 105

77 9: Patients Anxiety and Pain 10: Medical Emergencies 11: Dentofacial Growth and Development 15: Pulpal Disorders 16: Oral and Maxillofacial Surgery 17: Dental Emergencies Prevention and control of patients pain and anxiety. Prevention, recognition, and management of medical emergencies that occur in the dental setting. Recognition and management of malalignment and malocclusion in the deciduous, mixed, and permanent dentition. Management of pulpal and periradicular disorders. Performing uncomplicated oral surgical procedures and managing patients requiring specialty care. Management of dental emergencies. 07. Recognize the normal range of clinical findings and establish a working diagnosis for findings requiring treatment or representing deviations from normal. 01. Apply behavioral or pharmacological methods in caring for patients with fear and anxiety, and refer patients requiring special expertise. 02. Use safe and effective local anesthesia. 03. Use safe and effective inhalation sedation. 04. Prevent, recognize, and manage complications related to use of analgesics, local anesthesia and inhalation sedation techniques. 01. Assess the patient s risk for medical emergencies or complications from dental treatment by evaluating medical history and monitoring patient s symptoms. 03. Recognize when a medical emergency is occurring and identify the problem. 01. Evaluate the patient s dentofacial complex and occlusion, and develop a working diagnosis. 02. Recognize abnormal dentofacial growth and development that may create dental malalignment or malocclusion. 02. Manage pulpal and peri-radicular disorders. 01. Evaluate the patient s oral hard and soft tissue, identify problems needing treatment, develop a working diagnosis, evaluate treatment options and prognoses, and formulate a treatment plan that best meets the needs and desires of the patient. 02. Manage osseous and oral mucosal diseases. 01. Recognize dental emergencies requiring rapid referral for emergency medical treatment. 02. Diagnose and manage dental emergencies characterized by pain, swelling, fever, suppuration, and bleeding. 106

78 Standard Biomedical science instruction in dental education must ensure an in-depth understanding of basic biological principles, consisting of a core of information on the fundamental structures, functions and interrelationships of the body systems. During the biomedical foundational courses, dental students learn the biology and other factors that underlie normal and abnormal development and functions of human organ systems with emphasis on disease pathophysiology, recognition of clinical manifestations and systemic / oral health interrelationships. During courses in years one and two, dental students study morphology, anatomy, physiology, pathology and pharmacology for the organ systems of the human body and the head and the neck region after completing a review of human biology concepts, at the chemical, molecular, microscopic and gross structural levels, including genetic principles. Collectively, these courses provide students with the foundational concepts for comprehension of the pathogenic/pathological basis of disease, and understanding therapeutic strategies for management of diseases and abnormalities. As shown in Table 2-12c, 48% of course hours for biomedical sciences are devoted to primary instruction in the basic biological principles. Table 2-12c: Instructional Hours Devoted to Standard 2-12, Basic Biological Principles Standard 2-12 Instruction Hrs Hrs Addressing Std 2-12 BIOC 5013 Dental Biochemistry % CSBL 5032 Dental Histology % CSBL 5016 Dental Gross Anatomy % CSBL 5020 Dental Neuroscience % MICR 5013 Dental Microbiology % PHYL 5013 Physiology % PHAR 5001 Pharmacology % PATH 6019 General Pathology % PATH 6021 Oral Pathology % PATH 7023 Oral & Maxillofacial Pathology Conference % PHAR 8009 Pharmacotherapeutics % Other courses (Table 2-14) % Totals: % % National Board Part 1 Outcomes Table 2-12d indicates passing rates for UTHSCSA dental students on NBDE Part 1 for the years in comparison to national means. The pass rate on Part I of the National Board Dental Examination (NBDE) for the UTHSCSA Dental School was 94.8% in 2010 (for the 2012 graduating class) in comparison to the national average of 94.1%. The pass rate since 2006 has been 107

79 consistently over 90% with no particular section that has a significantly higher failure percentage than others. These outcomes support the conclusion that the instruction in the biomedical sciences for UTHSCSA dental students complies with Standard Table 2-12d: UTHSCSA Dental Student Pass Percentage on NBDE Part 1 Compared to National Means for All U.S. Dental Students; 2006 to Year UTHSCSA Dental School All U.S. Dental Schools % 91.4% % 96.3% % 91.6% % 94.0% % 94.1% Five Year Means 95.0% 93.5% Standards 2-13 and The biomedical knowledge base must emphasize that the oro-facial complex is an important anatomical area existing in a complex biological interrelationship with the entire body In-depth information on abnormal biological conditions must be provided to support a high level of understanding of the etiology, epidemiology, differential diagnosis, pathogenesis, prevention, treatment and prognosis or oral and oral-related diseases. Collectively, the biomedical foundation knowledge courses address Standard 2-13 and 2-14 from molecular, cellular, tissue and macroscopic viewpoints, as well as morphology. Several courses directly address the structural and functional relationships of hard tissue mineralization, stressing the biological basis of calcium and phosphate metabolism. This focus is relevant to student understanding of tooth structure and its pathophysiology. Overall, 52% of lecture, conference or laboratory instruction in courses addressing biomedical foundations focus on the structure and function of the oral cavity and associated pathophysiology as indicated in Table Three of the first year biomedical science courses, Gross Head and Neck Anatomy CSBL 5016, Dental Histology CSBL 5031 and Dental Neuroscience CSBL 5030, devote a substantial percentage of their course content to the oro-facial complex. During these courses, first year students learn the normal structural and functional relationships of the oral cavity as well as that of the head and neck. The embryological development of the oral cavity also is addressed in both courses, which facilitates students understanding of normal structure in the adult and development phases. The two other first year biomedical science courses, Dental Biochemistry BIOC 5013 and Dental Microbiology MICR 5013, each devote approximately 40% of their subject matter to dentally oriented topics. In addition, many biomedical science lectures and labs that may not exclusively emphasize the oro-facial complex do include discussions and illustrative case examples that illustrate the dental (oro-facial) relevance and clinical application of topics. These clinical cases and 108

80 other patient care correlations are often co-presented by clinical faculty, which is not reflected in Table 2-12c. On the other hand, biomedical science courses such as Physiology PHYL 5013 and General Pathology PATH 6019 do not specifically emphasize the oro-facial complex, but present fundamental biologic information and concepts that students learn as a basis for comprehension of the pathophysiology of oral disease and abnormalities that is addressed in Oral Pathology PATH 6021 and Clinical Medicine DIAG In the Clinical Medicine course, students learn the pathophysiology of commonly encountered medical conditions, and the principles of disease management including pharmacotherapeutics, and explore the clinical consequences of systemic disease in the oral health care setting. This course helps students comprehend the underlying etiology and sequlae of disorders that general dentists will encounter in the patient population of their practices. DIAG 6011 is sequenced just before students enter the clinic in year three. Students have learning experiences in Oral Pathology PATH 6021 during year two that focus exclusively on the orofacial complex. PATH 6021 is followed by Oral and Maxillofacial Pathology Clinicopathologic Conference PATH 7023 and Oral Medicine DIAG 7055 in year three that concentrate exclusively on the disease, abnormalities and conditions of the oro-facial complex, and Pharmacotherapeutics PHAR 8009, which focuses on drugs commonly used in prevention and treatment of oral health problems, which students apply during a 32-hour clinical rotation embedded in this course. Many clinical courses have integrated basic and clinical science content and team teaching by basic and clinical science faculty including: Cariology COMD 5046 and Physical Evaluation I DIAG 5014 in year one, Growth and Development ORTH 6077, Physical Evaluation II DIAG 6035, Applied Human Nutrition COMD 6025, and Temporomandibular Disorders RESD 6108 in year two, and Clinical Experience in Preventive Dentistry COMD 7050 in year three. Several other clinical courses in year two provide reviews of oro-facial anatomy, biological processes and disease pathophysiology pertinent to dental patient care issues including: Periodontics PERI 6082, Endodontics ENDO 6041, Orthodontics ORTH 6075, Oral Surgery OSUR 6051, and Implant Prosthodontics PROS Additional clinical courses that communicate biomedical science principles and information to students are listed in Table

81 Table 2-13: Summary of Hours of Oro-facial Complex Emphasis in Biomedical Science Courses STANDARD 2-13 Instruction Hrs Hrs Addressing Std 2-13 BIOC 5013 Dental Biochemistry % CSBL 5032 Dental Histology % CSBL 5016 Dental Gross Anatomy % CSBL 5020 Dental Neuroscience % MICR 5013 Dental Microbiology % PHYL 5013 Dental Physiology % PHAR 5001 Pharmacology % PATH 6019 General Pathology % PATH 6021 Oral Pathology % PATH 7023 Oral & Maxillofacial Pathology Conference % PHAR 8009 Pharmacotherapeutics % Other courses (Table 2-14) % Means: % % Table 2-14: Integration of Biomedical Sciences in Clinical Courses Clinical Course Biomedical Subject Matter Physical Evaluation I DIAG 5014 Cariology COMD 5046 Practical Infection Control DIAG 5049 Physical Evaluation II DIAG 6035 Clinical Medicine DIAG 6011 Applied Human Nutrition COMD 6025 Growth and Development ORTH 6077 Temporomandibular Disorders RESD 6018 Oral Surgery OSUR 6051 Local Anesthesia OSUR 6056 Gross Anatomy, Neuroanatomy, Physiology, Biochemistry, Pathology Biochemistry, Microbiology, Immunology, Pathology Microbiology, Immunology, Pathology Physiology, Pathology, Microbiology, Biochemistry, Neuroanatomy Physiology, Pathology, Microbiology, Immunology, Biochemistry, Neuroanatomy Pathology, Physiology, Biochemistry Gross Anatomy, Physiology Gross Anatomy, Physiology, Neuroanatomy General Pathology, Gross Anatomy, Physiology, Microbiology, Pharmacology Gross Anatomy, Neuroanatomy, Physiology, Pharmacology 110

82 Nitrous Oxide OSUR 6140 Endodontics ENDO 6041 Implant Prosthodontics PROS 6058 Periodontics PERI 6082 Oral Medicine DIAG 7055 Clinical Experience in Preventive Dentistry COMD 7050 Periodontics PERI 7081 Pharmacotherapeutics PHAR 8009 Gross Anatomy, Neuroanatomy, Physiology, Pharmacology Biochemistry, Microbiology, Immunology, General and Oral Pathology, Pharmacology Gross Anatomy, Physiology Gross Anatomy, Histology, Biochemistry, Microbiology, General and Oral Pathology Gross Anatomy, Histology, Pathology, Biochemistry, Pharmacology Microbiology, Biochemistry Gross Anatomy, Histology, Biochemistry, Microbiology, General and Oral Pathology Physiology, Pathology, Microbiology, Immunology Standard Biomedical science knowledge must be of sufficient depth and scope for graduates to apply advances in modern biology to clinical practice and to integrate new medical knowledge and therapies relevant to oral health care. The UTHSCSA Dental School offers a curriculum in the biomedical sciences of depth and scope sufficient for the application and integration of new and contemporary knowledge and therapies. As described in the responses for Standards 2-12, 2-13 and 2-14, there is a broad level of integration of basic and clinical sciences in courses throughout the curriculum. Dental students at UTHSCSA Dental School have consistently performed well on the National Board Dental Examination Part 1. The UTHSCSA Dental School, led by the Associate Dean for Academic Affairs and the school s two curriculum committees, implements several strategies and monitoring mechanisms to promote integration of the basic, behavioral and clinical science components of the students overall education experience as described in the response to Standard 2-9. As described in Standard 2-10, the Curriculum Management Committee implements a course review process where each course in the predoctoral education program is critiqued every four years by faculty peers and by students serving on course review teams. Currency, depth, focus and scope of course content are key elements in the review process. Appendix 2-10c in Standard 2-10 indicates the schedule of course reviews for and Under the leadership of Dr. John Rugh, in the Department of Developmental Dentistry and supported by an NIH / NIDCR R25 Educational Research Grant, the UTHSCSA Dental School has developed a series of courses and other learning and assessment activities, as well as a robust faculty development program, designed to achieve seven goals: 1. enhance student and faculty capacity to critically appraise the scientific literature; 111

83 2. increase clinical application of basic sciences with focus on biotechnology advances; 3. increase translation of biomedical and clinical advances into dental practice; 4. develop mechanisms for improved communication about biomedical breakthroughs and therapeutic methods among students, faculty and practitioners in the community; 5. create methods for rapid sharing of biomedical information; 6. provide a mechanism to assist Dental School faculty in identifying advances in the biologic sciences and biotechnology to incorporate into courses and identify new medical knowledge and dental treatment strategies for incorporation into the curriculum; and, 7. develop methods for better assessment of skills associated with evidence-based practice. This curriculum innovation is known as the CATs Initiative, named after a core component of the project developing student and faculty capacity to create Critically Appraised Topics. These courses and other experiences offer students the tools and understanding necessary to explore and interpret new information and to determine the best evidence available. These tools include an understanding of evidence search strategies using online and other databases, research study designs, biostatistics, and levels of evidence. The CATs Initiative is also described in the responses to Standards 2-22 and After four years of implementation, the CATs Initiative has increased student and faculty communication related to biomedical and clinical advances, leading to the development of an online library of several hundred Critically Appraised Topics. B. Supportive Documentation for Standards 2-12, 2-13, 2-14 and 2-15: 1. Appendix 2-5b: Class Schedules for First, Second, Third and Fourth years 2. Appendix 2-3b: Syllabi for Courses Pertinent to Standards 2-12, 2-13, 2-14 and 2-15: BIOC 5013 Dental Biochemistry CSBL 5032 Dental Histology CSBL 5016 Dental Gross Anatomy CSBL 5020 Dental Neuroscience MICR 5013 Dental Microbiology PHYL 5013 Dental Physiology PHAR 5001 Pharmacology PATH 6019 General Pathology PATH 6021 Oral Pathology PATH 7023 Oral & Maxillofacial Pathology Conference PHAR 8009 Pharmacotherapeutics 112

84 Behavioral Sciences Standard Graduates must be competent in the application of the fundamental principles of behavioral sciences as they pertain to patient-centered approaches for promoting, improving and maintaining oral health. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Description for Standard 2-16 The UTHSCSA Dental School believes that one of the characteristics of the dental profession is the delivery of oral health care that is personal, patient-centered, and delivered in a manner that is respectful of the patient s wishes and well being. Standard 2-16 is addressed by Dental School competency statements 7 and 8 and associated educational outcomes. Table 2-16: UTHSCSA Competencies and Educational Outcomes that Address Standard 2-16 UTHSCSA DS Competency Domain Competency Statement Graduates must be competent in: Educational Outcomes 7: Promotion of Patients Oral Health 8: Psychosocial and Behavioral Principles of Patient Care Health promotion and the prevention of oral diseases. Application of psychosocial and behavioral principles as they pertain to patient-centered approaches for promoting, improving, and maintaining oral health. 1. Educate individual patients concerning the etiology, prevention and control of oral diseases using a risk-based prevention approach. 2. Provide behavioral counseling and preventive therapies to reduce the severity of oral diseases and risks 3. Provide dietary counseling and nutritional education relevant to oral health and specific to each patient s dietary history and health habits. 4. Evaluate outcomes of prevention. 5. Recognize the roles and responsibilities of dentists and other health professionals in the improvement of oral health in the community. 6. Identify processes and programs that promote oral health and prevention of oral diseases at the community level. 1. Demonstrate caring and respectful behaviors when interacting with patients. 2. Apply interpersonal skills and communication that result in effective information exchange with patients. 3. Use psychosocial and behavioral principles to interact effectively with diverse patients. 4. Involve patients in decision-making and respond to their preferences, needs, and 113

85 values. 5. Integrate cultural, social, and behavioral factors that influence oral health practices and beliefs when developing treatment plans in collaboration with patients. UTHSCSA Dental School Curriculum for Standard 2-16 Standard 2-16 is addressed in didactic and clinical experiences throughout the curriculum. Year 1 Students are introduced to concepts of health promotion and the prevention or oral diseases in Oral Health Promotion and Disease Prevention COMD 5017 in year one. This course discusses evidence-based practices to prevent and promote oral health among individual patients and populations stressing determinants of oral health and methods to reduce disparities. COMD 5017 introduces students to a systematic approach to risk-based prevention and reviews contemporary methods to assess risks and prevent oral diseases and injury on the individual basis. This course also integrates patient education and counseling practices as a component of individualized prevention practice to facilitate behavior change. Year 2 In Nutrition COMD 6025, students explore risk factors for oral disease including diet, systemic diseases and tobacco use and students are introduced to the role of nutrition in oral health. In the course, Patient Centered Oral Health Care COMD 6048, students learn behavioral methods for alleviating fear and anxiety among dental patients, review typical causes of dental fear, and learn strategies for reducing fear and anxiety. Psychological approaches for working with patients with needle phobia, gagging and panic are also discussed in COMD During year 2, clinical application of health promotion and disease prevention principles occurs in three Preventive Methods (PM 1, PM 2, PM 3) modules of Clinical Introduction INTD 6088 where students work in groups to review clinical cases, assess the patient s oral health risk status and develop a preventive plan based upon these factors. In PM 1, students learn how to detect caries, both visually with a clinical examination and by use of new diagnostic technologies. In PM 2, student teams analyze cases presented via AxiUm, conduct risk assessment on these simulated cases and develop prevention plans. During PM 2, students explore case studies of edentulous patients, where they learn how to use dietary assessment tools and, working in groups, practice developing S-O-A-P (subjective findings, objective findings, assessment, plans) on the patients depicted in the cases. In PM 3, students learn methods for oral health and tobacco cessation counseling based on the stages of change model, and practice these skills in role plays based on case scenarios. Students then clinically apply these skills for a patient in the spring semester of year two, during a clinical application module in INTD All modules in INTD 6088 must be passed to achieve an overall passing grade in the course. In turn, students cannot advance into the third year without successful completion of INTD

86 Prevention Rotations in Years 1 and 2 Specific rotations afford students the opportunity to apply prevention in community settings. During year one, students participate in a dental public health prevention program at the Roy Cisneros Elementary School in the Edgewood Independent School District in San Antonio through School-Based Prevention COMD Students provide an age-appropriate oral hygiene message to the children and discuss healthy food choices that impact their oral and overall health. In year 2, students provide dental sealants for second grade children in a School-based Preventive Dentistry module in Clinic Introduction INTD In the Head Start module of INTD 6088, students complete a service-learning experience in caring for pre-school children by providing fluoride varnishes. In the pediatric dentistry module in INTD 6088, half of the second year class spends one afternoon at the Ricardo Salinas Clinic; the other half at the Frank Bryant Clinic. Both of the community clinics are located in underserved urban areas of San Antonio. Students provide patient education, prevention therapy or may perform an infant exam, depending on the patients seen at each clinic. Years 3 and 4 Students assess patients risk status and underlying risk factors, develop risk-based preventive plans for patients during year three, in the Preventive Dentistry Clinic COMD Students develop a nutritional assessment in the S-O-A-P format for an edentulous patient under the student s care for denture delivery, which includes interpretation of diet/nutritional status, assessment of oral health status, and screening for oral cancer. This note is reviewed and modified prior to the patient s next denture appointment. At this appointment, students are observed and evaluated by the Dental School s nutritionist as they provide behavior modification counseling for the edentulous patient pertinent to general oral health, diet, tobacco cessation if indicated, xerostomia and oral cancer risk. If necessary, some patients are referred to appropriate resources for additional counseling. Students receive feedback and coaching from the nutritionist after this observed patient encounter. All students complete this learning experience for one or more edentulous patients during the third year and are formally evaluated on the capacity to accomplish these risk assessment and patient counseling tasks. Students cannot pass COMD 7050 without successful completion of edentulous patient assessment and counseling. Behavior guidance strategies for children are addressed in year three through the didactic and clinical courses devoted to Pediatric Dentistry PEDO 7041 (lecture) and PEDO 7091 (clinic). During Clinical Patient Management INTD 7020 in year three, students learn and practice strategies for interpersonal communication and conflict resolution. Charts of students patients are evaluated by community oral health faculty members for risk assessment, interpretation and preventive plan formulation. This is accomplished via random auditing of the charts of patients who have received a comprehensive examination by third year students in each GPG. Two to three charts of each junior student are randomly selected and reviewed near the beginning of the clinic year in August, at mid-year in December and near the end of the year in late March (n = approximately 90 X 2.5 = 225 charts during each of the three review cycles). Student charts are audited for: completion of the risk assessment form; 115

87 formulation and implementation of a prevention plan; documentation that risk assessment, interpretation and behavioral modification counseling for diet, oral health and tobacco cessation have occurred; and, documentation that re-evaluation of patient s implementation of counseling recommendations has occurred. Feedback concerning audit results is provided to both faculty and students in each GPG. Students receive group and, as needed, individualized counseling. Assessment of Student Competency for Standard 2 16 Assessment of Comprehension of Foundational Concepts Students comprehension of the foundational concepts that form the basis for establishing therapeutic relationships with patients is assessed by written exams in the previously described didactic courses during years one and two (See course syllabi in Appendix 2-3b). Assessment of Progress Toward Competency Throughout years three and four, GPG faculty assess student s capacity to communicate with patients, and use behavioral science principles to implement patient-centered care and establish/maintain professional rapport on a daily and monthly basis, as well as on the mid-year and end-of-year comprehensive assessments, as described in Standard 2-8. Students are evaluated on their patient management skills for all patients encounters within the GPGs in Clinical Patient Management INTD 7020 in the third year and General Dentistry Clinic GEND 8077 in year four. As described earlier in this standard, students must successfully complete edentulous patient assessment and counseling activity in COMD 7050 in order to pass this course. The comprehensive early, mid and late year chart audits in the third year identify students who fail to meet the four expected standards for patient risk assessment and behavioral counseling. During year four, all independently performed graded clinical evaluations (see Table ) include assessment of students capacity to employ behavioral science principles in the management of patients. Assessment of Competency Attainment Students are specifically evaluated for their ability to apply fundamental principles of the behavioral sciences as they pertain to patient-centered approaches for promoting, improving and maintaining oral health on the following assessments in years three and four: as part of the patient management evaluation on the Monthly Assessment of Professionalism, Ethics and Progress Toward Competency within the GPGs (Appendix 2-8b); end-of year comprehensive evaluations completed by the GPG faculty at the conclusion of the third year (Appendix 2-8c); at the conclusion of the Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope in year 4 using the assessment form in Appendix 2-16a; 116

88 at the conclusion of the two-week South Texas Rotation in year 4 using the assessment forms in 2-16b and 2-16c; as a major assessment component for a restorative procedure that all fourth year students must independently and satisfactorily complete on a pediatric patient requiring local anesthesia and rubber dam placement. Appropriate pediatric patient behavior management is assessed during this clinical skills evaluation; and, based on the data sources described in this standard, each fourth year student s competency to promote patient s oral health using patient-centered strategies (UTHSCSA Competency 7; Table 2-16) and effectively use psychosocial and behavior principles of patient care (UTHSCSA Competency 8; Table 2-16) is assessed and certified by the student s GPG faculty using the senior year competency attainment certification (Appendix 2-8d). Students cannot pass General Dentistry Clinic GEND 8077 and cannot graduate without certification that these competencies have been attained. Format of Assessment Forms The formats of the daily, monthly, end-of-semester and end-of-year assessment forms are described in Standard 2-8. Notes on Rotation Assessments All rotation assessments are pass / fail. However, students must receive a satisfactory assessment for each category on the end-of-rotation evaluation to pass the rotation. All rotations in the fourth year must be passed in order to achieve a passing grade in GEND 8077 based on standards for satisfactory completion of this comprehensive clinical course described in Standard 2-8. B. Supportive Documentation for Standard 2 16: 1. Appendix 2-3b: Syllabi for Courses and Rotations Pertinent to Standard 2-16: COMD 5015 School Based Prevention COMD 5017 Oral Health Prevention and Disease Promotion for Individuals and Populations COMD 6025 Nutrition COMD 6048 Patient-Centered Oral Health Care INTD 6088 Clinical Introduction INTD 7020 Clinical Patient Management COMD 7050 Preventive Dentistry Clinic PEDO 7041 Pediatric Dentistry (didactic) PEDO 7091 Pediatric Dentistry Clinic GEND 8077 General Dentistry Clinic GEND 8077 Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope (Component of GEND 8077) 2. Appendix 2-7a: UTHSCSA Dental School Predoctoral Dental Education Competencies 117

89 3. Appendix 2-8a: Daily Assessment of Student Technical Development and Professionalism / Ethics; Years Three and Four 3. Appendix 2-8b: Monthly Assessment of Professionalism, Ethics & Progress Toward Competency; Years Three and Four 5. Appendix 2-8c: End-of-Semester and End-of-Year Progress Toward Competency Evaluations 6. Appendix 2-8d: Form for Fourth Year Assessment and Certification of Competency 7. Appendix 2-16a: Assessment Form for Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope 8. Appendix 2-16b: Assessment Form for South Texas Rotation in GEND Appendix 2-16c: Evaluation of Student Extramural Experience Multicultural Patient Care Standard Graduates must be competent in managing a diverse patient population and have the interpersonal and communications skills to function successfully in a multicultural work environment. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Description for Standard 2-17 It is the belief of the UTHSCSA Dental School that ethnic and cultural diversity among students, faculty, staff and patients enriches the academic environment and fosters appreciation of the health practices and beliefs of the increasingly diverse population of Texas and the U.S. as a whole. A diverse, multicultural educational environment broaden students understanding of health care in all components of society, and provides insight into access to care barriers and strategies for overcoming these barriers. Standard 2-17 is supported by the Principles for Predoctoral Education at the UTHSCSA Dental School that are articulated in the Preamble to the Predoctoral Education Competencies (Appendix 2-7a). Principles five and six apply to this standard: The curriculum provides dental students with a diverse clinical experience, grounded within a general dentistry concept, which includes community-based rotations in a variety of patient care environments. These community rotations provide students with service learning experiences and opportunities to provide health care for diverse populations of patients. 118

90 Patient care experiences, and associated learning, are based on the principle that students will be competent to provide dental care for patients with special needs and individuals across the age spectrum: infants, children, adolescents, adults, and the elderly when that care is within the scope of an entry-level general dentist. Standard 2-17 is addressed by Dental School competency statements 1, 5, 6, 7 and 8 and associated educational outcomes as indicated in Table 2-17a. Table 2-17a: UTHSCSA Competencies and Educational Outcomes that Address Standard 2-17 UTHSCSA DS Competency Domain Competency Statement Graduates must be competent in: Educational Outcomes 1: Ethics & Professional Responsibility 5: Patient Assessment 6: Treatment Planning 7: Promotion of Patients Oral Health 8: Psychosocial and Behavioral Principles of Patient Care Application of the principles of ethical reasoning and professional responsibility. Patient assessment and diagnosis Comprehensive treatment planning and assessment of treatment outcomes. Health promotion and the prevention of oral diseases. Application of psychosocial and behavioral principles as they pertain to patient-centered approaches for promoting, improving, and maintaining oral health. 04. Demonstrate professional behaviors when interacting with patients, employees, members of the community, and other health care providers. 01. Obtain and interpret dental, medical and social patient histories. 02. Discuss findings, diagnosis, treatment options and prognosis with patients or their legal representative to insure sufficient understanding for informed patient consent to treatment and obtain a written acceptance of the plan. 01. Educate patients about etiology, prevention and control of oral diseases using a risk-based prevention approach. 02. Provide behavioral counseling and preventive therapies to reduce severity of oral diseases and risk factors. 03. Provide dietary counseling and nutritional education relevant to oral health and to each patient s dietary history and health habits. 01. Demonstrate caring and respectful behaviors when interacting with patients and their families. 02. Apply interpersonal skills and communication strategies for effective information exchange with patients. 03. Use psychosocial and behavioral principles to interact effectively with diverse patients. 04. Involve patients in decision-making and respond to their preferences, needs, and values. 05. Integrate cultural, social, and behavioral factors that influence oral health practices and beliefs when developing treatment plans in collaboration with patients. 119

91 UTHSCSA Dental School Curriculum for Standard 2-17; Multicultural Patient Care Numerous courses and patient care experiences throughout the curriculum address this standard. Population diversity is introduced in year one in Oral Health Promotion and Disease Prevention COMD In year two, Patient-Centered Oral Health Care COMD 6048 emphasizes tailoring care to meet patients social, cultural and linguistic needs and explores major health belief systems embraced by people from diverse cultures. COMD 6048 also addresses strategies to facilitate patient-provider interactions and enhance oral and written communication including overcoming language barriers and patient s disabilities. During year 3, Pediatric Dentistry PEDO 7041 and Geriatrics DIAG 7052 provide opportunities for students to consider the influences of patient diversity in child, adolescent and elderly populations. In these courses, students learn and proactive communication strategies for young and older patients including patients with disabilities. In year four, Oral Health Care systems COMD 8014 examines disparities faced by diverse population groups in accessing dental care and obtaining dental insurance coverage. Multiple clinical experiences provide students opportunities to provide oral health care to a diverse patient population. San Antonio has a population that is approximately 61.2% Hispanic, 28.5% White, 2.1% Asian, and 6.9% African-American. As displayed in Table 2-17b, the UTHSCSA Dental School clinic population is consistent with the diversity seen in San Antonio and surrounding South Texas community. This community and regional diversity affords students with opportunities to provide oral health for these populations during Introduction to Patient Care INTD 5030 in year one where students support upperclassmen, in Clinic Introduction INTD 6088 during year 2 where students increase involvement in patient care, and during the GPG clinical experiences in years three and four, which are embedded as the primary learning mechanisms for Clinical Patient Management INTD 7020 and General Dentistry Clinic GEND Community-Based Rotations Numerous community-based clinical rotations enhance the student s ability to care for a diverse patient population, function successfully in a multicultural work environment and understand the diverse factors that impact oral health. As demonstrated in Table 2-17c, through the course of the curriculum, each dental student experiences 60 days (12 weeks) of required community-based education and service programs, all of which occur in clinics and other health care facilities that serve ethnically diverse communities and populations. The community-based rotations required for all students and several selective courses completed by numerous students are summarized in Appendix 1-8d. The majority of each student s 60 days of community-based educational experiences occurs in designated Dental Health Professional Shortage Areas (HPSA) in metropolitan San Antonio and throughout communities in South Texas reaching into the Lower Rio Grande Valley. In years one and two, students interact with school-aged children and Head-Start preschoolers. Clinical care is provided to children in years three and four at the Ricardo Salinas and Frank Bryant Clinics, located in underserved areas of metropolitan San Antonio, during the Pediatric Dentistry Clinical Course PEDO Students provide care for elderly populations in the UTHSCSA Dental School Senior Care during Geriatrics DIAG

92 In year four, the South Texas Community-Based rotation, a two-week rotation within General Dentistry Clinic GEND 8077, provides the opportunity for students to provide care at federally qualified community health centers. As described in Standard 2-16, the Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope, a component of GEND 8077, provides students with the opportunity to address the oral health needs of a homeless and vulnerable population, with substantial ethnic diversity. In summary, the diverse patient population of the Dental School and various communityeducation outreach programs, described previously in Standards 1-8 and 2-16 (Appendix 1-8d) provide students with experience in treating patients of diverse socioeconomic, ethnic and cultural backgrounds. Table 2-17b: Ethnicity of Patients Receiving Care at UTHSCSA Dental School Clinic; Population Percentage of Overall Patients Asian / Pacific Islander.05% Black.05% Hispanic 59% Native American.05% White 29% Unknown 11% Table 2-17c: Summary of UTHSCSA Dental School Required and Selective Clinical Outreach Education and Service Programs Academic Year Rotation Year 1 Year 2 Year 3 Year 4 Duration R S Duration R S Duration R S Duration R S School-Based Prevention Roy Cisneros Elementary Screenings, Fluoride Varnish Head Start Centers Primary Care/South Texas South Texas Community Health Centers (FQHC s) Primary Care/San Antonio San Antonio Christian Dental Clinic at Haven for Hope Oral Surgery University Health Center - Downtown Oral Surgery/Hospital Dentistry University Hospital ½ day ½ day 2 wks Summer ½ day 2 wks Summer 2 wks Summer 2 wks Summer ½ day 16 days 10 days 4.5 days 5 days 5 days 3 days 121

