VA Maryland Health Care System

Goals and Objectives for Resident Training

Upon completion of the program the resident will be able to act as a primary oral health care provider for;

1. Providing emergency and multidisciplinary comprehensive oral health care.
2. Obtaining informed consent.
3. Functioning effectively within interdisciplinary health care teams, including consultation and referral.
4. Providing patient-focused care that is coordinated by the general practitioner.
5. Directing health promotion and disease prevention activities.
6. Using advanced dental treatment modalities such as microscopy, rotary endodontics, electronic apex location, digital radiography, surgical hand pieces and dental materials.

Upon completion of the program the resident will be able to assess, diagnose and plan for the provision of multidisciplinary oral health care for a wide variety of patients with special needs. (Those patients whose medical, physical, psychological, or social situations make it necessary to modify normal dental routines in order to provide dental treatment for that individual). These individuals include, but are not limited to, people with developmental disabilities, complex medical problems and significant physical limitations.

Upon completion of the program the resident will be able to manage the delivery of patient-focused oral health care relating to the patient's social, cultural, behavioral, economic, medical and physical status.

Upon completion of the program the resident will be able to provide the following at an advanced level of skill and complexity beyond that accomplished in pre-doctoral training.

A. Operative Dentistry 

1. Diagnose and treatment plan the need for restorations via oral exam, radiographic interpretation and other diagnostic data.
2. Determine the appropriate restorative material and technique.
3. Perform comprehensive operative dentistry.
4. Diagnose and treat operative emergencies.
5. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

B. Replacement of teeth using fixed and removable prosthodontics 

1. Diagnose and treatment plan the need for fixed and/or removable appliances.
2. Make and assess preparations for fixed and removable appliances.
3. Make and assess impressions for fixed and removable appliances.
4. Construct provisional/interim restorations.
5. Design, request and evaluate the fabrication of prosthetic work performed by lab technicians.
6. Evaluate and deliver the final prosthesis.
7. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

C. Periodontal Therapy 

1. Diagnose, chart, classify, treatment plan, assess and manage the treatment of periodontal disease.
2. Provide comprehensive periodontal care using chemical and non-surgical technique.
3. Provide basic periodontal therapy and recognize the need for referral of complicated and advanced cases.
4. Manage surgical periodontics and advanced or complicated cases.
5. Assess and evaluate the prognosis and effectiveness of treatment.
6. Diagnose and treat periodontal emergencies.
7. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

D. Endodontic Therapy 

1. Diagnose pulpal and periapical pathology and determine/treatment plan the need for endodontic therapy.
2. Diagnose and provide initial treatment/referral of endodontic emergencies.
3. Recognize the need for consultation/referral of complicated or advanced cases.
4. Perform uncomplicated traditional or rotary endontics.
5. Manage complicated or advanced endodontic cases.
6. Demonstrate proficiency as evidenced by staff appraisals and self appraisals

E. Oral Surgery 

1. Diagnose, treatment plan and perform uncomplicated extractions and uncomplicated surgical extractions to include alveoloplasty.
2. Diagnose and treat/manage (based on complexity) the need for preprosthetic surgery.
3. Diagnose and treat/manage (based on complexity) the need for I and D of abscess.
4. Diagnose and treat/manage (based on complexity) the need for biopsy.
5. Diagnose, treatment plan and manage the treatment of complicated or advanced surgical extractions.
6. Provide initial treatment and appropriate referral for oral surgery emergencies.
7. Recognize the need for consultation or referral.
8. Diagnose and treat/manage postoperative complications.
9. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

F. Evaluation and treatment of dental emergencies 

1. Diagnose and provide treatment for uncomplicated dental emergencies.
2. Diagnose and provide initial treatment of complicated/advanced dental emergencies, and then manage these emergencies through appropriate consultation and referral.
3. Recognize the need for consultation and/or referral of dental emergencies.
4. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

