Criterion Referenced Evaluation

CNIH - Dental Hygiene Program2012

Revised March 2012

CANADIAN NATIONAL INSTITUTE OF HEALTH

Dental Hygiene Program

Spring 2012

CLINIC MANUAL

Section III – Clinical Assessment Performance Criteria

Table of Contents

Criterion Referenced Clinical Assessment 4

Format of Formative Clinical Sessions5

Clinical Feedback Class5

Prior to the Commencement of Clinic5

Throughout the Clinical Session5

Ensuring Public Safety in Clinical Education6

Duty Student Assignment6

End of Clinical Session6

Remediation7

Instructor Calibration7

Summative Evaluation of Clinical Performance7

Assessment of skills and/or procedures in clinical sessions8

Clinical Assessment Performance Criteria

Case Presentations

Adult minimal care 9

Adult periodontally involved 10

Child/adolescent 11

Senior adult 12

Case Decisions 13

Care Plan 14

Client/Operator Positioning15

Client Education 16

Coronal Polish17

Deposit Detection18

Deposit Removal 19

Enamel Sealants 20

Examinations:

Dental (Hard Tissue and Habits)21

Extra-oral 22

Extra-oral Observed23

Health history24

Indices(Plaque and Gingival25

Intra-oral 26

Occlusal 27

Periodontal 28

Perio-reevaluation29

Fluoride Application 31

Handpiece Maintenance 32

Impressions (alginate)33

Instrumentation Skills:

Activation 35

Adaptation35

Fulcrums 35

Grasp 36

Insertion 36

Operating Field Maintenance 36

Sharpening37

Ligate Arch Wires38

Orthodontic Bands 40

Tooth Separation41

Mouth Guards/Bleaching Trays 43

Nutrition Counselling 44

Radiographic Technique and Interpretation 45

Sanitization of the Treatment Unit 46

Student Goals and Self Assessment47

Ultrasonic/sonic Technique 48

Vital Signs

Blood pressure 49

Pulse 50

Respiration 51

Professional Development Skills

Introduction 52

Professional Development Categories

Documents management 52

Work habits53

Professional conduct53

Time management 54

Care of client tissues55

Professional Misconduct Penalties

Introduction55

Professional Misconduct Penalties Categories56

Document Mismanagement56

Work Habits56

Professional Misconduct56

Time Management56

Ethical Decision Making Model57

CLINICAL ASSESSMENT

CRITERION REFERENCED

Criterion referenced assessment means that students are evaluated consistently according to established descriptions of adequate performance. This has a number of advantages in the clinical setting. Criterion lists define standardized, observable behaviours that must be demonstrated by students as they perform basic instrumentation skills and clinical procedures. Clinical competence can be divided into three components:

1. The student must protect the client and the operator from harm during delivery of clinical service.

1. The skill or procedure must result in at least a minimally acceptable level of treatment effectiveness.

1. Client centered dental hygiene process of care and professional behaviour must be applied to all client care.

Criterion based assessment also stresses skill evaluation against objectively stated standards. The established standards stated in Section III of the Clinical Manual are also useful to students as a resource for peer and/or self-assessment of progress in developing clinical skills, application of the process of care and expected professional behaviour.

Based on these principles, performance criteria lists state behaviours to be observed at two levels:

1. Critical elements of performance: Some of the criteria are mandatory for maintenance of client and operator safety and treatment efficacy. These critical statements are written in bold face type in criteria lists and on assessment documents. To pass a skill all critical elements must be performed adequately, to the acceptable level for the term.

1. “Nice to do” standards: Some of the behavioural criteria are important for optimal delivery of service to the client but are more typically demonstrated by experienced professionals. These behaviours are listed as goals for students to achieve as early as possible. They are not required for a pass grade for the skill or procedure. They are written in ordinary type.

There is a criteria list for each of the clinical skills associated with the dental hygiene program (Reference: Clinical Manual Section III).

FORMAT OF FORMATIVE CLINICAL SESSIONS

Clinical sessions are designed to support ongoing learning of the dental hygiene process of care by offering opportunity for guidance, verbal and written feedback and student self-assessment.

Clinical Feedback Class:

The format for learning and applying the process of care in the clinical setting begins in Clinical Feedback class. This class is directly connected to clinic in that it is a forum to address clinical procedures, expectations, student and instructor concerns and questions. This class also offers reinforcement and review of material covered in theory courses. Attendance is mandatory.

Prior to the Commencement of Clinic:

Instructors communicate with each student in their group 15 minutes prior to the seating of the clients to discuss goals for the clinic and options for optimal client care. The lead clinician may offer verbal and/or written guidance/reminders for the clinic on the central white board.

Students must set and record a goal for the clinical session on their clinical feedback sheet.

Throughout the Clinical Session:

Throughout the clinical session verbal and written feedback on treatment goals, time management and means of addressing specific client needs is offered by the instructor in discussion with the student. This is evidenced on the daily grade sheet. All communication with the student must focus on and encourage student assisted learning in the use of critical thinking skills.