93 Pediatric Dentistry Dr. Frank Bryant Health Center Pediatric Dentistry Ricardo Salinas Clinic SAISD Primary Care (teens) Ricardo Salinas Clinic Primary Care/Colonia Mobile Van Program Webb County/Border Health Promotion/Disease Prev/Primary Care Program Mercy Ministries Primary Care/Mission Trips S. Texas Border Communities COSTEP/IHS Externship Indian Health Service Clinics Total Required Rotation Time/Academic Year 2-3 wks Summer ½ day 2 wks Summer 1 day 10 days Summer 4 days/ MV + 6 days/ MM Summer 3.5 days 3.5 days 1 day 2 days 2 days 2 days 2 days 3-6 wks Summer ½ day 2 days 27 days 30.5 days Total Required Outreach Clinical Rotation Time - 4 years/dental School = Total Selective Rotation Time 60 days/ 12 wks varies varies varies varies R = Required: all students participate equally S = Selective: clinical locations and programs vary RS = Summer participation in one 2-week clinical selective is required for juniors/rising seniors. Assessment of Student Competency for Standard 2 17 Assessment of Comprehension of Foundational Concepts Student mastery of concepts that form the foundation for providing culturally-sensitive care and managing a diverse patient population is assessed by written exams in the previously described didactic courses during years one and two (See course syllabi in Appendix 2-3b). Assessment of Progress Toward Competency Progress toward competency in managing a diverse patient population, including the behavioral components of patient care, is assessed throughout years three and four by supervising GPG faculty as part of the students' daily formative and monthly progress evaluations, as well as on the mid-year progress toward competency and end-of-year comprehensive assessment. This includes appraisal of communication skills, rapport, and degree of empathy and respect displayed by students for their patients. These on-going assessments contribute to determination of students' overall evaluation for the third-year Clinical Patient Management Course INTD 7020, and the fourth year General Dentistry Clinic GEND 8077, the primary clinical courses in the final two years of the curriculum. All independently performed clinical skill evaluations in the fourth year include assessment of students capacity to employ behavioral science, interpersonal and communication skills in the management of patients. As described previously in this standard and depicted in R 122

94 Table 2-17b, UTHSCSA dental students provide dental care for a diverse patient population at the Dental School and at community clinics, most of which are located in designated Dental Health Professional Shortage Areas (HPSA) throughout South Texas and the U.S. / Mexico Border Region. Assessment of Competency Attainment Although the daily evaluations completed in the GPG clinic reflect student s ability to work in a multicultural environment (as part of the patient management evaluation on that form; see Appendix 2-8a) the South Texas Rotation and the Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope allow a closer appraisal of communication skills, capacity to establish rapport and degree of empathy and respect for all types of patients. During the South Texas Rotation in GEND 8077, fourth year students are off campus for a twoweek period where they are immersed in the culture of South Texas and the U.S. / Mexico border region, in either Laredo, Harlingen, or Brownsville. The ethnicity and associated culture of this region is primarily Hispanic, which provides students with an opportunity to learn and appreciate different, culturally-based, perspectives about the importance and value of oral health and the importance of communicating in the patient s own language when dealing with health care issues. At the completion of the South Texas Rotation, students receive a comprehensive evaluation of clinical skills using the assessment form in Appendix 2-16b. This assessment form includes descriptive criteria for adjunct faculty to use and these criteria are categorized by discipline. In addition to clinical skills, adjunct faculty use the assessment form in Appendix 2-16c to evaluate other aspects of the students overall performance during the rotation including attitude, decisionmaking, patient management, cultural awareness and community activities. Students cannot pass the South Texas Rotation, and GEND 8077, without a satisfactory evaluation on both of these evaluations, including satisfactory assessments for patient management and cultural awareness. During the Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope, fourth year students provide patient care for a diverse transient population at a large urban homeless facility for one week where patients present with a variety of special needs. In this environment, supervising Dental School faculty have a unique opportunity to evaluate students interpersonal skills, cultural awareness and ability to function effectively in a multicultural work environment. At Haven for Hope, students are evaluated for each half-day of the rotation using the assessment form in Appendix 2-16a. During the week, students are evaluated by a variety of faculty using this instrument. At the end of the week, the rotation director conducts a wrap-up conference. For the conference, students write a reflection essay, based on guiding questions, about their experiences in this multi-cultural patient care setting and then participate in a group discussion of the responses. The reflection questions appear in Appendix 2-17a. The rotation director develops a final assessment of each student based on the daily faculty assessments and the final reflection exercise. Students must receive a satisfactory evaluation in each of the 11 categories on the rotation assessment form to receive a passing grade in the rotation. Students cannot pass GEND 8077 without a satisfactory assessment for the Haven for Hope Rotation. Based on the data sources described in this standard, each fourth year student s competency to manage a diverse patient population and use the interpersonal and communications skills to function successfully in a multicultural work environment is assessed by each students GPG 123

95 faculty using the senior year competency certification form (Appendix 2-8d). Students cannot pass General Dentistry Clinic GEND 8077 and cannot graduate without certification that these competencies have been attained. B. Supportive Documentation for Standard 2 17: 1. Appendix 2-3b: Syllabi for Courses and Rotations Pertinent to Standard 2-17: COMD 5017 Oral Health Care Promotion and Disease Prevention INTD 5030 Introduction to Patient Care COMD 6048 Patient-Centered Oral Health Care INTD 6088 Clinical Introduction INTD 7020 Clinical Patient Management DIAG 7052 Geriatrics PEDO 7041 Pediatric Dentistry (didactic) PEDO 7091 Pediatric Dentistry Clinic COMD 8014 Oral Health Care Systems GEND 8077 General Dentistry Clinic * Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope * South Texas Rotation 2. Appendix 2-8a: Daily Assessment of Student Technical Development and Professionalism / Ethics; Years Three and Four 3. Appendix 2-8b: Monthly Assessment of Professionalism, Ethics & Progress Toward Competency 4. Appendix 2-8c: End-of-Semester and End-of-Year Progress Toward Competency Evaluations 5. Appendix 2-8d: Form for Fourth Year Assessment and Certification of Competency 6. Appendix 2-16a: Assessment Form for Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope 7. Appendix 2-16b: Assessment Form for South Texas Rotation in GEND Appendix 2-16c: Evaluation of Student Extramural Experience 9. Appendix 2-17a: Reflection Essay Questions for Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope 124

96 Models of Oral Health Care Delivery Standard Graduates must be competent in evaluating different models of oral health care management and delivery. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Description for Standard 2-18 As indicated in Table 2-18, UTHSCSA Dental School competency domains 18 and 19 and associated educational outcomes address Standard Table 2-18: UTHSCSA Competencies and Educational Outcomes that Address Standard 2-18 UTHSCSA DS Competency Domain Competency Statement Graduates must be competent in: Educational Outcomes 18: Dental Practice Laws, Codes, Standards and Policies 19: Dental Practice and Oral Health Care Delivery Applying legal standards, rules, and regulations that govern dental practice and provision of oral health care. Applying practice management principles and demonstrating comprehension of models of oral health care delivery and financing. 04. Demonstrate understanding of the development and application of oral health policies that affect the oral health of individuals and communities. 03. Assess the impact of demographic, social, and economic trends on oral health status of the public and dental practice. 04. Demonstrate understanding of the models of oral health care delivery and financing that are implemented in various environments to meet the needs of individual patients and the community. 05. Demonstrate understanding of access to care, health workforce issues, and mechanisms for financing health and oral health services. UTHSCSA Dental School Curriculum for Standard 2-18; Oral Health Care Delivery Several didactic courses and community-based clinical rotations enable UTHSCSA dental students to explore and evaluate different models of oral health care management and delivery. The fouryear, longitudinal sequence of courses devoted to professional development and practice management (see description in Standard 2-19) introduces students to methods of oral health care delivery, including private dental practice (Foundations of Professional Development GEND 5001; Professional Development II GEND 6001; Practice Administration GEND 7026; and in the fourth year, Applied Practice Management GEND 8075 and Practice Administration GEND 8026). The primary course where students learn about models of oral health care delivery and financing is Oral Health Care Systems COMD 8014 in the fourth year. This course is purposefully conducted in year four after students have had patient care experiences in community-based clinics and 125

97 hospital settings, as subsequently described, and thus have a frame of reference for comparing and contrasting different systems for providing oral health care and general medical care services for the public. A goal of COMD 8014 is to help students become familiar with oral health policy issues that will influence their careers and examine factors influencing formulation of dental health policies. To accomplish this goal, students acquire knowledge about three key elements of oral health care systems: structure, financing, and personnel. Students learn how oral health care and medical care systems are organized and financed at local, state, and national levels, study methods for developing and evaluating community health programs, and compare models of oral health care including preferred provider organizations and health maintenance organizations. Students also explore demographic trends and population characteristics as they relate to access to dental care In years three and four, students participate in community-based Pediatric Dentistry rotations at the Ricardo Salinas Clinic (RSC) in San Antonio that has an associated Women, Infant and Children Clinic (WIC) and an Immunization Clinic and at the Frank Bryant Clinic (FBC). The RSC is part of the city of San Antonio Metropolitan Health District; the FBC a Federal Qualified Health Center. The primary recipients of care at the Ricardo Salinas Clinic are children, birth to 16 years of age. The center is located in an economically challenged area of San Antonio where the public has limited access to health care providers and facilities. The FBC is open to all patients in the designated catchment area. Fourth year students spend 3.5 days at each clinic while juniors spend two half days at RSC. These clinics provide the dental students with a unique opportunity to understand the oral and overall health needs of a community with limited health care resources. This educational experience in a comprehensive community clinic exposes students to a different model of oral health care management and delivery. Students also receive substantial training to expand and refine their diagnostic and clinical skills for infant, child and adolescent patients. Third and fourth year students treat children from 0 to 16 years of age. The third year rotation occurs in Pediatric Dentistry Clinic PEDO 7091, and the fourth year rotation is a component of General Dentistry Clinic GEND Sophomores, as part of Clinical introduction INTD 6088 rotate either to the Ricardo Salinas Clinic or the Frank Bryant Clinic for one half day where they provide patient education and/or assist junior and senior students as they provide care for children. During the third and fourth years, students complete rotations in the Oral and Maxillofacial Surgery (OMS) Clinic at University Health Center Downtown (UHCD), at the University Hospital, and at the OMS Clinic located at the UTHSCSA Dental School. UHCD and University Hospital are components of the Bexar County Metropolitan Hospital District, which is publicly funded. These clinics provide urgent care clinic for an economically challenged region of the city. The OMS rotations occur in Oral and Maxillofacial Surgery Clinic OSUR 7051 during year three and as a component of General Dentistry Clinic GEND 8077 in year four. In year four, all students complete two-week clinical rotations in affiliated Federally Qualified Community Health Centers in cities located along the Texas-Mexican border including Harlingen, Laredo and Eagle Pass. Students provide patient care in all dental disciplines in these clinics including limited exposure to prosthodontic and endodontic treatment. The South Texas Rotation is a component of the General Dentistry Clinic GEND

98 All UTHSCSA dental students complete a patient care rotation at a homeless facility in downtown San Antonio operated and funded by a coalition of public and private entities (Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope (Component of GEND 8077). This facility is one of the largest of its kind in the U.S. and provides a comprehensive array of support services for the indigent, transient and homeless population in San Antonio and Bexar County. During this rotation, students assess, provide health education, and deliver primary dental care for individuals either residing in the shelter or using its health care services. In addition to patient care delivery in the dental clinic at the shelter, students participate in seminars that address provision of health care for the indigent and homeless, learn about oral and systemic health issues that challenge this population, and learn about cultural and social issues that influence health care behaviors in this population. Assessment of Student Competency for Standard 2 18 Assessment of Comprehension of Foundational Concepts Students knowledge of the development, organization, and financing of the different models of oral health services in the United States is assessed by written examinations in the professional development and practice administration courses: Foundations of Professional Development GEND 5001; Professional Development II GEND 6001; Practice Administration GEND 7026; Applied Practice Management GEND 8075; and Practice Administration GEND (See course syllabi in Appendix 2-3b). Assessment of Competency Attainment Fourth year students competency in evaluating different models of oral health care management and delivery is formally assessed during the senior year in Oral Health Care Systems COMD 8014, where the course evaluations request students to compare and contrast several models of oral health care delivery. As described in preceding standards 2-16 and 2-17, students at UTHSCSA Dental School have ample experiences providing patient care in a variety of clinical settings that reflect different models of financial support, service, staffing and organization as well as different missions and priorities. During the Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope, students participate in a group reflective discussion that addresses the safety-net oral health care delivery model. To prepare, students write a reflection essay based on their patient care experiences in alternative settings including Haven for Hope and participate in group-discussions based on the essay (Appendix 2-17a). To assist in the development of the reflection essay, students are provided guiding questions to prompt analysis of their experiences in different types of health care delivery systems. During the small group conferences, students share insights from their reflection papers, which facilitates discussion of alternative strategies for delivering oral health care to the public. Students receive an assessment for reflection on the rotation evaluation form (Appendix 2-16a). Students cannot pass GEND 8077 without a satisfactory assessment for the Haven for Hope Rotation. Students cannot be certified as ready for graduation without passing Oral Health Care Systems COMD

99 B. Supportive Documentation for Standard 2-18: 1. Appendix 2-3b: Syllabi for Courses and Rotations Pertinent to Standard 2-18: GEND 5001 Foundations of Professional Development GEND 6001 Professional Development II GEND 7026 Practice Administration I OSUR 7051 Oral and Maxillofacial Surgery Clinic PEDO 7091 Pediatric Dentistry Clinic COMD 8014 Oral Health Care Systems GEND 8026 Practice Administration II GEND 8075 Applied Practice Management GEND 8077 General Dentistry Clinic Rotation syllabi: Year 4 - Ricardo Salinas Clinic Year 4 - Frank Bryant Clinic Year 4 - South Texas Rotation Year 4 - Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope (Component of GEND 8077). 2. Appendix 2-7a: UTHSCSA Dental School Predoctoral Dental Education Competencies 3. Appendix 2-16a: Assessment Form for Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope 4. Appendix 2-17a: Reflection Essay Questions for Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope 128

100 Practice Management Standard Graduates must understand the basic principles and philosophies of practice management, and have the skills to function successfully as the leader of the oral health care team. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Description for Standard 2-19 As indicated in Table 2-19, UTHSCSA Dental School competency domains 18, 19 and 20 and the associated educational outcomes address Standard Table 2-19: UTHSCSA Competencies and Educational Outcomes that Address Standard 2-19 UTHSCSA DS Competency Domain Competency Statement Graduates must be competent in: Educational Outcomes 18: Dental Practice Laws, Codes, Standards and Policies 19: Dental Practice and Oral Health Care Delivery Applying legal standards, rules, and regulations that govern dental practice and the provision of oral health care. Applying practice management principles and demonstrating comprehension of models of oral health care delivery and financing. 01. Apply federal, state and local laws and regulations that pertain to the practice of dentistry and provision of oral health services. 02. Interpret and apply codes, standards, and procedures that pertain to the practice or business administration of dentistry. 03. Evaluate and apply evidence-based guidelines for dental practice that promote, improve and maintain oral health. 04. Demonstrate understanding of oral health policies that affect the oral health of individuals and communities. 01. Develop professional goals and evaluate career options. 02. Apply business, financial and human resource management to dental practice. 03. Assess the impact of demographic, social, and economic trends on oral health status of the public and dental practice. 04. Demonstrate understanding of the models of oral health care delivery and financing implemented in various environments to meet needs of individual patients and the community. 05. Demonstrate understanding of access to care and health workforce issues, and mechanisms for financing health and oral health services. 129

101 20: Oral Health Care Team Demonstrating the skills necessary to function as a leader of the oral health care team. 01. Collaborate and communicate with oral health care team members in a multicultural work environment. 02. Demonstrate understanding of the roles of other health professionals and demonstrate the skills to interact with them to provide consultations, referrals, and follow-up care. 03. Participate with oral health care team members and other health care professionals in the coordination of care and promotion of health with patients. 04. Define the dentist s responsibility as a health professional, service provider, educator, member of the community and generator of new biomedical knowledge. UTHSCSA Dental School Curriculum for Standard 2-19; Practice Management The four year professional development / practice administration curriculum is a verticallyintegrated course sequence comprised of the following courses: (Foundations of Professional Development GEND 5001; Professional Development II GEND 6001; Practice Administration I GEND 7026; Practice Administration II GEND 8026; and Applied Practice Management GEND 8075). This continuum of courses is directed by faculty with extensive experience in dental private practice and the economics of health care systems. This faculty team insures year-to-year continuity so that learning experiences at each level prepare the student for activities in the subsequent year. These courses use a blended-learning approach including online education, simulations, classroom activities, projects, small group seminars, guest speakers from the practice community, and self-directed learning. In the professional development / practice administration curriculum, students learn: methodology for strategic planning; how to identify career goals and associated professional development needs; budgeting techniques and personal management of finances; business management concepts pertinent to establishing and maintaining dental practices; different types of dental practices; types of partnerships and associate relationships among dentists; factors that influence the viability of dental practices, and how to assess these factors; principles of site selection and office planning; techniques for staff recruitment and evaluation; strategies for planned career growth and lifelong learning; and, as a capstone in year four, how to develop a business plan for a dental practice. In the first year course, Foundations of Professional Development GEND 5001, students develop a strategic plan for achieving professional goals during their dental careers. Students also explore methods of personal financial planning including accounting principles, cash flow management, and balance sheets In the second year course, Professional Development II GEND 6001, students 130

102 learn how to conduct a SWOT analysis (strengths, weaknesses, opportunities and threats) to analyze simulated dental practices for viability. GEND 6001 also introduces students to budgeting principles and formats, budget monitoring strategies and software. The students' capstone exercise for the year two course is to develop a budget for a simulated dental practice. In the third year course, Practice Administration I GEND 7026, students learn and practice, in simulations, methods for selecting practice locations through analysis of community environment. Issues associated with practice construction or re-modeling are reviewed and augmented by personal accounts from dentists in the community who share their experience related to developing a dental practice. Students learn about associate contracts, methods of valuing practices, business systems for the office, computer utilization in private practice, personal and business insurance needs, OSHA compliance and third-party reimbursement. A major component of year three is dental office management where students learn patient scheduling, recruiting, training and evaluating office staff, developing personnel policies for a positive work environment and considerations in selecting associate dentists and dental hygienists. The practice management experience culminates in the fourth year courses, Practice Administration II GEND 8026 and Applied Practice Management GEND 8075, where students apply the knowledge acquired in years one, two and three to write a proposal for a dental practice loan that is critiqued by course faculty. During GEND 8075, students also explore issues related to establishing, purchasing, or becoming an associate in a dental practice in different settings: small township, suburban, and urban communities. Leader of the Oral Health Care Team During clinical education in years three and four (Clinical Patient Management INTD 7020 and General Dentistry Clinic GEND 8077) UTHSCSA dental students experience more than 2,000 hours of collaboration and teamwork with faculty members, student colleagues at lower and higher levels of training, other oral health care providers, and clinic staff for planning, scheduling, implementing and assessing the outcomes of patient care. A goal for the clinical phase of the curriculum is to help students acquire the confidence, organizational ability and communications skills to function effectively in a patient care environment and, by the time they reach the fourth year, to serve as mentors for second and third year students and coordinators of care for their family of patients. As described in the Forward section, a 2011 faculty workshop developed recommendations to enhance students opportunities to function in a leadership role (See Appendix F-4). These proposals are currently under consideration by the GPG Leaders for future implementation. Working in the clinic in INTD 7020 and GEND 8077, students have the opportunity to interact continually with the GPG s patient coordinator and scheduler to arrange appointments and sequence patient care. Working with the on-site dental laboratory provides students with the opportunity to communicate and collaborate with experienced technicians to maximize esthetic results and clinical functionality of fixed restorations and removable appliances. Medical consultations or referrals are initiated in INTD 7020, GEND 8077 and Geriatrics DIAG 7052 when indicated by patient s medical history or physical findings. During rotations, students observe the functioning of oral health care teams in community health centers. 131

103 Assessment of Student Competency for Standard 2 19 Assessment of Comprehension of Foundational Concepts Students knowledge of the principles and philosophies of practice management is assessed by written examinations, projects and simulations that are completed during the four-year professional development / practice administration curriculum, which consists of Foundations of Professional Development GEND 5001; Professional Development II GEND 6001; Practice Administration GEND 7026; Applied Practice Management GEND 8075; and Practice Administration GEND (See course syllabi in Appendix 2-3b). This continuum of courses addresses many issues related to health care team leadership and the multiple roles of the dental practitioner in the community Assessment of Progress Toward Competency Elements of leadership in an oral health care setting are assessed during the monthly progress evaluations completed for each student during the third and fourth clinical years within the General Practice Groups (GPGs), the major teaching/learning component of Clinical Practice Management INTD 7020 and General Dentistry Clinic GEND Assessment of Competency Based on the data sources described in this standard, each fourth year student s competency to demonstrate skills necessary to function as a leader of an oral health care team (UTHSCSA Competency 20) is assessed and certified by GPG faculty using the senior year competency certification form (Appendix 2-8d). Students cannot pass General Dentistry Clinic GEND 8077 and cannot graduate without certification that this competency has been attained. B. Supportive Documentation for Standard 2-19: 1. Appendix 2-3b: Syllabi for Dental School Courses and Rotations Pertinent to Standard 2-19: GEND 5001 Foundations of Professional Development GEND 6001 Professional Development II GEND 7026 Practice Administration I GEND 8026 Practice Administration II GEND 8075 Applied Practice Management INTD 7020 Clinical Patient Management GEND 8077 General Dentistry Clinic 2. Appendix 2-7a: UTHSCSA Dental School Predoctoral Dental Education Competencies 3. Appendix F-4: Report of Standard 2-19 Working Group at the January 2011 Accreditation Self-Study Workshop 4. Appendix 2-8d: Form for Fourth Year Assessment and Certification of Competency 132

104 Ethics and Professionalism Standards 2-20 and Graduates must be competent in applying ethical, legal and regulatory concepts to the provision and/or support of oral health care services Graduates must be competent in the application of the principles of ethical reasoning and professional responsibility as they pertain to patient care and practice management. Compliance: The UTHSCSA Dental School is in compliance with Standards 2 20 and A. Description for Standards 2-20 and 2-21 As indicated in Table 2-20, UTHSCSA Dental School Competency Domains 1 and 19 and associated educational outcomes primarily address Standards 2-20 and 2-21, although students attainment of all of the School s competencies are contingent on professional judgment and ethical conduct. Table 2-20: UTHSCSA Competencies and Educational Outcomes for Standards 2-20 and 2-21 UTHSCSA DS Competency Domain Competency Statement Graduates must be competent in: Educational Outcomes 1: Professional Judgment and Ethical Conduct 18: Dental Practice Laws, Codes, Standards and Policies Application of the principles of ethical reasoning and professional responsibility. Applying legal standards, rules, and regulations that govern dental practice and the provision of oral health care. 01. Identify the characteristics and responsibilities of a dental professional. 02. Demonstrate understanding of the ethical and professional responsibilities that dentists have to patients, employees, members of the community, and other health care providers. 03. Recognize and deal with ethical dilemmas by applying principles of ethical reasoning and professional responsibility. 04. Demonstrate professional behaviors when interacting with patients, employees, members of the community, and other health care providers. 05. Demonstrate understanding of ethical standards for biomedical research. 01. Apply federal, state and local laws and regulations pertaining to practice of dentistry and oral health services. 02. Interpret and apply codes, standards, and procedures that pertain to the practice or business administration of dentistry. 03. Evaluate and apply evidence-based guidelines for dental practice that promote, improve and maintain oral health. 133

105 UTHSCSA Dental School Curriculum for Standard 2-20 and 2-21; Ethical Conduct, Professionalism and Legal / Regulatory Concepts Students at the UTHSCSA Dental School study ethical, legal and regulatory concepts related to the practice of dentistry, professional judgment/responsibilities, and ethical conduct in a variety of courses in each year of the curriculum. The ethics component of Standard 2-20 is addressed in Professional Ethics COMD 5031 in year one and Professional Ethics COMD 7031 in year three which provide students with a foundation in ethical reasoning that governs the dental profession. This is accomplished through lectures and seminars using cases to stimulate reflection, analysis and debate. The first-year COMD 5031 course introduces students to ethical principles, and the core values of the dental profession. Students explore the question of what constitutes a profession and identify the responsibilities that dentists have to their patients, peers, and society, as well as the expectations of the public related to the dentist's roles and responsibilities. In year one, students also receive the ADA s Principles of Ethics and Code of Professional Conduct and participate in seminars to analyze the standards by which the profession holds its members accountable. Discussion of the ADA Principles of Ethics and Code of Professional Conduct continues in the third year ethics course, COMD 7031, which is enriched by the students' own patient care experiences and their observations of patient-provider interactions in community and hospital settings. Senior students are required to review the ADA s Principles of Ethics and Code of Professional Conduct prior to commencing their South Texas Rotation. Compliance for the legal and regulatory component of Standard 2-20 is attained in a variety of didactic and clinical courses. Students are introduced to the Health Insurance Portability and Accountability Act (HIPAA) Standards in year one in the informatics module of Introduction to Patient Care INTD Additional requirements under HIPAA (e.g., National Provider Identifier, Healthcare Integrity and Protection Data Bank [HIPDB] and Health Information Technology for Economic and Clinical Health Act [HITECH]) are addressed in Jurisprudence COMD 8032 that students complete in year four. Several courses address UTHSCSA Competency / Educational Outcome 18-03: evaluate and apply evidence-based guidelines for the practice of dentistry that promotes, improves and maintains oral health, which focuses on the dentist's professional responsibility to provide preventive care/services to enhance the oral health of the public. The concept of social justice in provision of health care services is addressed in Professional Ethics COMD 5031, Professional Ethics COMD 7031, Pediatric Dentistry PEDO 7041 and Oral Health Care Systems COMD Students initially learn about public sources of financial support for preventive dental services in COMD 5017 and then experience oral health policy during the Head Start Prevention module in Clinical Introduction INTD 6088 when they provide annual dental exams for children. The efficacy of fluoride and sealants in preventing dental caries is introduced in year one in COMD 5017 and then students receive hands-on experience during year two when they complete the school-based sealant module in Clinical Introduction INTD Students analyze the implications of the health care reform act upon the public's oral health and the impact on dental providers in COMD

106 Students learn professional responsibilities and legal/regulatory standards related to infection control in Practical Infection Control DIAG Students are introduced to the dentist's legal and professionalism responsibilities related to prescription writing in Pharmacology PHAR Professional responsibilities, laws and regulatory techniques to mitigate prescription drug diversion are addressed in Jurisprudence COMD Professional responsibilities, ethical conduct and legal regulations regarding local anesthesia and nitrous oxide are introduced in year two in Local Anesthesia OSUR 6056 and Nitrous Oxide OSUR 6140 respectively. The dentist's professional and legal responsibility to identify and report patient abuse and/or neglect is addressed in Pediatric Dentistry Clinic PEDO 7091, Geriatrics DIAG 7052, and COMD Regulations related to ionizing radiation are presented to students in Dental Radiology DIAG 6132, Geriatrics DIAG 7052, INTD 7020 and GEND Texas requirements regarding ownership and operation of dental x-ray units and lasers are addressed in COMD The dentist's legal responsibilities related to environmental hazards in dental practice are addressed in Operative Dentistry Clinic RESD 7011 and COMD A number of courses provide students with a foundation for the legal responsibilities associated with dental practice, and provide a detailed description of regulatory oversight mandated by the Texas Occupations Code and Texas Administrative Code: Professional Development II GEND 6001, Practice Administration GEND 7026, Practice Administration GEND 8026, Jurisprudence COMD 8032, and General Dentistry Seminar Students initially learn about the role of federal and state regulatory agencies, including OSHA and the Centers for Disease Control in Practical Infection Control DIAG 5049 with a more in-depth focus in Oral Health Care Systems COMD 8014 and Jurisprudence COMD Ethical and legal considerations related to the hiring and firing of employees are addressed in Practice Administration GEND Assessment of Student Competency for Standards 2 20 and 2-21 Overview At all levels of the curriculum, satisfactory evaluation for ethical behavior and professionalism is required in order for students to: pass courses; progress to the next year of the curriculum; and ultimately; graduate. Assessment of Comprehension of Ethical Conduct and Professionalism Principles and Laws Students knowledge of the principles and legal/regulatory standards identified in Table 2-21 are assessed by written examination, often in a scenario-based format or by essay and reflection journals requiring case analysis. As indicated in Table 2-21, formal, graded assessment of students comprehension of ethical, legal and regulatory concepts and standards occur in several courses during each year of the curriculum (See course syllabi in Appendix 2-3b). 135

107 Table 2-21: Ethical, Legal and Regulatory Concepts and Standards Measured by Written Examination at UTHSCSA Dental School Principles and legal/regulatory standards Course Title Year Ethical, legal and regulatory concepts Professional Ethics COMD 5031 Professional Ethics COMD 7031 Professional judgment and ethical conduct HIPAA and other patient protection, privacy and confidentiality regulations Oral health policies / public safety net policies and programs Social justice related to public health care services; dentist s roles and responsibility Professional Ethics COMD 5031 Professional Ethics COMD 7031 Level 3 HSC on-line training Jurisprudence COMD 8032 Pediatric Dentistry PEDO 7041 Oral Health Care Systems COMD 8014 Oral Health Promotion COMD 5017 Pediatric Dentistry PEDO 7041 Oral Health Care Systems COMD 8014 Regulatory standards for infection control Practical Infection Control DIAG Legal / regulatory standards for prescription writing and drug diversion Legal / regulatory standards for local anesthesia and nitrous oxide Legal / regulatory standards for reporting patient abuse and patient neglect Legal / regulatory standards for ionizing radiation and ownership of x-ray units and lasers Legal / regulatory standards for dental practice ownership; Texas Occupations Code; Texas Administrative Code Federal and State regulatory agencies; OSHA; Centers for Disease Control Ethical and legal considerations related to the hiring and firing of employees Legal / regulatory standards for environmental hazards in dental practice Pharmacology PHAR 5001 Jurisprudence COMD 8032 Local Anesthesia OSUR 6056 Nitrous Oxide OSUR 6140 Pediatric Dentistry Clinic PEDO 7091 Geriatrics DIAG 7052 Jurisprudence COMD 8032 Dental Radiology DIAG 6132 Clinical Patient Management INTD 7020 Geriatrics DIAG 7052 Jurisprudence COMD 8032 Professional Development II GEND 6001 Practice Administration GEND 7026 Practice Administration GEND 8026 Jurisprudence COMD 8032 General Dentistry Seminar 8078 Practical Infection Control DIAG 5049 Annual on-line OSHA certification Oral Health Care Systems COMD 8014 Jurisprudence COMD Practice Administration GEND Operative Dentistry RESD 7011 Jurisprudence COMD

108 Assessment of Progress Toward Competency The students ability to apply the principles of ethical reasoning and professional responsibility as they pertain to patient care and practice management is evaluated extensively during the clinical phase of the students education. As noted earlier in this Standard, students at UTHSCSA Dental School cannot pass courses, advance from year to year or graduate if they do not demonstrate ethical behavior and professionalism. In year three, during Professional Ethics COMD 7031, students are evaluated on their ability to recognize ethical dilemmas/ issues that arise in the clinic during patient care and use a decision-making model to develop and justify their proposed resolution, as well as their understanding of the role of dentists in social justice issues, and the importance of ethics in the business of dentistry and dental research. In General Dentistry Seminar GEND 8078 in year four, a reflection/research paper captures students ability to identify ethical dilemmas/issues and apply ethical reasoning to the analysis and resolution of these situations. In the clinic, students are expected to demonstrate ethical behavior and professionalism, including maintaining a professional rapport with patients, peers, staff and faculty and complying with clinical policies including those identified in Table 2-21, such as compliance with infection control standards, use of local anesthesia, and patient information privacy / confidentiality. These elements of ethics and professionalism are evaluated in years three and four in Clinical Patient Management INTD 7020 and in General Dentistry Clinic GEND 8077 by faculty at five levels: component of formative assessment for each patient encounter (Appendix 2-8b: Daily Formative Assessment); during monthly progress evaluations (Appendix 2-8c: Monthly Progress Evaluation); on mid-year and end-of-semester progress toward competency assessments (Appendix 2-8d); during independently performed skill assessments in year three and graded clinical examinations in year four; and, at the conclusion of the semester and the year during a formal appraisal of students professionalism (Appendix 2-20a: Semester Professionalism Evaluation; Years Three and Four). Student professionalism is evaluated as a component of General Dentistry s independently performed clinical skill evaluations and case presentations during year three (Appendix 2-20b: Evaluation Forms for General Dentistry Clinic GEND 7001 Competency Assessments and Case Presentations). Professionalism is also evaluated as a component of the students assessment in other clinical rotations including, as examples: Geriatric Clinical Rotation (Appendix 2-20c: DIAG 7052 Student Assessment Form); Periodontics Rotation (Appendix 2-20d: Periodontics Rotation GEND 7001 Evaluation Form); and, 137

