Competency Statements

For a resident to successfully complete the program, a rating of “Competent,” “Proficient” or “Expert” must be achieved in all competency areas by the end of the program, unless listed as optional.

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Global Competencies

Ethics / Professional Conduct
1. Ethics: Practice and promote professionalism and ethical principles in all aspects of the program, particularly with colleagues, staff, and patients regardless of their age, culture, socio-economic/educational/professional background or lifestyle preferences.
Attitude
1. Attitude: Self-assess abilities and limitations. Have a positive attitude and be an inquisitive, continuous learner who strives for quality education and self-improvement. Demonstrate organization, responsibility, reliability and punctuality.
Didactics
1. Academic presentations: Prepare and present patient cases of interest to colleagues, both formally and informally. Review the literature as appropriate. Prepare and present a formal lecture on a topic pertinent to dentistry or the practice thereof.
2. Emergency preparedness: Complete BLS and ACLS training. Participate in simulated medical emergency scenarios.
3. Legal: Learn about how the WA State Dental Quality Assurance Commission (DQAC) reviews complaints with regard to the WACs. Participate in the annual legislative process.
Practice Management
1. Efficiency: Use scheduling systems, insurance and financial arrangements to maximize production in dental practice.
2. Business: Gain an understanding of how to manage a CHC clinic and a private practice, including staffing, operations, facilities and finances.
3. Experts: Understand how to maximize the benefits of CPAs, bankers, attorneys and consultants with relation to dental practice.

General Dental Rotation Competencies

Overall Oral Health Care
1. Comp oral health provider: Function as the patient's primary and comprehensive oral health care provider—particularly patients with medically complex and/or special needs. Apply “Best Care” principles to all patient care interaction.
2. OSHA: Practice all accepted sterilization, disinfection, universal precautions and occupational hazard prevention procedures.
3. Public Health: Understand current trends of oral health care delivery as they apply at the community, state and national levels. Learn about the FQHC and Community Clinic systems, including community access-to-care issues.
4. Factors: Understand how cultural and social factors influence disease prevention, prevalence and delivery of oral care.
5. Access: Participate in the dental care of underserved populations.
Patient Evaluation and Plan of Care
1. H&P: Consistently obtain a quality medical history that identifies and characterizes the patient’s CC, HxPI, PMHx, surgeries/hospitalizations, ROS, medications, allergies and any other pertinent information. Perform a proper physical examination appropriate to the needs of the patient. Understand the “classic” H&P examination.
2. Diagnostics: Order/obtain and interpret appropriate imaging (radiographs, CT), laboratory data, diagnostic tests and any other additional information necessary to make appropriate treatment decisions.
3. Supplemental information: Look up supplemental information about “unknowns” (medications, syndromes, diseases, conditions, therapies, tests, etc.) sufficient for making educated decisions about patient care.
4. Experts: Utilize the services of medical doctors and other health care professionals as appropriate to make quality patient care decisions.
5. Assess risk: Establish an assessment of risk and differential/provisional/definitive diagnosis (es).
6. Tx plan: Integrate collected data and demonstrate sufficient understanding of the patient’s condition to create an individually appropriate, comprehensive, phased and sequenced plan of care. Obtain informed consent as appropriate.
Pharmacology/Pain control
1. Pharmacology: Appropriately utilize a variety of pharmacologic agents commonly required in dentistry, including local anesthetics, analgesics, sedatives, antiemetics, steroids, fluorides and antimicrobial medications. Use advanced theory/techniques where possible (for example, Gow-Gates, V2 division blocks, intraosseous delivery, scheduled dosing, trays, etc.).
2. Pain control: Provide control of acute pain through the proper use of psychological interventions, behavior management techniques, local anesthesia, sedatives and analgesics. Diagnose and manage patients with uncomplicated chronic pain complaints.
Sedation
1. Patient selection: Select an appropriate sedation modality for patients who would benefit from the use of sedation.
2. Provision: Provide appropriate oral +/- N2O minimal sedation and intravenous moderate sedation. Demonstrate appropriate record keeping. Understand how to prevent, recognize and manage complications related to the use of sedation.
Restorative dentistry
1. Materials/Knowledge: Incorporate latest scientific knowledge/principles to prescribe which restorative material to use in a given situation.
2. Technical quality: Restore single and multiple teeth (foundations and final restorations) utilizing amalgam, composite, gold, porcelain or other accepted materials while demonstrating advanced skills (speed, efficiency, finesse, etc.), without sacrificing quality.
Periodontics
1. Prevention: Use accepted prevention strategies such as oral hygiene instruction, nutritional education and pharmacologic intervention to help patients maintain or improve their oral health.
2. Perio Tx: Diagnose and treat early and moderate periodontal disease using nonsurgical, pharmacologic and surgical procedures. Manage advanced disease where possible.
Endodontics
1. Dx endo: Diagnose and treat pain of pulpal origin.
2. Technical skill: Perform uncomplicated non-surgical anterior and posterior endodontic therapy utilizing conventional and rotary techniques.
3. Complications: Understand how to manage mild-moderate endodontic complications.
4. Surgical endo: Understand the principles of, and indications for, surgical endodontic therapy. Perform an apicoectomy, if possible.
Prosthodontics
1. Dentures: Replace missing teeth/structures with properly designed and fitted removable (CD/RPD/implant-retained) dentures. Communicate case design with laboratory technicians and evaluate the resultant prostheses.
Implants
1. Tx plan: Evaluate patients for implants; prescribe what type of implant(s) should be placed, and in what location(s).
2. Placement: Appropriately place endosseous implants using proper principles and techniques, including simple bone grafting.
3. Restoration: Design and place proper final restorations (abutments/crowns, attachments) on implants.
Oral surgery
1. Evaluation: Evaluate complexity of exodontia, based upon clinical and radiographic (conventional / CT) data.
2. Dentoalveolar: Perform nonsurgical and surgical extraction of erupted, soft-tissue and bony-impacted teeth. Perform uncomplicated pre-prosthetic surgery (tori/exostoses removal, frenectomy, alveoplasty, etc.). Manage complications related to intraoral surgical procedures (i.e., infection, bleeding, and dry socket).
3. Orthognathics: Participate in the management of orthognathic surgery patients to gain an understanding of the issues involved.
4. Biopsies: (OPTIONAL) Perform biopsies of oral tissues.
Oral medicine
1. TMD: Understand basic TMD disorders. Manage conservatively, using orthotics (nightguards, repositioning stents, etc.), physical therapy and medications where appropriate. Provide referral, when appropriate.
2. Oral mucosal diseases: Recognize and manage oral mucosal diseases (i.e., autoimmune conditions, cancer, mucositis, and drug reactions). Use palliative care, biopsy, pharmacologic intervention or referral, as appropriate.
Orthodontics/Occlusion
1. Ortho and occlusion: Evaluate patients for occlusal disorders including malocclusion, attrition, erosion, rumination, occlusal interferences, etc. Provide appropriate intervention (treat vs. refer), as appropriate.
Hospital dentistry
1. GA cases: Perform preoperative History and Physical examinations, write orders and provide general dental treatment for adults in the O.R. setting, including appropriate perioperative activities and paperwork.
2. Hospital consults: Perform dental consultations and request medical consultations for hospitalized and other “complex/special needs” patients.
Dental Emergency Management
1. Eval/triage: Appropriately evaluate and triage incoming emergent needs.
2. Orofacial injuries: Manage uncomplicated toothaches, mild to moderate infections using appropriate drains and medications, avulsed/luxated/subluxated/fractured teeth, and lacerated intraoral and extraoral tissues.
3. Fractures: Understand the diagnosis and treatment of common maxillofacial osseous fractures. Work up and manage uncomplicated fractures with OMFS guidance.
Pediatric dentistry
1. Eruption theory: Understand and apply eruption and exfoliation sequences, management of the developing dentition, infant oral health guidelines.
2. Peds pharm: Appropriately modify pharmacologic agents (local anesthesia, fluoride, antibiotics, analgesics) for the pediatric patient.
3. Tx plan: Provide age-appropriate treatment plans.
4. Habits: Manage oral habits such as thumb sucking, bruxism, etc.
5. Behavior management: Use pharmacologic (oral/N2O) and non-pharmacologic behavior-management skills with the pediatric patient.
6. Parent control: Provide quality interaction and information for the parents of pediatric patients.
7. Restorative: Restore intra/extra-coronal defects in the primary dentition (amalgam, composite, SSC’s).
8. Pedo endo: Perform pediatric pulpal therapy.
9. Surgery: Perform uncomplicated surgical procedures on pediatric patients.
10. Ortho: Diagnose, prescribe and fit limited orthodontic and/or space maintenance appliances.
11. GA: Provide dental care under general anesthesia for pediatric patients.
12. Emergency tx: Provide emergency treatment (toothache, infections, and trauma) for pediatric patients.

