Cnsultatin n Internatinal Sciety f Dental Regulatrs Dentist Accreditatin Standards and Dentist Cmpetencies Issue date: 24 February 2016 Clsing date: 20 April 2016 Summary Dental regulatrs must cntribute t and mnitr the educatin f dental prfessins. The Internatinal Sciety f Dental Regulatrs (ISDR) has develped accreditatin standards fr dentistry prgrams, supprted by prpsed cmpetencies fr newly qualified general dentists. The apprach t setting internatinal standards is principle-based, due t the inability t apply prescriptive standards internatinally because f varied legislative, regulatry and educatinal framewrks in each jurisdictin. These prvide a cre framewrk fr ISDR members, and will be available t ther jurisdictins where dentistry is taught. The framewrk can be further refined by individual jurisdictins t align with their different educatin, regulatry and legislative systems hwever ISDR members must retain the cre principles. ISDR is nw cnsulting with stakehlders n the prpsed accreditatin standards fr dentistry prgrams and the cmpetencies fr dentists. Feedback is invited and will be cnsidered t infrm finalisatin f the accreditatin standards and cmpetencies fr general dentists. Cnsultatin questins 1. D yu supprt the cncept f ISDR General Dentist Accreditatin Standards? If nt, please prvide yur reasns. 2. D yu have any suggested amendments n the General Dentist Accreditatin Standards? 3. Hw d the ISDR General Dentists Accreditatin Standards align/cmpare t the standards in yur jurisdictin? 4. D yu supprt the ISDR General Dentist Cmpetencies? If nt, please prvide yur reasns. 5. Hw d the ISDR General Dentist Cmpetencies align/cmpare t the cmpetencies in yur jurisdictin? 6. D yu have any suggested amendments n the General Dentist Cmpetencies? 7. D yu agree with the prpsed ISDR endrsement prcess? If nt, please prvide yur reasns? Submissins can be addressed t Irwin Fefergrad, Executive Directr ISDR and emailed t inf@isdrnline.rg by clse f business 20 April 2016 (Ontari, Canada, EST).
Backgrund The majrity f jurisdictins where dental prfessins are regulated have an accreditatin r educatinal quality assurance framewrk. The primary bjective is t ensure that dental practitiners achieve the necessary knwledge and skills t be eligible t be licensed/registered t practise dentistry cmpetently and safely. Accreditatin standards are used t assess whether a prgram f study, and the educatin prvider that delivers the prgram, meet the threshld standards t fulfill this bjective. In 2014 the ISDR General Assembly prvided the executive cmmittee with a mandate t implement internatinal accreditatin standards. 1 This is aligned with the ISDR visin t encurage best practices amngst dental regulatry authrities wrldwide in prtecting, prmting and maintaining the health and safety f the public by ensuring minimum standards fr the dental prfessins. The purpse f internatinal accreditatin standards The ratinale fr internatinal accreditatin standards primarily derives frm increased internatinal wrkfrce mbility dentistry is nt immune t this ccurrence, and wrkfrce mvement includes registered practitiners, new graduates and academics. Dental educatin is fast becming an internatinal resurce. Dental educatin institutins are sharing staff and students in exchange prgrammes and share educatinal resurces thrugh the internet, scial media and ther digital media tls. In this rapidly develping wrld f glbal dental educatin it is vital that the standards f educatinal resurces, staff and new graduates are agreed, established and maintained by the dental educatin cmmunity. 2 At the 2007 Glbal Cngress n Dental Educatin it was recmmended that a cmmn quality assurance and educatinal framewrk shuld be adpted t prmte internatinalisatin and increased c-peratin, and that the framewrk shuld allw fr diversity between institutins. The authrs als expressed the view that Internatinal recgnitin f qualificatins shuld be the glbal aim fr dental educatin. 2 Achieving acceptance f internatinal accreditatin standards and cmpetencies fr dentists is an imprtant first step in aligning threshld standards fr dental educatin acrss jurisdictins, with the ultimate aim t prtect the health and safety f patients accessing dental services. There are increasing expectatins in regulatin t remve r lessen barriers and administrative burdens t enter a prfessin. Having agreement n what thse threshld standards are, wuld assist the varius mutual recgnitin f qualificatin initiatives between jurisdictins. The standards can als be used t develp and implement accreditatin standards in thse jurisdictins new t regulatin r dental educatin quality assurance. The develpment prcess 1 Recmmendatin 5: Implementatin f internatinal accreditatin 2 Hbsn et al. 2007. Quality Assurance, Benchmarking, Assessment and Mutual Internatinal Recgnitin f Qualificatins. Chapter 2.3. Glbal Cngress n Dental Educatin 2