109 Several community-based rotations including the School-based Prevention / Sealants Program (during Clinical Introduction INTD 6088), the South Texas Rotation, and the Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope. Assessment of Competency Attainment Based on the numerous data sources described in this standard, each fourth year student s competency to apply principles of ethical reasoning and professional responsibility (UTHSCSA Competency 1; Table 2-20) is assessed and certified by GPG faculty using the fourth year competency certification form (Appendix 2-8d). Students cannot pass General Dentistry Clinic GEND 8077 and cannot graduate without certification that this competency has been attained. B. Supportive Documentation for Standards 2-20 and 2-21: 1. Appendix 2-3b: Syllabi for Courses and Rotations Pertinent to Standards 2-20 and 2-21: COMD 5017 Oral Health Promotion DIAG 5049 Practical Infection Control GEND 5001 Foundations of Professional Development INTD 5030 Introduction to Patient Care COMD 5031 Professional Ethics PHAR 5001 Pharmacology DIAG 6132 Dental Radiology GEND 6001 Professional Development II INTD 6088 Clinical Introduction OSUR 6056 Local Anesthesia OSUR 6140 Nitrous Oxide RESD 7011 Operative Dentistry COMD 7031 Professional Ethics DIAG 7052 Geriatrics INTD 7020 Clinical Patient Management PEDO 7041 Pediatric Dentistry (Didactic) PEDO 7091 Pediatric Dentistry Clinic GEND 7026 Practice Administration I GEND 7001 General Dentistry Clinic (third year) COMD 8014 Oral Health Care Systems GEND 8026 Practice Administration II COMD 8032 Jurisprudence GEND 8077 General Dentistry Clinic (fourth year) GEND 8078 General Dentistry Seminar 2. Appendix 2-7a: UTHSCSA Dental School Predoctoral Dental Education Competencies 3. Appendix 2-8a: Daily Assessment of Student Technical Development and Professionalism / Ethics; Years Three and Four 4. Appendix 2-8b: Monthly Assessment of Professionalism, Ethics & Progress Toward Competency 138

110 5. Appendix 2-8c: End-of-Semester and End-of-Year Progress Toward Competency Evaluations 6. Appendix 2-8d: Form for Fourth Year Assessment and Certification of Competency 7. Appendix 2-16a: Assessment Form for Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope 8. Appendix 2-16b: Assessment Form for South Texas Rotation 9. Appendix 2-20a: Semester Professionalism Evaluation; Years Three and Four 10. Appendix 2-20b: Evaluation Forms for GEND 7001 Skill Assessments & Portfolio Presentations 11. Appendix 2-20c: Assessment Form for Geriatrics DIAG Appendix 2-20d: GEND 7001 Periodontics Rotation Evaluation Form Life-long Learning and Self-Assessment Standard Graduates must recognize the role of lifelong learning and self-assessment in maintaining competency. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Description for Standard 2-22 The UTHSCSA Dental School, through its curriculum and patient care programs, strives to implement a culture that encourages students to continually self-assess strengths and weaknesses and develop strategies for continued professional development. In the preamble to the UTHSCSA Dental School Predoctoral Education Competencies (Appendix 2-7a; Page 2), the fourth guiding principle for the curriculum states: To stay up-to-date and effectively analyze issues, controversies and emerging diagnostic and therapeutic technologies, general dentists must demonstrate critical thinking and pursue self-directed learning for life-long professional growth. Additionally, the Dental School conceptualization of overall, global, competency and readiness for entry-level practice (Appendix 2-7a; Page 4) emphasizes the importance of lifetime commitment to professional growth: To demonstrate readiness for entry into professional practice, students at UTHSCSA Dental School must demonstrate that they can accomplish the competencies described in this document that indicate the knowledge, skills and values that new graduates need in order to begin their professional roles in society. It is recognized that these competencies represent only a starting point for the dentist s life-long professional journey a journey which must include ongoing developmental activity to enhance, refine and maintain patient care skills, and to develop new capabilities needed to serve the evolving oral health needs of the public. 139

111 The Dental School has a strong curricular focus on evidence-based practice and enhancement of student and faculty capacity in critical appraisal of the biomedical literature. This curriculum and research project, known as the CATs Initiative (Critically Appraised Topics), is funded by a NIH/NIDCR R25 Educational Research Grant (Appendix 2-22a: CATs Initiative Website). The Principle Investigator for the CATs grant and the Director of Evidence-Based Dental Practice at UTHSCSA Dental School is Dr. John Rugh in the Department of Development Dentistry. The CATs curriculum and outcomes of this initiative have been described in several publications identified below (Appendices 2-22b, 2-22c, and 2-22d). Rugh JD, Hendricson WD, Glass BJ; Hatch JP, Deahl TS, Guest GF, Ongkiko RM, Gureckis KM, Jones AA, Rose WF, Gakunga PT, Stark DL, Steffensen B. Teaching Evidence Based Practice at San Antonio. Texas Dental Journal. 2011; 128(2): Hendricson WD, Rugh JD, Hatch JP, Deahl T, Wallmann ER. Validation of an Instrument to Assess Evidence-Based Practice Knowledge, Attitudes, Access and Confidence in the Dental Environment. J Dent Educ. 2011; 75(2): Rugh JD, Hendricson WD, Hatch JP, Glass BJ. The San Antonio CATs Initiative. J Am Coll Dent Summer;77(2): Several Dental School competencies and educational outcomes address Standard Table 2-22: UTHSCSA Competencies and Educational Outcomes that Address Standard 2-22 UTHSCSA DS Competency Domain Competency Statement Graduates must be competent in: Educational Outcomes 2: Critical Thinking and Problem Solving 3: Self-Assessment The use of critical thinking and problem solving during patient care. Self-assessment of progress toward overall readiness for general dental practice and attainment of individual competencies. 02. Retrospectively critique patient care to evaluate clinical decisions, rationale for treatment, and outcomes. 03.Use a critical appraisal process to explore patient care issues and uncertainties by identifying questions, locating and appraising best available evidence and implementing treatment based on this appraisal. 04. Apply a critical appraisal process to analyze claims for therapeutic effectiveness in literature, continuing education programs and advertisements. 01. Assess progress toward competency and readiness for dental practice. 02. Identify learning needs and create plans to address these needs. 03. Assess strengths and weaknesses of patient care and identify strategies for improvement. 140

112 18: Dental Practice Laws, Codes, Standards and Policies 20: Oral Health Care Team Applying legal standards, rules, and regulations that govern dental practice and the provision of oral health care. Demonstrating the skills necessary to function as a leader of the oral health care team. 03. Evaluate and apply evidence-based guidelines for the practice of dentistry that promotes, improves and maintains oral health. 04. Define the dentist s responsibility as a health professional, service provider, educator, member of community and generator of biomedical knowledge. Dental School Curriculum Related to Standard 2 22; Life-long Learning and Self-Assessment Students at UTHSCSA Dental School engage in educational activities pertinent to Standard 2-22 by the CATs Initiative and by other strategies in didactic and clinical courses. The CATs Initiative is described first followed by a summary of learning experiences and competency assessment in other components of the curriculum. The UTHCSA Dental School CATs Initiative The UTHSCSA Dental School recognized the need for new learning approaches to enhance students capacity in critical appraisal and development of their appreciation and readiness for lifelong learning after graduation. To accomplish these goals, the Dental School implemented the CATs Initiative. The overarching aim of CATs is to teach lifelong learning and critical thinking skills that students can apply during their practice career. The CATs Initiative addresses Standards 2-22 (Lifelong Learning) and 2-23 (Critical Thinking). The approach involves collaborative student and faculty preparation of Critically Appraised Topics (CATs) and the establishment of a searchable online database of these CATs. The key elements of the CATs initiative are indicated in Appendix 2-22e. CATs provides a mechanism whereby clinical and research faculty, specialty residents and alumni in private practice collaborate on the common task of establishing the best possible answers to clinically relevant questions. Predoctoral and advanced education residency curricula were revised to include in-depth instruction on evidence-based practice (EBP) skills in preparation for development of CATs. During year 2, Evidence-Based Dentistry INTD 6010 provides dental students with the foundational evidence searching and critical appraisal skills necessary to keep up-to-date and critically evaluate new knowledge, products and procedures during his or her professional career. These skills include the ability to: (1) formulate focused questions based on uncertainties in patient care, (2) search the literature, (3) critically read and evaluate various sources of evidence including articles published in the dental and medical literature, advertisements, Internet sources and information presented in continuing education programs and (4) make judgments about the applicability of the knowledge to patients and other clinical problems. These four skills are taught, practiced and evaluated in the context of the students primary objective in the course: learning how to write CATs Critically Appraised Topics. Appendix 2-22f displays the format of a CAT summary and indicates the evaluation criteria. CAT exercises occur in several didactic clinical courses during year 2 and in the students clinical activities embedded in 141

113 the GPGs in years three and four. Third and fourth year students make CAT presentations, in PowerPoint format, based on patients they have treated. These CAT presentations occur during GPG case conferences where students and faculty analyze the evidence and conclusions for each CAT presented. The training of faculty in EBP and CATs preparation skills is a critical component of the project. Over 80% of the faculty have received training and 80 faculty now annually supervise the development of CATs by students. Several course directors implement CATs assignments in clinical courses during years two and three of the curriculum to provide an immersion experience for the students and to integrate critical appraisal of the biomedical literature throughout the curriculum. In the spring semester of year two, students develop CATs under the guidance of faculty mentors in the Critical Thinking Module of Clinical Introduction During this activity, student and faculty teams develop a focused clinical question using the PICO format and then students conduct a search for best available evidence and write a CAT summary using skills learned in INTD During the spring semester of year two, students also participate in an EBP OSCE Module in Clinical Introduction 6088 that assesses the student s ability to use an appropriate PubMed search strategy to find the best evidence needed to answer a clinical question. During the OSCE, the student is given two clinical scenarios and corresponding PICO questions. The student has 20 minutes to read each scenario and question, search PubMed, and identify the strongest evidence available to answer the question. CATs Online Library CATs developed by students and faculty members are being published in an online CATs library to promote the transfer of new knowledge to other students, faculty, private practitioners and ultimately the public (Appendix 2-22g). The online CATs library provides users with rapid up-todate evidence-based answers to focused clinical questions. The library is searchable by keywords and is accessible in the clinics and classrooms. The online CATs library was made available to private practice dentists, dental educators and the public in To date, approximately 350 CATs have been created. FAST CATs Academic Detailing Program A major component of the CATs initiative is the Faculty, Alumni, Student Team (FAST CATs) Program. This academic detailing program involves private practice dentists in the CATs program. Twenty dental students participate each summer in a selective course (FAST CATS Academic Detailing SELC 8153), which involves writing a CAT with a faculty mentor then visiting five dental offices to discuss the CAT with practicing dentists and obtain their perspectives. Practitioners are asked to comment on the practicality and efficacy of the new diagnostic and treatment modalities that are communicated in the CATs. The practitioner receives one hour CE credit for review and comments on the CAT. To date, 59 students have visited 177 dental offices. The program has received enthusiastic ratings from both students and practitioners. In 2011, 12 third-year students were nominated by their GPG Directors, based on previous EBP and CAT presentations, to produce CAT videos for use in the FASTCATs program and for posting on the CATs website. Each video summarized a critically appraised topic pertinent to dentistry and provides references and links to online resources. Students who visited dental office in the 2011 FASTCATs program provided these videos to the dentists they visited and discussed the findings of the evidence-based review. 142

114 Outcome Assessment for the CATs Initiative Although the ultimate outcome of the CATs Initiative is the extent to which students use critically appraised evidence to guide patient care in practice, several measures have been developed to assess how well EBP concepts are connecting with faculty and students. A primary measure is quality of the CATs written by students during the final exam for the EBP Course INTD 6010 and the EBP Rotation in INTD The course directors for INTD 6010 and the EBP Rotation compare students CATs from year to year and have observed more sophistication as students and faculty gain experience. The investigators for the CATs grant developed a 35-item questionnaire to measure EBP knowledge, attitudes, evidence accessing strategies and confidence in critical appraisal before and after training. This instrument is the EBP KACE (Knowledge, Attitudes, Accessing, Confidence Evaluation). The development and validation of the KACE is described in Appendix 2-22c. Over three years of pre and post training assessment with the KACE ( ) indicates that dental students, dental residents and faculty members comprehension of core EBP concepts, their attitudes about using EBP, their diversity of sources and methods for obtaining information, and their level confidence in critical appraisal skills has improved substantially. Influence of the CATs Initiative on Student and Faculty Research The CATs Initiative has been a catalyst for student and faculty research. As itemized in Appendix 2-22h, more than 50 student and faculty papers, abstracts, posters and presentations have reported aspects of the CATs Initiative. UTHSCSA Dental Students have made multiple presentations on EBP and CATs topics and projects at ADEA, AADR and IADR each year since Other Learning Experiences Pertinent to Standard 2-22 During GEND 5001 Foundations of Professional Development, year 1 students complete a personal SWOT analysis (Strengths, Weaknesses, Opportunities and Threats) to assess their readiness for dental school and lifelong professional development. Based on the outcomes of the SWOT analysis, students develop goals or their dental school career and preliminary goals for their professional career and also write a personal mission statement that reflects their philosophy of dental practice. These activities form the basis for students learning experiences and subsequent career planning activities in the professional development and practice administration courses in years two, three and four. During Introduction to Dental Radiography DIAG 5009 in year one, students complete a selfevaluation worksheet prior to submitting the radiographic series (Appendix 2-22i: Radiology Complete Mouth Radiological Survey Evaluation Form). In year two, students in Operative Dentistry RESD 6002 and Prosthodontic PROS 6011 and Preclinical Implant Prosthodontics PROS 6058 preclinical laboratory courses self-assess their projects before an instructor evaluates it. Selfassessment is also a component of all practical exams in Preclinical Implant Prosthodontics PROS 6058 (Appendix 2-22j: Preclinical Prosthodontic Evaluation Forms). During the third and fourth years, students are expected to self-assess their own performance and clinical outcomes for each patient appointment, and they receive feedback from GPG faculty on the thoroughness of this self-critique. The philosophy is that in order to correct a problem or deficiency, students must first be able to recognize that one exists, and determine the cause of the 143

115 deficiency so it can be avoided or accounted for in future patient care situations. The educational goal is to instill the value and necessity of constant self-evaluation in students and promote the concept that self-appraisal must extend beyond the dental school experience and become a core component of their approach to dental practice throughout their career. Students are also expected to provide self-assessment in the skill assessments and competency exams conducted in years three and four including: Year three General Dentistry Clinic GEND 7001 (Appendix 2-20b: Evaluation Forms for GEND 7001 Skill Assessments); Year three Prosthodontics clinical experiences in Compete Dentures PROS 7099, Removable Prosthodontics PROS 7092, and Fixed Prosthodontics PROS 7019 (Appendix 2-22k: Clinical Prosthodontic Evaluation Forms); and, Year four General Dentistry Clinic GEND 8077 (Appendix 2-22l: GEND 8077 Competency Evaluation Forms). Student Participation in Scientific and Professional Meetings Students are aware of faculty participation in Continuing Education courses, scientific meetings and symposia. The importance of faculty presentation and attendance at professional meetings in contributing to lifelong learning is stressed to students by encouraging their participation at meetings to present research findings, table clinics and as representatives to professional organizations. In and , approximately 25 dental students each year presented research at local, national and international meetings, including AADR and IADR. The Office of Continuing Education conducts courses annually that focus on our alumni, students and faculty, providing students with a by example understanding of the importance of lifelong learning. The students class and clinic schedule is adjusted so they can attend several annual Dental School scholarly and continuing education events such as the Holler s Memorial Lecture conducted each year in November, the Dental Science Symposium conducted each year in April and the Dental School Grand Rounds conducted on Friday mornings throughout the academic year. These and other professional development/continuing education activities are described in more detail in Standard 3-2. Curriculum time is allocated for these events to provide a forum where faculty and students can interact in a professional learning atmosphere. Assessment of Student Competency for Standard 2 22 Assessment methods for the two components of Standard 2-22 are described in this sequence: (1) life-long learning, and (2) self-assessment. Assessment of Comprehension of Foundational Concepts Pertinent to Life-Long Learning: Evidence Search and Critical Appraisal Students capacity to use the foundational evidence search and critical appraisal skills of EBP is assessed in Evidence-Based Practice INTD 6010 and the EBP Rotation in INTD 6088 by a written evaluation of the students' performance of these critical appraisal tasks. In INTD 6010, students' 144

116 capacity to create Critically Appraised Topics (CATs) is formally assessed as graded exercises during the course and as the major component of the final examination. Assessment of Progress Toward Competency in Recognizing the Role of Life-Long Learning in Competency Development The primary mechanism for appraisal of students commitment to lifelong learning is analysis of student performance in the four-year continuum of courses devoted to professional development and practice administration. (Foundations of Professional Development GEND 5001; Professional Development II GEND 6001; Practice Administration I GEND 7026; and fourth year Practice Administration II GEND 8026). As described in Standard 2-18, this sequence of courses emphasizes preparation for lifelong learning and includes graded activities related to needs assessment for career growth and setting goals for professional development. However, during-school evaluations to appraise students lifelong learning skills or their appreciation for the importance of life-long learning are indirect measures of students capacity for life-long learning throughout a professional career. Given that limitation, UTHSCSA Dental School evaluates the following data sources as evidence of students' recognition of the importance of continual professional development: extent of student participation in the Dental School s Distinction in Research Program; extent of student participation in the Dental School s Distinction in Teaching Program; number of students presenting abstracts and table clinics for UTHSCSA research events; number of students presenting abstracts at national meetings such as ADEA and AADR; number of students participating in specialty meetings through fellowships; participation in ASDA and other student organizations at UTHSCSA Dental School; attendance at scientific seminars and meetings conducted at UTHSCSA Dental School; and, collaboration with UTHSCSA Dental School faculty members on research projects. Assessment of Comprehension of Foundational Concepts Pertinent to Self-Assessment During year one, students complete graded self-assessment exercises in GEND 5001 Foundations of Professional Development, including a personal SWOT analysis (Strengths, Weaknesses, Opportunities and Threats) to demonstrate understanding of the self-assessment process. Assessment of Progress Toward Competency in Self-Assessment Students capacity to perform systematic searches for evidence to answer clinical research questions is evaluated in the INTD 6088 EBP Rotation by their performance on computer-based simulations in an OSCE format. Students capacity to plan and write CATs is evaluated during the faculty-mentored CAT development exercise in Clinical Introduction INTD Third and fourth year students develop and present CATs based on patients they have treated in the clinic during case conferences conducted by the GPGs. These presentations are formally evaluated and represent a component of the students overall evaluation in Clinical Patient Management INTD 7020 in year three and General Dentistry Clinic GEND 8077 in year four. Students cannot pass INTD 7020 and GEND 8077 without satisfactory assessments for these case presentations. 145

117 Virtually every patient care activity in years three and four require students to self-assess their performance as a component of the overall evaluation process. Progress toward competency in self-assessment during the clinical curriculum is determined by attending GPG faculty as part of the students' professionalism evaluation on the monthly progress reports and as a component of the student overall professionalism evaluation for Clinical Patient Management INTD 7020 in year three and General Dentistry Clinic GEND 8077 in year four. Students capacity to self-assess performance and identify needed improvements is also evaluated on the mid-year and end-ofyear progress toward competency assessments (Appendix 2-8c). Assessment of Competency Attainment Based on the data sources described in this standard, each fourth year student s competency to self-assess progress toward overall readiness for general dental practice and attainment of individual competencies (UTHSCSA Competency 3; Table 2-22) is assessed and certified by GPG faculty using the senior year competency certification form (Appendix 2-8d). Students cannot pass General Dentistry Clinic GEND 8077 and cannot graduate without certification that this competency has been attained. B. Supportive Documentation for Standard 2-22: 1. Appendix 2-3b: Syllabi for Dental School Courses Pertinent to Standard 2-22: DIAG 5009 Introduction to Dental Radiology GEND 5001 Foundations of Professional Development GEND 6001 Professional Development II INTD 6010 Evidence-based Dentistry RESD 6002 Preclinical Operative Dentistry PROS 6011 Prosthodontic Treatment PROS 6058 Preclinical Implant Prosthodontics INTD 6088 Clinical Introduction PROS 7019 Fixed Prosthodontics INTD 7020 Clinical Patient Management GEND 7026 Practice Administration I GEND 7001 Year 3 General Dentistry Clinic PROS 7092 Removable Prosthodontics PROS 7099 Compete Dentures GEND 8026 Practice Administration II GEND 8077 Year 4 General Dentistry Clinic 2. Appendix 2-7a: UTHSCSA Dental School Predoctoral Dental Education Competencies 3. Appendix 2-8c: End-of-Semester and End-of-Year Progress Toward Competency Evaluations 4. Appendix 2-8d: Form for Fourth Year Assessment and Certification of Competency 5. Appendix 2-20b: Evaluation Forms for GEND 7001 Skill Assessments and Portfolio Presentations 146

118 6. Appendix 2-22a: CATs Website [Screenshot] 7. Appendix 2-22b: Pdf of manuscript: Rugh JD, Hendricson WD, Glass BJ; Hatch JP, Deahl TS, Guest GF, Ongkiko RM, Gureckis KM, Jones AA, Rose WF, Gakunga PT, Stark DL, Steffensen B. Teaching Evidence Based Practice at San Antonio. Texas Dental Journal. 2011; 128(2): Appendix 2-22c: Pdf of manuscript: Hendricson WD, Rugh JD, Hatch JP, Deahl T, Wallmann ER. Validation of an Instrument to Assess Evidence-Based Practice Knowledge, Attitudes, Access and Confidence in the Dental Environment. Journal of Dental Education. 2011; 75(2): Appendix 2-22d: Pdf of manuscript: Rugh JD, Hendricson WD, Hatch JP, Glass BJ. The San Antonio CATs Initiative. Journal of the American College of Dentistry Summer;77(2): Appendix 2-22e: Elements of the CATs Curriculum Initiative 11. Appendix 2-22f: Format of a CAT Summary and CAT Evaluation Criteria 12. Appendix 2-22g: CATs Library Website [Screenshot] 13. Appendix 2-22h: Student and Faculty Papers, Abstracts and Presentations for CATs 14. Appendix 2-22i: Radiology Complete Mouth Radiographic Survey Evaluation Form 15. Appendix 2-22j: Preclinical Prosthodontic Evaluation Forms 16. Appendix 2-22k: Clinical Prosthodontic Evaluation Forms 17. Appendix 2-22l: GEND 8077 Evaluation Forms for Graded Clinical Examinations 147

119 Critical Thinking Standard Graduates must be competent in the use of critical thinking and problem solving related to the comprehensive care of patients. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Description for Standard 2-23 The UTHSCSA Dental School defines critical thinking as: "The process of assimilating and analyzing information; this encompasses an interest in finding new solutions, a curiosity with an ability to admit to a lack of understanding, a willingness to examine beliefs and assumptions and to search for evidence to support these beliefs and assumptions, and the ability to distinguish between fact and opinion." The UTHSCSA Dental School ascribes to the belief that: "The cornerstone of professional practice is the application of thought processes that allow dentists to recognize pertinent information in a patient s presentation, make accurate decisions based on deliberate and open-minded review of available options, evaluate outcomes of therapeutic decisions, and assess their own performance" (American Dental Education Association, Commission on Change and Innovation; Appendix 2-23a). Numerous UTHSCSA Dental School courses facilitate development of students' critical thinking so that they can begin to use these mental skills in the Dental School clinic and build the foundation for the critical thinking that will be required for competent professional practice after graduation. As indicated by UTHSCSA Dental School competency domain two, and educational outcomes 2-03 and 2-04, emphasis is placed on cultivating the students' capacity to apply a critical appraisal process so that they will be discerning consumers and users of biomedical information and research evidence during their practice careers. Table 2-23 indicates the UTHSCSA Dental School competencies and educational outcomes that address Standard Table 2-23: UTHSCSA Competencies and Educational Outcomes that Address Standard 2-23 UTHSCSA DS Competency Domain Competency Statement Graduates must be competent in: Educational Outcomes 2: Critical Thinking and Problem Solving Use of critical thinking and problem solving during patient care. 01. Apply a systematic reasoning process during patient care. 02. Retrospectively critique patient care to evaluate clinical decisions. 03.Use a critical appraisal process to explore patient care issues by identifying questions, locating and appraising best evidence and implementing treatment based on this appraisal. 04. Apply a critical appraisal process to analyze claims for therapeutic effectiveness in the literature 148

120 3: Self-Assessment 5: Patient Assessment 6: Treatment Planning Self-assessment of progress toward overall readiness for general dental practice and attainment of individual competencies. Patient assessment and diagnosis. Comprehensive treatment planning and assessment of treatment outcomes. 01. Assess progress toward competency and readiness for dental practice. 02. Identify learning needs and create plans to address these needs. 03. Assess strengths and weaknesses of patient care and identify improvements. 02. Identify the presence of systemic disease with oral manifestations or implications for dental care 06. Prescribe or perform radiographic, clinical, laboratory and other diagnostic procedures and interpret their findings. 07. Recognize normal range of clinical findings and establish working diagnosis for findings requiring treatment or represent significant deviations from normal. 01. Develop a comprehensive and properly sequenced plan of treatment and, if needed, obtain consultation from or refer the patient to other health care providers based on evaluation of diagnostic data. 02. Evaluate outcomes of treatment on an ongoing basis using recall strategies, and modify treatment plans as needed. UTHSCSA Dental School Curriculum Related to Standard 2 23; Critical Thinking The ability to apply a systematic reasoning process is central to the planning, delivery and assessment of patient care. Students begin to acquire these skills during the first year in Physical Evaluation I DIAG 5014 and during year two in Physical Evaluation II DIAG 6035 where they learn methods for systematic data collection and practice patient assessment skills including interviewing/history-taking, intra-oral / extra-oral examination and charting. In Physical Evaluation II DIAG 6035, students develop capacity to analyze data obtained from patient assessments, synthesize this information into a diagnosis and create a treatment strategy to address the patient s oral health problems, the cornerstone mental processes for critical thinking during patient care. During year two, students practice and refine patient assessment, diagnosis and treatment planning skills during modules devoted to these skills in Clinical Introduction INTD 6088 and in Clinical Medicine DIAG Oral Pathology PATH 6021 in year two places strong emphasis on recognition and diagnosis of oral lesions and other abnormalities. In addition, each of the discipline-oriented preclinical courses in year two (Endodontics ENDO 6041 and 6142, Operative Dentistry RESD 6001 and 6002, Oral Surgery OSUR 6051, Orthodontics ORTH 6075, Periodontics PERI 6082, Prosthodontics PROS 6011, 6012, 6018, 6019, 6058, , and Temporomandibular Disorders RESD 6108) emphasize recognition, assessment and diagnosis of abnormal conditions pertinent to their component of dental care, and provide cases and simulations for students to practice these skills. The second year course, Evidence-Based Dentistry INTD 6010, is also a foundational curriculum component for Standard INTD 6010 prepares students to ask questions, think critically and 149

121 to make sound judgments regarding the acceptance of new knowledge, products, and procedures in private practice. Students learn commonly used clinical research methods with focus on critical scrutiny of outcomes reported in the dental and medical literature. Students learn how to identify patient care uncertainties, formulate focused questions in the PICO format (i.e., question is stated with these components: Problem in Particular Patient/Population, Intervention, Comparison, Outcome), conduct searches of electronic databases, and critically appraise research reports. Based on cases depicting controversies in dental therapy, students write research questions, conduct evidence searches, appraise found information and develop a summary in the Critically Appraised Topic Summary format. During the clinical case conferences in years three and four conducted within the GPGs, students present patients they are treating in the clinic who have challenging dental problems for group problem-solving concerning diagnostic and therapeutic strategies. To prepare for these case presentations, students conduct a literature review pertinent to the patient s condition and include their findings in the conference. Third year courses in Oral Medicine DIAG 7055, Radiographic Interpretation DIAG 7036 and Oral and Maxillofacial Pathology Clinicopathologic Conference PATH 7023, each stress recognition, assessment and diagnostic skills and provide students with practice opportunities via case scenarios. During the courses addressing ethical conduct and professional responsibilities as described in Standards 2-20 and 2-21, students explore ethical scenarios pertinent to dental practice and health care (Professional Ethics COMD 5031, Professional Ethics COMD 7031, General Dentistry Seminar GEND 8078 and Jurisprudence COMD 8032), students are expected to determine the pertinent ethical issues, propose viable options, and discuss possible outcomes. These exercises enable students to enhance their problem-solving and critical-thinking skills. In the third and fourth years, the students' patient assessment and treatment planning, guided by GPG faculty, for provision of oral health care in the Dental School clinic is a fundamental mechanism for cultivation of critical thinking and problem solving skills. During their clinical education, UTHSCSA dental students apply their accumulated knowledge and skills to plan and deliver patient care under supervision and coaching by clinical instructors. The process of assessing patients oral health problems and planning dental care allows the students to assimilate and use pathophysiological concepts, practice critical appraisal of evidence and use problem solving skills on a daily basis to assess and resolve patient care challenges. Assessment of Student Competency for Standard 2 23 Assessment of Comprehension of Foundational Concepts In Evidence-Based Dentistry INTD 6010, assessment is based on faculty evaluation of students' capacity to implement an evidence-based approach to exploring clinical questions, described in a PICO format culminating in develop of Critically Appraised Topics (CATs) as described previously in Standard Students evidence searching skills are reassessed later in year 2 with an EBP OSCE in Clinical Introduction INTD

122 For other courses, indicated below, that address Standard 2-23 in a didactic or conference format, students' comprehension of foundational concepts is assessed by case - based and other types of written examinations as well as analysis of patient care dilemmas by essay and reflection papers. Physical Evaluation I DIAG 5014 Professional Ethics COMD 5031 Physical Evaluation II DIAG 6035 Clinical Medicine DIAG 6011 Oral Pathology PATH 6021 Radiographic Interpretation DIAG 7036 Oral and Maxillofacial Pathology Clinicopathologic Conference PATH 7023 Professional Ethics COMD 7031 Oral Medicine DIAG 7055 General Dentistry Seminar GEND 8078 Jurisprudence COMD 8032 Assessment of Progress Toward Competency A component of the daily assessments, monthly progress evaluations, mid-year and end-of year progress toward competency assessments and overall grade during year 3 in Clinical Patient Management INTD 7020 and during year four in General Dentistry Clinic GEND 8077 is GPG faculty appraisal of students capacity to diagnose patient's oral health conditions and develop viable treatment plans. Students' abilities in patient assessment, formulation of a diagnosis and development of appropriate and feasible treatment plans are assessed by clinical skill evaluations in both the third and fourth years, including independently performed clinical skill evaluations specifically devoted to patient assessment, diagnosis and treatment planning as indicated in Table In Oral Medicine DIAG 7055, students ability to appraise available diagnostic tests to detect oral cancer is evaluated. During year three, students develop and present case presentations for implant patients and patients needing complex treatment (General Dentistry Clinic GEND 7001). Students ability to develop and justify treatment strategies is a major component of the evaluation of these case presentations. In GPG case conferences during years three and four, students are formally assessed by clinical faculty on their evidence-based case presentations developed in a CATs format as described in Standard For these case presentations, students are assessed on the thoroughness of their evidence review pertinent to the patient s condition. Faculty evaluation of these presentations is a component of students overall evaluation in Clinical Patient Management INTD 7020 in year three and General Dentistry Clinic GEND 8077 in year four. Students cannot pass INTD 7020 and GEND 8077 without satisfactory assessments on these case presentations. Assessment of Competence Attainment Based on the data sources described previously in this standard, each fourth year student s competency to use critical thinking and problem-solving during patient care (UTHSCSA Competency 2; Table 2-23) is assessed and certified by GPG faculty using the senior year 151

123 competency certification form (Appendix 2-8d). Students cannot pass General Dentistry Clinic GEND 8077 and cannot graduate without certification that this competency has been attained. B. Supportive Documentation for Standard 2 23: 1. Appendix 2-3b: Syllabi for Courses Pertinent to Standard 2-23: DIAG 5014 Physical Evaluation I COMD 5031 Professional Ethics DIAG 6035 Physical Evaluation II DIAG 6011 Clinical Medicine ENDO 6041 Endodontics Didactic ENDO 6142 Preclinical Endodontics INTD 6010 Evidence-Based Dentistry OSUR 6051 Oral Surgery ORTH 6075 Orthodontics PATH 6021 Oral Pathology PERI 6082 Periodontics PROS 6011 Fixed Prosthodontics PROS 6012 Preclinical Fixed Prosthodontics PROS 6018 Prosthodontic Treatment of Edentulous Patients PROS 6019 Preclinical Prosthodontic Treatment of Edentulous Patients PROS 6058 Preclinical Implant Prosthodontics PROS 6059 Implant Prosthodontics PROS 6094 Removable Prosthodontics RESD 6001 Operative Dentistry Didactic RESD 6002 Preclinical Operative Dentistry RESD 6108 Temporomandibular Disorders INTD 6088 Clinical Introduction DIAG 7036 Radiographic Interpretation GEND 7001 General Dentistry Clinic INTD 7020 Clinical Patient Management PATH 7023 Oral and Maxillofacial Pathology Clinicopathologic Conference COMD 7031 Professional Ethics DIAG 7055 Oral Medicine GEND 8077 General Dentistry Clinic GEND 8078 General Dentistry Seminar COMD 8032 Jurisprudence 2. Appendix 2-7a: UTHSCSA Dental School Predoctoral Dental Education Competencies 3. Appendix 2-8a: Daily Assessment of Student Technical Development and Professionalism / Ethics; Years Three and Four 4. Appendix 2-8b: Monthly Assessment of Professionalism, Ethics & Progress Toward Competency 5. Appendix 2-8c: End-of-Semester and End-of-Year Progress Toward Competency Evaluations 152

