2. UFCD Competencies for the New Dental Graduate

Competency Domain I: Professionalism

The new dental graduate of the University of Florida College of Dentistry must demonstrate professional behavior including ethical conduct, critical thinking based on a sound scientific foundation, assessment of the outcomes of care, lifelong learning, and active participation in the community. In order to confirm or establish and then maintain the oral health of their patients, dentist must first be competent in interpersonal communication skills and the biomedical sciences. In addition, the general dentist must be able to manage behavioral factors that affect oral health and the delivery of oral health care.

Ethics

1. The new dentist must be able to identify and evaluate ethical issues associated with professional interactions with patients, staff and colleagues, and choose solutions that are ethically sound. Specifically, the new dental graduate must be able to:

a. Discern and manage the ethical issues of dental practice in a continually changing environment.

b. Provide humane and compassionate care for all patients within the context of a patient-centered system of care delivery.

c. Maintain honesty in relationships with patients, peers and faculty.

d. Serve patients and interact with colleagues and staff without discrimination.

e. Deal appropriately with incompetent, unethical, or chemically or psychologically impaired colleague or staff member.

Critical Thinking and Information Management

2. The new dentist must be able to acquire and synthesize new information in a critical, scientific and effective manner, and integrate information deemed valuable into practice. Specifically, the new dental graduate must be able to:

a. Engage in continued learning, self-assessment in maintaining competency, and the pursuit of higher skill levels.

b. Draw upon current biomedical science and clinical knowledge to exercise evidence-based judgment.

c. Use technology to retrieve and organize written and electronic sources of information and knowledge.

d. Critically evaluate the information published in professional and scientific literature; statements made by speakers at continuing education courses, meetings, study clubs, etc.; and claims made by product manufacturers and sales representatives.

Assessment of Treatment Outcomes

3. The new dentist must be able to evaluate the appropriateness of clinical decisions and the long-term impact of care on the patient.

Career Development and Professional Practice

4. The new dentist must recognize the career options and opportunities available within the dental profession. In addition, the new dentist must be able to apply fundamental business principles to establish a dental practice and manage a dental office. Specifically, the new dental graduate must be able to:

a. Develop a personal and professional philosophy which will provide guidance in career choices as well as relationships with patients, staff and peers, as appropriate for a dental student.

b. Assess one's competence, recognize one's limitations, and make referrals to one's professional colleagues when necessary.

c. Demonstrate the ability to communicate professional knowledge verbally and in writing.

d. Demonstrate acceptable interpersonal skills in interacting with peers, faculty, staff, and patients.

e. Assess the advantages and disadvantages of different models of oral health care practice to both the patient and the health care provider.

f. Understand the general principles of managing a general dental practice, or to function effectively within an established practice.

g. Demonstrate knowledge of jurisprudence, risk management, and records maintenance.

h. Routinely use universal precautions and comply with regulations regarding infection control, hazard communication, and medical waste disposal in order to protect patients, employees, and the community.

Patient Management

5. The quality of patient care is dependent on the interaction between the dental team and the patient. Thus, the general dentist must be able to manage behavioral factors that affect oral health and the delivery of oral health care. Specifically, the new dental graduate must be able to:

a. Establish and maintain productive and confidential relationships with patients using effective interpersonal skills.

b. Recognize and manage key psychological, physical, emotional and behavioral factors affecting treatment and the dentist-patient relationship.

c. Recognize common behavioral disorders and understand their management.

d. Use appropriate and effective techniques to manage anxiety, distress, discomfort, and pain.

e. Refer patients with chronic pain or dental phobia that are beyond the scope of management by a general dentist.

Community Involvement

6. The new dentist must be able to interact with others as well as assume a leadership role in improving the oral health of all individuals residing in the community. Specifically, the new dental graduate must be able to:

a. Promote the oral health of the community through education and participation in community-based activities.

b. Apply epidemiology to address public health issues and be able to incorporate the principles and techniques of epidemiology in solving clinical or community oral health problems.

Competency Domain II: Assessment of the Patient and the Oral Environment

Assessment must precede any treatment and enables the general dentist to provide appropriate oral health care.