An accreditatin wrking grup was established immediately fllwing the 2014 cnference. The members were: Cedric Grlleau - EU law & EU public affairs advisr, Belgium; Ordre Natinal des Chirurgiens- Dentistes (France) Prfessr Claude Lamarche - Dean f the Faculty f Dental Medicine, University f Mntreal, Canada; President f Cmmissin f Dental Accreditatin, Canada Prfessr Rbert Lve - University f Otag, New Zealand (until December 2015); Dean f Dentistry and Oral Health Griffith University, Australia Marie Warner Chief Executive Dental Cuncil New Zealand; President ISDR. At its first meeting the wrking grup agreed that the nly achievable apprach t setting internatinal standards was principle-based, due t the inability t apply prescriptive standards internatinally because f varied legislative, regulatry and educatinal framewrks. The wrking grup develped extensive mapping dcuments f accreditatin standards fr dental prgrams and general dentist cmpetencies acrss six jurisdictins. The wrking grup was als prvided with prpsed cmpetencies frm the Assciatin fr Dental Educatin in Eurpe, and draft Cmpetencies fr a Beginnning Dental Practitiner in Canada frm the Assciatin f Canadian Faculties f Dentistry. These dcuments were used t identify cmmnalities at a principle level, and infrmed the draft ISDR dcuments develped. The prpsed accreditatin standards fr dental prgrams and general dentist cmpetencies were presented t the 2015 ISDR General Assembly in September, where it was unanimusly supprted in-principle, and apprved fr cnsultatin. The prpsed ISDR General Dentist Accreditatin Standard The ISDR General Dentist Accreditatin Standard is a principle-based framewrk. It is the expectatin that member jurisdictins will emply the framewrk as the minimum basis fr accreditatin f dentist prgrams. This wuld supprt individual jurisdictins t refine and further develp its standards t suit their particular regulatry framewrk, educatinal system and ppulatin s ral health needs. It als encurages innvatin by educatinal institutins t enhance and individualise their teaching - withut a defined, prescriptive curriculum. The ISDR General Dentist Accreditatin Standard has been based n dental prgrams equivalent t at least five academic years f tertiary educatin. The standards prpse that educatinal prgrams in dentistry must address: 1. Public safety and standard f patient care 2. Gvernance & quality assurance 3. Prgram 4. Student jurney 5. Assessment. The prpsed ISDR General Dentist Accreditatin Standard is detailed in Appendix 1. 3
The prpsed ISDR General Dentist Cmpetencies The accreditatin standards are underpinned by five prpsed dmains f dentist cmpetencies, being: 1. Prfessinalism 2. Diagnsis and treatment 3. Cmmunicatin and cllabratin 4. Oral health prmtin 5. Practice management. The prpsed ISDR General Dentist Cmpetencies is detailed in Appendix 2. ISDR Endrsement Prcess If the accreditatin standards and cmpetencies framewrk fr general dentists is adpted, an ISDR endrsement prcess will cmmence fr member jurisdictins. It is envisaged that the endrsement prcess will entail a desktp review by a panel f experts. The jurisdictin s accreditatin standards and criteria, plicies and prcedures, and dentist cmpetencies will be assessed t determine if they align with the ISDR accreditatin standards and cmpetencies fr general dentists. The jurisdictin s applicatin must be supprted by ne ISDR member. Successful jurisdictins will be granted full recgnitin, and can publically display that its accreditatin standards and cmpetencies fr dentists are recgnised t be in accrdance with the ISDR Dentist Accreditatin Standards Framewrk. Onging mnitring will include advising the ISDR f key changes t standards, plicies r prcesses. Once established, a similar prcess might be undertaken fr ther dental prfessins, such as dental hygiene. The ptin f a glbal dental curriculum framewrk t encurage cnvergence f educatin prgrams, might als be explred in the future. Next steps The utcme f the cnsultatin and the updated versins will be presented fr final cnsideratin at the 4 th Internatinal Cnference f Dental Regulatrs n 20 May 2016 in Geneva, Switzerland. Acknwledgements The ISDR executive thanks the accreditatin wrking grup members - Cedric Grlleau, Prfessrs Claude Lamarche and Rbert Lve, and Marie Warner fr their valuable cntributins and time dedicated t the prject. The wrking grup wants t acknwledge the fllwing jurisdictins whse accreditatin material were used in the mapping exercises: Australian Dental Cuncil, Cmmissin n Dental Accreditatin, Cmmissin n Dental Accreditatin f Canada, Dental Cuncil - New Zealand, General Dental Cuncil - UK, Ireland Dental Cuncil; and the Assciatin f Canadian Faculties f Dentistry and Assciatin fr Dental Educatin in Eurpe. 4
