Competencies for the New General Dentist
As approved by the ADEA House of Delegates on April 2, 2008
Preamble
The general dentist is the primary oral health care provider, supported by dental specialists, allied dental professionals, and other health care providers. The general dentist will address health care issues beyond traditional oral health care and must be able to independently and collaboratively practice evidence-based comprehensive dentistry with the ultimate goal of improving the health of society. The general dentist must have a broad biomedical and clinical education and be able to demonstrate professional and ethical behavior as well as effective communication and interpersonal skills. In addition, he/she must have the ability to evaluate and utilize emerging technologies, continuing professional development opportunities and problem-solving and critical thinking skills to effectively address current and future issues in health care.
As used in this document, 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. Competency assumes that all behaviors are performed with a degree of quality consistent with patient well-being and that the general dentist can self-evaluate treatment effectiveness. In competency-based dental education, what students learn is based upon clearly articulated competencies and further assumes that all behaviors/abilities are supported by foundation knowledge and psychomotor skills in biomedical, behavioral, ethical, clinical dental science and informatics areas that are essential for independent and unsupervised performance as an entry-level general dentist. In creating curricula, dental faculty must consider the competencies to be developed through the educational process, the learning experiences that will lead to the development of these competencies, and ways to assess or measure the attainment of competencies.
The purpose of this document and the proposed foundation knowledge concepts are to:
- Define the competencies necessary for entry into the dental profession as a general dentist. Competencies must be relevant and important to the patient care responsibilities of the general dentist, directly linked to the oral health care needs of the public, realistic, and understandable by other health care professionals;
- Reflect (in contrast to the 1997 competencies) the 2002 IOM core set of competencies for enhancing patient care quality and safety, and illustrate current and emerging trends in the dental practice environment; they are divided into domains, are broader and less prescriptive in nature, are fewer in number, and most importantly will be linked to requisite foundation knowledge and skills;
- Serve as a central resource, both nationally for ADEA and locally for individual dental schools, to promote change and innovation in predoctoral dental school curricula;
- Inform and recommend to the Commission on Dental Accreditation standards for predoctoral dental education;
- Provide a framework for the change, innovation, and construction of national dental examinations, including those provided through the Joint Commission on National Dental Examinations and clinical testing agencies;
- Assist the development of curriculum guidelines, both nationally for ADEA and locally for individual dental schools, for both foundation knowledge and clinical instruction;
- Provide methods for assessing competencies for the general dentist;
- Through periodic review and update, serve as a document for benchmarking, best practice, and interprofessional collaboration and additionally, as a mechanism to inform educators in other health care professions about curricular priorities of dental education and entry-level competencies of general dentists.
Domains
- Critical Thinking
- Professionalism
- Communication and Interpersonal Skills
- Health Promotion
- Practice Management and Informatics
- Patient Care
- Assessment, Diagnosis, and Treatment Planning
- Establishment and Maintenance of Oral Health
The statements below define the entry-level competencies for the beginning general dentist:
1. Critical Thinking:
Graduates must be competent to:
1.1 Evaluate and integrate emerging trends in health care as appropriate.
1.2 Utilize critical thinking and problem-solving skills.
1.3 Evaluate and integrate best research outcomes with clinical expertise and patient values for evidence-based practice.
2. Professionalism
Graduates must be competent to:
2.1 Apply ethical and legal standards in the provision of dental care.
2.2 Practice within one's scope of competence and consult with or refer to professional colleagues when indicated.
3. Communication and Interpersonal Skills
Graduates must be competent to:
3.1 Apply appropriate interpersonal and communication skills.
3.2 Apply psychosocial and behavioral principles in patient-centered health care.
3.3 Communicate effectively with individuals from diverse populations.
4. Health Promotion
Graduates must be competent to:
4.1 Provide prevention, intervention, and educational strategies.
4.2 Participate with dental team members and other health care professionals in the management and health promotion for all patients.
4.3 Recognize and appreciate the need to contribute to the improvement of oral health beyond those served in traditional practice settings.
5. Practice Management and Informatics
Graduates must be competent to:
5.1 Evaluate and apply contemporary and emerging information including clinical and practice management technology resources.
5.2 Evaluate and manage current models of oral health care management and delivery.
5.3 Apply principles of risk management, including informed consent and appropriate record keeping in patient care.
5.4 Demonstrate effective business, financial management, and human resource skills.
5.5 Apply quality assurance, assessment, and improvement concepts.
5.6 Comply with local, state and federal regulations including OSHA and HIPAA.
5.7 Develop a catastrophe preparedness plan for the dental practice.
6. Patient Care
A. Assessment, Diagnosis, and Treatment Planning
Graduates must be competent to:
6.1 Manage the oral health care of the infant, child, adolescent, and adult, as well as the unique needs of women, geriatric and special needs patients.