Examination of the Patient

7. The new dentist must be able to perform a patient examination that collects biological, psychological, and social information needed to evaluate the medical and oral condition for patients of all ages. This includes the ability to recognize and manage behavioral factors that affect oral health and use the information to implement strategies that facilitate the delivery of oral health care. Specifically, the new dentist must be able to:

a. Identify the chief complaint of the patient and obtain a history of the present illness.

b. Obtain a reliable and valid medical, medication, family, psychological, and dental history.

c. Recognize signs of patient abuse and neglect, and report as required to legal authorities.

d. Evaluate the health risks of each patient including the use of tobacco products, alcohol, and other unhealthy behaviors.

e. Establish the comprehensive patient record as a legal document and maintain accurate patient treatment records using SOAP when appropriate.

f. Identify patient expectations and goals for dental care, and achievable results, including diagnostic procedures to assist in visualizing the desired outcome.

g. Initiate a consultation or referral to clarify questions related to the patient's systemic health, medications or mental health.

h. Perform a comprehensive extraoral, intraoral, and limited physical examination appropriate for the patient, including assessment of vital signs, and documentation of findings.

i. Prescribe, perform and interpret a radiographic examination appropriate for the patient.

j. Order relevant clinical laboratory and other diagnostic tests, understanding their diagnostic reliability and validity, and interpret their results.

k. Evaluate existing dental restorations, prostheses and the effects of missing teeth.

l. Produce diagnostic casts and mount them, when indicated, on a semi-adjustable articulator using a face-bow transfer and interocclusal records.

Diagnosis

8. The new dentist must be able to determine a differential, provisional, or definitive diagnosis by interpreting and correlating findings from the history and the patient interview, the clinical and radiographic examination, and other diagnostic tests. Specifically, the new dental graduate must be able to:

a. Relate extra-oral and intra-oral clinical findings to the presence of systemic disease(s) and discuss how the disease(s) affect overall health, treatment planning and delivery of dental care.

b. Assess the etiology and contributing factors, location, extent, and activity level of caries and periodontal diseases and identify conditions that require treatment, management or referral.

c. Differentiate pulpal health from disease, and identify conditions that require treatment, management or referral.

d. Diagnose oral mucosal and osseous diseases or disorders and identify conditions that require treatment, management or referral.

e. Identify the clinical characteristics of temporomandibular disorders and other orofacial pain conditions, and identify conditions that require treatment, management or referral.

f. Identify developmental or acquired occlusal abnormalities and identify conditions that require treatment, management or referral.

g. Determine the patient's esthetic requirements and discuss the degree to which those requirements can be met.

h. Identify the patient's behavior(s) which may contribute to orofacial problems.

i. Identify when patient discomfort and/or anxiety affects oral health or interferes with the delivery of care and identify conditions that require treatment, management or referral.

Treatment Planning

9. The new dentist must be able to develop, present, and discuss individual treatment plans considering all significant biological, psychological and socioeconomic patient factors. Specifically, the new dental graduate must be able to:

a. Develop an individualized disease control and preventive plan for the patient.

b. Develop a comprehensive, properly sequenced treatment plan based on all diagnostic data that acknowledges the unique needs and values of the patient.

c. Develop an alternative treatment plan or plans, as appropriate, to achieve patient satisfaction and to acknowledge that the patient is the center of care.

d. Communicate with other health care professionals to obtain additional information and/or treatment.

e. Present clinical and radiographic findings, diagnoses, treatment options and prognoses to the patient.

f. Obtain informed consent for proposed dental treatment.

g. Discuss the patient's responsibilities, time requirements, sequence of treatment, estimated fees and payment responsibilities.

h. Manage situations where patient's wishes and dentist's recommendations are in conflict.

Competency Domain III: Establishment of a Healthy Oral Environment

In order to maintain or establish a healthy oral environment, the general dentist must be competent to provide emergency, preventive, therapeutic, and maintenance care using evidence-based clinical judgment. When oral conditions are healthy and stable, prevention of disease and maintenance of health are the goals of subsequent care. When active oral disease exists, control of etiology and elimination of the disease and restoration to health are the goals of subsequent care. Competent clinical care is based upon a biomedical and behavioral foundation.