Appendix 1 Prpsed ISDR Dentist Accreditatin Standards 5
Frewrd Dental regulatrs must cntribute t and mnitr the educatin f its members. The Internatinal Sciety f Dental Regulatrs (ISDR) has develped accreditatin standards fr dentistry prgrams that prvides a cre framewrk fr ISDR members, and ther jurisdictins where dentistry is taught. The framewrk can be further refined by individual jurisdictins t align with educatin system, regulatry and legislative differences. T assist the educatinal prgrams in dentistry, the standards fr educatinal prgrams must address: 1. Public safety 2. Academic gvernance & quality assurance 3. Prgram f study 4. Student jurney 5. Assessment. The ISDR General Dentist Accreditatin Standard is based upn the fllwing definitin f a dentist: The dentist as a practitiner is cncerned with the health needs f the public. The dentist s educatin shall prvide the knwledge and skills necessary fr carrying ut preventin, assessment, diagnsis and treatment f cnditins and diseases f the rfacial cmplex and assciated tissues, within the scpe f the practitiner s apprved educatin, training and cmpetence, including cnsultatin with, r refer t, ther health care prviders when apprpriate fr the best interest f the patient. A dentist is educated in the basic and clinical sciences as well as in related health subjects. A set f cmpetencies fr a dentist has been develped by the ISDR, and supprts the ISDR General Dentist Accreditatin Standards. The ttal lengths f different prgrams vary in each educatin system but must be equivalent t at least five (5) academic years f tertiary educatin. In recgnising the need fr universally accepted standards the ISDR acknwledges the educatin systems are part f the culture f any gegraphic regin. The ISDR General Dentist Accreditatin Standard is a principlebased framewrk develped t set a benchmarking standard fr dental educatin. This is f particular imprtance t achieve alignment in standards t prtect the safety f the patients in a glbal marketplace that results in increasing student and staff mbility. It is the expectatin by ISDR that all members will emply the cre framewrk as the minimum basis fr accreditatin f dental educatin prgrams, as this supprts the ISDR mandate t encurage best practices amng dental regulatry authrities wrldwide in prtecting, prmting and maintaining the health and safety f the public by ensuring prper standards fr the dental prfessins. The ISDR Dentist Accreditatin Standard can be used by accreditatin bdies t develp and implement accreditatin standards as part f applicatin t ISDR membership. ISDR is the final arbiter and interpreter f the cntent f these Standards. 6
Accreditatin Dmains Standard 1 Public safety and standard f patient care Clinical educatin must emphasise patient safety, cntemprary practice and prfessinal standards Patient management must be based n the principles f patient-centred care, cmprehensive patient care, and infrmed cnsent All staff must be apprpriately qualified and clinical teaching staff must be registered There must be clearly defined utcme criteria t determine when a student is cmpetent t advance frm pre-clinical educatin t patient treatment There must be quality assurance prcesses t mnitr the standards f care prvided by students, including the apprpriateness, necessity and quality f care. There must be mechanisms t identify and address deficiencies in care. There must be effective student health screening and management prcesses The dental educatin prvider must ensure patient care is delivered in a safe envirnment that cmplies with relevant regulatins regarding health care. There must be effective prcesses addressing areas f ccupatinal health and safety (including radiatin safety), universal infectin cntrl prtcls, management f medical emergencies, patient cmplaints, and cnfidentiality f patient infrmatin 2 Gvernance & quality