124 6. Appendix 2-8d: Form for Fourth Year Assessment and Certification of Competency 7. Appendix 2-23a: ADEA Commission on Change and Innovation. Educational Strategies Associated with Development of Problem- Solving, Critical Thinking and Self-Directed Learning. J Dent Educ. 2006; 70(9): Information Management Standard Graduates must be competent in the use of information technology resources in contemporary dental practice. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Description for Standard 2-24 An essential skill of the contemporary dentist is the ability to access, evaluate, and apply emerging patient care theories and modalities as they become available in the scientific and professional practice literature. UTHSCSA dental students matriculate with a range of technology-related skills, and the school strives to enhance those skills with curricular and patient care experiences that reflect emerging science and contemporary practice standards. This commitment to developing student competency in information technology is articulated in the preamble to the UTHSCSA Dental School Predoctoral Education Competencies (Appendix 2-7a; Page 4). The seventh guiding principle for the UTHSCSA Dental School curriculum states: graduates will be prepared for the evolving science and technology associated with patient care by using information technology throughout their learning experiences. Table 2-24 indicates the UTHSCSA Dental School competencies and educational outcomes that address Standard Table 2-24: UTHSCSA Competencies and Educational Outcomes that Address Standard 2-24 UTHSCSA DS Competency Domain Competency Statement Graduates must be competent in: Educational Outcomes 2: Critical Thinking and Problem Solving 5: Patient Assessment Use of critical thinking and problem solving during patient care. Patient assessment and diagnosis. 03.Use critical appraisal to explore patient care issues and uncertainties by identifying questions, locating and appraising best available evidence and implementing treatment based on appraisal. 06. Prescribe or perform radiographic, clinical, laboratory and other diagnostic procedures and interpret their findings. 18: Dental Practice Laws & Policies Applying legal standards, rules, and regulations that govern dental practice and the provision of oral health care. 03. Evaluate and apply evidence-based guidelines for the practice of dentistry that promotes, improves and maintains oral health. 153

125 UTHSCSA Dental School Curriculum Related to Standard 2 24; Information Management The Dental School has implemented an electronic computer-based curriculum support program (ecsr) for predoctoral students. Starting in August 2000, students matriculated with a specified laptop computer and software. A comprehensive approach to the integration of information technology in support of the predoctoral curriculum was developed to enhance the educational process. This approach guides the use of computer-based systems by students and faculty to support both academic and clinical missions. At UTHSCSA Dental School, the student s computer is the portal to both didactic and clinical information and systems. As part of Introduction to Patient Care INTD 5030 in year one, students complete a Dental Informatics Module that includes orientation to: computer operating systems and hardware, all software applications that students are expected to utilize in their first year, access to didactic content resources, current literature search strategies, evidence-based dentistry, information security and privacy guidelines and regulations. The Dental Informatics Module culminates with a demonstration of the information management skills that freshmen students have acquired. Year one students are assigned to groups that are assigned clinical topics to investigate using online data sources. Each group develops a PowerPoint presentation based on the outcomes of their information search. The presentations are in the form of a Critically Appraised Problem (CAP), which is similar in format to the CATs that students learn in year two. Each student group presents their CAP to the entire class. All faculty members are invited to attend the CAP presentations. UTHSCSA dental students have access to all their required and recommended textbooks, dental manuals, streaming video instructional clips, and web links related to dentistry on a highly searchable e-library called Vitalsource Bookshelf. This electronic library is updated throughout the four-year curriculum. The University also provides a dedicated server for Blackboard (an online course management system) as a mechanism for distribution of more dynamic content such as course syllabi, additional reading materials, lab and clinic manuals, assignments, and electronic presentations). Virtually all Dental School courses now utilize some form of internet technology for content distribution. is the standard means of communication between the students and course directors, faculty, clinical support staff and the school administration. A core learning experience to develop students' capacity to search electronic databases for biomedical information is Evidence Based Dentistry INTD 6010 in year two. Students learn and practice strategies for conducting online searches for needed information via the internet, including extensive work with PubMed and also learn several other databases and search engines pertinent to oral health care. As described in the response for Standard 2-22, second year students have several information search assignments after INTD 6010 in other courses such as Periodontics PERI 6082 and Temporomandibular Disorders RESD 6108 that build upon information accessing skills learned in the EBP course. As students enter clinical care, they receive training in the use of clinical information systems and media used to support patient care. The Dental School utilizes a server-based Clinical Information System, Electronic Patient Record (EPR), and PACS System for managing patient care and associated data (PACS = Picture Archiving and Communication System). Students are required to access the system for patient information including schedules, patient transaction histories and aggregated assigned patient information. During years three and four, students use an Electronic 154

126 Patient Record via components of a comprehensive system (axium) that includes patient medical and dental history, physical exam, risk assessments, charting, progress notes, radiology orders, dental and medical consultations, and general, surgical, and treatment consents. Additionally the EPR e-outcomes support quality assurance via electronic outcomes of care, and laboratory services satisfaction surveys. Third year students have a required clinical case presentation with criteria to incorporate clinical images into their presentations. Students are trained to use highresolution digital SLR cameras that are available for use by students in the clinic. The predoctoral clinic uses a PACS System (MiPACS; Medicor Imaging) for radiology support. All intraoral and extraoral radiographic images including Cone-Beam CTs are available through a DICOM compliant system. The primary courses addressing Standard 2-24 in years three and four are Clinical Patient Management INTD 7020, and General Dentistry Clinic GEND 8077, which integrate the educational, behavioral, ethical, and professional development of the students within the clinical practice setting by means of the General Practice Group (GPG) structure as previously described in other standards. Assessment of Student Competency for Standard 2 24 Overview Dental students cannot function in the Dental School s educational and patient care environment, which depends on digital communication and access to computer-based systems without the competency required to use these resources. To a large extent, student attainment of competency pertinent to Standard 2-24 is demonstrated by successful performance in all courses of the curriculum, including didactic courses in years one and two where use of Vitalsource Bookshelf is essential and in clinical courses during years three and four where effective use of axium and other aspects of the Clinical Information System is essential. However, the Dental School implements several specific evaluations for Standard 2-24 to determine students (1) acquisition of foundational information management and computer software skills, and (2) ability to apply these skills during patient care. Assessment of Comprehension of Foundational Concepts Students capacity to use computer operating systems and hardware, associated software applications including Vitalsource Bookshelf and the Blackboard course management system is assessed during the Informatics Module in Introduction to Patient Care INTD 5030 at the beginning of year one. Evidence-Based Dentistry INTD 6010 provides a primary assessment of students' capacity to use information management. Assessment is based on faculty evaluation of students' capacity to implement an evidence-based approach to exploring clinical questions, through systematic searches of electronic databases, culminating in develop of Critically Appraised Topic Summaries (CATS). The final examination in INTD 6010 requires students to conduct a database search and answer clinical questions arising in case scenarios depicting patients with oral health care conditions where treatment strategies are uncertain. Students skills for online information 155

127 accessing are also evaluated during the EBP OSCE in year two during Clinical Introduction INTD Assessment of Progress Toward Competency In the clinical years, students' capacity to use the clinical information systems that support patient care are assessed as a component of the daily formative assessments, monthly progress evaluations, mid-year and end-of-year progress toward competency assessments and overall course evaluations in Clinical Patient Management INTD 7020, and General Dentistry Clinic GEND Clinical faculty also formally evaluate student case presentations in General Dentistry Clinic GEND 7001 during year three and GEND 8077 in year four. Students develop these case presentations in PowerPoint format and are expected to include digital images of patients and links to information sources. Students cannot pass GEND 7001 and GEND 8077 without satisfactory assessments on these case presentations, which require effective use of information technology. Assessment of Competency Attainment Based on the data sources described previously in this standard, each fourth year student s competency to use information technology resources (CODA Standard 2-24; several related UTHSCSA educational outcomes; Table 2-24) is assessed and certified by GPG faculty using the senior year competency certification form (Appendix 2-8d). Students cannot pass General Dentistry Clinic GEND 8077 and cannot graduate without certification that this competency has been attained. B. Supportive Documentation for Standard 2 24: 1. Appendix 2-3b: Syllabi for Courses Pertinent to Standard 2-24: INTD 5030 Introduction to Patient Care; Dental Informatics Module INTD 6010 Evidenced-Based Dentistry PERI 6082 Periodontics PROS 6018 Prosthodontic Treatment of Edentulous Patients INTD 6088 Clinical Introduction INTD 7020 Clinical Patient Management GEND 7001 General Dentistry Clinic - Year 3 GEND 8077 General Dentistry Clinic - Year 4 2. Appendix 2-7a: UTHSCSA Dental School Predoctoral Dental Education Competencies 3. Appendix 2-8a: Daily Assessment of Student Technical Development and Professionalism / Ethics; Years Three and Four 4. Appendix 2-8b: Monthly Assessment of Professionalism, Ethics & Progress Toward Competency 5. Appendix 2-8c: End-of-Semester and End-of-Year Progress Toward Competency Evaluations 6. Appendix 2-8d: Form for Fourth Year Assessment and Certification of Competency 7. Documents that will be available on-site during the February 21 23, 2012 Site Visit: 156

128 Vitalsource Bookshelf (DVD) Blackboard (website excerpt) axium example electronic patient record screen MiPACS example screen Examples of GEND 7001 case presentations by students Clinical Sciences Standard At a minimum, graduates must be competent in providing oral health care within the scope of general dentistry, as defined by the school, for the child, adolescent, adult, and geriatric, including: a. patient assessment and diagnosis; b. comprehensive treatment planning; c. health promotion and disease prevention; d. informed consent; e. anesthesia, pain and anxiety control; f. restoration of teeth; g. replacement of teeth; h. periodontal therapy; I. pulpal therapy; j. oral mucosal disorders; k. hard and soft tissue surgery; l. dental emergencies; m. malocclusion and space management; and, n. evaluation of the outcomes of treatment. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Overview Statement for Standard 2-25 One of the guiding principles for UTHSCSA Dental School is to graduate individuals who have received an education based on the concept that general dentists' are primary health care providers (Appendix 2-7a; Preamble to Education Competencies). Patient assessment and diagnosis, consideration of the patient's overall health status, comprehensive treatment planning and oral health promotion for individuals and the community are competencies that underlie dental practice, and are emphasized in the clinical curriculum. The framework for assessment of the individual, component, competencies that comprise entry-level general dental practice, and assessment of overall competence necessary for unsupervised dental practice in the public domain was described in Standard

129 NBDE Part II Performance by UTHSCSA Dental Students UTHSCSA Dental Students perform strongly on the National Board Dental Examination Part II for Clinical Sciences. Table displays the percentage of UTHSCSA Dental Students who passed NBDE Part II annually from in comparison to national means. Table : UTHSCSA Dental Student Pass Percentage on NBDE Part II Compared to National Means for All U.S. Dental Students; Classes of 2005 to Class UTHSCSA Dental School All U.S. Dental Schools % 94.4% % 94.9% % N/A % 93.6% % 93.2% % 80.4% % 94.1% 7 year means 95.7% 91.8% Format for Narrative Response to Standard 2-25 a - n The narrative responses for Standards 2-25 a - n include four sections: competencies and educational outcomes that address each component of Standard 2-25 a - n; (see the following summary of universal competencies that apply to 2-25 a n) synopsis of foundational curriculum that provide knowledge, skill and experiential basis for students' subsequent acquisition of competency; summary of assessments pertaining to foundational knowledge, skills, and professional values; and, description of independently performed clinical skills evaluation methods in years three and four to determine students' attainment of competency associated with each domain of Standard 2-25, a n. UTHSCSA Competencies that Apply Universally to Standard 2-25 UTHSCSA Dental School competency domains 1-9 (See Appendix 2-7a) apply universally to all areas in Standard These "global" competencies are listed in Table After the description for Standard 2-25a, these global competencies, and associated educational outcomes, will not be listed for each area within Standard

130 Table : Global Competencies that Apply to All Aspects of Clinical Education at UTHSCSA Dental School and All Components of Standard 2-25, a - n Competency 1 Graduates will use principles of ethical reasoning and professional behavior during their interactions with patients, other health care providers and the public. Competency 2 Graduates will use critical appraisal during patient care. Competency 3 Graduates will be able to self-assess quality of patient care, identify learning needs and identify strategies for enhancement of professional performance. Competency 4 Graduates will be able to apply biomedical science knowledge and principles for the management of patients. Competency 5 Graduates will be able to assess the health care status of patients across the age spectrum from child to elderly, including individuals with special needs, and develop a diagnosis for identified abnormalities and problems. Competency 6 Graduates will be able to develop treatment plans to address oral health care problems of patients across the age spectrum from infant to elderly including individuals with special needs, and assess the outcomes of treatment. Competency 7 Graduates will be able to provide counseling and education to promote patients oral health. Competency 8 Graduates will be able to apply psychosocial and behavioral principles for promoting, improving, and maintaining patients oral health. Competency 9 Graduates will be able to manage patients anxiety and pain. Summary of Clinical Skill Evaluation Methods for Standard 2-25 a-n Table identifies the primary evaluation measures used, in conjunction with other measures as described in Standard 2-8 (See Table 2-8), to determine students' attainment of competency for Standard 2-25, a - n. These measures are described in the narrative responses for components of Standard The evaluations listed in Table are patient care processes and procedures that are independently performed (unassisted) by students to determine acquisition of clinical skills associated with UTHSCSA competencies and CODA Clinical Science Standards. Note about Names of Clinical Skill Evaluations in Table In the course syllabi (Appendix 2-3a) in which the clinical skill evaluation listed in Table are administered, various titles and descriptors are used to identify these assessments including: Competency exam Graded exam or graded clinical examination Graded clinical experience Skill assessment Progress assessment Progress re-assessment Credentialing assessment Pass/Fail examination Daily clinical outcomes assessment 159

131 In table , these descriptors have been eliminated to avoid confusion. All listed evaluations are appraisals of students ability to independently perform a specified oral health care task. In general, evaluations of students clinical skills conducted in the third year are progress toward competency assessments, while those conducted in the fourth year, especially later in the year, are more definitive indicators of the student s capacity as they draw closer to graduation. All year 3 clinical skill evaluations must be passed independently to advance to the senior year. All fourth year clinical skill evaluations must be passed independently to be considered for graduation certification. Several of the clinical skill evaluations are listed in two or more domains of Standard 2-25 because they measure multiple dimensions of patient care. Evaluations in italics within Table are comprehensive assessments of students progress toward competency, across all domains of Standard 2-25, routinely completed by GPG Leaders and faculty, as described in Standard 2-8. Table : Primary Clinical Skill Evaluation Measures To Assess Students' Progress Toward Competency for Standard 2-25 a - n. Component Evaluations of Students Independent Performance of Clinical Skills Year a Patient assessment & Diagnosis Oral Medicine Competency Assessment in DIAG 6035 (2) Full Mouth Radiographic Survey (2) Radiographic Interpretation (2) - Online Examination Portfolio Presentations (2): Complex Patient (1) and Implant Patient (1) TMD Occlusal Assessment and TMJ Function Periodontal Therapy Part I: Assessment, Diagnosis and Plan for Therapy Case Presentation Dental Emergency Care Mock WREB: Patient Assessment and Treatment Planning Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments b Treatment Planning Portfolio Presentations (2): Complex Patient (1) and Implant Patient (1) Periodontal Therapy Part I: Assessment, Diagnosis and Plan for Therapy Case Presentation Diagnosis and Treatment Planning Outcomes of Care Examination Mock WREB: Patient Assessment and Treatment Planning Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments c Health Promotion & Disease Prevention Behavior Modification Counseling and Management for Edentulous Patient Diagnosis and Treatment Planning Periodontal Therapy Part I: Assessment, Diagnosis and Plan for Therapy Periodontal Therapy Part II: Scaling and Root Planing Periodontal Therapy Part III: Re-evaluation of SCRP Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments and and 4 3 and 4 3 and and and 4 3 and 4 3 and and 4 3 and 4 3 and 4 3 and 4 3 and 4 3 and 4 160

132 d Informed Consent Diagnosis and Treatment Planning Dental Emergency Care Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments e f g Anesthesia, Pain & Anxiety Control Restoration of Teeth Replacement of Teeth Oral Surgery Daily and End-of-Rotation Clinical Assessments (See 2-25e) Nitrous Oxide Administration (n = 10 observed and evaluated) Restorative Clinical Evaluations (See 2-25f) Pediatric Restorative Procedure Dental Emergency Care Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments Direct restoration: amalgam, composite Fixed Prosthodontics (Manikin Exam) Fixed Prosthodontics: Preparation Fixed Prosthodontics: Prep and Provisional Restoration Fixed Prosthodontics: Complete Single Unit Restoration Single-Unit Crown Cast Dowell Core Evaluation Direct Restoration Anterior Composite Direct Restoration Amalgam Single Unit Crown Pediatric Restorative Procedure Mock WREB: Class III composite, Class II composite or Class II amalgam Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments Complete Denture Removable Partial Denture Comprehensive Complete Denture Exam: Written and OSCE Fixed Partial Denture Fixed Partial Denture Complete Prosthodontics (Edentulous) Removable Partial Denture Design, Part I Removable Partial Denture Fabrication, Part II Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments 4 3 and 4 3 and 4 3 and 4 3 and and 4 3 and and 4 3 and 4 3 and and 4 3 and 4 3 and and 4 3 and 4 3 and 4 h Periodontal Therapy Periodontal therapy 1, 2 & 3: periodontal exam, diagnosis, treatment planning, SCRP, and re-evaluation of SCRP Progress Assessment of Dental Prophylaxis Clinical Periodontics Rotation Periodontal therapy 1, 2 & 3: Diagnosis, Non-Surgical Therapy & Re-Evaluation Outcomes of Care Evaluation (includes a Periodontics Component) Mock WREB: One quadrant of scaling and root planing Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments and 4 3 and 4 3 and 4 161

133 i Pulpal Therapy Pulpal Therapy Credentialing Evaluation by Endodontics Faculty in Endodontic Clinic: single rooted or simple multi-rooted premolar tooth (minimum of two patients) Single rooted or simple multi-rooted premolar tooth - Diagnosis, Treatment Planning and Treatment (2 clinical evaluations during year 4) Mock WREB: Pulpal Therapy in Extracted Tooth Mounted in Manikin Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments j k Oral Mucosal Disorders Hard and Soft Tissue Surgery Geriatric Rotation Oral Surgery UHC Downtown Rotation Daily Evaluation Diagnosis and Treatment Planning Oral Medicine Competency Assessment in PHARM 8009 Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments Oral Surgery UHC Downtown Rotation Daily Evaluation Oral Surgery Daily and End-of-Rotation Clinical Assessments (See 2-25e) Dental Emergency Care Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments l Dental Emergencies Dental Emergency Care Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments m n Malocclusion & Space Management Evaluation of Treatment Outcomes TMD Occlusal Assessment and TMJ Function Pediatric Patient Exam and Treatment Planning OSCE: TxP, Space Maintenance, Dental Trauma & Antibiotics for Pediatrics No Assessment Form Space Maintenance Simulation Exercise Infant Oral Examination Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments Outcomes Of Care Daily Assessment of Student Technical Development & Professionalism / Ethics Monthly Assessment of Professionalism, Ethics & Progress Toward Competency Mid-Year and End-of-Semester Progress Toward Competency Assessments and 4 3 and 4 3 and and and 4 3 and 4 3 and 4 3 and 4 3 and and 4 3 and 4 3 and and 4 3 and 4 3 and and 4 3 and 4 3 and and 4 3 and 4 3 and 4 Assessment Forms for Components of Standard 2-25 As described in Standard 2-8, the following assessment instruments, displayed in the appendices indicated below, are employed by GPG faculty throughout years three and four of the students clinical experience for daily feedback, monthly progress evaluations, end-of-semester and end-ofyear comprehensive assessments, and end-of-fourth year final assessment of competency attainment. Appendix 2-8a: Daily Assessment of Student Technical Development & Professionalism / Ethics Appendix 2-8b: Monthly Assessment of Professionalism, Ethics & Progress Toward Competency 162

134 Appendix 2-8c: End-of-Semester and End-of-Year Progress Toward Competency Evaluations Appendix 2-8d: Form for Fourth Year Assessment and Certification of Competency Appendix 2-8e contains other evaluation forms used for independently-performed, disciplinespecific clinical skill evaluations in the third and fourth years that are indicated in Table NOTE: Appendices 2-8a, 2-8b, 2-8c, 2-8d, 2-8e will not be listed for each component of Standard 2-25, a n to minimize redundancy. Other General Resource Appendices Appendix 2-3b contains the syllabi for courses and rotations that were described in Standard 2-3. Appendix 2-7a contains the UTHSCSA Dental Schools Competencies for Predoctoral Dental Education that were described in Standard 2-7. NOTE: Appendices 2-3a and 2-7a will not be listed for each component of Standard 2-25, a- n. Rotations and Modules Within Courses Table indicates the number of rotations and modules that occur within several large interdisciplinary courses that occur throughout the curriculum. See Appendix 2-3b for names of the specific rotations and modules within these courses. This appendix provides an orientation to the various course sub-units that are described in the narrative responses for Standards 2-25 a n. Table : Rotations and Modules Within Interdisciplinary Courses Interdisciplinary Course Year Number of Rotations and Modules in Course INTD INTD INTD GEND GEND Students Experience with Pediatric Patients The UTHSCSA Dental School competencies apply universally to patients throughout the age spectrum from infant to the elderly, and include patients with special needs. UTHSCSA dental students complete Pediatric Dentistry PEDO 7041, a didactic course that addresses foundation principles underlying oral health care for infants, children and adolescents. Junior students then complete Pediatric Dentistry Clinic PEDO 7091 that includes a one-day rotation at the Ricardo Salinas community clinic as well as patient care experiences in the Pediatric Dental Clinic at UTHSCSA. Senior students complete a 3.5-day pediatric rotation, as a component of General Dentistry Clinic GEND 8077 at the Frank Bryant community clinic, a 3.5-day pediatric rotation at the Ricardo Salinas clinic, and a one-day primary care for adolescents rotation, also at the Ricardo 163

135 Salinas Clinic. As indicated in Table 2-17, students also have opportunities for two-week pediatric dentistry rotations. As described in Standard 2-16, dental students have several experiences in school-based prevention and oral health education programs in the first and second years of the curriculum. 2-25a. Patient Assessment and Diagnosis A. Description for Standard 2-25a Educational outcomes in many UTHSCSA Dental School competency domains address this standard Demonstrate understanding of the ethical and professional responsibilities that dentists have to patients, employees, members of the community, and other health care providers Recognize and deal with ethical issues/dilemmas by applying the principles of ethical reasoning and professional responsibility Demonstrate professional behaviors when interacting with patients, employees, members of the community, and other health care providers Explore uncertainties in diagnostic and/or treatment approaches by identifying questions, locating and appraising best available evidence and implementing patient therapy based on this appraisal Assess, diagnose and treat patients only within one s competence Demonstrate comprehension of the structure, function and pathology of cells, tissues, organs and organ systems, and apply this knowledge during management of patients Recognize diseases in the following categories, and explain clinical presentation, pathophysiology and implications for dental treatment: a. diseases unique to the head, neck and oral cavity; b. systemic diseases with oral manifestations; and, c. systemic diseases without oral manifestations, but often present in dental patients Establish and maintain rapport and communication with the patient Perform a complete patient interview consisting of: description of patient s chief compliant / reason for current dental appointment, oral health history and history of dental treatment, medical history, including a review of systems and current and/or chronic health problems actively managed by a physician or other health care provider, name(s) of primary care physician and other physicians or dentists the patient sees routinely, medication history including inventory of current prescriptions, drug allergies and adverse drug reactions, and, family and social history. 164

136 5-03 Identify the presence of systemic disease with oral manifestations or implications for dental care, and manage dental treatment of these patients Conduct head and neck examinations, including assessment for head and neck cancer Perform intraoral examinations of the hard and soft tissues of the mouth Prescribe or perform radiographic, clinical, laboratory and other diagnostic procedures and interpret their findings or reports Demonstrate awareness of the diagnostic benefits of radiographic procedures, the risks of radiation exposure, and patient selection criteria when prescribing radiographs Interpret findings from patient interview and examination and present them clearly to supervising dental faculty in a standardized format Recognize the normal range of clinical findings and establish a working diagnosis for findings that require treatment or represent a significant deviation from normal Initiate medical or dental consultation or referral when appropriate and revise the working diagnosis as indicated based on information derived from consultants Evaluate the patient s dentofacial complex and occlusion, and develop a working diagnosis Evaluate the patient s periodontium and peri-implant tissues, develop a diagnosis, identify treatment options and their prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Evaluate the outcomes of initial periodontal therapy, reassess the diagnosis and prognosis, determine the need for additional periodontal treatment, and manage follow-up treatment Evaluate the patient s teeth and supporting structures, develop a diagnosis, identify treatment options and their prognoses, and formulate a plan of treatment that best meets the needs and desires of the patient Evaluate the patient s edentulous areas, supporting and limiting anatomical structures, develop a diagnosis, identify treatment options and their prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Evaluate the patient s pulpal and periapical tissues, develop a diagnosis, identify treatment options and their prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Assess the patient s oral hard and soft tissue, identify problems needing treatment, identify treatment options and their prognoses, develop a diagnosis, and formulate a treatment plan that meets patient s needs and desires. 165

137 2-25a - Foundational Curriculum and Assessment of Progress Toward Competency The basic science departments in the UTHSCSA School of Medicine and the Department of Comprehensive Dentistry have the primary responsibility for the development of the foundational pathophysiological knowledge and clinical skills in assessment and diagnosis needed for students to enter the junior clinical year. In year 1, students are taught and examined on knowledge related to data gathering and recording, performing a head and neck exam, making and developing radiographs and identifying normal findings in Physical Evaluation I DIAG 5014 and Introduction to Dental Radiography DIAG These learning experiences occur concurrently with presentation of the foundation biomedical sciences, emphasizing normal development, structure and function, to help students understand and appreciate the patient care context and potential application of the basic science courses. In year 2, students build upon their ability to identify normal findings by studying abnormalities that evolve for systemic health and oral health, and are then evaluated on knowledge of these abnormal conditions, primarily in General Pathology PATH 6019, Oral Pathology PATH 6021, and Clinical Medicine DIAG During year 2, students expand their knowledge of patient assessment techniques, practice these skills, and then are evaluated on knowledge related to recording and assessing patient findings and developing a Clinical Problem List in Physical Evaluation II DIAG By the end of year 2, students have been evaluated via written examinations on normal and abnormal conditions related to all of the dental disciplines in the following clinical foundations didactic courses: Operative Dentistry RESD 6001, Prosthodontics PROS 6011 (Fixed), 6018 (Complete Dentures), 6094 (Removable), and 6059 (Implant), Periodontics PERI 6082, Endodontics ENDO 6041, Orthodontics ORTH 6075, Oral Surgery OSUR 6051, and Temporomandibular Disorders RESD Students in years 1, 2, and 3 participate in rotations that are components of Physical Evaluation I DIAG 5014, Physical Evaluation II DIAG 6035, Clinical Medicine DIAG 6011, Oral Medicine DIAG 7055, and Geriatrics DIAG These rotations allow the faculty to assess each student s progress towards competency in patient assessment and diagnosis. Students capacity to assess radiographic images is refined in the third year course Radiographic Interpretation DIAG In addition, Oral Medicine faculty members assess fourth year students performance in patient assessment and diagnosis of mucosal disease as a component of Pharmacotherapeutics PHAR 8009 by assigning students a series of clinical and simulated cases in the Tertiary Care Oral Medicine Clinic. During the four-week Oral Surgery rotation in year 3, dental students encounter numerous patients with various forms of Diabetes, liver disease, hepatitis C, cardiovascular disease, pulmonary disease, circulatory problems, and substantial poly-pharmacy for many patients. Students are expected to conduct comprehensive reviews of the patients' medical histories and incorporate this information, as well as discussion of implications for dental treatment, into their daily patient presentations prior to initiation of therapy. Students perform comprehensive medical assessments and case presentations during the OMS rotation, and repeat this experience during a one-week OMS rotation in the fourth year. 166

138 Competency Evaluation for Standard 2-25a To enter the third year, students must receive satisfactory evaluations on two Oral Medicine Competency Assessments during Physical Evaluation II DIAG Successful performance on these assessments is necessary to pass DIAG During year 3, students are expected to apply and integrate their knowledge and developing skills for comprehensive assessment and diagnosis as part of their care for their patients. Third year students independently perform two skill assessments in taking full mouth radiographic surveys and two skills assessment on radiographic interpretation, which are completed online. Students capacity for patient assessment and diagnosis, as well as comprehension of pathophysiology related to medical and dental health problems, is assessed during two Portfolio Presentations, based on patients selected from the student s overall family of patients with faculty approval, that address: (1) a patient with medical and/or dental complexity, and (2) an implant patient. Students Portfolio Cases are presented in GPG conferences and include a review of the evidence base pertinent to patient health issues and therapeutic strategies. The Portfolio Presentations are evaluated by supervising GPG faculty members. During the third year, students also must successfully complete an independently performed TMD Occlusal Assessment and TMJ Function skill assessment, which focuses on patient evaluation and diagnosis. During the third and fourth years, students must successfully complete independently performed Periodontal Therapy Assessment, Diagnosis and Therapy Planning Evaluations (one per year). In year 4, students are evaluated for attainment of competency in patient assessment and diagnosis by the GPG faculty through an independently developed Case Presentation and an independently performed Dental Emergency Care Examination. All fourth year students are also evaluated for competence in patient assessment skills during the Patient Assessment and Treatment Planning component of the Mock WREB Examination conducted in the spring semester. A component of students' daily formative assessments, monthly progress evaluations, mid-year progress toward competency assessments, and end-of-semester/end-of-year evaluations during year 3 and year 4 is based on GPG faculty members appraisal of students capacity to assess and diagnose patient's oral health conditions. Each of the comprehensive (global, assessment), evaluation forms include appraisal of progress toward and ultimate attainment of competency in patient assessment and diagnosis (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress to the fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations. B. Supportive Documentation for Standard 2-25a 1. Appendix 2-3b: Syllabi for Dental School Courses Pertinent to Standard 2-25a: DIAG 5014 Physical Evaluation I DIAG 5009 Introduction to Dental Radiography PATH 6019 General Pathology PATH 6021 Oral Pathology DIAG 6011 Clinical Medicine 167

139 DIAG 6035 Physical Evaluation II DIAG 7036 Radiographic Interpretation PEDO 7041 Pediatric Dentistry DIAG 7052 Geriatrics DIAG 7055 Oral Medicine GEND 7001 General Dentistry Clinic - Year 3 INTD 7020 Clinical Patient Management PHAR 8009 Pharmacotherapeutics GEND 8077 General Dentistry Clinic - Year b: Comprehensive Treatment Planning A. Description for Standard 2-25b These educational outcomes within several UTHSCSA Dental School competency domains address Standard 2-25b: 2-02 Explore uncertainties in diagnostic and/or treatment approaches by identifying questions, locating and appraising best available evidence and implementing patient therapy based on this appraisal Assess, diagnose and treat patients only within one s competence Demonstrate comprehension of the structure, function and pathology of cells, tissues, organs and organ systems, and apply this knowledge during management of patients Recognize diseases in the following categories, and explain clinical presentation, pathophysiology and implications for dental treatment: a. diseases unique to the head, neck and oral cavity; b. systemic diseases with oral manifestations; and, c. systemic diseases without oral manifestations, but often present in dental patients Establish and maintain rapport and communication with the patient Plan oral health care for patients across the age spectrum: infant, child, adolescent, adult, and the elderly, and for individuals with special needs Determine and consider patient s dental, medical and personal situation in evaluating the range of oral health care strategies appropriate for that individual 6-03 Develop an individualized, comprehensive and properly sequenced plan of treatment based on patient assessment, evaluation of diagnostic data, scientific evidence and patient preferences Discuss findings, diagnosis, treatment alternatives, and the risks and benefits of each therapeutic option with patients, their caregivers and/or their legal representative to 168

