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WellSpan Medical Education

General Practice Residency Goals and Objectives

Introduction to the goals and objectives

The upcoming year will be rigorous and is designed to give you an opportunity to gain clinical experience and proficiency in a wide variety of medical and dental areas. The subsequent sections outline the goals and objectives for the residency program. It is expected at the completion of the year that you will have had exposure or gained proficiency as noted in each of the areas listed. It is important that you become familiar with these goals and objectives. During the course of the year through evaluations, meetings with your mentor, and daily interaction with faculty these areas will be assessed to ensure you are receiving the necessary experience and training to meet the stated goals.

Patient Assessment and Diagnosis

I. Medical Risk Assessment

    1. Medical history (ROS, social history, family history, hospitalizations, medications/allergies)
    2. Assignment of ASA classification
    3. Medical management
      a. Systemic disease and dental treatment implications
      b. Development of interdisciplinary skills

II. Dental Assessment

    1. Dental history
    2. Intraoral and extraoral examination
    3. Appropriate charting and radiographs
    4. Diagnosis

Planning and providing comprehensive multidisciplinary oral health care

I. Treatment planning

    1. Development of a comprehensive treatment plan based on sound diagnoses
    2. Appropriate sequence of treatment
    3. Effective revision of treatment as indicated by changing of patient’s needs
    4. Modification of treatment secondary to patient’s medical conditions
    5. Informed consent and treatment options

II. Delivery of comprehensive care with appropriate multidisciplinary treatment

    1. Providing comprehensive care at a level beyond a recent dental graduate
    2. Developing a team approach in the management of complex cases and utilizing appropriate referral
    3. Pre and Post treatment communication

Hospital Dentistry

I. Admissions/Discharge of Same day surgeries

    1. Pre-admission preparation
      a. Review of history & physical
      b. appropriate labs
      c. medications
      d. diagnostic studies
    2. Pre-operative orders
    3. O.R. protocol and consent
    4. Operative reports
    5. Post-operative orders and notes
    6. Discharge instructions and follow-up

II. Inpatient Consults

    1. Requesting medical consults
    2. Conducting consults from other services and providing appropriate treatment

III. Call Responsibilities (Emergency Department coverage)

IV. Hospital Governance

    1. Hospital organization/structure
    2. Credentialing Process
    3. Application for privileges
    4. Hospital record protocol

Outpatient

I. Practice Management

    1. Financial considerations (dental insurance contracts, payment options, pre-authorizations, financial contracts)
    2. Insurances (malpractice, disacility, etc)
    3. Associateships/partnerships
    4. Employee management
    5. Informational technology
    6. Quality management

II. Infection Control

    1. OSHA/infection control protocol
    2. Ethics and Patient Care

III. Ergonomics

    1. Four handed dentistry

IV. Multidisciplinary Skills

    1. Team approach
    2. Appropriate referral
    3. Communication
    4. Follow-up

V. Community service

    1. SMA’s (shared medical/dental appointment)
    2. Margaret Moul rotation
    3. Community cancer center meetings
    4. Healthy York Network

Ethics and Professionalism

I. Ethical Theories

II. Professional responsibility and patient care as it relates to ethical decision making

Off-Service Rotations

I. Anesthesia Rotation

    1. Perform a proper pre-operative evaluation
    2. Properly assess the effects of pharmacologic agents
    3. Gain experience in venipuncture techniques and the administration of intravenous agents
    4. Experience in airway management
    5. Experience and participate in anesthetic induction and intubation
    6. Participate in the administration of anesthetic agents
    7. Gain experience in the anticipation, recognition and management of medical emergencies that can occur in the administration of anesthesia

II. Medicine Rotation

    1. Gain experience in taking, recording and interpreting a complete medical history
    2. Be familiar with the routine elements of a physical examination which include vital signs, head, eyes, ears, nose and throat (HEENT), cardiovascular system, lungs, abdomen, muscular skeletal system and neurological system
    3. Residents will learn to interpret the physical evaluation performed by a physician with an understanding of the process, terms and techniques employed.
    4. Developing an understanding for the indications of laboratory studies and other techniques used in the diagnosis of oral and systemic diseases and how to interpret their results
    5. Developing an understanding of the relationship between oral health care and systemic disease
    6. Gain experience in the technique of physical examination (ie. Inspection, palpation, percussion, and auscultation)

III. Emergency Medicine Rotation

    1. Participate in the treatment of medical emergencies that may occur concurrently with dental treatment
    2. Exposure in ordering laboratory tests, radiographic studies and other specific tests as needed to appropriately treat medical emergencies
    3. Gain experience in the interpretation of radiographic studies (ie. Cat scans, MRI’s and other radiographs)
    4. Develop skills in airway management
    5. Developing and understanding the skills needed to support a patient’s respiratory and/or circulatory system when required because of systemic collapse

Restorative

I. Remain current in the field of operative dentistry and learn indications for amalgams, resins (anterior and posterior), glass ionomers, bonding agents