assurance The dental educatin prvider must have autnmy fr prgram delivery within an institutin The dental educatin prvider must have apprpriate academic leadership The dental educatin prvider must shw integratin and interactin with higher educatin structures t facilitate prvisin f brad based educatin The dental educatin prvider must be integrated with the brader health sectr t apply the principles f patient-centred care There must be effective internal and external quality imprvement prcesses (incl staff prfessinal develpment and perfrmance evaluatin) t ensure adequacy f prgram delivery, quality imprvement and linkage t cntemprary practice There must be a defined gvernance structure and stakehlders (incl staff, students, external) must be represented n cmmittees 7
Accreditatin Dmains Standard 3 Prgram The dental educatin prvider must have an educatinal philsphy (missin/purpse statement) based n evidenced based teaching, research literacy, inter/intra prfessinal learning, and preparatin f a caring, knwledgeable graduate practitiner wh can practise safely, cmpetently and independently The curriculum must cver the relevant bilgical, bimedical, behaviural, cultural, technical and clinical sciences in rder that learning bjectives achieve expected ISDR Dentist Cmpetencies. The clinical expsure and management f patients must be sufficient t achieve cmpetence acrss the full range f learning utcmes and ISDR Dentist Cmpetencies The curriculum must prepare students t undertake self-directed learning during prfessinal practice The prgram resurces, such as facilities, staff/student rati, budget and administrative supprt, must be apprpriate t deliver the prgram The prgram duratin must be sufficient as t achieve the utcme f a practitiner wh can practise the expected ISDR Dentist Cmpetencies safely, cmpetently and independently 4 Student jurney Defined admissin selectin criteria must encurage recruitment f a diverse student ppulatin, be transparent and fllwed fairly Students must have access t cmprehensive prgram infrmatin, such as curriculum, learning bjectives, assessment details The educatin prvider must have in place an effective student grievance prcess, academic and persnal student supprt, and must bserve the principles f equity and diversity 5 Assessment Assessment criteria and prcesses must be clear, transparent, valid and reliable Assessments must be mapped t all learning bjectives and ISDR Dentist Cmpetencies Multiple assessment tls must be used including student selfassessment, direct clinical bservatin and invlvement f examiners external t the faculty There must be apprpriate prcesses fr assessr calibratin, evaluatin and mderatin 8
Prpsed ISDR Dentist Cmpetencies Appendix 2
Intrductin The term cmpetent has been defined by Chambers (1993) as "the behaviur expected f the beginning practitiner. This behaviur incrprates understanding, skill, and values in an integrated respnse t the full range f requirements presented in practice". Lachiver and Tardif (2002) expanded n the definitin f cmpetence as fllws: A cmpetence culd be defined as a cmplex ability t act based n effectively mbilizing and using a set f resurces. This ability highlights that each cmpetence is active in nature, allwing an individual t implement a set f reflectins, prcess, strategies, and actins in perfrming a given task. It helps distinguish cmpetence frm a simple prcedure, preventing cmpetence frm becming miscnstrued as a synnym f knw-hw. It therefre endws cmpetence with cmprehensive rle and character. Tardif (2006) adds that cmpetence invlves knwing hw t act based n calling-up and cmbining varius internal and external resurces within a grup f situatins. Epstein and Hundert (JAMA, 2002;287:226-35) defined cmpetence in Medicine as the habitual and judicius use f cmmunicatin, knwledge, technical skills, clinical reasning, emtins, values, and reflectin in daily practice fr the benefit f the individuals and cmmunities being served. 3 In 2008 Licari & Chambers defined cmpetency as the ability t cmbine evidence based knwledge, persnal attitudes, and clinical skills t undertake hlistic dental care. 4 Persnal attributes may include creativity, ethics, aesthetics, and critical sense. Kramer et al. (2009) emphasized that persnal attributes include a desire fr patient wellbeing and t self-evaluate the effectiveness f the treatment. As life-lng learning becmes a crucial attribute fr all mdern clinicians, the ability t self-assess perfrmance and identify future learning gals is an essential skill that needs t be develped in a mdern healthcare curriculum. Self-assessment, self-reflectin and self-regulatin can prmte a deeper understanding in current knwledge. 