140 insure a sufficient understanding for informed patient consent to treatment and obtain a written acceptance of the plan Evaluate outcomes of treatment on an ongoing basis, including use of a patient recall system, and modify treatment plans based on changing circumstances Modify a patient s dental treatment plan based on assessment of medical risks Create a plan to treat malocclusion and provide or manage that care Evaluate the patient s periodontium and peri-implant tissues, develop a diagnosis, identify treatment options and their prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Evaluate the patient s teeth and supporting structures, develop a diagnosis, identify treatment options and their prognoses, and formulate a plan of treatment that best meets the needs and desires of the patient Evaluate the patient s edentulous areas, supporting and limiting anatomical structures, develop a diagnosis, identify treatment options and their prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Evaluate the patient s pulpal and periapical tissues, develop a diagnosis, identify treatment options and their prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Assess the patient s oral hard and soft tissue, identify problems needing treatment, identify treatment options and their prognoses, develop a diagnosis, and formulate a treatment plan that meets patient s needs and desires. 2-25b: Foundational Curriculum and Assessment of Progress Toward Competency Treatment planning skills build upon the foundational learning experiences previously described for patient assessment and diagnosis in Standard 2-25a. Students acquire the foundation principles of treatment planning during year 1 with data gathering and documentation in Physical Evaluation I DIAG In year 2, students learn how to develop a problem list in Physical Evaluation II DIAG 6035 and other discipline-oriented courses. Second year students also complete a clinical rotation in Clinical Introduction INTD 6088 where they are evaluated on their ability to develop a patient problem list. Students are introduced to treatment planning strategies and options in the second year preclinical courses of the various dental disciplines and students knowledge of treatment planning pertinent to these disciplines is evaluated by written examinations within the following courses: Operative Dentistry RESD 6001, Prosthodontics PROS 6011 (Fixed), 6018 (Complete Dentures), 6094 (Removable), and 6059 (Implant), Periodontics PERI 6082, Endodontics ENDO 6041, Orthodontics ORTH 6075, Oral Surgery OSUR 6051, and Temporomandibular Disorders RESD Students learn treatment planning principles and considerations for child and adolescent patients in Pediatric Dentistry PEDO 7041 during the fall 169

141 semester of the third year. In years 3 and 4, students develop a comprehensive, individualized treatment plan for each of their assigned patients from a problem list. This represents a major learning activity for students and a primary basis for faculty mentoring and feedback in the clinic. Each treatment plan is critiqued by a GPG faculty member, and these critiques contribute substantially to formulation of a student s comprehensive evaluations for assessment, diagnosis and treatment planning on the daily formative assessments, monthly progress evaluations, midyear, and end-of-semester/end-of-year evaluations (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Competency Evaluation for Standard 2-25b During year 3, students progress toward competency for patient assessment, diagnosis and treatment planning, as well as comprehension of pathophysiology related to medical and dental health problems, is assessed during two Portfolio Presentations, based on two patients selected from the student s overall family of patients with faculty approval, that address: (1) a patient with medical and/or dental complexity, and (2) an implant patient. Students portfolio cases are presented in GPG conferences. Presentations include a review of the evidence pertinent to patient health issues and therapeutic strategies, and are evaluated by supervising GPG faculty members. During the third year, students must also successfully complete several independently performed Treatment Planning Evaluations during their Oral Surgery Rotation, which focus on treatment planning for medically complex patients. During the third and fourth years, students must successfully complete independently performed Periodontal Therapy Assessment, Diagnosis and Therapy Planning Evaluations (one per year). In year 4, students are evaluated for attainment of competency in comprehensive treatment planning by the GPG faculty by means of an independently developed Case Presentation and an independently performed Diagnosis and Treatment Planning Evaluation. Students must also successfully complete an independently performed Outcomes of Care Evaluation, which requires review and analysis of assessment, diagnostic and treatment planning decisions and appraisal of patient outcomes. In addition, each student independently develops and presents a Case Presentation during the spring semester of the fourth year that focuses on assessment, diagnosis, treatment planning and appraisal of outcomes with associated analysis of best evidence to support treatment decisions. During the fourth year, senior students must also independently complete, with a satisfactory evaluation, an Outcomes of Care Examination that focuses on assessment of treatment planning decisions. All fourth year students are also evaluated for competence in treatment planning skills during the Patient Assessment and Treatment Planning component of the Mock WREB Examination conducted in the spring semester. All of these fourth year assessments are formally evaluated activities that must be successfully completed to pass GEND 8077 and to be certified as ready for graduation. A component of students' daily formative assessments, monthly progress evaluations, mid-year progress toward competency assessments, and end-of-semester/end-of-year comprehensive evaluations during year 3 and year 4 is based on GPG faculty members appraisal of students capacity to assess and diagnose patient's oral health conditions. Each of the comprehensive evaluation forms include appraisal of progress toward and ultimate attainment of competency in treatment planning (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress 170

142 to the fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations. B. Supportive Documentation for Standard 2-25b 1. Appendix 2-3b: Syllabi for Dental School Courses and Rotations Pertinent to Standard 2-25b: DIAG 5014 Physical Evaluation I DIAG 5009 Introduction to Dental Radiography PATH 6019 General Pathology PATH 6021 Oral Pathology DIAG 6011 Clinical Medicine DIAG 6035 Physical Evaluation II DIAG 7036 Radiographic Interpretation PEDO 7041 Pediatric Dentistry INTD 7020 Clinical Patient Management GEND 7001 General Dentistry Clinic - Year 3 GEND 8077 General Dentistry Clinic - Year c. Health Promotion and Disease Prevention A. Description for Standard 2-25c These educational outcomes within UTHSCSA Dental School competency domains 7 and 8 address Standard 2-25c: 7-01 Educate individual patients concerning the etiology, prevention and control of oral diseases using a risk-based prevention approach Provide behavioral counseling and preventive therapies to reduce the extent and severity of oral diseases and risk factors Provide dietary counseling and nutritional education relevant to oral health and specific to each patient s dietary history and health habits Evaluate outcomes of preventive interventions Recognize the roles and responsibilities of dentists and other health professionals in the improvement of oral health in the community Identify processes and programs that promote oral health and the prevention of oral diseases at the community level Involve patients in decision-making and respond to their preferences, needs, and values Integrate cultural, social, and behavioral factors that influence oral health practices and beliefs when developing treatment plans in collaboration with patients. 171

143 2-25c - Foundational Curriculum and Assessment of Progress Toward Competency First year students acquire foundational knowledge and are evaluated on their knowledge of community, provider, and individual strategies for the primary prevention of oral diseases and conditions in Oral Health Promotion and Disease Prevention for Individuals and Populations and School Based Prevention COMD During this course, students learn strategies to enhance one-on-one communication and methods to facilitate education among culturally diverse patients. In COMD 5017, students are evaluated on the application of contemporary oral health promotion principles that influence changes at community and individual levels. Students are also evaluated on their knowledge of the disease processes of dental caries, periodontal diseases, and on individual home care through the periodontal clinical exercises and the preventive aspects of Community Dentistry. COMD 5017 is followed by a community experience with a school-based oral hygiene and nutrition education program for elementary children in School Based Prevention COMD First year students are evaluated on their ability to successfully place sealants by Comprehensive Dentistry faculty in the Sealant Rotation of Introduction to Patient Care INTD A didactic course on caries risk management (Cariology COMD 5046) evaluates students' knowledge of the need for and methods of disease prevention, based on the literature. Year 2 students must successfully complete a Preventive Measures Rotation during Clinical Introduction INTD 6088, during which students learn about prevention for the individual patient, including risk assessment, professional fluoride application, home care and principles of tobacco cessation. Finally, students acquire foundational knowledge on nutritional deficiencies or excesses that contribute to oral diseases and learn techniques for dietary counseling in Nutrition COMD 6025 and the Preventive Methods Rotation of Clinical introduction INTD Second year students' knowledge of nutritional deficiencies, disordered eating and dietary counseling are evaluated by written exams in COMD 6025 and the Preventive Methods Rotation in INTD Second year students also provide care for patients in community settings during a half-day rotation, which includes sealant application in a school-based clinic and a half day placing varnishes at Head Start Center during INTD The attending faculty evaluates the student s knowledge and skill in the application of prevention for each pediatric patient. This experience may include, but is not limited to, examination of oral structures, accurate identification of hard/soft tissue lesions and oral pathology, assessment of risk and application of prevention, and/or referral to local clinics for comprehensive care that cannot be completed in the scope of this experience. Each student is expected to demonstrate a level of competence associated with their skill level and application of knowledge of oral disease processes. Assessment for this rotation is on a pass/fail basis. Students are assessed on the principles of individual-centered patient education and provision of culturally sensitive and competent dental care in Patient Centered Oral Health Care: Behavioral, Social and Cultural Dimensions COMD During years 1, 2, 3 and 4 of the curriculum, students participate in a preventive program funded by Methodist Healthcare Ministries for high-risk children. The program occurs over two consecutive Fridays during which students give oral hygiene instruction, place sealants where 172

144 indicated, and may apply fluoride (Healthy Smile Month Project). Students participate in this program annually during rotations in INTD 5030, INTD 6088, GEND 7001 and GEND In year 3, students identify patients at high-risk for oral disease and manage their prevention programs, including counseling about home care, diet and preventive measures, as part of their routine patient assessment processes in the GPGs. Students assess patients risk status and underlying risk factors, and develop risk-based preventive plans for patients in Preventive Dentistry Clinic COMD Students develop a nutritional assessment in the S-O-A-P format for an edentulous patient under the student s care for denture delivery, which includes interpretation of diet/nutritional status, assessment of oral health status, and screening for oral cancer. The S-O- A-P note is reviewed by supervising faculty and modified as indicated prior to the patient s next denture appointment. At this appointment, students are observed and evaluated by the Dental School s nutritionist as they provide behavior modification counseling for the edentulous patient pertinent to general oral health, diet, tobacco cessation if indicated, xerostomia and oral cancer risk. All students complete this health promotion and risk assessment experience for one or more edentulous patients during the third year and are formally evaluated on the capacity to accomplish these risk assessment and patient counseling tasks. Students cannot pass COMD 7050 without successful completion of edentulous patient assessment and counseling. In years 3 and 4, students also develop a plan of prevention as a component of patients comprehensive treatment planning for all patient s seen in the GPGs. Charts of third year students patients are evaluated by community oral health faculty members (Comprehensive Dentistry Department) for risk assessment, interpretation and preventive plan formulation. This is accomplished by auditing of charts of patients who received a comprehensive examination by third year students in each GPG. Two to three charts of each third year student are randomly selected and reviewed near the beginning of the clinic year (August), mid-year (December) and near the end of the year in late March; (n = approximately 90 X 2.5 = 225 charts during each of the three review cycles). Students charts are audited for: completion of the risk assessment form; formulation and implementation of a prevention plan; documentation that risk assessment, interpretation and behavioral modification counseling for diet, oral health and tobacco cessation have occurred; and, documentation that re-evaluation of patient s implementation of counseling recommendations has occurred. Students with deficiencies are informed and counseled by auditing faculty and/or GPG faculty, with follow-up monitoring. Deficiencies are indicated in the student s monthly progress evaluations. Students cannot be promoted from the third to fourth year if deficiencies remain at the end of the year. Behavior guidance strategies for children are addressed in year 3 through the didactic and clinical courses devoted to Pediatric Dentistry PEDO 7041 (lecture) and PEDO 7091 (clinic). During 173

145 Clinical Patient Management INTD 7020 in year 3, students learn and practice strategies for interpersonal communication and conflict resolution. Competency Evaluation for 2-25c In both year 3 and 4, students competency in health promotion and disease prevention is assessed during Periodontal Therapy Evaluations (Periodontal Therapy 1, 2 and 3) that are described in Standard 2-25h. As noted previously in this standard, third year students cannot pass COMD 7050 (Preventive Dentistry Clinic) without successful completion of the Behavior Modification Counseling and Management Exercise for Edentulous Patients, and successful completion of the oral disease risk assessment and risk prevention interventions. In year 4, students are assessed for competency in health promotion and disease prevention during an independently performed Diagnosis and Treatment Planning Evaluation. A component of students' daily formative assessments, monthly progress evaluations, mid-year progress toward competency, and end-of-semester/end-of-year evaluations during year 3 and year 4 is based on GPG faculty members appraisal of students capacity to provide health promotion and disease prevention. Each of the comprehensive evaluation forms include appraisal of progress toward and ultimate attainment of competency in health promotion and disease prevention (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress to the fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations. B. Supportive Documentation for Standard 2-25c 1. Appendix 2-3b: Syllabi for Dental School Courses Pertinent to Standard 2-25c: COMD 5015 School Based Prevention COMD 5017 Oral Health Promotion and Disease Prevention INTD 5030 Sealant Rotation in Introduction to Patient Care COMD 5046 Cariology INTD 6088 Preventive Measures Rotation in Clinical Introduction COMD 6025 Nutrition COMD 6048 Patient Centered Oral Health Care: Behavioral, Social and Cultural Dimensions INTD 7020 School-Based Prevention Rotation in Clinical Patient Management GEND 7001 General Dentistry Clinic - Year 3 GEND 8077 General Dentistry Clinic - Year 4 174

146 2-25d. Informed Consent A. Description for Standard 2-25d These educational outcomes within UTHSCSA Dental School competency domain 6 address Standard 2-25d: 6-01 Develop a comprehensive and properly sequenced plan of treatment and, if needed, obtain consultation from or refer the patient to other health care providers based on evaluation of diagnostic data Discuss findings, diagnosis, treatment options and prognosis with patients or their legal representative to insure sufficient understanding for informed patient consent to treatment and obtain a written acceptance of the plan Evaluate outcomes of treatment on an ongoing basis using recall strategies, and modify treatment plans as needed. 2-25d - Foundational Curriculum and Assessment of Progress Toward Competency Instruction related to informed consent is distributed throughout the curriculum with foundational concepts introduced during years 1 and 2 in Oral Health Promotion and Disease Prevention for Individuals in Populations COMD 5017, Professional Ethics COMD 5031, Physical Evaluation I & II DIAG 5014 and DIAG 6035, and Patient Centered Oral Health Care: Behavioral, Social, and Cultural Dimensions COMD 6048, as well as in the clinical foundations courses in year 2: Operative Dentistry RESD 6001, Prosthodontics PROS 6011 (Fixed), 6018 (Complete Dentures), 6094 (Removable), and 6059 (Implant), Periodontics PERI 6082, Endodontics ENDO 6041, Orthodontics ORTH 6075, Oral Surgery OSUR 6051, and Temporomandibular Disorders RESD In years 3 and 4, informed consent is a component of each patient assessment and treatment plan evaluation with special emphasis on students' documentation of the discussions if patients do not accept recommended treatment. Additionally, students receive instruction on how to provide / obtain consent informed in the Oral Surgery clinical rotation during Oral and Maxillofacial Surgery OSUR Chart audits include assessment of informed consent and occur through two mechanisms: 1) a bi-annual chart audit by each GPG Leader, and 2) a random Clinic Quality Assurance chart audit by a clinical supervisor. Competency Assessment for 2-25d During year 3, students are assessed for capacity to provide informed consent during several treatment planning evaluations in Oral and Maxillofacial Surgery OSUR Students cannot pass this clinical course without successful completion of these independently performed evaluations. In year 4, students are assessed for competency in obtaining informed consent during the independently performed Diagnosis and Treatment Planning Evaluation and Dental Emergency Care Evaluation. During both, students are evaluated for their ability to explain treatment plains 175

147 and alternatives to patients, explain risks and benefits of alternative therapeutic approaches, and obtain informed consent. A component of students' daily formative assessments, monthly progress evaluations, mid-year progress toward competency, and end-of-semester/end-of-year evaluations during year 3 and year 4 is based on GPG faculty members appraisal of students capacity to provide informed consent for all patients. Each of the comprehensive evaluation forms include appraisal of progress toward and ultimate attainment of competency in informed consent (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress to the fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations. B. Supportive Documentation for Standard 2-25d 1. Appendix 2-3b: Syllabi for Dental School Courses Pertinent to Standard 2-25d: COMD 5017 Oral Health Promotion and Disease Prevention COMD 5031 Professional Ethics DIAG 5014 Physical Evaluation I DIAG 6035 Physical Evaluation II COMD 6048 Patient Centered Oral Health Care: Behavioral, Social and Cultural Dimensions INTD 7020 Clinical Patient Management OSUR 7051 Oral and Maxillofacial Surgery GEND 7001 General Dentistry Clinic - Year 3 GEND 8077 General Dentistry Clinic - Year e. Anesthesia, Pain and Anxiety Control A. Description for Standard 2-25e These educational outcomes within UTHSCSA Dental School competency domain 9 address Standard 2-25e: 9-01 Apply behavioral and/or pharmacological methods in caring for patients with fear and anxiety, and refer those patients requiring special expertise Use safe and effective local anesthesia techniques Utilize safe and effective inhalation sedation Prevent, recognize, and manage complications related to use of analgesics, local anesthesia and inhalation sedation techniques. 2-25e - Foundational Curriculum and Assessment of Progress Toward Competency Students acquire foundational knowledge related to communication skills, anatomical structures, and pharmacology of anesthetics in year 1, and comprehension of these foundations is evaluated by written examinations in several courses including Physical Evaluation 1 DIAG 5014, Gross Head and Neck Anatomy CSBL 5032, Dental Neuroscience CSBL 5020, and Pharmacology PHAR

148 Students acquire foundational knowledge of the principles and techniques of anesthesia in two courses in year 2, and are evaluated by written examinations: Local Anesthesia OSUR 6056, and Nitrous Oxide OSUR Anesthesia and other pain control concepts presented in these courses are reinforced in Endodontics ENDO 6041 and Operative Dentistry RESD 6001 subsequently in the second year. During year 2, students learn and practice the skill of intra-oral injections for local anesthesia (LA) during two half-day OMS rotations at either the University Health System Downtown s Oral Surgery Clinic or the Oral Surgery Clinic in the dental school in INTD During these LA rotations, students provide 6-12 on OMS patients under close faculty supervision and coaching. Students cannot receive course credit for INTD 6088 until they have demonstrated proficiency with LA injections to the satisfaction of the supervising OMS faculty members. In the spring semester of year 2, students learn assessment techniques and psychological strategies for effectively reducing fear, anxiety and pain in dental patients in Patient-Centered Oral Health Care COMD 6048, and comprehension is evaluated by written examinations. The application of communication strategies for increasing patient comfort during dental visits is included in COMD 6048, and is also assessed. The clinical basis and practical use of analgesics are presented during year 2 in Introduction to Oral Surgery OSUR 6051 and during the Oral and Maxillofacial Surgery Clinical Rotation, OSUR 7051 in year 3. The third year Oral Surgery course includes a pharmacy workshop that covers prescription writing and services that the pharmacy and pharmacist can offer the dentist to aid in patient care. In years 3 and 4 within the GPGs, students' administration of nitrous oxide occurs under close faculty supervision during patient care experiences with decreased supervision as students experience increases. The training sequence concludes with at least one independently performed administration without faculty assistance, which is formally assessed by supervising clinicians, either OMS faculty or GPG faculty depending on clinic location. A minimum of ten Nitrous Oxide experiences must be successfully completed and documented by supervising faculty using the Nitrous Oxide Experience Log (Appendix 2-25e-1) in order to be certified by the Texas State Board of Dental Examiners. Documentation of student certification is maintained in the Oral and Maxillofacial Surgery Department. Additional experiences and remediation are required if a students' competency in Nitrous Oxide is not certified by supervising faculty. Competency Assessment for Standard 2-25e During the Oral Surgery Clinical Rotation in year 3 (OSUR 7051), students' knowledge of anesthetics is evaluated by written examinations. Capacity to administer intra-oral injections must be demonstrated for successful completion of OSUR 7051 using the OSUR Daily and End-of- Rotation Assessment Form (Appendix 2-25e-2). This assessment must be successfully completed to receive credit for this course. Throughout year 3, students progress toward competency in anesthesia, pain and anxiety control is evaluated by GPG faculty during each restorative clinical evaluation, (See Standard 2-25f) that requires administration of a local anesthetic. Throughout year 4, students competence in anesthesia, pain and anxiety control is evaluated by GPG faculty as a component of every patient care procedure performed by students that requires 177

149 the administration of a local anesthetic. In year 4, anesthesia technique is formally evaluated as part of virtually every clinical skill evaluation for restorative dentistry and prosthodontics (see the list of clinical evaluations for 2-25f in Table ) and also during the Dental Emergency Care Clinical Evaluation. All fourth year students must independently and satisfactorily complete a Pediatric Restorative Clinical Skill Evaluation requiring local anesthesia and rubber dam placement. A component of students' daily formative assessments, monthly progress evaluations, mid-year progress toward competency, and end-of-semester/end-of-year evaluations during year 3 and year 4 is based on GPG faculty members appraisal of students capacity to provide to provide proper anesthesia for patients for all dental procedures requiring pain control. Each of the evaluation forms for daily, monthly, mid-year and end-of year include appraisal of progress toward and ultimate attainment of competency in anesthesia, pain and anxiety control (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress to the fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations. B. Supportive Documentation for Standard 2-25e 1. Appendix 2-3b: Syllabi for Dental School Courses Pertinent to Standard 2-25e: DIAG 5014 Physical Evaluation I CSBL 5032 Gross Head and Neck Anatomy CSBL 5020 Dental Neuroscience PHAR 5001 Pharmacology OSUR 6051 Oral Surgery OSUR 6056 Local Anesthesia OSUR 6140 Nitrous Oxide RESD 6001 Operative Dentistry COMD 6048 Patient Centered Oral Health Care: Behavioral, Social and Cultural Dimensions OSUR 7051 Oral and Maxillofacial Surgery Clinical Rotation INTD 7020 Clinical Patient Management GEND 7001 General Dentistry Clinic - Year 3 GEND 8077 General Dentistry Clinic - Year 4 2. Appendix 2-25e-1: Nitrous Oxide Experience Log 3. Appendix 2-25e-2: OSUR 7051 Daily and End-of-Rotation Assessment Form 178

150 2-25f. Restoration of Teeth A. Description for Standard 2-25f These educational outcomes within UTHSCSA Dental School competency domain 13 address Standard 2-25f: Evaluate the patient s teeth and supporting structures, develop a working diagnosis, evaluate treatment options and their prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Restore teeth, utilizing appropriate materials to ensure adequate restoration of form, function, esthetics, and the protection of teeth and supporting structures Communicate effectively with dental laboratory technicians and critically evaluate laboratory products Evaluate outcomes of treatment and manage maintenance of the restoration. 2-25f - Foundational Curriculum and Assessment of Progress Toward Competency The Predoctoral Division of the Comprehensive Dentistry Department has the primary responsibility for developing the students knowledge and skills necessary to meet Standard 2-25f. In year 1, the initial development and evaluation of knowledge and preclinical skills occurs in Dental Anatomy and Occlusion RESD 5004 / RESD 5005, and Biomaterials RESD Major elements of the students' learning experience in year 2 are the didactic and preclinical Operative Dentistry and Fixed Prosthodontic courses, which are conducted in the School's Simulation Lab (RESD 6001, RESD 6002, PROS 6011 and PROS 6012). In these courses, students are evaluated through written examinations and independent preclinical skill assessments to ensure that they possess the knowledge and skills necessary to progress to patient care. Students receive additional instruction in biomaterials in Biomaterials II RESD 6102 in coordination with the preclinical simulation lab courses for both operative and prosthodontics. Didactic courses in Operative Dentistry (RESD 7010) and Fixed Prosthodontics (PROS 7018) continue during year 3, focusing on treatment strategies to address patients' unique needs, and clinical problem-solving. In these courses, students are evaluated by means of written examinations on their knowledge of diagnosis, treatment planning, outcomes assessment, materials and tooth restoration techniques. In year 3, the didactic and preclinical lab component of the Esthetic Dentistry (RESD 7050) course concentrates on porcelain veneers. Students are evaluated at the end of the course with a written exam and skills assessment in which they demonstrate their knowledge and their ability to independently prepare a porcelain veneer preparation on a simulation tooth. During year 3, students must successfully complete independently performed and timed clinical skill evaluations in Operative Dentistry Clinic RESD 7011 that include all aspects necessary to prepare and restore a tooth without faculty assistance. The operative clinical skill evaluation is an Amalgam or Composite Direct Restoration. 179

151 In the third year Fixed Prosthodontics Clinic (PROS 7019), students demonstrate progress toward competency by completing a Fixed Prosthodontics Manikin Examination to demonstrate mastery of foundational skills and then complete three independently performed clinical skill evaluations. The three progress-toward-competency evaluations in PROS 7019 are increasingly comprehensive as the junior year progresses. The first of the assessments is a Tooth Preparation Only Exam. Later in the year, the second assessment involves Preparation and Provisional Restoration. The more heavily weighted third assessment involves the Complete Delivery Sequence for a Single Unit Restoration including: preparation, fabrication of a provisional restoration, impression making, cast and die laboratory work and case submission to a laboratory, crown pre-cementation, and crown cementation steps. Third year students also must independently and satisfactorily complete a Single-Unit Crown and a Cast Dowell Core Evaluation. Third year students choose the cases for their clinical evaluations and must be able to defend their treatment plans and the types of materials and techniques used, with the later components representing key elements of the overall evaluation. Students must achieve satisfactory evaluations on all of these clinical skill assessments to pass PROS Throughout year 3, each student s progress toward competency is comprehensively appraised, across multiple dimensions of performance, and in relation to UTHSCSA Dental School Competency 13, tooth restoration, at monthly GPG faculty meetings General Dentistry Clinic GEND 7020; Year 3). Each student receives a monthly evaluation of progress and recommendations for improvement where indicated (Appendix 2-8b: Monthly Progress Evaluation). During year 4, students complete an advanced course in Esthetic Dentistry (RESD 8051) to roundout instruction for Standard 2-25f. Senior students continue to provide restorative care for their family of patients throughout the year and continue to receive daily formative assessments, monthly progress evaluations and mid-year and end-of year comprehensive evaluations from their GPG faculty in General Dentistry Clinic GEND Competency Assessment for Standard 2-25f To progress into the fourth year, third year students must independently perform and successfully complete the seven previously described clinical skill evaluations related to tooth restoration. Fourth year students must satisfactorily complete the independently performed clinical skill evaluations listed below: direct restoration anterior composite; direct restoration amalgam; single unit crown; and, restorative procedure requiring local anesthesia and rubber dam placement on a pediatric dental patient. Appropriate pediatric patient behavior management is assessed during this clinical skill evaluation. These clinical skill evaluations are scheduled when students and their GPG Leaders determine that the student is ready to challenge the evaluation, based on assessment of previous patient care 180

152 experiences. A second major assessment of the fourth year student s ability to independently provide patient care pertinent to Standard 2-25f occurs during the Mock WREB. Fourth year students have a choice of doing one of three restorations: Class II Composite, Class III Composite or Class II Amalgam. Student must successfully complete the mock WREB evaluation to pass GEND 8077 and be eligible for graduation certification. During year 4, senior students are assigned patients that provide a variety of experiences in tooth restoration to further challenge their ability to manage different restorative problems and employ different techniques. Senior students receive daily formative assessments, monthly progress evaluations, a mid-year progress toward competency evaluation, and an end-of year competency attainment evaluation from their GPG faculty pertinent to Standard 2-25f and UTHSCSA Competency Domain 13 (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the endof-year comprehensive evaluations. Appendix 2-8e contains the evaluation forms used by faculty to assess students independentlyperformed, discipline-specific clinical skill evaluations in the third and fourth years including those forms pertinent to the assessments described for Standard 2-25f. B. Supportive documentation for Standard 2-25f 1. Appendix 2-3b: Syllabi for Dental School Courses Pertinent to Standard 2-25f: RESD 5001 Biomaterials I RESD 5004 Dental Anatomy and Occlusion RESD 5005 Preclinical Dental Anatomy and Occlusion RESD 6001 Preclinical Operative Dentistry Lecture RESD 6002 Preclinical Operative Dentistry Lab PROS 6011 Preclinical Fixed Prosthodontics Lecture PROS 6012 Preclinical Fixed Prosthodontics Lab RESD 6102 Biomaterials II RESD 7010 Operative Dentistry Lecture RESD 7011 Operative Dentistry Clinic RESD 7050 Esthetic Dentistry PROS 7019 Fixed Prosthodontics Clinic GEND 7001 General Dentistry Clinic - Year 3 GEND 8077 General Dentistry Clinic - Year 4 RESD 8051 Esthetic Dentistry 181

153 2-25g. Replacement of Teeth A. Description for Standard 2-25g These educational outcomes within UTHSCSA Dental School competency domain 14 address Standard 2-25g: Evaluate the patient s edentulous areas, supporting and limiting anatomical structures, develop a diagnosis, evaluate treatment options and their prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Replace missing teeth with fixed and removable prostheses Communicate with dental laboratory technicians and critically evaluate laboratory outcomes Evaluate outcomes of treatment and manage the maintenance of dental prostheses. 2-25g - Foundational Curriculum and Assessment of Progress Toward Competency The Department of Comprehensive Dentistry has primary responsibility for the initial evaluation of knowledge and the preclinical skills development for this standard. In year 1, the development and evaluation of students' foundational knowledge and preclinical skills occurs in Dental Anatomy and Occlusion RESD 5004 / RESD 5005, and Biomaterials RESD During Prosthodontic courses in year 2, students learn fundamental treatment modalities for the edentulous patient and the partially edentulous patient with and without dental implants (Removable Prosthodontics Partially Edentulous Patient and Preclinical Removable Prosthodontics Partially Edentulous Patient PROS 6094 / 6095, Prosthodontic Treatment for the Edentulous Patient Lecture and Preclinical Prosthodontic Treatment for the Edentulous Patient PROS 6018/6019; and Prosthodontic Treatment for the Dentate/Partially Dentate Patient and Preclinical Prosthodontic Treatment for the Dentate/Partially Dentate Patient PROS 6011/6012. These treatment modalities include, but are not limited to removable and fixed prostheses. The student s knowledge related to diagnosis, treatment planning, materials and techniques is evaluated by written examinations during the second year prosthodontics didactic courses (PROS 6094 and PROS 6018). During prosthodontic preclinical laboratory courses in year 2 (PROS 6095 and PROS 6019), students acquire the preclinical technique skills related to removable and fixed prostheses necessary to proceed to direct patient care. Students' capacity to perform designated techniques is assessed in graded simulation exercises throughout year 2 preclinical lab courses in prosthodontics. Students receive additional instruction in biomaterials in Biomaterials II RESD 6102 in coordination with preclinical simulation lab courses. Didactic courses devoted to fixed and removable prosthodontics in years 3 and 4 further expand students' knowledge base and continue to assess students' comprehension of diagnosis, treatment planning, outcomes assessment, materials and techniques related to replacement of missing teeth by means of written examinations (Removable Partial Denture Lecture PROS 7091, and Fixed Prosthodontics Lecture PROS 7018 and Complete Dentures PROS 7095). 182

154 In years 3 and 4 in the clinic, students gain experience as they progress towards competence in the replacement of teeth by providing fixed and removable prosthodontic care to their assigned patients (Removable Prosthodontics Course PROS 7092, Fixed Prosthodontics Clinic Course PROS 7019 and Complete Dentures Clinic PROS 7099 ). Competency Assessment for Standard 2-25g: During year 3, students are evaluated on application of knowledge, clinical skills and values in providing complete dentures, and removable partial dentures to their patients. In year 3, students must independently perform and successfully complete four clinical skill evaluations involving missing teeth to demonstrate competency pertinent to Standard 2-25g and UTHSCSA Dental School Competency Domain 14: Complete Denture Removable Partial Denture Comprehensive Complete Denture OSCE Fixed Partial Denture Third year students cannot progress to year four without successful independent completion of these evaluations. Throughout year 3, each student s progress toward competency is comprehensively appraised, across multiple dimensions of performance, and in relation to UTHSCSA Dental School Competency 14, tooth replacement, at monthly GPG faculty meetings (General Dentistry Clinic GEND 7001; Year 3). Each third year student receives a monthly evaluation of progress and recommendations for improvement where indicated (Appendix 2-8b: Monthly Progress Assessment Form), as well as mid-year progress toward competency and an end-of-year comprehensive evaluations (Appendices 2-8c and 2-8d). In year 4, students must independently perform and successfully complete four clinical skill evaluations involving missing teeth to demonstrate competency pertinent to Standard 2-25g and UTHSCSA Dental School Competency Domain 14. These fourth year clinical skill evaluations are: A Fixed Partial Denture; Complete Prosthodontics for an edentulous patient (either a complete denture or a removable partial denture); Removable Partial Denture Design; and, Removable Partial Denture Fabrication. These competency exams are scheduled when students and their GPG Leaders determine that the student is ready for the examination, based on assessment of previous patient care experiences involving removable and fixed prosthodontics. Fourth year students also must complete a nongraded Prosthodontic OSCE where they answer questions about occlusion, dental implants, removable partial dentures, complete dentures and fixed partial dentures. The OSCE is implemented to assess each senior students' comprehension of fundamental concepts and to identify students in need of additional instruction and experience. 183