II. Properly prepare teeth for the above mentioned restorative materials with recommended cavity preparations

III. Know the indications for post placement

IV. Understand indication for inlay/onlay and crown placement

V. Be familiar with different crown materials

Periodontal Therapy

I. To properly diagnose and classify gingivitis and periodontal disease with clinical and radiographic findings

II. To effectively treat periodontal disease with appropriate treatment, patient education, maintenance and referrals

III. To assist or perform periodontal surgery including: gingivectomy, crown lengthening, implant placement and gingival grafts

IV. To have an understanding of the esthetic aspect of periodontal tissues when performing surgical procedures in the anterior portions of the oral cavity and also in the placement of anterior implants

Occlusion

I. Occlusion overview

|II. TMJ disorders and orofacial pain

III. Occlusal disorders

Oral Surgery

I. Hard and Soft Tissue Surgery

    1. Resident will be able to perform routine extractions
    2. Resident will be able to surgically extract fully erupted teeth
    3. Resident will have exposure and some experience in third molar extractions
    4. Resident will be able to manage oral mucosal diseases
    5. Resident will have exposure in pre-prosthetic surgery
    6. Resident will have insight to clinical limitations and the need for appropriate referral

II. Treatment of Medical and Dental Emergencies

    1. Treatment of head and neck infections
      a. Medical/dental assessment (ROS, medications, allergies, HPI)
      b. Appropriate dx through the use of clinical examination, radiographs, and laboratory studies
      c. Antiobiotic therapy and its limitations
      d. Indications for culturing and technique
      e. Appropriate treatment and referral
    2. Dental alveolar trauma and oral maxillofacial trauma
      a. Medical/dental assessment (ROS, medications, allergies, HPI)
      b. Proper diagnosis through the use of clinical examination, radiographs, and laboratory studies
      c. Providing appropriate treatment for dental alveolar trauma and follow-up care
      d. Exposure to oral maxillofacial trauma with experience in diagnosing and developing communication skills with the oral maxillofacial surgeon
    3. Post operative complications< /br> a. post operative bleeding
      b. alveolar osteitis
      c. pain management< /br> d. post operative infections
    4. Management of Medical Emergencies< /br> a. recognition of medical emergencies and identifying the type and source of the medical problem< /br> b. appropriate management of medical emergencies and identifying the need for EMS activation< /br> c. documentation with medical/legal ramifications and appropriate follow-up

Endodontics

I. To properly diagnose pulpal pathology using clinical exams, tests and radiographs

II. To diagnose and provide appropriate pulpal therapy for traumatized teeth, including crown fractures, root fractures, luxations, and avulsions

III. To diagnose and treat cracked tooth syndrome

IV. To be proficient in the use of rotary endodontics and condensation

V. To be proficient at conventional and rotary endodontics for anterior teeth, bicuspids and uncomplicated molars

VI. Understand clinical limitations and when referral is indicated

VII. Appropriate treatment of post-endodontic complications

Pharmacology

I. Use of common dental medications

    1. Local anesthetic
    2. Anxiety medications
    3. Antibiotics
    4. Analgesics

II. Drug interactions (over the counter) Prescription Drugs and Street Drugs

III. Drugs and effects on dental treatment

IV. Herbal medications

Pain and Anxiety Control

I. Perform a thorough patient evaluation and assign an ASA classification prior to treatment

II. Control pain and anxiety in a conscious patient with the use of behavior management, local anesthesia, inhalation analgesia, combination sedation

III. Become familiar with venipuncture and anesthetic emergency management

IV. Understand the risks, benefits, indications for dental treatment with any of the sedation modalities

V. Understand the indications and contraindications for the different sedation techniques

Pediatrics

I. Diagnosis and treatment planning

II. Pediatric restorative procedures

III. Pulpal therapy for pediatric patients including primary teeth and premature secondary teeth (open apices)

IV. Behavioral and pharmacokinetic modalities with the pediatric population

    1. Nitrous oxide
    2. Chairside behavioral skills

V. Space maintenance

VI. Developing skills to effectively treat special needs patients with developmental and physical disabilities

Preventive Dentistry

I. Patient education and motivation

II. Microbiology of caries formation and patient behavioral modification to control caries rates

III. Fluorides in a preventive program topical/systemic

IV. Nutritional assessment of dental patients

Implant Dentistry

I. Appropriate diagnosis and treatment planning

II. Surgical considerations in placement of implants

III. Surgical placement and restoration of implants

IV. Esthetic considerations for anterior implant placement and restoration

V. Follow-up and maintenance of implant dentistry

Orthodontics

I. Overview of space maintenance, growth and development, and adjunct orthodontic therapies

Fixed and Removable Prosthetics

I. To diagnose a patient’s need for replacement of missing teeth and to treatment plan appropriately taking into consideration the indications and contraindications for fixed, removable and implant prosthesis

II. To gain experience in fabricating complete and partial removable dentures, fixed dentures, immediate dentures, overdentures, and restoring implants

III. To select the appropriate prosthetic materials and develop an appropriate occlusal scheme

Research (Optional)

I. Identify and utilize the different roles of the Emig Research Center

II. Know where to obtain research information

III. Define the term research in human subject

IV. Review IRB/HITAA regulations

V. Identify resources for implementing research projects

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