5 The definitin f cmpetence adpted fr the purpse f the ISDR General Dentist Accreditatin Standards and the ISDR General Dentist Cmpetencies is the ability f a dentist graduate t cmbine evidence based knwledge, persnal attitudes, and clinical skills t undertake cmprehensive dental care. The ISDR Dentist Cmpetencies supprts the ISDR Dentist Accreditatin Standards as the benchmark cmpetencies t be achieved by dentist graduates f ISDR member jurisdictins. Similarly t the ISDR Dentist Accreditatin Standards individual jurisdictins can refine and further develp these cmpetencies t meet individual jurisdictin statutry, educatinal r patient-health needs. 3 Prpsal t Revise the Cmpetencies fr a Beginning Dental Practitiner in Canada ; April 2013 4 Licari FW, Chambers DW. Sme Paradxes in Cmpetency-Based Dental Educatin. J Dent Educ. 2008;72(1):8-18 5 Manakil J, Gerge R. Reviewing Cmpetency in Dental Educatin. Internatinal Jurnal f Dental Clinics. 2011;3(2):33-39 10
A cmpetent dentist must: Prfessinalism Recgnise the value f self-assessment, critical thinking, and self-directed learning t maintain clinical cmpetence during the practising career Understand and apply the principles f ethical practice and prfessinal respnsibility. Establish the principle f leadership within the dental team t facilitate patient-centred care. Diagnsis and treatment Understand scientific principles and apply the knwledge f bilgical, bimedical, behaviural, technical and clinical sciences t the management f patients. Obtain, recrd and interpret a cmprehensive and cntempraneus patient histry. Obtain infrmatin and establish an individualised treatment plan. Within the dentist scpe f practice, be able t: Apply the principles f disease preventin in the management f ral and dental disease and verall patient welfare Manage diseases and cnditins f the peridntium and supprting tissues Manage tth tissue lss by restring the dentitin Manage the lss f teeth by rehabilitating the dental arches Manage pulp and periapical diseases and cnditins Extract teeth and perfrm ther minr ral surgical prcedures Manage diseases and cnditins f the ral hard and sft tissues Manage dental trauma Understand the management f maxillfacial trauma Manage skeletal and dental cclusal discrepancies Manage medical emergencies Recgnise and take accunt f the needs and preferences f different patient grups Recgnise thse treatments that are beynd his/her skills and experience, and refer apprpriately. 11
Cmmunicatin and cllabratin Cmmunicate effectively, prvide pertinent infrmatin t btain infrmed cnsent and facilitate patient-centred care. Respect and manage patients and clleagues frm diverse backgrunds and beliefs withut prejudice r discriminatin. Oral health prmtin Recgnise the determinants f ral health issues in ppulatins, and the rle f dentists in planning ral health care fr cmmunities. Practice management Be aware f and cmply with all legal and regulatry requirements related t the prvisin f ral health care. Manage and maintain a safe wrking envirnment. Understand the different mdels f ral health care management and delivery systems within the jurisdictin f registratin. Be cmpetent in the use f cntemprary infrmatin technlgy and ensure patient infrmatin is prtected. 12
Glssary ISDR Dentist Accreditatin Framewrk Accreditatin Apprpriately qualified Assessments Clinical Cmpetence Dental educatin prvider Diversity Equity Gvernance Infrmed cnsent Granting f recgnitin that the educatinal prgram meets and maintains minimum standards t achieve cmpetent dentist graduates. Teaching staff have the relevant qualificatins and experience at the required level, t ensure teaching is cntemprary, based n evidence-based science and at the level required fr the qualificatin ffered. A variety f methds t evaluate, measure, and dcument the academic readiness, learning prgress, and skill acquisitin f students. Any treatment prvided in a pre-clinical setting r n patients, including btaining medical histries, treatment planning and ral health prmtin. Ability f a dentist graduate t cmbine evidence based knwledge, persnal attitudes, and clinical skills t undertake cmprehensive dental care. A prvider delivering an accredited dentist prgram, meeting any tertiary educatinal requirements set by the jurisdictin The recgnitin f and respect fr individual differences, these