6.2 Prevent, identify, and manage trauma, oral diseases, and other disorders.
6.3 Obtain and interpret patient / medical data, including a thorough intra/extra oral examination, and use these findings to accurately assess and manage all patients.
6.4 Select, obtain, and interpret diagnostic images for the individual patient.
6.5 Recognize the manifestations of systemic disease and how the disease and its management may affect the delivery of dental care.
6.6 Formulate a comprehensive diagnosis, treatment, and/or referral plan for the management of patients.
B. Establishment and Maintenance of Oral Health
Graduates must be competent to:
6.7 Utilize universal infection control guidelines for all clinical procedures.
6.8 Prevent, diagnose, and manage pain and anxiety in the dental patient.
6.9 Prevent, diagnose, and manage temporomandibular disorders.
6.10 Prevent, diagnose, and manage periodontal diseases.
6.11 Develop and implement strategies for the clinical assessment and management of caries.
6.12 Manage restorative procedures that preserve tooth structure, replace missing or defective tooth structure, maintain function, are esthetic, and promote soft and hard tissue health.
6.13 Diagnose and manage developmental or acquired occlusal abnormalities.
6.14 Manage the replacement of teeth for the partially or completely edentulous patient.
6.15 Diagnose, identify, and manage pulpal and periradicular diseases.
6.16 Diagnose and manage oral surgical treatment needs. .
6.17 Prevent, recognize, and manage medical and dental emergencies.
6.18 Recognize and manage patient abuse and/or neglect.
6.19 Recognize and manage substance abuse.
6.20 Evaluate outcomes of comprehensive dental care.
6.21 Diagnose, identify, and manage oral mucosal and osseous diseases.
Appendix
Glossary of Terms
Critical thinking: 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.
Competency: a complex behavior or ability essential for the general dentist to begin independent, unsupervised dental practice; it assumes that all behaviors and skills are performed with a degree of quality consistent with patient well-being and that the general dentist can self-evaluate treatment effectiveness.
Curriculum guidelines (content): the relevant and fundamental information that is taught for each category of foundation knowledge; these are to be used as curriculum development aids and should not be construed as recommendations for restrictive requirements.
Domain: broad, critical category of activity for the general dentist.
Emerging technologies: current and future technologies used in patient care including technologies for biomedical information storage and retrieval, clinical care information, and technologies for use at the point of care.
Evidence-based dentistry: an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence relating to the patient's oral and medical condition and history integrated with the dentist's clinical expertise and the patient's treatment needs and preferences.
Foundation knowledge and skills: the basic essential knowledge and skills linked to and necessary to support a given competency; these would serve to help guide curriculum in dental schools, help assist educators in removing irrelevant, archaic information from current curricula, aid in including important new information, and help test construction committees develop examinations based upon generally-accepted, contemporary information.
General dentist: the primary dental care provider for patients in all age groups who is responsible for the diagnosis, treatment, management, and overall coordination of services related to patients' oral health needs.
Health promotion: public health actions to protect or improve oral health and promote oral well-being through behavioral, educational and enabling socio-economic, legal, fiscal, environmental, and social measures; it involves the process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health; includes education of the public to prevent chronic oral disease.
Informatics: applications associated with information and technology used in health care delivery; the data and knowledge needed for problem solving and decision making and the administration and management of information and technology in support of patient care, education, and research.
Interprofessional health care: the delivery of health care by a variety of health care practitioners in a cooperative, collaborative, and integrative manner to ensure care is continuous and reliable.
Management: includes all actions performed by a health care provider that are designed to alter the course of a patient's condition; such actions may include providing education, advice, treatment by the general dentist, treatment by the general dentist after consultation with another health care professional, referral of a patient to another health care professional, monitoring treatment provided, and may also include providing no treatment or observation.
Patient-centered care: the ability to identify, respect, and care about patients' differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision-making and management; and continuously advocate disease prevention, wellness, and promotion of healthy life styles, including a focus on population health.
Problem-solving: the process of answering a question or achieving a goal when the path or answer is not immediately obvious using an acceptable heuristic or strategy such as the scientific method.
Special needs care: an approach to oral health management tailored to the individual needs of people with a variety of medical conditions or physical and mental limitations that require more than routine delivery of oral care; special care encompasses preventive, diagnostic, and treatment services.