155 During year 4, senior students are assigned patients that provide a variety of experiences in replacing teeth to further challenge their ability to manage different case scenarios. Senior students receive daily formative assessments, monthly progress evaluations, a mid-year progress to competency evaluation, and an end-of year competency attainment evaluation from their GPG faculty pertinent to Standard 2-25g and UTHSCSA Competency Domain 14 (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations. Appendix 2-8e contains the evaluation forms used by faculty to assess students independentlyperformed, discipline-specific clinical skill evaluations in the third and fourth years including those forms pertinent to the assessments described for Standard 2-25g. B. Supportive Documentation for Standard 2-25g 1. Appendix 2-3b: Syllabi for Dental School Courses Pertinent to Standard 2-25g: RESD 5001 Biomaterials I RESD 5004 Dental Anatomy and Occlusion Lecture RESD 5005 Preclinical Dental Anatomy and Occlusion Lab RESD 6012 Biomaterials II PROS 6094 Removable Prosthodontics for Partially Edentulous Patient PROS 6095 Preclinical Removable Prosthodontics for Partially Edentulous Patient PROS 7091 Removable Partial Denture Lecture Course PROS 7092 Removable Partial Denture Clinical Course PROS 6018 Prosthodontic Treatment of the Edentulous Patient PROS 6019 Preclinical Prosthodontic Treatment of the Edentulous Patient PROS 6011 Prosthodontic Treatment for the Dentate/Partially Dentate Patient PROS 6012 Preclinical Prosthodontic Treatment for the Dentate/Partially Dentate Patient PROS 6058 Preclinical Implant Prosthodontic Treatment for the Edentulous & Partially Edentulous Patient PROS 6059 Implant Prosthodontic Treatment for the Edentulous & Partially Edentulous Patient PROS 7095 Complete Dentures PROS 7099 Complete Dentures Clinic GEND 7001 General Dentistry Clinic - Year 3 GEND 8077 General Dentistry Clinic - Year 4 184

156 2-25h. Periodontal Therapy A. Description for Standard 2-25h These educational outcomes within UTHSCSA Dental School competency domain 12 address Standard 2-25h: Evaluate the patient s periodontium and peri-implant tissues, establish baseline conditions, develop a working diagnosis, evaluate treatment options and prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Perform initial periodontal therapy including a dental prophylaxis, scaling and root planing Evaluate the outcomes of periodontal therapy, reassess the diagnosis and prognosis, and determine the need for additional periodontal treatment Recognize the need for periodontal and peri-implant surgery and manage surgical care Devise and manage programs to maintain patient s periodontal and peri-implant health. 2-25h - Foundational Curriculum and Assessment of Progress Toward Competency The responsibility for didactic and preclinical instruction for predoctoral students resides in the Department of Periodontics and all teaching in years 1 and 2 of the curriculum is provided by specialty faculty members within this department. In year one, students receive an introduction to periodontal disease, its etiology and pathogenesis and treatment in Periodontics PERI Assessment of students' foundational knowledge in periodontics is accomplished by written exams and assessment of skills is accomplished by written exams, observation of students' performance in preclinical exercises, and an Objective Structured Clinical Examination (OSCE). In the second year, students complete Periodontics PERI 6082, which features didactic and clinical components and builds upon students' foundational knowledge acquired in the first year periodontics introductory-level course. During PERI 6082, students are evaluated on their ability to plan, deliver and reevaluate non-surgical periodontal therapy and their comprehension of concepts of monitoring periodontal patients longitudinally. In this course, preclinical exercises are conducted in patient care clinics as well as in the simulation laboratory. During the preclinical exercises, students are evaluated on their ability to demonstrate periodontal diagnostic and instrumentation skills. Assessment of knowledge and values is accomplished by written examinations and assessment of skills acquisition occurs by objective testing and an OSCE. Following completion of PERI 6082, second year students see their first patient in a clinical module within INTD 6088 that focuses on history taking, diagnosis, and providing limited non-surgical periodontal therapy. In the third and fourth years, three didactic courses are presented by the Department of Periodontics: Periodontics PERI 7081 and Implantology PERI 7059 in year 3, and Periodontics PERI 8015 in year 4, which focus on clinical application of foundational concepts and skills, introduction of advanced techniques, and problem-solving. Assessment of knowledge, skills and values regarding periodontics and implantology is accomplished via written examinations. 185

157 During the third year clinical experience (Clinical Patient Management INTD 7020 and General Dentistry Clinic GEND 7001) each student performs periodontal therapy as part of a comprehensive treatment plan under the guidance of GPG faculty who are primarily general dentists and prosthodontic specialists. Also, in the third year, students complete a 3-day rotation in the postdoctoral periodontics clinic in which they observe, assist and sometimes participate in advanced periodontal therapies on patients referred to that clinic. Predoctoral student activity in the rotation is assessed by postdoctoral students. In year 4, in General Dentistry Clinic GEND 8077, students continue to provide periodontal therapy for their family of patients, as indicated within context of patients' overall treatment needs. There are also several selective courses (See Appendix 2-5c) offered across the curriculum by the Department of Periodontics in which students are introduced to broader concepts and more advanced periodontal therapies including periodontal flap surgery. In summary, students progression toward competency in periodontics are evaluated at multiple points in the curriculum. The first periodontal patient experience is in the second semester of the second year. Students are assigned a family of patients at the beginning of the third year within their GPG and this group is augmented over time as necessary to incorporate adequate clinical experiences in periodontics and other aspects of general dentistry. Competency Assessment for Standard 2-25h: During year 3, students must independently perform and successfully complete two periodontics clinical skills evaluations. The Competency Assessment for Periodontal Therapy Parts 1, 2 and 3, assesses periodontal examination, diagnosis, treatment planning, scaling and root planing, and reevaluation of scaling and root planing. The Progress Assessment Examination of Dental Prophylaxis assesses all aspects of the dental prophylaxis appointment. Student self-assessment is a component of these competency examinations. Assessment and treatment of peri-implant tissues is included in these competency assessments when existing implants and restorations are present in the student s patients. Third year students also complete a Clinical Periodontics Rotation in GEND 7001 where they receive a comprehensive end-of-rotation evaluation. In year 4, students are assessed for competency in periodontal therapy by the GPG faculty through three independently performed examinations, which must be successfully completed to pass GEND 8077 and be certified as ready for graduation. These clinical evaluations are described below. Clinical Evaluation for Periodontal Therapy, Parts 1, 2 and 3, which includes assessment of the diagnosis, non-surgical therapy and reevaluation of these procedures that are all completed on one patient. Clinical Evaluation for Outcomes of Care, which evaluates the student s abilities to examine and assess the outcomes of care on a completed comprehensive patient. The Outcomes of Care Evaluation contains a section specific to periodontal outcomes. On the Mock WREB in the spring semester, fourth year students conduct a periodontal assessment and provide one quadrant of SCRP. Student must successfully complete the mock 186

158 WREB evaluation to pass GEND 8077 and be eligible for graduation certification. A component of students' daily formative assessments, monthly progress evaluations, mid-year progress toward competency, and end-of-year evaluations during year 3 and year 4 is based on GPG faculty members appraisal of students capacity to provide to provide periodontal therapy consistent with the scope of UTHSCSA Competency 12 and associated educational outcomes for all patients in need of such therapy. Each of the evaluation forms for daily, monthly, mid-year and end-of year include appraisal of progress toward and ultimate attainment of competency in periodontal therapy (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress to the fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations. Appendix 2-8e contains the evaluation forms used by faculty to assess students independentlyperformed, discipline-specific clinical skill evaluations in the third and fourth years including those forms pertinent to the assessments described for Standard 2-25h. B. Supportive Documentation for Standard 2-25h 1. Appendix 2-3b: Syllabi for Dental School Courses and Rotations Pertinent to Standard 2-25h: PERI 5081 Periodontics - Year 1 PERI 6082 Periodontics - Year 2 PERI 7059 Implantology - Year 3 PERI 7081 Periodontics - Year 3 GEND 7001 General Dentistry Clinic - Year 3 INTD 7020 Clinical Patient Management PERI 8015 Periodontics - Year 4 GEND 8077 General Dentistry Clinic - Year 4 187

159 2-25i Pulpal Therapy A. Description for Standard 2-25i These educational outcomes within UTHSCSA Dental School competency domain 15 address Standard 2-25i: Evaluate the patient s pulpal and peri-radicular tissues, develop a working diagnosis, evaluate treatment options and their prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Manage pulpal and peri-radicular disorders Create coronal access to diseased pulpal tissues Clean, shape, and obturate the root canal system when treatment is within the scope of care Evaluate outcomes of treatment and recognize the need for endodontic retreatment or endodontic surgery. 2-25i - Foundational Curriculum and Assessment of Progress Toward Competency The Endodontics Department has primary responsibility for the development of students' foundational knowledge and their acquisition of initial skills in pulpal therapy. Students acquire knowledge of internal tooth anatomy and comprehension is evaluated in Dental Anatomy and Occlusion RESD 5004 in year 1. In year 2, students acquire foundational knowledge and preclinical skills needed to perform root canal therapy using extracted teeth and simulations in the Endodontics lecture and lab courses (ENDO 6041 and ENDO 6142). Beginning in the second year Endodontic lecture/lab courses and continuing in years 3 and 4 with ENDO 7041 and ENDO 8043, students learn and are evaluated for knowledge of topics related to endodontic diagnosis and treatment planning, assessment of treatment outcomes and techniques in oral pathology and radiographic interpretation. In year 3, when a student s patients require pulpal therapy that the student is eligible to perform, the student treats these patients in the predoctoral Endodontic Clinic (ENDO 7043) supervised by Endodontic faculty. Students are evaluated on their capacity to independently perform diagnosis, access, instrumentation and obturation for both patients, and if indicated to enhance capacity, for additional patients. Third year students must complete two patient cases to the satisfaction of the Endodontic faculty who then credential the students as being capable of providing single rooted and simple multi-rooted premolar therapy for their patients in the GPG clinic, under supervision and evaluation by GPG faculty. By the end of year three, junior students must independently and successfully complete endodontic treatment on either three single rooted teeth, or one single rooted tooth and one simple multi-rooted premolar tooth. Subsequent to certification, during years 3 and 4, students perform pulpectomies on patients as needed during emergency rotations and restorative procedures. Overall, students are expected to independently and successfully provide single rooted and simple multi-rooted premolar therapy 188

160 for a minimum of two patients during year 4, both of which representing formally graded clinical skills evaluations as described in the following section. A molar endodontics selective course is also offered during the senior year for all interested students. The schedule for the selective corresponds to students scheduling of patients needing endodontic treatment of a molar, so many students are able to take this selective (SELC 8160; See Appendix 2-5c). In this selective, students first are instructed on the unique anatomy of molar teeth followed by performing endodontic treatment on extracted teeth. Endodontic therapy is then completed under the supervision of the Endodontic faculty. Following certification, the students are able to perform multi-rooted endodontic therapy within their GPGs. Competency Assessment for Standard 2-25i: In year 4, students must successfully complete three independently performed clinical skill evaluation pertinent to pulpal therapy. Diagnose, treatment plan and treat a single or a simple multi-rooted premolar tooth as a clinical skills evaluation. Students' performance is evaluated by a panel of Comprehensive Dentistry and Endodontic faculty. Students are evaluated on diagnosis, access, quality of radiographs, instrumentation and obturation. In the event of failure on this endodontic evaluation, remediation includes counseling, manikin exercises and a re-take of the exam. Provide pulpal therapy on one additional tooth as a second clinical skills evaluation exam, which is assessed as pass / fail by supervising GPG faculty. Successfully complete a timed Mock WREB exercise in which students perform endodontic therapy on an extracted tooth mounted in a manikin. Students who fail the endodontic component of the mock WREB repeat the exercise until performance is rated as satisfactory. Fourth year students cannot pass GEND 8077 and be certified as ready for graduation without successful completion of these clinical evaluations. A component of students' daily formative assessments, monthly progress evaluations, mid-year progress toward competency assessment, and end-of-year evaluations during year 3 and year 4 is based on GPG faculty members appraisal of students capacity to provide to provide pulpal therapy consistent with the scope of UTHSCSA Competency 15 and associated educational outcomes for all patients in need of such treatment. Each of the evaluation forms for daily, monthly, mid-year and end-of year include appraisal of progress toward and ultimate attainment of competency in pulpal therapy (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress to the fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations. Appendix 2-8e contains the evaluation forms used by faculty to assess students independentlyperformed, discipline-specific clinical skill evaluations in the third and fourth years including those forms pertinent to the assessments described for Standard 2-25i. 189

161 B. Supportive Documentation for Standard 2-25i 1. Appendix 2-3b: Syllabi for Dental School Courses Pertinent to Standard 2-25i: RESD 5004 Dental Anatomy and Occlusion RESD 5005 Preclinical Dental Anatomy and Occlusion ENDO 6041 Endodontic Lecture ENDO 6142 Preclinical Endodontics Lab ENDO 7041 Endodontic Lecture ENDO 7043 Endodontic Clinic GEND 7001 General Dentistry Clinic INTD 7020 Clinical Patient Management GEND 8077 General Dentistry Clinic ENDO 8043 Endodontic Lecture - Year j. Oral Mucosal Disorders A. Description for Standard 2-25j These educational outcomes within several UTHSCSA Dental School competency domains address Standard 2-25j: 4-01 Demonstrate comprehension of the structure, function and pathology of cells, tissues, organs and organ systems, and apply this knowledge during management of patients Recognize diseases in the following categories, and explain clinical presentation, pathophysiology and implications for dental treatment: a. diseases unique to the head, neck and oral cavity; b. systemic diseases with oral manifestations; and, c. systemic diseases without oral manifestations, but frequently present in dental patients Identify the presence of systemic disease with oral manifestations or implications for dental care, and manage dental treatment Perform intraoral examinations of the hard and soft tissues of the mouth Recognize the normal range of clinical findings and establish a working diagnosis for findings that require treatment or represent a significant deviation from normal Evaluate the patient s oral hard and soft tissue, identify problems needing treatment, develop a working diagnosis, evaluate treatment options and their prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Manage osseous and oral mucosal diseases. 190

162 2-25j - Foundational Curriculum and Assessment of Progress Toward Competency Competencies 4, 5 and 16, and the associated educational outcomes pertaining to Standard 2-25j overlap with competencies for assessment, diagnosis and treatment planning. Students' learning experiences and the evaluation of their capacity to conduct head and neck examinations and document normal findings (educational outcome 5-04) begins in years 1 and 2 with Physical Evaluation I, Physical Evaluation II (DIAG 5014 and DIAG 6035), and Introduction to Dental Radiography DIAG In these courses, student acquire knowledge and skills related to data gathering and recording/documentation, performing a head and neck exam, making and developing radiographs and identifying normal findings. Each course includes a clinical component, where students practice these skills on classmates and on patients. These learning experiences in patient assessment occur concurrently with the students' study of the foundation biomedical sciences, primarily Gross Head and Neck Anatomy CSBL 5016, Dental Histology CSBL 5032, and Physiology PHYL 5013, which emphasize normal development, structure and function. Coordination of patient assessment and basic science coursework provides students with the foundations to achieve educational outcome 5-07: "recognize the normal range of clinical findings and establish a working diagnosis for findings that require treatment or represent a significant deviation from normal", in conjunction with year 2 courses in pathology and oral diagnosis described in the next paragraph. In year 1, students acquire foundational knowledge and basic skills related to data gathering and recording, performing a head and neck exam, making and developing radiographs and identifying normal findings in Physical Evaluation I DIAG 5014 and Introduction to Dental Radiography DIAG Assessment of students comprehension of foundational knowledge and basic patient assessment skills is measured by written examinations, most of which involve patient scenarios. In year 2, students acquire foundational knowledge related to educational outcomes 4-02 and 5-02 in General Pathology PATH 6019 and Oral Pathology PATH 6021, and their comprehension is assessed by written examinations, primarily based on case scenarios. Students acquire foundational knowledge related to recognition and management of dental patients with oral manifestations of systemic diseases in Clinical Medicine DIAG 6011 and are assessed on their ability to apply this knowledge to patient care situations in written examinations. In year 3, students receive additional learning experiences to enhance their ability to diagnose and manage oral mucosal and bone disorders (educational outcomes 5-07, 16-01, 16-02) in Oral Medicine (DIAG 7055) and in Oral and Maxillofacial Pathology: Clinicopathological Conference PATH Students' knowledge base related to diagnosis and management of oral mucosal and bone disorders is assessed by written examinations in DIAG For the clinical component of the Oral Medicine course, third year students complete rotations in the Senior Care Clinic and Tertiary Care Oral Medicine Clinic, where they are assessed daily on their capacity to conduct systematic patient evaluations, recognize dental abnormalities and propose treatment methods. PATH 7023 is conducted in a case-based, problem-centered format and focuses exclusively on recognition and diagnosis of oral mucosal disorders, with written assessment of students' capacity to identify features of common disorders. Students' understanding of concepts and techniques pertinent to diagnosis and management of oral mucosal and bone disorders is also assessed by 191

163 written examinations in Radiographic Interpretation DIAG 7036 and Geriatrics DIAG 7052 during the third year. Students' knowledge and diagnostic capabilities related to oral mucosal disorders, and their ability to manage simple oral bony and oral mucosal abnormalities (educational outcome 16-02) in their assigned family of patients within the GPGs are evaluated by supervising faculty on the daily formative assessments and the monthly progress evaluations. Students' knowledge and diagnostic capabilities related to oral mucosal disorders are also evaluated in the Oral and Maxillofacial Surgery Clinic Course (OSUR 7051) by means of student case presentations focusing on assessment and diagnosis of dental disorders seen in the OMS clinic population including bony and mucosal abnormalities, weekly written assessments, and daily assessments of students' capacity to systematically assess assigned patients who come to the Oral Surgery clinics of the Dental School for treatment of a wide variety of dental abnormalities. In year 4, the Pharmacotherapeutics PHAR 8009, which includes an Oral Medicine Clinical Rotation, builds upon and reinforces the knowledge and skills necessary to diagnose and manage osseous and oral mucosal disorders, and complete an assessment of their capacity to recognize, diagnose and manage these dental abnormalities, which is described below. Required fourth year clinical rotations in the Tertiary Care Oral Medicine Clinic, the Dental Emergency Care, and Oral Surgery, all components of General Dentistry Clinic GEND 8077, allow students to experience assessment and treatment of patients with mucosal and bone disorders. Competency Assessment for Standard 2-25j: Students must obtain satisfactory evaluations for each of the assessments listed below pertinent to UTHSCSA Competency 16 and Standard 2-25j in order to progress from year three to year four and to be certified as ready for graduation in year 4. In year 3, obtain a satisfactory end-of-rotation evaluation for the Geriatrics Clinical Rotation in Geriatrics DIAG In years 3 and 4, obtain satisfactory daily and end-of-rotation evaluations for the Oral Surgery UHC Downtown Rotations in OSUR 7051 and GEND In year 4, students' ability to recognize and manage osseous and oral mucosal diseases is evaluated through an independently performed Diagnosis and Treatment Planning Evaluation. In year 4, students' ability to recognize and manage osseous and oral mucosal diseases is also evaluated during an independently performed Oral Medicine Competency Assessment in Pharmacotherapeutics PHAR A component of students' daily formative assessments, monthly progress evaluations, mid-year progress toward competency assessment, and end-of-year evaluations during year 4 is based on GPG faculty members appraisal of students capacity to recognize, diagnose and manage osseous and oral mucosal diseases that occur in the students' family of patients, consistent with the scope of UTHSCSA Competency 16 and associated educational outcomes and Each of the evaluation forms for daily, monthly, mid-year and end-of year include appraisal of progress toward and ultimate attainment of competency in management of osseous and oral mucosal diseases (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress to the 192

164 fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations. B. Supportive Documentation for Standard 2-25j 1. Appendix 2-3b: Syllabi for Dental School Courses and Rotations Pertinent to Standard 2-25j: CSBL 5016 Gross Head and Neck Anatomy CSBL 5032 Dental Histology PHYL 5013 Physiology DIAG 5014 Physical Evaluation I DIAG 6035 Physical Evaluation II PATH 6019 General Pathology PATH 6021 Oral Pathology DIAG 7055 Oral Medicine PATH 7023 Oral and Maxillofacial Pathology: Clinicopathological Conference DIAG 7036 Radiographic Interpretation DIAG 7052 Geriatrics OSUR 7051 Oral and Maxillofacial Surgery - Year 3 INTD 7020 Clinical Patient Management PHAR 8009 Pharmacotherapeutics GEND 8077 General Dentistry Clinic - Year 4 OSUR 8055 Oral and Maxillofacial Surgery - Year k. Hard and Soft Tissue Surgery A. Description for Standard 2-25k These educational outcomes within UTHSCSA Dental School competency domains 12 and 16 address Standard 2-25k: Recognize the need for periodontal and peri-implant surgery and manage surgical care Evaluate the patient s oral hard and soft tissue, identify problems needing treatment, develop a working diagnosis, evaluate treatment options and their prognoses, and formulate a treatment plan that best meets the needs and desires of the patient Manage osseous and oral mucosal diseases Perform oral surgical procedures and manage complications Identify and manage patients requiring specialty care Assess outcomes of treatment and manage follow-up care. 193

165 2-25k - Foundational Curriculum and Assessment of Progress Toward Competency The Oral and Maxillofacial Surgery Department has primary responsibility for the development of students' foundational knowledge and their acquisition of initial skills in surgical technique. Courses in the biomedical sciences, especially Gross Head and Neck Anatomy CSBL 5016, and behavioral sciences (Patient-Centered Oral Health Care COMD 6048) provide foundational concepts that facilitate development of competency in hard and soft tissue surgery. Oral Pathology PATH 6021 and Oral Medicine DIAG 7055 also support students' acquisition of foundational knowledge related to the UTHSCSA Dental School Competencies associated with Standard 2-25K. Surgical principles and techniques are also addressed in Periodontics PERI 6082 and Endodontics ENDO 6041 in year 2. Patient assessment for surgery overlaps with competencies of assessment, diagnosis and treatment planning, and informed consent, previously described for Standards 2-25a, 2-25b and 2-25d, which are addressed in Physical Evaluation 1 DIAG 5014 and Physical Evaluation II DIAG Students acquire foundational knowledge about various surgical techniques, and comprehension of these concepts is evaluated in year 2 in the introductory course: Oral Surgery OSUR During Year 3, in the Oral Surgery clinical rotation (Oral and Maxillofacial Surgery OSUR 7051), students participate in seminars during which they apply knowledge of oral surgery principles and techniques to patient care via case simulations. Students complete case-based written exams during the third year OMS course to assess their capacity for clinical application of foundational oral surgery principles. During year 3, students complete a four week oral surgery clinical rotation, during which they daily assess patients in pain, perform non-complicated extractions, conduct post-operative treatments and have numerous opportunities during the month to assist OMS residents in complex surgical procedures. On average, students perform approximately 40 oral surgical procedures, most of which are extractions, during the four-week third year OMS clinical course, OSUR Students are evaluated by OMS faculty on preoperative procedures, the actual surgical procedure and postoperative procedures for each patient (Appendix 2-25k - 1) and comprehensively at the conclusion of the rotation using the same monthly progress evaluation form employed by the GPGs as previously described (Appendix 2-8b). Students' overall evaluation for OSUR 7051 is based on the School's multi-source assessment model including: daily assessments for patient care activities and surgical procedure; faculty evaluation of students case presentations and case analysis in conferences, performance on weekly written examinations; and, faculty evaluation of an independently research paper addressing an aspect of oral surgery of interest to the student. Successful completion of the OSUR 7051 clinical rotation certifies that students are ready to provide surgical care within their GPGs under the supervision of the GPG faculty. Students must successfully complete the OSUR 7051 clinical course to advance to year 4. The focus of the dental care provided by the students at the (University Health Center Downtown; UHCD) is dentoalveolar surgery using local anesthesia or nitrous oxide sedation. No routine, 194

166 preventive, restorative or prosthodontic dental care is available at the UHCD. Most of the head and neck trauma patients treated through the emergency room at University Hospital are followed at the UHCD clinic. This allows dental students on the OMS rotation at UHCD to assist Oral and Maxillofacial Surgery residents and observe intravenous sedation and general anesthesia in an outpatient setting. This clinical education environment allows students to see the aftermath of major facial trauma and the results of aggressive management of these injuries. The patients seen by dental students at the UHCD are not screened as at the Dental School Clinic and thus present with a wide range of systemic and oral medicine disorders, which provides a rich and diverse learning environment for the students. During their four-week rotation, dental students typically encounter numerous patients with various forms of Diabetes, liver disease, hepatitis C, cardiovascular disease, pulmonary disease, circulatory problems, and substantial poly-pharmacy for many patients. Dental students conduct comprehensive reviews of the patients' medical histories and incorporate this information along with discussion of implications for dental treatment, into their daily patient presentations prior to initiation of therapy. During the third year clinical experience (Clinical Patient Management INTD 7020 and General Dentistry Clinic GEND 7001), students perform hard and soft tissue surgery as part of the patient's comprehensive treatment plan under the guidance of GPG faculty who are primarily general dentists and prosthodontic specialists. In year 4, in General Dentistry Clinic GEND 8077, students continue to provide oral surgery for their family of patients, as indicated within context of patients' overall treatment needs. Surgical skills also are evaluated as part of the Dental Emergency Care Clinic (DEC) rotation, a component of GEND 8077, and several other rotations at community clinics. Students complete an additional week-long fourth year Oral Surgery Rotation during GEND Students also complete Advanced Oral and Maxillofacial Surgery OSUR 8055, a lecture-based course, in the fourth year, which focuses on surgical alternatives, new developments in therapeutic technique, and clinical problem-solving. Competency Assessment for Standard 2-25K: There are three major evaluations pertinent to appraisal of students' progress toward and attainment of competency in hard and soft tissue surgery, consistent with scope of the UTHSCSA Dental School Competencies 12 and 16. As noted, third year students must pass OSUR 7051 to progress to the fourth year of the curriculum, so this month-long clinical rotation functions as a major competency progress assessment for UTHSCSA Competencies 12 and 16 and CODA Standard 2-25k. Fourth year students must successfully complete the Oral Surgery Rotation in GEND 8077 where student performance is assessed daily by OMS faculty for adequacy of patient assessment, preoperative procedures, the actual surgical procedure and postoperative procedures. A component of students' daily formative assessments, monthly progress evaluations, midyear progress toward competency assessment, and end-of-year evaluations during years 3 and 4 is based on GPG faculty members appraisal of students capacity to provide appropriate hard and soft tissue surgery for patients, consistent with the scope of UTHSCSA Competencies 195

167 12 and 16 and educational outcomes 16-01, and Each evaluation form for daily, monthly, mid-year and end-of year include appraisal of progress toward and ultimate attainment of competency in hard and soft tissue surgery (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress to the fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations, including hard and soft tissue surgery. Additionally, students' clinical skill evaluation for the Dental Emergency Care (DEC) Rotation within GEND 8077 often involves assessment and treatment of a patient with dental problems requiring hard and soft tissue surgery. B. Supportive Documentation for Standard 2-25k 1. Appendix 2-3b: Syllabi for Dental School Courses Pertinent to Standard 2-25k: CSBL 5016 Gross Head and Neck Anatomy DIAG 5014 Physical Evaluation I DIAG 6035 Physical Evaluation II COMD 6048 Patient-Centered Oral Health Care OSUR 6051 Oral Surgery - Year 1 PATH 6021 Oral Pathology PERI 6082 Periodontics ENDO 6041 Endodontics DIAG 7055 Oral Diagnosis OSUR 7051 Oral and Maxillofacial Surgery - Year 3 GEND 7001 General Dentistry Clinic - Year 3 INTD 7020 Clinical Patient Management GEND 8077 General Dentistry Clinic - Year 4 OSUR 8055 Oral and Maxillofacial Surgery - Year 4 2. Appendix 2-25k-1: Oral and Maxillofacial Daily Assessment Form 196

168 2-25l. Dental Emergencies A. Description for Standard 2-25l These educational outcomes within UTHSCSA Dental School competencies 10 and 17 address Standard 2-25l: Assess the patient s risk for medical emergencies or complications from dental treatment by evaluating medical history and monitoring patient s symptoms Modify a patient s dental treatment plan based on assessment of medical risks Recognize dental emergencies requiring rapid referral for emergency medical treatment Diagnose and manage dental emergencies characterized by pain, swelling, fever, suppuration, and bleeding Assess outcomes of dental emergency care. 2-25l - Foundational Curriculum and Assessment of Progress Toward Competency In addition to basic biomedical science and behavioral science content, many courses in the UTHSCSA Dental School curriculum support development of students' knowledge base and associated clinical skills needed to recognize and manage dental emergencies. Students acquire specific knowledge about the management of dental emergencies in year 2 in Periodontics PERI 6082, in Periodontics PERI 7081 and Endodontics ENDO 7041 during the third year, and in the fourth year Endodontics ENDO Assessment of a student s ability to manage dental emergencies occurs in several clinical sites. In years 3 and 4, students are evaluated on their ability to manage any dental emergency within their own family of patients by the GPG faculty and as a component of the Oral Surgery clinical rotations (OSUR 7051). In year 4, students rotate through Dental Emergency Care Clinic (DEC), a component of General Dentistry Clinic GEND 8077, where patients present from outside the GPGs family of patients. As previously described in 2-25k, the oral surgery rotation in years 3 and 4 provide students with substantial opportunities to participate in emergency care. In all of these venues, students are evaluated on their ability to apply the knowledge, skills and values they have learned in didactic courses and in previous clinical experiences. Competency Assessment for Standard 2-25l: Students must successfully complete one independently performed Dental Emergency Clinical Evaluation. A component of students' daily formative assessments, monthly progress evaluations, mid-year progress toward competency assessment, and end-of-year evaluations during years 3 and 4 is based on GPG faculty members appraisal of students capacity to recognize and manage any dental emergencies that arise during dental care in the student's family of patients as well as providing urgent dental care for patients as needed when assigned to the Dental Emergency Care Clinic consistent with the scope of UTHSCSA Competencies 10 and 17 and associated educational outcomes. Each of the evaluation forms for daily, monthly, mid-year and end-of year include 197

169 appraisal of progress toward and ultimate attainment of competency in management of dental emergencies (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress to the fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations, including management of dental emergencies. B. Supportive Documentation for Standard 2-25l 1. Appendix 2-3b: Syllabi for Dental School Courses and Rotations Pertinent to Standard 2-25l: PERI 6082 Periodontics - Year 2 PERI 7081 Periodontics - Year 3 ENDO 7041 Endodontics - Year 3 OSUR 7051 Oral and Maxillofacial Surgery Clinical Rotation GEND 8077 General Dentistry Clinic; Dental Emergency Care Rotation 2-25m. Malocclusion and Space Management A. Description for Standard 2-25m The educational outcomes within UTHSCSA Dental School competency domain 11 address Standard 2-25m: Competency 11: Graduates will be able to recognize and manage malalignment and malocclusion in the deciduous, mixed, and permanent dentition Evaluate the patient s dentofacial complex and occlusion, and develop a working diagnosis Recognize abnormal dentofacial growth and development that may create dental malalignment or malocclusion Recognize the need for space maintenance to retain interdental space and tooth positions Recognize and manage orthodontic therapy when needed to facilitate restorative treatment Evaluate the patient s scheme of occlusal contacts and diagnose malocclusion Perform a diagnostic mounting of casts of the patient s dentition Develop a treatment plan to treat malocclusion that best meets the needs and desires of the patient, and provide or manage that care Evaluate the outcomes of treatment. 198