culd include race, ethnicity, gender, sexual rientatin, sci-ecnmic status, age, physical and mental abilities, religius, plitical r ther beliefs. Fairness r justice in treating peple. The establishment f plicies and prcesses, and cntinuus mnitring f their prper implementatin, by the members f the gverning bdy f the educatinal institutin. Obtaining permissin frm a patient befre perfrming a prcedure, infrming the patient that care culd be prvided by a student, explaining the reasn fr the prcedure, the nature f the prcedure, ptential benefits and assciated risks, expected csts, and ensuring the patient understands the infrmatin prvided and have an pprtunity t ask any questins t infrm his/her chice t prceed, r nt, with the prcedure. Infrmed cnsent is nt a nce-ff prcess and must be repeated fr any new r changed treatment plan. 13
Jurisdictin Learning bjectives Quality assurance Management prcess as referenced in standard There must be student health screening and management prcess The gegraphical area which a dental regulatry authrity gverns dentists, including the dentistry prgrams. Brief statements that describe what students are expected t learn by the end f a defined perid. Assurance f a desired level f quality in patient care delivered, by reviewing the varius stages f delivery, including whether plicies and prcedures are crrectly and cnsistently fllwed. Measures put in place t mnitr and supprt a student with a knwn health cnditin r disability, whilst prtecting the safety f the patients and public. Occupatinal health and safety als knwn as wrkplace safety The safety, health and welfare f the staff, students, patients and the public in the setting where dental care is prvided. Patient-centred care Patient management Practice management Pre-clinical Prfessinal standards The primary cncern f care delivered is the patient. T manage the ral health care needs f a patient include all actins perfrmed by a health care prvider that are designed t alter the curse f a patient s cnditin. Such actins may include prviding educatin, advice, treatment by the dentist, treatment by the dentist after cnsultatin with anther health care prfessinal, referral f a patient t anther health care prfessinal, mnitring treatment prvided, but als may include prviding n treatment r bservatin. Manage assumes the use f the least invasive therapy necessary t gain a successful utcme in accrdance with patient wishes. 6 The assessment f infrmatin and the leadership f a general dental practice t facilitate patient-centred care. 7 Simulatin labratries, treatment nt delivered n patients. Standards set by a regulatry bdy r legislature t assure a minimum standard, and includes ethics and prfessinalism. 6 Prpsal t Revise the Cmpetencies fr a Beginning Dental Practitiner in Canada; April 2013 7 Prpsal t Revise the Cmpetencies fr a Beginning Dental Practitiner in Canada; April 2013 14
Referral Registered Research Literacy Identifying a symptm, cnditin r disease that falls utside f the prfessinal s knwledge, skills and experience, and sending the patient t an apprpriate health practitiner/prfessinal fr further treatment; prviding the ther practitiner with the relevant medical infrmatin. A healthcare prfessinal registered r licensed with the apprpriate regulatry bdy that enables the dentist t practise dentistry in that jurisdictin. T undertake at least a small-scale research prject, using apprpriate research methdlgies, relevant t the area f practice; and t critically reflect n literature f clinical nature and t use the literature effectively in clinical decisin making. Self-directed learning Student jurney Student grievance prcess Tertiary Educatin in its bradest meaning, describes a prcess in which individuals take the initiative with r withut the help f thers, in diagnsing their learning needs, frmulating learning gals, identifying resurces fr learning, chsing and implementing learning strategies and evaluating learning utcmes. 8 The experiences f a student during studying, includes supprt and interest beynd academic needs includes persnal, financial, health and wellbeing supprt. A prcess where a student can ldge a cmplaint against students, staff, patients, r the prgram; and the cmplaint is dealt with in a timely fashin, with discretin, withut prejudice r retaliatin. (Frmal) educatin, fllwing secndary educatin at a schl, at a cllege r university. 8 Knwles, M. S. (1975) Self-directed learning: A guide fr learners and teachers, Prentice Hall, Englewd Cliffs, New Jersey. 15