Emergency Treatment

10. The new dentist must be able to prevent, recognize, manage and/or promptly refer the majority of dental emergency situations encountered in the practice of dentistry. Specifically, the new dental graduate must be able to:

a. Diagnose and manage dental emergencies.

b. Prevent, manage, and/or promptly refer medical emergencies commonly encountered in dental practice.

Health Promotion and Maintenance

11. The new dentist must be knowledgeable of health promotion and preventive interventions and effectively work with patients to achieve a state of oral health. Specifically, the new dental graduate must be able to:

a. Instruct patients in effective oral hygiene methods and in the prevention of dental disease.

b. Develop educational and preventive strategies to assist patients in reducing oral disease risks and achieving oral health.

c. Prescribe and monitor effects of pharmacotherapeutic agents.

d. Assess patient's diet and provide nutritional counseling relevant to oral disease prevention.

c. Record and interpret oral health indices to determine patient progress in the prevention and elimination of oral disease.

d. Evaluate all treatment results and provide or recommend additional action to maintain oral health.

Restoration to Optimal Oral Health and Function

The new dentist must be able to provide oral health therapies that satisfy the functional and esthetic requirements of the patient. A desirable dentition is comfortable and effective in function, and socially pleasing in appearance. Dental disease, congenital deformity, or traumatic incidents may compromise any or all of these qualities to varying degrees. In order to rehabilitate a compromised dentition, the new dentist must be competent to provide dental treatment which restores form, function, and esthetics of defective and/or missing teeth.

12. The new dental graduate must be able to perform preventive and restorative procedures that preserve tooth structure, prevent hard tissue disease, and promote soft tissue health. Specifically, the new dental graduate must be able to:

a. Remove or treat carious tooth structure using techniques that maintain pulp vitality and restore the tooth to form, function and esthetics.

b. Create biomechanically sound restorations which support and retain anatomical, functional, and esthetic restorations and prostheses.

c. Treat typical dental diseases that occur in the primary, mixed, and permanent dentitions among cooperative children and adolescents.

d. Fabricate and place biomechanically sound provisional restorations and prostheses.

e. Obtain all necessary records and use them to prepare accurately articulated casts, including working casts used to fabricate restorations and prostheses.

f. Apply concepts related to physiologic occlusion to develop functional occlusal patterns.

g. Critique pre-arranged artificial teeth to meet the esthetic needs of the patient and the requirements of the clinical conditions.

h. Direct the laboratory fabrication of restorations and prostheses to correct anatomical form, function, and esthetics and modify them, when necessary, following critical evaluation.

i. Modify treatment plans, if indicated, based on disease progression, unexpected circumstances, or special patient needs.

j. Select and manipulate restorative materials to establish anatomical form, function and esthetics based on sound scientific principles.

k. Apply the understanding of dental biomaterials failure mechanisms to patient care.

l. Apply understanding of the principles governing the biocompatibility of dental biomaterials.

13. The new dental graduate must be able to treat and manage periodontal pathology in the primary, mixed, and permanent dentition. Specifically, the new dental graduate must be able to:

a. Manage factors contributing to the initiation and progression of the periodontal diseases.

b. Manage secondary periodontal etiologic factors.

c. Demonstrate an understanding of the principles of surgical periodontal techniques.

d. Explain and discuss the need for advanced periodontal surgical procedures and the proper method of referral for specialty care.

14. The new dental graduate must be able to evaluate, treat and manage conditions requiring reparative surgical procedures of the hard and soft tissues, and to employ appropriate pharmacological agents to support the treatment. Specifically, the new dental graduate must be able to:

a. Perform a simple extraction of an erupted tooth.

b. Perform a surgical extraction of an erupted tooth and the uncomplicated removal of fractured or residual root tips.

c. Perform simple preprosthetic surgical procedures.

d. Treat localized odontogenic infections.

e. Manage common intraoperative and postoperative surgical complications.

f. Explain the indications, contraindications and techniques for the management of complex conditions requiring surgical treatment.