170 2-25m - Foundational Curriculum and Assessment of Progress Toward Competency The primary responsibility for the development of students' knowledge, skills, and values associated with Standard 2-25m and associated UTHSCSA Dental School competencies is shared between the Departments of Developmental Dentistry and Comprehensive Dentistry. The Pediatric Dentistry Division of the Developmental Dentistry Department concentrates on space maintenance and prevention of malocclusion (educational outcome 03). The Orthodontic Section of the Developmental Dentistry focuses on educational outcomes 01, 02 and 04 while Comprehensive Dentistry is responsible for occlusal function and temporomandibular disorders (educational outcomes 05, 06 and 07). Students acquire foundational knowledge on normal form, function, eruption sequence and occlusal analysis during year one in Dental Anatomy and Occlusion RESD 5004 / During year two, students receive instruction on the etiology, diagnosis and management of temporomandibular disorders, and comprehension of these concepts is assessed by written examinations, in Temporomandibular Disorders RESD In year three, students acquire the foundational knowledge needed to understand the developing occlusion and techniques for space maintenance in the third year Pediatric Dentistry Didactic Course (Pedo 7041) and comprehension of these principles is evaluated by written examinations. Diagnosis and treatment planning for space maintenance is emphasized in the Pediatric Dentistry clinical rotations in years three (Pediatric Dentistry Clinic PEDO 7091; two-weeks) and four (a Pediatric Dentistry Rotation in General Dentistry Clinic GEND 8077; seven days total). Students acquire, and then must demonstrate the knowledge and skills necessary to fabricate a space maintainer in a laboratory setting during the third year Pediatric Dentistry Clinic Pedo During Year 4, students complete seven days of pediatric dentistry rotations at two community clinics where they participate in treatment planning and provide comprehensive dental care for the pediatric dental population of these clinics, including space management, restorative care, and preventive services. Supervising faculty at each clinic observe and assess students' performance daily and at the conclusion of the rotation. The Orthodontic section of the Developmental Dentistry Department prepares students to recognize and manage malalignment and malocclusion in the child and adult patient. The fundamentals of craniofacial development are taught in the fall semester of year two in Growth and Development ORTH Emphasis is placed on the role of facial growth in the development of normal occlusion and malocclusion. This is followed in the spring semester of year two by a course in orthodontic diagnosis (Orthodontics ORTH 6075), which focuses on critical analysis of the available database and the development of a problem list. In the year three orthodontic course (ORTH 7073), students receive additional learning experiences and then are evaluated on their ability to recognize and diagnose abnormal growth and development that results in malocclusion. During ORTH 7073, students complete six problem-based case analyses and present their finding to their peers in small seminar groups. These active learning sessions are evaluated by a member of the orthodontic faculty who serve in an advisory capacity and do not direct the activity. 199

171 In year 2, an orthodontic selective is available in which students learn to construct and use basic removable and fixed orthodontic appliances. Completion of this selective course qualifies students to participate in a clear aligner technique course in year 3. In years 3 and 4, several orthodontic clinic rotations are also available on a selective basis. Competency Assessment for Standard 2-25m: There are five major evaluations for appraisal of students' attainment of competency in malocclusion and space maintenance, consistent with the scope of Dental School Competency 11. Third and fourth year students perform TMD Occlusal and Function Assessments on all patients. GPG faculty assess students' performance on this clinical evaluation. During year three, students must independently and successfully complete a clinical skill evaluation of their ability to perform a Pediatric Patient Exam and Treatment Planning. Students are assessed by faculty for their ability to conduct a comprehensive dental examination on a pediatric patent, assess occlusion, assess the need for space maintenance, and also are assessed for their ability to develop and justify a treatment plan for the child. Third year students complete a 15 station OSCE examination covering treatment planning, space maintenance, dental trauma management, and antibiotic prescription for a pediatric dental patient. Knowledge of space maintenance is evaluated in year 3 by means of a simulation exercise during which students assess eight child patient cases. During this evaluation, students must select the appropriate space maintenance appliance for each case. In year four, students must successfully complete an independently conducted infant oral exam. Students must successfully complete all of these evaluations to progress from the third to the fourth year and to ultimately be certified as ready for graduation. A component of students' daily formative assessments, monthly progress evaluations, mid-year progress toward competency assessment, and end-of-year evaluations during years three and four is based on GPG faculty members appraisal of students capacity to provide appropriate dental therapy for malocclusion and space maintenance for patients in the student's family of consistent with the scope of UTHSCSA Competency 11 and associated educational outcomes. Each of the evaluation forms for daily, monthly, mid-year and end-of year include appraisal of progress toward and ultimate attainment of competency in management of malocclusion and space maintenance (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress to the fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations, including management of dental emergencies, including management of malocclusion and space maintenance. 200

172 B. Supportive Documentation for Standard 2-25m 1. Appendix 2-3b: Syllabi for Dental School Courses Pertinent to Standard 2-25m: PEDO 6015 Pediatric Dentistry Case Conferences PEDO 7041 Pediatric Dentistry Lecture PEDO 7091 Pediatric Dentistry Clinic ORTHO 6077 Growth and Development ORTHO 6075 Orthodontics Lecture ORTHO 7073 Orthodontics Lecture and Case Analysis 2-25n. Evaluation of the Outcomes of Treatment A. Description for Standard 2-25n Educational outcomes within several Dental School competency domains address Standard 2-25n: 6-03 Evaluate outcomes of treatment on an ongoing basis using recall strategies, and modify treatment plans as needed Evaluate outcomes of preventive interventions Evaluate the outcomes of treatment (Competency: malalignment and malocclusion) Evaluate the outcomes of periodontal therapy, reassess the diagnosis and prognosis, and determine the need for additional periodontal treatment Evaluate outcomes of treatment and manage maintenance of the restoration Evaluate outcomes of treatment and manage the maintenance of the dental prostheses Evaluate outcomes of treatment and recognize need for endodontic re-treatment or endodontic surgery Assesses outcomes of treatment and manage follow-up care (Competency: oral surgery) Assess outcomes of dental emergency care. 2-25n - Foundational Curriculum and Assessment of Progress Toward Competency Adhering to the ADA principles of non-malfeasance and beneficence, students acquire knowledge and skills on how to evaluate outcomes of treatment in the didactic and clinical courses for all disciplines, as indicated by the educational outcomes identified above. Initial instruction on patient outcomes assessment occurs in years 1 and 2 in Physical Evaluation (DIAG 5014 and DIAG 6035) and in preclinical courses devoted to endodontics, oral surgery, orthodontics, restorative dentistry, periodontics and prosthodontics. Students' comprehension of outcome assessment principles is measured by written examination in these courses. An evaluation of treatment outcomes is performed by students for all patients receiving dental care in the predoctoral clinic upon completion of all components of the treatment plan. This is a 201

173 graded clinical evaluation (Outcomes of Care Clinical Evaluation, described later in this standard) and contributes to students overall assessment in years 3 and 4 in the GPGs. Outcomes are documented electronically using e-outcomes under the supervision of the GPG faculty. During years 3 and 4 within their GPGs, students evaluate the outcome of preliminary periodontal therapy during the reassessment appointment where decisions are made regarding patient response and if additional therapy is needed. During year 4, students routinely demonstrate their ability to evaluate the outcomes of their treatment and to evaluate what caused treatment to fail or to make recommendations to improve and/or maintain optimum oral health, for all completed patients. Additionally, as a component of GEND 8077, students re-evaluate effectiveness of preventive therapies and behavior modification as a routine component of patient treatment within the GPGs. The prescribed interval for re-evaluation is based upon such assessments as the patient s initial caries risk status. Competency Assessment for Standard 2-25n: There are two major evaluations pertinent to appraisal of students' progress toward and attainment of competency in assessment of the outcomes of patient care, consistent with scope of the UTHSCSA Dental School Competency 6. In year 4, students are assessed for competence in the evaluation of the outcomes of treatment by the GPG faculty through an independently performed Outcomes of Care Clinical Evaluation, which is a key component in students' overall assessment for General Dentistry Clinic GEND Students write and submit assessments of outcomes of care for all completed patients, which are discussed with GPG faculty. Students develop an amplified assessment of care for one designated patient and present this assessment for the Outcomes of Care Clinical Evaluation. A component of students' daily formative assessments, monthly progress evaluations, midyear progress toward competency assessment, and end-of-year evaluations during years 3 and 4 is based on GPG faculty members appraisal of students' capacity to assess the outcomes of dental therapy for patients, and plan/implement any post-treatment follow-up assessments, management and maintenance that are indicated, consistent with the scope of UTHSCSA Competency 6 and several other competencies. Each of the evaluation forms for daily, monthly, mid-year and end-of year include appraisal of progress toward and ultimate attainment of competency in management of malocclusion and space maintenance (Appendices 2-8a, 2-8b, 2-8c, and 2-8d). Third year students cannot progress to the fourth year and fourth year students cannot be certified as ready for graduation with unsatisfactory evaluations on any component of the end-of-year comprehensive evaluations, including assessing the outcomes of dental therapy. Students' capacity to assess outcomes of patient care is also evaluated in several other formal assessments including the Patient Portfolio Presentations described in Standard 2-25a and 2-25b. 202

174 B. Supportive Documentation for Standard 2-25n 1. Appendix 2-3b: Syllabi for Dental School Courses and Rotations Pertinent to Standard 2-25n: DIAG 5014 Physical Evaluation I DIAG 6035 Physical Evaluation II GEND 7001 General Dentistry Clinic INTD 7020 Clinical Patient Management GEND 8077 General Dentistry Clinic - Year 4 Special Needs Patients Standard Graduates must be competent in assessing the treatment needs of patients with special needs. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Description for Standard 2-26 UTHSCSA Dental School has developed the following definition of patients with special needs. Special needs patients include patients whose medical, physical, psychological, or social situations may make it necessary to modify normal dental routines in order to provide dental treatment for that individual. These individuals include, but are not limited to, people with developmental disabilities, complex medical problems, and significant physical limitations. The sixth guiding principle for the UTHSCSA Dental School curriculum (Appendix 2-7a; Page 2) states: Patient care experiences, and associated learning, are based on the principle that students will be competent to provide dental care for patients with special needs and individuals across the age spectrum: infants, children, adolescents, adults, and the elderly when that care is within the scope of an entry level general dentist. UTHSCSA Dental School Competencies and Educational Outcomes that Address Standard 2-26 The preamble section of the UTHSCSA Dental School Competencies for Predoctoral Education (Appendix 2-7a; Page 3) states: "Each competency statement is a broad general description of an essential patient care skill or professional role that the entry-level general dentist must be able to perform unassisted and unsupervised. The competencies apply to dental patients at all life-stages: infant, child, adolescent, adult and the elderly and also apply to individuals with special needs. Thus, all UTHSCSA Dental School competencies apply to the assessment, diagnosis and treatment of oral health problems in patients with special needs. 203

175 UTHSCSA Curriculum for Standard 2 26; Special Needs Patients The Dental School assures that all graduating students are competent in assessing the treatment needs of patients with special needs by integrating appropriate educational experiences are through all levels of the predoctoral didactic and clinical curriculum. Students learn about assessment skills pertinent to individuals with special needs in Physical Evaluation I DIAG 5014 and Physical Evaluation II DIAG Students acquire foundational knowledge about the assessment of patients with special needs in several courses including Oral Surgery OSUR 6051, Local Anesthesia OSUR 6056, Clinical Medicine DIAG 6011, and Patient-Centered Oral Health Care COMD 6048 in year 2; Pediatric Dentistry PEDO 7041 and PEDO 7091, Oral and Maxillofacial Surgery OSUR 7051, and Geriatrics DIAG 7052 in year 3. Pharmacotherapeutics PHAR 8009, and Advanced Oral and Maxillofacial Surgery OSUR 8055 in year 4 each address topics pertinent to assessment and management of patients with special needs. Collectively, these courses address a variety of topics pertinent to the dental care of patients with special needs including assessment and management of patients with developmental disabilities, team management of the cleft palate patient, management of older adults including mobility and chair access / positioning issues, assessment and treatment planning for the medically compromised patient, and dental care for patients taking multiple medications. Students clinical experience with special needs patients occurs during a Geriatric Clinic Rotation in Geriatrics DIAG 7052 (year 3), a rotation in Oral Medicine DIAG 7055 (year 3), the Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope in year 4 and the Oral Surgery Rotations in years 3 (OSUR 7051) and 4 (a rotation within GEND 8077). In addition, the patient families of all third and fourth year students in the GPGs contain individuals with medical, physical, psychological, or social conditions that must be taken into consideration to provide proper treatment. Table indicates the types and number of medically compromised patients/medically complex seen by students in the Dental School clinic in Table : Patients With Complex Medical Conditions Seen in the UTHSCSA Predoctoral Dental Clinic During Medical Condition Number of Patients Hypertension/other CV diseases Hypertension: 1448; Other CV dz: 392 Pulmonary / Respiratory Disease 488 Diabetes 635 Hypo/hyperthyroidism 475 Cancer hx of radiation/chemotherapy 214 Neurological Disorder depression/other 677; Other: 227 Sensory Deficit (vision, hearing) Vision: 131; Hearing:559 White blood cell/immune problems 86 Joint Prostheses 173 Poly-pharmacy (more than one prescription)

176 Competency Assessment Methods for Standard 2-26 Assessment of Comprehension of Foundational Concepts Assessment of student acquisition of foundational concepts during the primarily didactic courses that address oral health care for patients with special needs is measured via written examinations. (See course syllabi in Appendix 2-3b). Assessment of Progress Toward Competency Evaluation of students progress toward competence in assessing the treatment needs of patients with special needs occurs through multiple faculty observations throughout years 3 and 4 in each of the clinical settings where special needs patients are treated including the main Dental School predoctoral student clinic at UTHSCSA, the Oral Surgery Clinic at UTHSCSA, pediatric clinics in metropolitan San Antonio (Ricardo Salinas and Frank Bryant), the University Health System Downtown Center (Oral Surgery), Haven for Hope Homeless Facility, and affiliated community clinical sites in Laredo, Harlingen and other U.S. / Mexico Border Region communities, where dental students provide supervised patient care during their South Texas Rotations. In the UTHSCSA Dental School predoctoral clinic, students performance is assessed on a daily basis (Appendix 2-8a), as well as longitudinally via monthly progress evaluations (Appendix 2-8b) and mid-year progress toward competency, end-of-semester and end-of-year competency assessments (Appendix 2-8c), as described in Standard 2-8. The mid-year and end-of-year progress toward competency assessments require a specific appraisal of the students capacity to assess and manage oral health care for patients with special needs. These evaluations are provided by GPG faculty who assess students ability to provide comprehensive oral health care in a manner that integrates sound therapeutic principles with the patient s medical and physical condition, and in a manner that also demonstrates a compassionate consideration of the unique needs of each individual patient. Assessment of Competency Attainment Third year students capacity to assess the treatment needs of patients with special needs is evaluated during Geriatrics DIAG 7052 using the assessment form displayed in Appendix 2-17a. During this clinical course, students provide dental care for a multicultural population of elderly, frail patients with substantial medical co-morbidities, physical and cognitive limitations, and psycho-social, and economic circumstances that influence their health status. In the fourth year, students are also evaluated for capacity to assess the treatment needs of patients with special needs during their Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope using the assessment form displayed in Appendix 2-16a. During this rotation, which is a component of GEND 8077, students provide patient care for a transient population at an urban homeless shelter. This population includes a substantial number of individuals with substantial medical co-morbidities, and physical and cognitive limitations. Students write reflection essays, which are graded, about their experiences in providing health care for this special needs population. Students cannot pass General Dentistry Clinic GEND 8077 and cannot graduate without satisfactory assessment in DIAG 7052 and the Haven for Hope Rotation. 205

177 Based on the data sources described in this standard, each fourth year student s competency to assess the treatment needs of patients with special needs is evaluated and certified by GPG faculty using the senior year competency certification form (Appendix 2-8d). Students cannot pass General Dentistry Clinic GEND 8077 and cannot graduate without certification that this competency has been attained. B. Supportive Documentation for Standard 2 26: 1. Appendix 2-3b: Syllabi for Dental School Courses and Rotations Pertinent to Standard 2-26: DIAG 5014 Physical Evaluation I DIAG 6035 Physical Evaluation II OSUR 6051 Oral Surgery OSUR 6056 Local Anesthesia DIAG 6011 Clinical Medicine COMD 6048 Patient-Centered Oral Health Care PEDO 7041 Pediatric Dentistry (Didactic) PEDO 7091 Pediatric Dentistry Clinic OSUR 7051 Oral and Maxillofacial Surgery DIAG 7052 Geriatrics PHAR 8009 Pharmacotherapeutics OSUR 8055 Advanced Oral and Maxillofacial Surgery GEND 8077 Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope (Rotation within GEND 8077) 2. Appendix 2-7a: UTHSCSA Dental School Predoctoral Dental Education Competencies 3. Appendix 2-16a: Assessment Form for Primary Care Clinical Rotation at San Antonio Christian Dental Clinic at Haven for Hope 4. Appendix 2-16b: Assessment Form for South Texas Rotation in GEND Appendix 2-20c: Assessment Form for Geriatrics DIAG

178 Life Support for Medical Emergencies Standard Graduates must be competent in providing appropriate life support measure for medical emergencies that may be encountered in dental practice. Compliance: The UTHSCSA Dental School is in compliance with Standard A. Description for Standard 2 27 UTHSCSA requirements for B.L.S. certification, course work that addresses life support for medical emergencies, and competency assessment methods are in place to assure that each Dental School graduate is competent to provide basic life support for medical emergencies that may occur in dental practice. Table 2-27 lists UTHSCSA Dental School competencies that support Standard Table 2-27: UTHSCSA Competencies and Educational Outcomes that Address Standard 2-27 UTHSCSA DS Competency Domain Competency Statement Graduates must be competent in: Educational Outcomes 4: Biomedical Sciences Application of biomedical sciences to the assessment and treatment of patients. 01. Demonstrate comprehension of the structure, function and pathology of cells, tissues, organs and organ systems, and apply this knowledge during assessment and treatment of patients. 02.Recognize diseases in the following categories, and explain clinical presentation, pathophysiology and implications for dental treatment: a. diseases of head, neck and oral cavity; b. systemic diseases with oral manifestations; c. systemic diseases without oral manifestations, but frequently present in dental patients. 10: Medical Emergencies Prevention, recognition, and management of medical emergencies that occur in the dental setting. 01. Assess the patient s risk for medical emergencies or complications from dental treatment by evaluating medical history and monitoring patient s symptoms. 02.Modify a patient s dental treatment plan based on assessment of medical risks. 03.Recognize when a medical emergency is occurring and identify nature of problem. 04.Provide health care provider BLS. 05.Manage the transfer of the patient to a higher level of care when indicated. 06. Maintain certification in CPR. 207

179 UTHSCSA Dental School Curriculum for Standard 2 27; Medical Emergencies Recognition, management and prevention of medical emergencies is emphasized throughout the curriculum. Symptoms and manifestations of diseases and abnormalities for each human organ system are described in General Pathology PATH Foundational knowledge related to patient evaluation and risk management is introduced early in the curriculum in Physical Evaluation 1 DIAG 5014 and Physical Evaluation II DIAG 6035 and also in Oral Surgery OSUR 6051 and Clinical Medicine DIAG The Clinical Medicine course focuses on recognition of commonly occurring medical disorders and describes commonly used treatments. During the third year, the Oral and Maxillofacial Surgery Clinical course (OSUR 7051) and Oral Medicine DIAG 7055 address recognition and management of medical emergencies. In these third year courses, students also learn to modify patient treatment strategies to reduce the risk of a medical emergency occurrence. Students also gain awareness of pharmacologic side effects, reactions and interaction in Pharmacology PHAR 5001 which is reinforced in Pharmacotherapeutics PHAR 8009 in year 4. During Local Anesthesia OSUR 6056, Nitrous Oxide OSUR 6140 in year 2 and Oral and Maxillofacial Surgery OSUR 7051 in year 3, students learn specific techniques for recognition of impending or occurring medical emergencies, how to identify risks through analysis of the medical history and appraisal of signs and symptoms, and how to take appropriate actions. All dental students maintain certification in CPR. During year 1 and year 3, as scheduled rotations, students are trained in basic life support by the UTHSCSA Department of Emergency Medical Technology, and demonstrate competency to provide CPR (Basic Life Support EMST 5001 and 7001). Institute of Medical Emergency Preparedness (IMEP) Medical Emergency Preparedness Program UTHSCSA Dental School is the first dental school in the U.S. to incorporate an online medical emergency preparedness training program, developed by the Institute of Medical Emergency Preparedness (IMEP), into the predoctoral curriculum for students, as well as to implement medical emergency training for faculty and staff members. IMEP provides online training programs for dental professionals in preparing for medical emergencies within the dental field. Fourth year UTHSCSA dental students complete online simulations that address various types of medical emergencies that may occur in the dental office during Applied Practice Management GEND Competency Assessment Methods for Standard 2 27 Assessment of Comprehension of Foundational Concepts Students foundational knowledge of systemic diseases with oral manifestations and systemic diseases without oral manifestations, but frequently present in dental patients is evaluated by written examinations in General Pathology PATH 6019 in the fall semester of year 2. Students knowledge of the signs and symptoms of medical emergencies, and risk factors that can be identified from medical history and physical examination are evaluated by written examinations in Local Anesthesia OSUR 6056, Nitrous Oxide OSUR 6140 and Clinical Medicine DIAG 6011 in year 2 and in Oral and Maxillofacial Surgery OSUR 7051 in year

180 Assessment of Progress Toward Competency Students knowledge and skills in prevention and recognition of medical emergencies are assessed in year 3 in Oral and Maxillofacial Surgery OSUR 7051 by means of students case presentations and simulation exercises. Students must obtain a satisfactory evaluation on these presentations and simulations to pass this course. Students knowledge of strategies to manage medical emergencies are evaluated by case scenarios in several other courses: OSUR 6056, OSUR 6140, OSUR 7051 and DIAG Student certification in CPR is accomplished in Basic Life Support EMST Additionally, each junior student must successfully complete nine (one per month) online IMEP medical emergency management simulations. Compliance is monitored by the GPG Leaders. Assessment of Competency Attainment To be certified as competent in UTHSCSA Dental School Competency 10: Prevention, Recognition and Management of Medical Emergencies in the Dental Setting, each fourth year student must independently complete the online IMEP medical emergency management module, which includes nine medical emergency simulations. The IMEP online module is a component of Applied Practice Management GEND Students cannot pass GEND 8075 without successful completion of the IMEP medical emergency management module, and cannot graduate without passing GEND B. Supportive Documentation for Standard 2-27: 1. Appendix 2-3b: Syllabi for Dental School Courses and Rotations Pertinent to Standard 2-27: PHAR 5001 Pharmacology DIAG 5014 Physical Evaluation I DIAG 6035 Physical Evaluation II PATH 6019 General Pathology OSUR 6051 Oral Surgery OSUR 6056 Local Anesthesia OSUR 6140 Nitrous Oxide DIAG 6011 Clinical Medicine EMST 7001 Basic Life Support Third Year OSUR 7051 Oral and Maxillofacial Surgery DIAG 7055 Oral Medicine PHAR 8009 Pharmacotherapeutics GEND 8075 Applied Practice Management 2. Appendix 2-7a: UTHSCSA Dental School Predoctoral Dental Education Competencies 3. CPR credentialing log for students (Will be available onsite during February 21-23, 2012 Site Visit) 209

181 UTHSCSA Dental School CODA Self Study Report Standard Three STANDARD 3: FACULTY AND STAFF 210

182 UTHSCSA Dental School CODA Self Study Report Standard Three Number and Distribution of Faculty and Staff Standard The number and distribution of faculty and staff must be sufficient to meet the dental school s stated purpose/mission, goals and objectives. Compliance: The UTHSCSA Dental School is in compliance with Standard 3-1. A. Description for Standard 3-1 The faculty and staff of the UTHSCSA Dental School support a four-year Doctor of Dental Surgery Program, and nine advanced education programs in Dental Radiology, Endodontics, Oral and Maxillofacial Surgery, Orthodontics, Pediatric Dentistry, Periodontics, Prosthodontics, Dental Public Health, Advanced Education in General Dentistry, in addition to a DDS/PhD Program that is described in Standard 6. During , a total of 534 pre-and post-doctoral students were enrolled in the academic programs of the UTHSCSA Dental School. This total includes 409 predoctoral students and 129 students in the advanced education programs identified in the preceding paragraph. These academic programs are staffed by a core of 113 full-time faculty members who provide instruction in classrooms, seminars, laboratories and clinics, direct courses, contribute to program development, revision and evaluation and participate in scholarly endeavors. At the UTHSCSA Dental School, following University of Texas System guidelines, full-time is defined as 100% time commitment (five days per week). Full-time faculty are supported and supplemented by 102 part-time faculty members who collectively comprise 25.5 full time equivalent (FTE) positions. These 102 part-time faculty members are employed from 5% to 90% time, with most in the 20% to 50% range. Combining full and part-time faculty, there are currently 148 full-time equivalent faculty positions at the UTHSCSA Dental School. Individuals with full-time positions comprise 76% (113/148) of the Dental School faculty with the remaining 24% comprised of the part-time positions. As indicated in Table 3-1, the number of full-time and part-time faculty positions has evolved from in 2004 to in 2008 to the current level of

183 UTHSCSA Dental School CODA Self Study Report Standard Three Table 3-1-1: UTHSCSA Dental School Faculty, Staff and Student Data September 2011 Mid-Term Review April 2008 CODA Self Study Feb Overall Faculty to Student Ratio Number of students Predoctoral Students 1:3.6 1:3.2 1: Postdoctoral Students 09/2011: 534 predoc (405) and postdoc (129) students / FTE faculty 2. Full-time Faculty FTE FTE FTE 3. Part-time Faculty FTE for part-time faculty and number of part-time faculty comprising total FTE 35.0 FTE (102 P/T faculty) 33.2 FTE (89 P/T faculty) 27.5 FTE (85 P/T faculty) Total Faculty FTE (F/T and P/T) FTE FTE FTE 4. Faculty to student ratio during pre clinical laboratory instruction See Table :6 ave for all labs 5. Faculty to student ratio when students are providing patient care Maximum students providing patient care per session in Dental School clinic: 168 Overall: 1:5 3 rd year: 1:4 4 th year: 1:10 1:6 ave for all labs 1:5 1:5 GPG faculty per clinic session (4 X 8 = 32) 6. Number of Vacant Positions 5.7 FTE 5.0 FTE 6.0 FTE 7. Dean and departmental chairs hold Yes Yes Yes full-time administrative appointments. 8. Appointments of other administrators Vice Dean, Associate Deans and one Assistant Dean hold % administrative appointments, with remainder of salary from appointments in academic departments. Two Assistant Deans hold administrative positions at 30% and 10%. 9. Total number of staff FTE Faculty to Staff Ratio 09/2011: FTE staff / FTE faculty 1:1.90 1:2.15 1:2.45 Faculty to Student Ratios As indicated in Table 3-1-1, the overall faculty to student ratio at the Dental School is currently 1:3.6 (148.0 FTE faculty members and 534 predoctoral and advanced education students). In 2004 and 2008, the ratio was 1:3.2. The change in ratio has resulted from an increase in combined predoctoral and advanced education enrollment from 428 in 2005 to the September

184 UTHSCSA Dental School CODA Self Study Report Standard Three enrollment of 534 (24.7% increase) with a net gain of 14.5 FTE faculty positions (10.8% increase) over the same six-year period. Preclinical Instruction The total faculty to predoctoral student ratio allows the Dental School to maintain an approximate 1:6.0 faculty to student ratio during preclinical laboratory instruction for all courses combined. Calculation of this ratio is based on annual effort reports by departments that designate the number of faculty members assigned, on average, for preclinical simulation lab sessions in all disciplines in relation to the total number of students enrolled in the labs (from 92 to 100 per class since 2006). Table indicates faculty to student ratios for preclinical courses in Table 3-1-2: Faculty to Student Ratios for Preclinical Courses at UTHSCSA Dental School During Name of Preclinical Lab Course Number of Students in Labs Number of Faculty Faculty to Student Ratio Dental Anatomy and Occlusion :6.1 (RESD 5005) Preclinical Operative Dentistry :6.2 (RESD 6002) Fixed Prosthodontics (PROS 6012) :6.2 Complete Dentures (PROS 6019) :6.2 Preclinical Implant Prosthodontics :5.4 Treatment (PROS 6058) Preclinical Removable Prosthodontics :5.5 (PROS 6095) Preclinical Endodontics (ENDO 6142) :6.0 Mean 1:5.9 Note: The numbers of students in each preclinical laboratory course vary due to the number of students remediating each course. Clinical Instruction During , the Dental School s eight General Practice Groups (Clinical Practice Groups) are each staffed by four core faculty members who are in the clinic approximately 8 (of 10) clinic sessions per week. In , there are 208 junior and senior students assigned to the eight GPGs, for an average of 26 students per clinical group (13 students in each class per group). Based on a total of 32 core faculty members assigned to the eight GPGs who mentor and supervise 208 third and fourth year students, the overall faculty to student ratio is 1:6.5. However, all students are never in the clinic simultaneously. Approximately 40 students (20%) are on clinical and other rotations outside of the Dental School clinic at any point in time. In a typical clinic period, when both juniors and seniors are seeing patients at the same time, approximately 160 students are guided by the 32 GPG faculty for an actual faculty to student ratio of 1:5. When junior 213

185 UTHSCSA Dental School CODA Self Study Report Standard Three students are in the clinic alone, the faculty to student ratio is 1:4 or better depending on the number of third year students on rotations. When seniors are in the clinic alone, one faculty member supervises approximately ten students, which has been the model at this Dental School for more than 30 years based on enhanced student self-sufficiency and reduced need for faculty intervention as fourth year students approach graduation. Unfilled Faculty Positions Fall 2011 As of September 2011, 5.7 of the 148 faculty positions were unfilled, representing 3.8% of the total. Faculty Recruitment and Retention in Current Budgetary Environment Reductions in appropriations for higher education in the state of Texas, one of the primary legislative responses to the state's substantial disparity between revenues and expenditures, has produced a challenging environment for recruitment and retention of faculty at all state supported universities including the UTHSCSA. The Dental School administration works closely with the UTHSCSA President s Office to secure additional sources of revenue for enhancement of faculty compensation and potential addition of instructional positions to support the predoctoral education program. In the Dental School's annual programmatic objectives for 2011 submitted to the UTHSCSA administration, Dean Kenneth Kalkwarf proposed alternative methods for faculty salary augmentation including re-directions from several other revenue streams available to the Dental School. Given the current and anticipated future budgetary climate for higher education in Texas, there is no guarantee that additional funding can be secured for faculty compensation or for development of additional faculty positions. Administrative Positions The Dean and the five departmental chairs hold full-time administrative appointments. The Vice Dean, four Associate Deans, one Assistant Dean, and the Director of the International Dentist Education Program hold 70-90% administrative appointments, maintaining faculty positions in Dental School departments for the remainder of their appointments. The Director of Continuing Dental Education has a 100% administrative appointment. One Assistant Dean (Administration) has a 100% administrative appointment. One Assistant Dean (Educational and Faculty Development) has a 30% administrative position with an additional 10% support as Co- Investigator for an NIH grant. One Assistant Dean (Clinical Research) has a 10% administrative appointment and a 90% faculty appointment in the Periodontics Department. In addition to these full-and part-time administrative positions, each department has a variety of academic, clinical and research directors and coordinators who are based within the department. The percentage time of these appointments is variable. All administrative appointments within the University of Texas system are made at the pleasure of the supervising administrator, and ultimately, in the case of the Dean and the chairs, the Board of Regents. Faculty members assignments and responsibilities are determined by their chair and are used by the chair as a framework from which to determine the scope of a faculty member s annual assessment. Appendix 3-1a indicates Department Chairs and Program Directors (CODA Table 7). Appendix 3-1b is an alphabetical roster of full-time faculty members (CODA Table 8) and Appendix 3-1c identifies all part-time faculty members (CODA Table 9). Faculty members are listed by department in 214

186 UTHSCSA Dental School CODA Self Study Report Standard Three Appendix 3-1d (CODA Table 10). Appendices 3-1e, 3-1f and 3-1g provide information about biological science, clinical science and behavioral sciences faculty members (CODA Tables 11, 12 and 13). Support Services and Staff The UTHSCSA provides a variety of support services for all schools at the health science center including the Dental School: student services (registration and records, financial aid and scholarships, counseling, career services, student life activities including intramural athletic programs, minority student affairs, international student affairs, and health and wellness programs); custodial services, physical plant maintenance, grounds and maintenance; campus recreational facilities; construction and renovation; educational resources including audiovisual equipment purchasing, set-up and installation; faculty development; information technology including web design, online courses and computer training; laboratory animal resources; legal services including technology transfer and patent consultation; multi-media services including photography, medical illustration and video production; human resources, employee benefits and equal opportunity employment services; library services; mail room and postal services; biomedical equipment repair; financial management; research administration; environmental health and safety; compliance office; telecommunications and networking; bursar and cashiers; facilities management; grants management (Office of Sponsored Programs); Institutional Review Board (IRB); campus security and parking operations; campus bookstore; public relations; alumni affairs and development; and, governmental / legislative relations. The Dental School provides modest financial support for some UTHSCSA core services, primarily information technology, financial management, alumni affairs and development. Staff support within the School is decentralized. The Dean s Office provides administrative and clerical support to manage school-wide programs. Each department has a full-time administrator and appropriate additional staff support to support the programs and activities of the department and faculty 215