G. Pain and anxiety control utilizing behavioral and pharmacological techniques. 

1. Diagnose and evaluate the patient's level of pain and/or anxiety.
2. Treatment plan and provide control of pain and anxiety through local, behavioral and pharmacological techniques.
3. Determine when to refer the patient for management of the appropriate level of pain and anxiety control.
4. Determine the ability of the patient to safely undergo the appropriate type of pain/anxiety control through appropriate medical risk assessment and/or consultation.
5. Anticipate, prevent, diagnose and treat/manage complications and medical emergencies arising from pain and anxiety control.
6. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

Upon completion of the program the resident will be able to manage (diagnose and treatment plan the need for care and coordinate the delivery of that care) the following;

A. Medical emergencies 

1. Anticipate, prevent, diagnose and manage potential medical emergencies through medical risk assessment.
2. Anticipate the impact of systemic disease on dental treatment and the effect of dental treatment on medical health.
3. Anticipate, diagnose and provide initial treatment for medical emergencies to include BLS.
4. Manage medical emergencies after initial diagnose and treatment has been performed.
5. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

B. Implants 

1. Diagnose and treatment plan the need for implants including appropriate patient selection.
2. Place and restore uncomplicated implant cases.
3. Manage the placement and restoration of complicated or advanced implant cases to include directing ideal implant placement and evaluating of the quality of treatment provided by the referral.
4. Diagnose and treat implant emergencies for initial care, then manage via referral.
5. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

C. Oral mucosal diseases 

1. Diagnose and treatment plan the need for evaluation of abnormal mucosal lesions and abnormal radiographic appearance.
2. Recognize the need for consultation/referral of lesions.
3. Diagnose and treatment plan the need for biopsy. Perform uncomplicated/simple biopsies and manage complicated/difficult biopsies.
4. Diagnose and treat complications of oral mucosal disease treatment and biopsy.
5. Recognize the oral manifestation of systemic disease.
6. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

D. Temporomandibular disorder and orofacial pain 

1. Diagnose and manage temporomandibular disorder and orofacial pain.
2. Provide conservative therapy to include construction of an occlusal appliance.
3. Recognize the need for consultation and referral.
4. Evaluate and assess the quality of care given by the provider to whom the referral was made.
5. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

E. Occlusal disorders 

1. Diagnose and manage occlusal disorders.
2. Diagnose and provide minor occlusal adjustment.
3. Recognize the need for consultation and referral for cases involving more than minor occlusal disorders to include full mouth equilibration, orthodontic and orthognathic disorders.
4. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

The program will include:

1. Assignments in the critical review of scientific literature.
2. Involvement in a structural system of continuous quality improvement for patient care.
3. BLS certification.

The program will provide the resident with formal instruction in physical evaluation and medical assessment to include;

1. Taking, recording, and interpreting a complete medical history.
2. Understanding the indications of and interpretations of laboratory studies and other techniques used in the diagnosis of oral and systemic diseases.
3. Understanding the relationship between oral health care and systemic disease.
4. Interpreting the physical evaluation performed by a physician with an understanding of how it impacts on proposed dental treatment.
5. Appropriately interacting with other health care providers.

The program will provide the resident with instruction in the principles of practice management.

The program will provide the resident with an understanding of hospital organization, function, the credentialing process and confidentiality of information.

The resident will receive training and experience in the management of inpatients or same day-surgery patients to include:

1. Reviewing medical histories and physical examinations.
2. Prescribing treatment and medications.
3. Providing care in the operating room
4. Preparing the patient record, including notations of medical history, review of physical examination, pre- and post-operative orders and description of surgical procedures.

Goals and Objectives for off-service rotations 

Anesthesia

The resident will receive supervised practical experience in the following:

Preoperative evaluation
Assessment of the effects of behavioral and pharmacologic techniques
Venipuncture technique
Patient monitoring
Airway management and intubation
Administration of pharmacologic agents
Prevention and treatment of anesthetic emergencies
Assessment of patient recovery from anesthesia

Primary Care Medicine

The resident will receive supervised practical experience in the following:

Obtaining and interpreting the patient’s chief complaint, medical and social history, and review of systems
Obtaining and interpreting clinical and other diagnostic data from other health care providers
Using the services of clinical, medical, and pathology laboratories
Performing a history and physical evaluation and collecting other data in order