ENDODONTICS SAUDI BOARD PROGRAM SAUDI BOARD FINAL CLINICAL EXAMINATION OF ENDODONTICS (2017)

ENDODONTICS SAUDI BOARD PROGRAM SAUDI BOARD FINAL CLINICAL EXAMINATION OF ENDODONTICS (2017)

I Objectives a. Determine the ability of the candidate to practice as a specialist and provide consultation in the general domain of his/her specialty for other health care professionals or other bodies that may seek assistance and advice. b. Ensure that the candidate has the necessary clinical competencies relevant to his/her specialty including but not limited to history taking, physical examination, documentation, procedural skills, communication skills, bioethics, diagnosis, management, investigation and data interpretation. c. All competencies contained within the specialty core curriculum are subject to be included in the examination. II Eli gibility a. Passing Saudi Board Part II (final) written examination. b. Candidates are allowed a maximum of three attempts to pass final specialty clinical examination within a period of 5 years provided that evidence of continuing clinical practice is presented and approved by the specialty scientific council. c. If the candidate did not pass the three attempts, an exceptional attempt may be granted upon the approval of the scientific and executive councils, provided evidence of continuing clinical practice is presented. d. A candidate who failed to pass the clinical examination including the exceptional attempt has to pass Part II written examination again, after which he/she is allowed to sit the final specialty clinical examination only once provided that evidence of continuing clinical practice is presented and approved by the scientific council. e. After exhausting above attempts candidate is not permitted to sit the Saudi board final specialty clinical examination. III General Rules a. Saudi board final specialty clinical examination will be held once each year within 4-8 weeks after Part II written examination. b. If the percentage of failure in the clinical examination are 50% or more the examination shall be repeated after 6 months. c. Specialty clinical examinations shall be held on the same day and time in all centers, however if consecutive sessions are used, suitable quarantine arrangements must be in place. d. If examination is conducted on different days, more than one exam version must be used. IV Exam Format a. The Endodontic final clinical examination shall consist of 8 graded stations each with 15 minute encounters. b. The 8 stations consist of 4 Objective Structured Clinical Exam (OSCE) stations with 1 examiner each and 4 Structured Oral Exam (SOE) stations with 2 examiners each. c. All stations shall be designed to assess integrated clinical encounters. d. SOE stations are designed with preset questions and ideal answers. e. Each OSCE station is assessed with a predetermined performance checklist. A scoring rubric for postencounter questions is also set in advance.

V Final Clinical Exam Blueprint* DIMENSIONS OF CARE Health Promotion & Illness Prevention 1±1 Station(s) Nonodontogenic pain or trauma 1±1 Station(s) Medically compromised or surgical 1±1 Station(s) Diagnosis or Problem solving 1±2 Station(s) # Stations DOMAINS FOR INTEGRATED CLINICAL ENCOUNTER Patient Care 3±1 Station(s) Patient Safety & Procedural Skills 1±1 Station(s) Communication & Interpersonal Skills 2±1 Station(s) Professional Behaviors 1±1 Station(s) 1 1 1 1 3±1 1 1±1 1 1 2 1 1 2 Total Stations 2 2 2 3 9±1

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

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

X OSCE Station Sample** Endodontic Clinical Exam Station 1 Instructions to Resident Scene: Dental clinic 10-year-old child who presented with pain from the upper anterior area after trauma YOU HAVE 15 MINUTES TO INTERVIEW THE PATIANT AND DO THE FOLLOWING: 1. What would you ask the patient to retrieve his dental history regarding the traumatic injury? 2. What are the types of radiographs you will request for this case? 3. Based on the image shown which teeth were involved? Mention the type of injury? 4. What should your clinical examination be in the case? 5. Pulpal responses to traumatic injuries are affected by the degree of injury to the neurovascular supply. What is the possible outcome of the pulp? 6. Tooth #21 was diagnosed with necrotic pulp and acute apical abscess and tooth #21 was asymptomatic irreversible pulpitis with symptomatic apical periodontitis. What are the treatment modalities of managing immature tooth (#21)? 7. If tooth # 21 is intruded, how do you bring it back to the previous position? Performance Evaluation: Station 1