187 UTHSCSA Dental School CODA Self Study Report Standard Three members. Administrative and auxiliary support for patient care is provided by the Dental School s Outpatient Clinic Office and function under the guidance of the Vice Dean. Clinic and patient care operations are described more fully in the response to Standard 5. Support Personnel As of September 2011, 282 FTE support personnel were employed at UTHSCSA Dental School. As indicated in Table 3-1-2, the faculty to support staff ratio is currently 1:1.9. The total number of support personnel at the Dental School was 327 in 2004, 318 in 2008 and 282 in 2011, a reduction of 13% between 2004 and This reduction in workforce has primarily occurred in response to the stagnation in budget appropriations for higher education from the state of Texas over the past decade, including the budget reductions within the UTHSCSA and the Dental School during The support personnel include staff positions dedicated to clinic operations and patient care services as well as other non-clinical personnel who support administrative operations within the Dental School including curriculum management, extramural educational programs in the community, student admissions, continuing education programs, faculty practice, and computer support. Additional support personnel assist with Dental School research programs. Table indicates the number of support staff for different tasks and roles at the Dental School as of September Table 3-1-3: Categories of UTHSCSA Dental School Support Staff Position Category Number Administrative Assistants 37 Vice Dean, Associate Deans and Assistant Deans 9 Clinical support staff (cashier, dispensary, patient reception / registration, record 89 room, patient care coordinators/schedulers, sterilization, maintenance and repair) Computer Support Personnel 7 Continuing Dental Education Staff (includes the CDE Director) 6 Director of Faculty Practice (DDS) 1 Dental School Business Affairs Staff 7 Dental Assistants 73 Dental Hygienists 8 Patient Accounts / Financial Records 20 Patient Educator 1 Radiology Technicians 1 Other: 23 Total

188 UTHSCSA Dental School CODA Self Study Report Standard Three B. Supportive Documentation for Standard 3 1 (CODA Tables 7 13): 1. Appendix 3-1a: Department Chairs and Program Directors (CODA Table 7) 2. Appendix 3-1b: Full-time Faculty Members (CODA Table 8) 3. Appendix 3-1c: Part-time Faculty Members (CODA Table 9) 4. Appendix 3-1d: Departmental Listing of Faculty Members (CODA Table 10) 5. Appendix 3-1e: Basic Science Faculty Members (CODA Table 11) 6. Appendix 3-1f: Clinical Science Faculty Members (CODA Table 12) 7. Appendix 3-1g: Behavioral Science Faculty Members (CODA Table 13) Faculty Development Standard The dental school must show evidence of an ongoing faculty development process. Compliance: The UTHSCSA Dental School is in compliance with Standard 3-2. A. Description for Standard 3-2 The UTHSCSA Dental School is committed to helping faculty members meet their professional development and career goals and has committed substantial resources to faculty development initiatives. Faculty development programs and opportunities are available at four levels: national opportunities; UTHSCSA campus-wide programs; school-wide Dental School activities; and, departmental-level efforts. National Faculty Development Opportunities UTHSCSA Dental School has been an active participant in the American Dental Education Association (ADEA) for many years. Approximately 25 faculty members attend either the fall or spring ADEA national meetings each year. Two members of the Dental School have served as ADEA President (former faculty member and Associate Dean, Dr. Victor Sandoval, and current Dean, Dr. Kenneth Kalkwarf) and many faculty members have assumed leadership roles within ADEA over the past decade. For example, Dean Kalkwarf was the Chair of the ADEA Commission on Change and Innovation (CCI) from 2005 to Four to six Dental School faculty members and administrators have attended each of the CCI Liaisons Summer Conferences. 217

189 UTHSCSA Dental School CODA Self Study Report Standard Three Dental School faculty member Dr. Olav Alvares served as Editor of the Journal of Dental Education and Assistant Dean Bill Hendricson served as Associate Editor from Dental School faculty members historically have been very productive in educational research. This activity has led to more than 40 publications in the Journal of Dental Education since 2000, including eight in 2010 and six in Other Dental School faculty members have received notable recognitions since the 2005 CODA Site Visit. Dr. Lily Garcia, Department of Comprehensive Dentistry was selected for participation in the ELAM Fellowship (Executive Leadership in Academic Medicine). Three faculty members have been selected for the OKU Stephen H. Leeper Award for Teaching Excellence: Drs. Tom Marshall, Don Willmann and James Summit. Dr. Joe Connor was selected for 2010 American Dental Association Golden Apple Award for Inspiring Careers in Dental Education. Dr. Ken Kalkwarf, Dr. Bill Dodge and Mr. William Hendricson received the ADEA Presidential Citation for contributions to dental education. Dean Kalkwarf also received the ADA Distinguished Service Award in The Dental School coordinates the curriculum break in the spring semester with the ADEA annual meeting to allow participation by students and faculty. Eleven UTHSCSA Dental School faculty have been selected to participate in the ADEA Leadership Institute, a year long, four-phase professional development program focusing on academic leadership at the school and national levels. Several Dental School faculty have participated in the ADEA sponsored Institute for Teaching and Learning (ITL), a 60-hour professional development program focusing on best practices in educational strategies, and the 30-hour Chairs and Academic Managers Program (CAMP), which focuses on the skills needed to function as a program administrator in health professions education institutions. UTHSCSA Campus-wide Programs The Academic Center for Excellence in Teaching (ACET) at the UTHSCSA presents a variety of courses and seminars annually including: Curriculum Development, Educational Research, Grant Writing, Research Methods, Teaching Skills Development, and Test Scoring and Survey Administration. In addition, ACET works collaboratively with the Academic Technology Services (ATS) to conduct technology-based workshops for the faculty, including Multi-media Course Development, PowerPoint Presentation Design, and consultation support for utilizing online teaching tools such as Blackboard. These courses are available for faculty members in the Dental School. ACET also conducts monthly lunch-hour brown bag seminars on various teaching, learning and assessment topics that are available to Dental School faculty. The ACET annual report is in Appendix 3-2a. The major faculty development related to teaching is the UTHSCSA Teaching Excellence Course (UTEC) that has been conducted for 35 years at this campus. The UTEC goal is to help health professions educators develop teaching skills that will enhance the quality of their interactions with students and make teaching more enjoyable and rewarding. The course provides a forum to share teaching experiences and exchange success stories as well as lessons learned. Participants receive hands-on experience with key teacher tasks such as evaluating student competence, developing standardized tests and rating scales, presenting lectures, planning courses, teaching procedural skills, dealing with difficult students, guiding students with questions and providing feedback. Participants also explore cognitive theories, strategies to enhance motivation, review 218

190 UTHSCSA Dental School CODA Self Study Report Standard Three educational best practices and complete teaching and cognitive self-assessments. In the current version of UTEC, participants also develop and implement an educational research project and present their findings in a poster at an annual UTHSCSA symposium. Since 2000, two to four Dental School faculty have attended UTEC annually. Since the inception of UTEC in 1975, more than 100 Dental School faculty have completed the course. ACET also provides small grants ($3-5,000) in the Scholarship of Teaching and Learning (SoTL) program that are awarded on a competitive basis to promote interdisciplinary and multidisciplinary teaching innovations to enhance faculty members teaching skills and students learning outcomes. Five dental school faculty have been awarded SoTL grants since 2006 to support innovative projects such as: development of web-based courses, creation of a clinical rotation for students in a homeless shelter, establishment of an online case sharing mechanism to enrich students clinical experience, and creation of interdisciplinary health care teams comprised of dental students, medical students, nursing students and dental hygiene students. The UTHSCSA offers several other professional development opportunities for Dental School faculty including a Master of Science Degree in Clinical Investigation (MSCI) and various workshops on research skills conducted by the Institute for Integration of Medicine and Science (IIMS). The MSCI program includes coursework on topics such as: designing clinical research protocols, patient-centered, ethical clinical research, biostatistics, data management and dissemination, scientific communication, grantsmanship, writing for publication, developing and validating research instruments, and cross-cultural adaptation of clinical research instruments. A number of Dental School faculty have taken individual courses in the MSCI program. The IIMS program offers half-day workshops, short courses and individualized mentoring in topics such as: locating funding sources and opportunities, understanding the NIH application and peer review process, writing grant applications, writing career development (K) award applications, scientific writing, protocol development and research design principles. Dental school faculty members have attended a number of these workshops and short courses in recent years. The UTHSCSA conducts a year-long academic leadership program titled the LEAD (Leadership, Education and Development) Institute. Twelve Dental School faculty have completed the LEAD Institute since its inception in The Lead curriculum includes: practice of effective leaders, leadership versus management, strategies for interpersonal effectiveness, motivating others, understanding and addressing sources of resistance, managing organizational change and growth, self-assessment of leadership and personality styles, team building, values-driven decision-making, building and communicating vision, and translating vision into actions plans. The UTHSCSA established an Academy of Master Teachers to recognize excellence in teaching, curriculum design and educational research by faculty members. The Dental School currently has 14 members in the Academy. Dr. Karen Troendle, Comprehensive Dentistry, is the current Chair of the Academy. Faculty in the Academy participate in conferences and an annual retreat that is focused on strengthening the educational mission of the UTHSCSA. UTHSCSA annually selects faculty members to receive the Presidential Teaching Excellence Award with selection based on a competitive, peer-review process. A total of 17 Dental School faculty have received this award including Dr. John Overton in 2009 and Dr. Erica Oliveira in

191 UTHSCSA Dental School CODA Self Study Report Standard Three Dental School Faculty Development The Dental School Faculty Development Policy appears in Appendix 3-2b. The school-wide faculty development initiative is guided by the Faculty Development Committee, and is a programmatic responsibility of the Associate Dean for Academic Affairs. The committee s charges are to: 1) conduct needs assessments; 2) recommend faculty development programs to the Associate Dean for Academic Affairs and the Dean; 3) develop means to support faculty development; 4) plan and evaluate school-wide faculty development programs; 5) periodically review and make recommendations to the Dean concerning departmental faculty development; and 6) conduct an annual orientation for new faculty. The goal of Dental School-level faculty development is to provide enrichment opportunities of relevance to a wide spectrum of the faculty that augment departmental programs and the individual efforts of faculty members. Schoolwide faculty development consists of eleven annually occurring events that are summarized below. Faculty members are encouraged to take advantage of these initiatives and in many cases, the academic calendar of the Dental School is adjusted to facilitate participation. The Faculty Development Committee plans and conducts two faculty development programs each year: a one-day Faculty Development Day in October and a two-day Faculty Advance in May. These programs have occurred annually at the Dental School for more than 30 years. Agendas for recent Dental School Faculty Development Days and the Faculty Advance are in Appendices 3-2c and 3-2d. The Faculty Developments Days and Faculty Advances have annual themes and combine professional development workshops, reports of curricular and research projects and problem solving related to Dental School operations and issues. Nationally recognized dental educators have conducted workshops for the faculty at recent programs including Dr. Judith Albino (promoting and sustaining innovation), Dr. Marilyn Lantz (methods for student admissions interviews), Dr. Paula O Neill (professional development and mentoring) and Dr. Phillip Hujoel (evidence-based practice). Attendance at the Faculty Development Day and the Faculty Advance has ranged from faculty members per session since The Faculty Development Committee conducts an annual New Faculty Orientation (NFO) Program for newly employed faculty members. The NFO consists of nine seminars during the fall semester each year and other orientation events including a breakfast seminar with the Dean, a Welcome to the Faculty recognition and brochure at the annual Faculty Dinner, mid-year and end-of year How s It Going lunch and program, and one-on-one fall and spring semester meetings with the Assistant Dean for Faculty Development to review progress on the new faculty Getting Started checklist (Appendix 3-2e). The schedule for the 2011 NFO Program appears in Appendix 3-2f. Approximately 6 10 new faculty members participate in the NFO program annually. The Office of the Vice Dean for Patient Care also conducts an annual Clinical Orientation for all faculty with responsibilities for clinical education and patient care. The agenda for the 2011 Clinical Orientation is in Appendix 3-2g. A Dental School Grand Rounds Seminar is conducted approximately 20 times annually on Friday mornings in a time period when few curricular activities are scheduled to facilitate attendance. The Grand Rounds Seminars consist of presentations on scientific topics of interest by Dental 220

192 UTHSCSA Dental School CODA Self Study Report Standard Three School faculty members and occasionally by faculty from other UTHSCSA schools. Four to six presentations each year are dedicated to topics pertinent to predoctoral dental education. For example, in , the Grand Rounds included a series of five presentations on best practices for assessing student progress toward competency. The Grand Rounds presentations are coordinated by the Faculty Development Committee and the Associate Dean of Academic Affairs. Grand Rounds are open to all faculty members. Predoctoral students and postgraduate students are also invited. Grand Rounds are attended by 40 to 50 faculty each week who receive continuing education hours. Faculty attendance is documented to satisfy the requirements of the Texas State Board, the Academy of General Dentistry and annual departmental faculty evaluations. Appendix 3-2h provides Grand Rounds schedules for recent years. Clinical faculty members have the opportunity to maintain and refine patient care skills via participation in the Dental School Faculty Practice. Approximately 40 faculty members currently treat patients in the Faculty Practice Clinic. In-service programs are routinely conducted throughout the year by faculty teams, departments and the Office of Patient Care as needs and interests arise. To accomplish one of the goals of an NIH-funded science translation grant (i.e., CATs grant described in Standards 2-22 and 2-23) led by Principle Investigator Dr. John Rugh (Developmental Dentistry), more than 40 faculty development seminars and workshops on issues pertaining to evidence-based practice and critical appraisal of the scientific literature have been conducted during the past four years at the Dental School by Dr. Rugh and his team. Seventy-five percent of the Dental School s course directors have participated in these faculty development activities. The UTHSCSA Dental School conducts a day-long Continuing Dental Education Course each year in November titled the Annual James P. Hollers Memorial Lectureship in recognition of one of the founding fathers of UTHSCSA, Jim Hollers (a dentist) who played a pivotal role in establishment of this health science center in the 1950s and 60s. This program, which is in its 27 th year, consists of an invited symposium speaker from a leading member of the dental community. In 2010, Dr. Charles Goodacre, Dean of the Loma Linda School of Dentistry, conducted the Hollers program on the topic of: Clinical Complications with Conventional and Implant Prostheses: How to Minimize Them and How to Manage Them When They Do Occur. No curricular activities are scheduled on the day of the Hollers Symposium to facilitate faculty and student participation in the day s events. The Office of Continuing Dental Education at the UTHSCSA Dental School sponsors more than 200 programs annually, conducted at the Dental School, online and at other sites around the nation. Numerous Dental School faculty members serve as course directors or instructors in these courses, which provides an important venue for professional development for these individuals. In April each year, the school conducts the Dental Science Symposium which features keynote presentations by noted biomedical and oral health researchers, seminars by Dental School faculty, and presentations, posters and table clinics by predoctoral and postdoctoral students. In 2010, the keynote speaker was Dr. Kenneth Kornman, President, Interleukin Genetics, who presented 3rd Generation Nutrition and Periodontal Disease. The Dental Science Symposium is coordinated by the Associate Dean for Research. No curricular activities are scheduled on the day 221

193 UTHSCSA Dental School CODA Self Study Report Standard Three of the Dental Science Symposium to facilitate faculty and student participation in the day s events. Approximately 75 faculty members attend annually. Appendix 3-2i provides Dental Science Symposium schedules for recent years. The Associate Dean for Research and the Dental School Research Committee also conduct a monthly Research Seminar Series that is open to all faculty members. Appendix 3-2j provides Research Seminar Series schedules for recent years. Rosters listing faculty participants in the annual Faculty Development Days, Faculty Advances, New Faculty Orientations, Grand Rounds Seminars, and the Dental Science Symposium for recent years will be available during the February 21-23, 2012 Site Visit. Departmental-Level Faculty Development The Dental School s faculty development policy (Appendix 3-2b) mandates that each department maintain an active program of support for the professional development of faculty members. The faculty development policies of the five Dental School departments are in Appendix 3-2k. Faculty development within the departments facilitates achievement of the educational, research and service goals of the department and support the professional growth of individual faculty members. Faculty development within departments includes: 1. at initial employment, provision of a job description for faculty members, which indicates position title, academic rank, terms of employment and track (tenure or non-tenure); 2. at initial employment, orientation to the promotion and tenure process / standards by the chairperson or designated mentors; 3. at initial employment, orientation to the history, structure and responsibilities of the department by the chairperson or designated mentors; 4. consultation by the chairperson or designated mentors to support creation of a career plan for each faculty member, which identifies aspirations and professional development needs; 5. an annual performance assessment by the chairperson or designated division director; 6. for faculty on tenure-track, guidance by the chairperson and/or designated colleague mentors to facilitate achievement of promotion standards; and, 7. opportunities for faculty to participate in meetings and continuing education courses pertinent to responsibilities and for maintenance of clinical / discipline-based expertise. B. Supportive Documentation for Standard 3-2: 1. Appendix 3-2a: ACET Annual Report 2. Appendix 3-2b: Dental School Faculty Development Policy 3. Appendix 3-2c: Faculty Development Day Agenda Appendix 3-2d: Faculty Advance Agenda

194 UTHSCSA Dental School CODA Self Study Report Standard Three 5. Appendix 3-2e: New Faculty Checklist 6. Appendix 3-2f: New Faculty Orientation Schedule Appendix 3-2g: Clinical Orientation Schedule 8. Appendix 3-2h: Grand Rounds Schedules Appendix 3-2i: Dental Science Symposium Schedules Appendix 3-2j: Research Seminar Series Appendix 3-2k: Faculty Development Policies for Departments Faculty Governance Standard Faculty must be ensured a form of governance that allows participation in the school s decision-making processes. Compliance: The UTHSCSA Dental School is in compliance with Standard 3-3. A. Description for Standard 3-3 Several mechanisms exist to assure that UTHSCSA and the Dental School have a system of shared faculty governance. At the level of the Health Science Center, the primary faculty governance process is the UTHSCSA Faculty Senate. The Bylaws of the UTHSCSA Faculty Senate appear in Appendix 3-3a. The Mission of the Faculty Senate of the UTHSCSA is to provide representation for the University Faculty to ensure that every member of the Faculty has a voice regarding issues that may affect his or her rights, privileges, responsibilities, and welfare as regarding the teaching, research, and clinical programs and services of the UTHSCSA. The Faculty Senate can present recommendations to the President of the UTHSCSA, Deans, and Executive Committee of the University, the Assemblies of the various schools of the UTHSCSA, the various University and School committees and Administrators, and the Office of the Chancellor and Board of Regents of the University of Texas System, as specified by the University of Texas Regents' Rules. The number of Senators representing each of the five current schools at the UTHSCSA (Biomedical Sciences, Dental, Health Professions, Nursing and Medicine) is based on the number of faculty in each school. Currently, the Dental School, has four representatives in the UTHSCSA Faculty Senate, out of 24 total positions. Dental School representatives on the UTHSCSA Faculty Senate are elected by the Dental School Faculty Assembly. The UTHSCSA has 21 Standing Committees that are appointed by the President upon recommendation by the UTHSCSA Committee on Committees. All Standing Committees report to the President. The full-time faculty of the UTHSCSA elect the Committee on Committees. Dental 223

195 UTHSCSA Dental School CODA Self Study Report Standard Three School faculty comprise three of the twelve positions on the UTHSCSA Committee on Committees. Members of the standing committees are full-time members of the faculty, except on those committees requiring additional representatives in order to comply with the charge of the committee and/or state and federal laws and committees that have student or resident representation. As indicated in Appendix 1-8a, numerous Dental School faculty members serve on UTHSCSA Standing Committees and through these committees, participate in the institution s decision-making process. Within the Dental School, faculty members are ensured participation in the school s decisionmaking processes through multiple mechanisms as described in the Academic Organization and Bylaws of the UTHSCSA Dental School (Appendix 1-6a). The Dental School Faculty Bylaws and composition of dental school committees were revised in 2011 to reflect the administrative restructuring that occurred in June In accordance with the rules and regulations of the Board of Regents of The University of Texas System, each of the schools at the UTHSCSA has a Faculty Council and a Faculty Assembly. The Dental School Faculty Council acts as the principal policy-making and governing body on academic matters. Council membership includes the Dean, Vice Dean, Associate and Assistant Deans, Program Directors, Chairs, two voting faculty representatives selected by the Faculty Assembly, and representatives from the other schools at UTHSCSA. The Dental School Faculty Assembly is charged with active participation in major planning for that school and the UTHSCSA campus as a whole. The Faculty Assembly is comprised of all full-time faculty from the Dental School and Basic Sciences departments in the Graduate School of Biomedical Sciences who are involved in teaching dental students. Assembly leadership occurs through an executive committee of elected officers. The officers of the Dental School Faculty Assembly are elected from the membership of the Faculty Assembly. The Dental School Faculty Assembly appoints a Committee on Committees that is composed of three faculty members from the Dental School clinical departments and two from the basic science departments. The Committee on Committees makes recommendations to the Dean, and the Dean appoints the individuals to the various Dental School Standing Committees. As noted previously, The Faculty Assembly conducts the election process to select the School's representatives on the UTHSCSA Faculty Senate. The Faculty Assembly is also charged with nominating faculty for UTHSCSA awards recognizing excellence in Teaching, Clinical Services and Research as well as selected faculty members for Dental School Teaching awards. The Dental School Standing Committees provide mechanisms for faculty involvement in the planning and assessment of School programs. These committees are listed below: Academic Performance Committee Admissions Committee Advanced Education Committee Clinical Quality Assurance Committee Curriculum Committee Curriculum Management Committee Faculty Development Committee General Practice Administration Committee 224

196 UTHSCSA Dental School CODA Self Study Report Standard Three Instruments and Materials Committee Research Committee Strategic Planning Committee Student and Faculty Relations Committee The mission and member composition of each Dental School Standing Committee is described in the Academic Organization and Bylaws of the UTHSCSA Dental School (Appendix 1-6a). Appendix 3-3b indicates current chairs and members of each Dental School Standing Committee (CODA Table 14). Minutes of the meetings of the Dental School Faculty Council, Faculty Assembly and Standing Committees will be available onsite for inspection during the February 21-23, 2012 Site Visit. In addition to faculty participation in standing Dental School Committees, the Dean periodically appoints Ad Hoc Task Forces to assess urgent / emerging issues where prompt deliberation is essential or in situations where widespread faculty input is needed from many sectors of the Dental School. Appropriate committee chairs are appointed to these ad hoc Task Forces in addition to faculty members with expertise and responsibilities associated with the issue under scrutiny. Task Forces are typically charged to investigate a topic and submit a recommendation to the Dean for consideration, often in a short time frame. Table 3-4 indicates examples of Task Forces appointed by the Dean in recent years, and their charges. Table 3-4: Examples of Task Forces Appointed Task Force Curriculum Innovation Task Force ( ) Assessment Task Force ( ) Dental Hygiene Curriculum Integration Task Force ( ) Dental Hygiene Student Services Task Force ( ) Dental School Bylaws Revision ( ) Portfolio Assessment ( ) Charge Assess the organization and delivery of the predoctoral curriculum, and propose alternative formats for faculty consideration Organize year-long assessment of our assessments and conduct Grand Rounds presentations addressing assessment issues and best practices Identify opportunities and strategies for blending educational experiences of dental students and dental hygiene students Recommend methods to integrate and/or coordinate student services for dental students and dental hygiene students including recruitment and admissions Review existing Bylaws document and propose modifications Develop a new format for assessment of student competency 225

197 UTHSCSA Dental School CODA Self Study Report Standard Three B. Supportive Documentation for Standard 3 3: 1. Appendix 1-6a: Academic Organization and Bylaws of the UTHSCSA Dental School 2. Appendix 1-8a: Dental School Faculty Serving on UTHSCSA Standing Committees 3. Appendix 3-3a: Bylaws of the UTHSCSA Faculty Senate 4. Appendix 3-3b: Chairs and Members of Dental School Standing Committees for (CODA Table 14) Minutes of the meetings of the Dental School Faculty Council, Faculty Assembly and Standing Committees will be available onsite during the February 21-23, 2012 Site Visit. Assessment of Faculty Performance Standard A defined process must exist that ensures objective measurement of the performance of each faculty member in teaching, patient care, scholarship and service. Compliance: The UTHSCSA Dental School is in compliance with Standard 3-4. A. Description for Standard 3-4 The evaluation of individual faculty members is managed at the department level. All departments perform assessment of the faculty using an evaluation system based on the Promotion and Tenure Guidelines of the UTHSCSA (Chapter 3: Faculty Policies and Procedures; (Appendix 3-4a). Modification of Faculty Performance Evaluation Processes During the Dental School's self-study process, it became apparent that departments employed varied approaches to assessment of faculty performance, using different methods for communicating assessments to faculty members. The Standard 3 Self Study Task Force identified that several different tools were used by the departments to measure performance of faculty members including effort reports completed by faculty members, eight-point visual analog scales, written comments and verbal conversations. Given the implementation of the new XYZ Compensation Plan for faculty, described below, Dean Kenneth Kalkwarf charged the department chairs to develop a uniform process for evaluation of faculty performance based on the XYZ plan. The updated performance evaluation system is being implemented in including revised faculty evaluation policies for each of the new Dental School departments. The policies of each department for evaluation of faculty performance appear in Appendix 3-4b. Faculty evaluation policies within each department are tailored to each department s mission, programs and needs. 226

198 UTHSCSA Dental School CODA Self Study Report Standard Three XYZ Compensation Plan A new system for faculty compensation was implemented in 2011 at UTHSCSA in an effort to recognize and reward exemplary faculty members' performance and provide incentives for faculty efforts that are consistent with the Missions of the UTHSCSA and which enhance the programs and reputation of the institution. The XYZ Compensation Plan (Appendix 3-4c) is based on this formula: Base salary = Core ( guaranteed ; protected to the fullest extent possible) salary (X) + Specialty-associated salary (Y) = Total compensation = Base salary (X+Y) + Incentive payments (Z) Base (core) salary (X) is designed to be not be less than 70% of the national median for nonspecialty associated compensation for all dental school faculty members in public institutions at each academic rank (assistant, associate or full professor), as calculated by the American Dental Education Association (ADEA). Specialty-associated salary (Y) includes income from funding streams and activities that may not be generally available to all members of the faculty such as: salary budgeted from research grants and contracts practice plan augmentation (professional services, such as patient care) administrative stipends Veteran s Administration salary (South Texas Veterans Healthcare System) Incentive payments (Z) are salary supplements that are allocated as non-recurring merit payments for extraordinary productivity, accomplishments or commitment. As identified by the UTHSCSA Faculty Senate, examples of these accomplishments include: major National/International Award Nobel Prize, Medal of Science; election to the National Academy of Sciences/Institute of Medicine or equivalent; special recognition by a national/international scientific or clinical organization; election to the UT System Academy of Health Educators; receiving a target number of major research grants; and, service to the UTHSCSA or School resulting in a truly transformative positive change. Faculty Support The UTHSCSA requires a Tenure Track Mid-Probationary Review (Appendix 3-4d) of faculty in the fifth year of their nine-year probationary period. The mid-probationary review is particularly valuable in providing clear and concise feedback to faculty regarding their performance and progress toward tenure. The responsibility for overseeing the process of mid-probationary review is shared by the Associate Vice President for Academic Affairs of the UTHSCSA, the schools, and the departments. The mid-probationary reviews are conducted by committees within each department. The membership of the mid-probationary review committees is determined by each department. Committee recommendations do not represent a guarantee of promotion and/or tenure outcome. 227

199 UTHSCSA Dental School CODA Self Study Report Standard Three The mid-probationary review is developmental and advisory in nature and focuses on the candidate s progress toward meeting the UTHSCSA s criteria for achieving promotion and tenure. The strengths and weakness of the candidate s performance are reviewed. Suggestions are made for improvement of identified deficits so that the candidate can meet the Health Science Center s criteria. In addition, the mid-probationary review considers the candidate s work environment, including division of time for departmental assignments and support resources to determine how these factors influence the candidate s capacity to accomplish the goals necessary for achieving tenure, and for meeting departmental objectives. The UTHSCSA has an established policy for Post-Tenure Review (Appendix 3-4e). Review of tenured faculty is scheduled at five-year intervals following the initial year of being granted tenure, although there are several special circumstances when the review can be deferred for up to one year. The process of Post-Tenure Review is conducted within the Dental School. From among the full-time tenured faculty, five individuals are selected by the Dean to serve as a Post Tenure Evaluation Committee (PTEC). The members of the PTEC serve a three-year term. Faculty members who are scheduled for periodic evaluation are not eligible to serve that year on the Committee. One additional tenured faculty member from outside of the School also serves on the PTEC. This committee member is also selected by the Dental School Dean. All Dental School administrators (Associate Deans, Directors and Chairs) are formally evaluated every four years via the Evaluation of Academic Administrators process (Appendix 3-4f). The evaluation consists of two components: (1) an assessment by the Dean of the activities and outcomes for a programmatic area, in the case of Associate Deans and Directors, or departmental activities and outcomes, in the case of chairs, over the past four years, and, (2) a compilation of data from a management skills survey distributed to peers and subordinates of the administrator being assessed. An annual Chairs' Review and Outcomes Assessment is also used by the Dean to evaluate the department chair s administrative accomplishments and leadership. The Evaluation form used in this process is in Appendix 3-4g. B. Supportive Documentation for Standard 3 4: 1. Appendix 3-4a: UTHSCSA Handbook of Operating Procedures: Promotion and Tenure Guidelines; Chapter Appendix 3-4b: Policies for Evaluation of Faculty Performance in Each Department 3. Appendix 3-4c: XYZ Compensation Plan 4. Appendix 3-4d: UTHSCSA Handbook of Operating Procedures: Policy and Process for Tenure Track Mid-Probationary Review; Chapter Appendix 3-4e: UTHSCSA Handbook of Operating Procedures: Policy and Process for Post- Tenure Review; Chapter Appendix 3-4f: UTHSCSA Handbook of Operating Procedures: Process for Evaluation of Academic Administrators; Chapter

200 UTHSCSA Dental School CODA Self Study Report Standard Three 7. Appendix 3-4g: Evaluation Form for Review of Department Chairs Promotion and Tenure Process Standard The dental school must have a stated process for promotion and tenure (where tenure exists), that is clearly communicated to the faculty. Compliance: The UTHSCSA Dental School is in compliance with Standard 3-5. A. Description for Standard 3-5 The process for promotion and tenure is described in the UTHSCSA Handbook of Operating Procedures in Chapter 3, Faculty Policies and Procedures. Chapter reviews general considerations for appointment or promotion without regard to rank (Appendix 3-5a). Chapter describes the promotion, tenure and appointment process (Appendix 3-5b). A hard copy of Chapter 3 of the UTHSCSA Handbook of Operating Procedures will be available during the February 21-23, 2012 Site Visit. At the beginning of each year, all UTHSCSA faculty members are notified via of the processes and deadlines for promotion, tenure and appointment by the UTHSCSA Associate Vice President for Academic Affairs. The Office of the Vice President for Academic Affairs conducts annual Promotion and Tenure workshops at UTHSCSA that are open to all faculty members. All new Dental School faculty members are oriented to the UTHSCSA Promotion and Tenure system during the New Faculty Orientation Program and receive a summary of the guidelines for promotion for both tenure track and non-tenure (Appendix 3-5c). The chair of the UTHSCSA Promotion and Tenure Committee has conducted a seminar on promotion and tenure for new Dental School faculty each year since The Getting Started Checklist (Appendix 3-2e) provided to all new faculty includes scheduling a meeting with the faculty member s department chair to discuss: appointment category (tenure-track or non-tenure track); academic job title (instructor, assistant professor, associate professor, professor); terms of employment and sources of salary; time allocation for teaching, service, faculty practice, research, or administration; and, guidelines for promotion and process for peer review. Each faculty member is required to maintain a current curriculum vitae using a standardized electronic CV template developed by the UTHSCSA. Each department has a Promotion and Tenure Review Committee that meets periodically to review the credentials and activities of each full-time tenure-track faculty member. The 229

201 UTHSCSA Dental School CODA Self Study Report Standard Three committees provide guidance to faculty members with tenure track appointments to assist these individuals in meeting the stated criteria for promotion and tenure and prepare packages for submission to the UTHSCSA s Promotion, Tenure and Appointment Committee. The UTHSCSA Committee reviews the promotion, tenure, and/or appointment packages submitted by the departments and makes decisions regarding tenure, promotion and appointment. UTHSCSA Dental School faculty members have a strong track of success in achieving promotion within academic ranks and tenure as indicated in Appendix 3-5d. B. Supportive Documentation for Standard 3 5: 1. Appendix 3-2e: New Faculty Getting Started Checklist 2. Appendix 3-5a: UTHSCSA Handbook of Operating Procedures: General Considerations for Appointment or Promotion Without Regard to Rank; Chapter Appendix 3-5b: UTHSCSA Handbook of Operating Procedures: Promotion, Tenure and Appointment Process; Chapter Appendix 3-5c: Checklist of Promotion and Tenure Criteria and Standards 5. Appendix 3-5d: Anonymous listing of Dental School Faculty Presented for Promotion for the Past Five Years and the Results of the Tenure and Promotion Evaluation 230

202 UTHSCSA Dental School CODA Self Study Report Standard Four STANDARD 4: EDUCATIONAL SUPPORT SERVICES 231