15. The new graduate must be able to treat and manage functional disorders involving the masticatory system. Specifically, the new dental graduate must be able to:

a. Relate the dynamic integrated function of the masticatory system to their long-term oral function.

b. Identify the clinical conditions and the etiological /contributing factors associated with functional disturbances in the masticatory system.

c. Provide nonsurgical therapies for functional disorders of the masticatory system and appropriately refer patients with multifactorial oral pain disorders.

16. The new graduate must be able to evaluate and manage limited developmental or acquired occlusal discrepancies of the primary, mixed, and permanent dentition. Specifically, the new dental graduate must be able to:

a. Analyze and plan minor orthodontic treatment and recognize the need to refer complex cases to a specialist.

17. The new dental graduate must be able to diagnose, treat, and evaluate treatment outcomes of pulpal diseases and subsequent periradicular pathosis in the primary, mixed, and permanent dentition. Specifically, the new dental graduate must be able to:

a. Evaluate the pulp and periradicular tissues and arrive at a diagnosis and prognosis to formulate a treatment plan.

b. Perform endodontic treatment for single-rooted and multi-rooted permanent teeth including uncomplicated molars.

c. Perform post-operative evaluation of root canal treated teeth and supporting structures.

18. The new dental graduate must be able to recognize, manage and/or promptly refer oral mucosal and osseous diseases or disorders. Specifically, the new dental graduate must be able to:

a. Identify and manage or refer oral manifestations of systemic diseases and the oral sequelae of the treatment of systemic diseases due to medications and radiation therapy.

b. IIdentify and manage or refer oral medical disorders including injurious, developmental, infectious, metabolic, immunologic, neoplastic, reactive and degenerative conditions of the oral and perioral tissues.

Non-Independent skills

Students will have didactic familiarity and be exposed to the following concepts and skills, but are not expected to be able to perform these skills independently. The new dental graduate will:

1. Understand the principles and techniques involved in periodontal surgical procedures.

2. Understand the principles and techniques involved in the placement and restoration of endosseous implants.

Glossary of Terms in Competency-Based Education and Evaluation

• Active learning: Learning which focuses on student's individual responsibility to engage in continued learning, self-assessment in achieving and maintaining competency, and the pursuit of higher skill levels.

• Competencies: Statements describing the abilities needed to be in the independent practice of dentistry. Competencies combine foundation knowledge, skills, understanding, and professional values and are performed independently in realistic settings.

• Competency-based education: A planned sequence of student experiences designed to move students through the stages in the competency continuum. Different methods of instruction and evaluation are used as appropriate to each level of professional growth, and the entire sequence is coordinate to produce a competent beginning practitioner.

• Competency-based evaluation: Use of evaluation techniques and decisions that match the stages along the competency continuum. Novices are assessed with tests, beginner with simulation, and competent student with authentic evaluation. Management of students is guided by assessing the correct educational qualification path for each student to decide which experiences they are qualified for. Educational diagnosis of learning difficulties and remedial interventions are also part of the evaluation system.

• Behavioral objectives: Specific statements of expected student behavior as a result of a short-term educational experience, such as a lecture. A course typically has many behavioral objectives, most of which are cognitive in nature, although they might alternatively be in the psychomotor or affective domains. By contrast, competencies normally cross disciplines and always combine skill, understanding, and supporting values.

• Curriculum guidelines: Suggestions from special interest groups, usually disciplines or subdisciplines, about desired course topical coverage. There are no requirements for dental schools to conform to such guidelines, and the result of implementing all of them would be unreasonably large programs.
  

• Foundation knowledge and skills: The necessary core body of cognitive basic and behavioral science and psychomotor skills for novices and beginners. These are what students must know and be able to do to benefit from the curriculum experiences designed to produce competency.

• Treatment: The management and care of a patient for the purpose of combating a disease or disorder.

• Manage: Recognize and treat accordingly or refer and follow-up situations beyond the competency of the dentist.

• Management: Direction of care so that care is provided in a judicious manner which encourages patient compliance.