Medicine Rotation Competencies

Internal Medicine
1. Experience medicine: Witness how our medical colleagues approach the management of illness, including medications, surgery and non-surgical therapies. Link our didactic training about medical conditions with real-life clinical presentations.
2. H&P refinement: Refine skills in obtaining an H&P.
3. Protocols: Learn about hospital protocols/procedures, including orders, notes and reports in the electronic medical record (EPIC).
Cardiology
1. Didactics: Learn about cardiac anatomy, physiology, pathophysiology and medical/surgical therapeutics.
2. Cardiology: Experience how patients are worked up, diagnosed and treated in both the outpatient & inpatient setting.
3. Cardiothoracic surgery: Witness cardiac surgery to gain a better understanding of cardiac disease, surgical capabilities, operating room protocols and perfusion therapy.
Anesthesia
1. Assessment: Evaluate the patient’s physical status, relate it to the planned surgical procedure and help determine choice of anesthesia.
2. Equipment: Appropriately prepare and use the anesthesia equipment, monitors and medications during MACs and GAs.
3. Pharmacology: Understand basic pharmacology, pharmacokinetics and interaction of commonly used anesthetic and sedative medications, as well as secondary medications utilized during general anesthesia (e.g., muscle relaxants, analgesics, etc.).
4. Fluids: Understand the basic principles of fluid and electrolyte balance.
5. Airway: Manage routine/non-complex airways using bag-valve-mask, LMA, nasal and oral intubation techniques.
6. Venipuncture: Perform routine/non-complex venipuncture and insertion of intravenous catheters for the infusion of fluid.
7. Recovery: Participate in the management of patients during recovery from anesthesia.
8. Didactics: Demonstrate self-directed learning and accountability of assigned reading topics. Actively participate in discussion sessions with the Anesthesia faculty on various topics of their choosing.
Emergency Medicine
1. Assessment: Learn to physically evaluate a multi-trauma patient and apply those principals to the evaluation of a dental trauma patient. Learn how certain psychosocial factors (such as domestic or child abuse) play a role in trauma.
2. Protocols: Learn the proper protocols and methods involved in establishing the condition of an acutely ill or trauma patient, such as neurological status and hemodynamic status. Learn when it is appropriate to get certain specialties involved in the care of a sick patient.
3. Evaluation: Learn how to appropriately order laboratory and imaging studies on acutely ill or trauma patients.