ENDODONTIC SAUDIBOARD PROGRAM MANAGEMENT OF TRAUMA- Station 1 Question/Ideal Answers Mark 1. How do you take the history of dental traumatic injury in general? The following questions are intended to elicit essential information about the traumatic event. When did the injury occur? Time factors are important especially in avulsion and displacement injuries. Also, treatment delay may signal possible child abuse, if the patient is a minor. Where did the injury occur? For legal and insurance purposes, this information is important to be recorded in the patient file. How did the injury occur? Answers to this question may guide evaluation of the extent of trauma, for example, a blow to the chin may transmit to the condyles. Has the patient been unconscious? If so, medical attention must be sought, but that does not preclude urgent immediate /20 dental care such as replantation of an avulsed tooth. Are there previous injuries to the teeth? Some children are accident prone, and participants in various sports will frequently show radiographic indication of previous trauma. Such information can affect treatment options. Is there a change in the bite? Changes in occlusion following an injury would indicate possible tooth luxation, alveolar/jaw fracture, or condylar fracture. Is there increased sensitivity to temperature changes? This is typically observed in teeth with crown fractures exposing the dentin. 2. What are the types of radiographs you will request for this case? It is recommended that 1. One steep occlusal exposure along. 2. Three periapical bisecting angle exposures in different angle. /15 3. One radiograph to examine the presence of impacted foreign bodies in penetrating soft tissue wounds. 4. CBCT 3. Based on the image shown which teeth were involved? Mention the type of injury Tooth #21: Intrusive luxation with complicated crown fractures (Ellis Class III)(Crown fracture with pulp exposure) Tooth #11: Uncomplicated crown fractures Ellis Class II (Enamel and dentin fracture without pulp exposure) 4. What should your clinical examination be in the case? Begin with evaluation of any soft tissue wounds, including examination for the presence of impacted foreign bodies. Teeth are examined for fractures or infractions, if the pulps are exposed and the extent. Any displacement of teeth must be noted. /20 Mobility test. Percussion test Pulpal sensibility test. 5. Pulpal responses to traumatic injuries are affected by the degree of injury to the neurovascular supply. What is the possible outcome of the pulp? Three possible outcomes exist: c) Pulp canal obliteration. 6- Tooth #21 was diagnosed with necrotic pulp and acute apical abscess and tooth #21 was asymptomatic irreversible pulpitis with symptomatic apical periodontitis. What are the treatment modalities of managing immature tooth (#21)? a. Vital pulp therapy (Cvek pulpotomy, pulpotomy, apexogensis) /15 And final restoration 7- if Tooth # 21 is intruded, how do you bring it back to the previous position? Spontaneous eruption Orthodontic intervention Surgical repositioning a) b. Pulpal healing. Apical barrier b) c. Pulpal necrosis. Conventional root canal treatment Total 0

Questioning Skills (ONE choice only) Awkward, exclusive use of closed-ended or leading questions and jargon Somewhat awkward; inappropriate terms; minimal use of open-ended questions Borderline unsatisfactory; moderately at ease; appropriate language; uses different types of questions Borderline satisfactory; moderately at ease; appropriate language; uses different types of questions At ease; clear questions; appropriate use of open and closed-ended questions Confident; skillful questioning Professional Behavior with Patient (ONE choice only) Offensive or aggressive; frank exhibition of unprofessional conduct Negative attitude toward patient Borderline unsatisfactory; does not truly instill confidence Borderline satisfactory; manner inoffensive, but does not necessarily instill confidence Attempts professional manner with some success Overall demeanor of a professional; caring, listens, communicates effectively Overall Organization of Patient Encounter (ONE choice only) No logical flow; scattered, inattentive to patient's agenda Counsels patient before taking history or doing physical Minimal organization; scattered approach Appropriate approach to patient Skillful approach to patient Skillful, professional approach to patient and effective use of time

XI SOE Station Sample** STATION 2 Instructions to candidate: A 13-year male is referred to the emergency endodontic clinic with right extra-oral swelling, 2 month earlier (1 st visit), patient presented with lingering pain and it was radiating to his ear. Tooth #46 had big occlusal caries and the tooth was sensitive to percussion. Emergency treatment was done with temporary restoration. Today (2ed visit), the patient is presented with extra oral swelling, fever and lymphadenitis. Patient Care/Treatment Planning Mark 1. What are the required examinations tools would you perform in the first visit? Endo-Ice test, percussion test, palpation test, periodontal probing and mobility Periapical and bitewing radiograph 2. What is the pulpal diagnosis in the first visit? Symptomatic irreversible pulpitis with Symptomatic apical periodontitis 3. What is the pulpal and periapical diagnosis in the second case? Previously initiated therapy and acute apical abscess 4. List 2 possible mechanisms for the Flare-up? Apical extrusion of debris and microorganism Change in the microbiota or environmental conditions Leakage and microorganism due to leakage a. What is the emergency treatment plan? b. Elimination of source infection by chemo mechanical debridement, drain from inside the tooth and intracanal medication c. Relief of occlusion d. Drainage establishment (extra oral) e. Systemic Antibiotic and Analgesics. f. Good patient commination and reassurance and close follow up. 5. What are the microorganisms that might be present in the second visit? The acute apicall abscess is usually polymicrobial comprising facultative anaerobes, such as viridans group streptococci and the Streptococcus anginosus group, with predominantly strict anaerobes, such as anaerobic cocci,prevotella and Fusobacterium species. 6. During treatment in the emergency visit, the patient loses consciousness. Mention tow possible causes? Syncope, hypoglycemic, hyperglycemic coma, vasovagal attack, MI, Stroke. 7. What is the definite treatment plan for this tooth? NSRCTX 8. What is the prognosis of this case? Favorable Total marks: 0 /26 /16 /8 /5 /5