Instructors observe the performance of various clinical skills/procedures as well as student behaviour and communication skills on an ongoing basis. Professional developmentskill grades are assigned at each clinical session in each of the specified areas (document management, work habits, professional conduct, time management, and care of client tissues), and recorded on the student’s clinical feedback grade sheet. Professional development skills are also evaluated in the “Case Decisions” area. The CDHO Ethical Decision Making Model is used in the assignment, documentation and discussion of all grades with the student. (Reference: Clinical Manual Section III – Clinical Assessment Performance Criteria – Professional development skills).

There is an opportunity for the students, as they feel ready, to independently exhibit their critical thinking skills in the clinic in the independent assessment and client centered treatment required of their “Case Presentations” ( Reference: Clinical Manual Section III Clinical Assessment Performance Criteria)

Professional behaviour and interaction with clients, students, and fellow team members in the clinic is expected of the instructors at all times and is required modelling for student learning.

Ensuring Public Safety in Clinical Education

Clinical instructors are held by the College of Dental Hygienists of Ontario (CDHO) to ensure that the public trust bestowed upon CDHO registrants is upheld during clinical sessions in the educational setting.

Should student actions or deficient knowledge, skills or clinical reasoning place the client at risk the clinical instructor will immediately discontinue student involvement in client care.

Client care must be delivered in a manner that upholds the CDHO standards of practice. Grave errors that occur as a result of a student’s significant knowledge, skill or clinical reasoning deficit will result in the assignment of a Professional Misconduct Penalty. For specific information relating to professional misconduct penalties please refer to the appropriate pages in this section of the Clinical Manual.

Duty Student Assignment

There is a duty student assigned for each clinical session. The tasks of the duty student are performed under the supervision of the clinical instructors/front desk staff and/or the clinical technician as they learn the responsibilities in the dispensary/sterilization area and reception area.

End of Clinical Session:

Instructors review student performance individually and ensure a clear understanding of all feedback and assigned grades. This is done in a discussion format with the student. If a student is in disagreement with the grade assigned and cannot resolve it with the instructor, he/she may address it with the lead instructor. If a resolution cannot be reached the student is advised to write up a communication sheet and set an appointment with the clinical co-ordinator.

Students perform a Self-Audit of the client’s chart record(s) from the clinical session, and the chart documentation requirements are reviewed and finalized by the supervising instructor with the student.

Students are required to reflect on their clinic and make notations in the self-assessment portion of the clinical grade sheet. This is a further opportunity for the instructors to address any student learning needs.

Debriefing of the clinical session is held 10 minutes prior to the end of the clinical session either for the group as a whole or in the individual instructor session groups.

Revised March, 2012

Remediation:

Students exhibiting difficulty with clinical skills may be recommended for remedial. Students exhibiting a lack of the knowledge required for safe and efficient client care may be required to complete an assignment on the deficient topic or may be referred to the theory course material applicable. If a student exhibits ongoing learning difficulties, ineffectiveness or unsafe practice the clinical co-ordinator will be advised and will take the appropriate action. If a student is determined to be in a failing position in any competency at any point in the term, that student is required to attend remedial sessions specific to the deficiency. (Reference: Clinical Manual Section I – Preclinical Protocol – Remedial/Open Lab Sessions)

Instructor Calibration

Instructor calibration is critical to standardized evaluation. It is initially achieved by providing each instructor with a faculty manual, clinical manual and student handbook for reference, as well as access to library resources and email access to all theory instructors at CNIH.

Each week the clinical co-ordinator communicates via email the results of each clinical feedback class. Weekly calibration meetings and/or email communication also support standardization.

For further calibration instructors are required to meet prior to each clinical session to clarify information from feedback classes and calibration meetings, as well as any immediate clinical concerns. Lead clinicians are advised of their responsibilities and expected to keep open communication with all other lead clinicians and the clinical co-ordinator. Any immediate

concerns in the clinic can also be documented in the Communication Binder in the clinic for all instructors to view.

As an overseer of all clinical activities, the clinical co-ordinator monitors clinical proceedings in each clinical session on a rotational basis as needed and facilitates communication and the transfer of information to all clinical instructors, technicians, clinical receptionists and administration for the smooth operation of the clinic. A lead clinical instructor is assigned to all clinical sessions and provides the clinical co-ordinator with any and all relevant information from the clinical session.

SUMMATIVE EVALUATION OF CLINICAL PERFORMANCE

Clinical skills and procedures are assigned a grade based on the term the student is in. The grading scheme for each performance criteria is in Section III of the clinical manual. It is meant to be a guide only and instructors are advised to temper their grades based on any extenuating circumstances in each clinic and in consideration of the student’s stage of learning. The clinical appendices outline the clinical requirements for each term as well as evaluation policies.

Students are encouraged to track their own clinical requirements by maintaining a student copy of their grade sheet for each clinical session. Students have the opportunity to transcribe the grades earned during that session at the end of each clinical session for their own records. The clinical co-ordinator reviews and files all original student grade sheets and provides a summary

Revised September, 2010

grade sheet to each student periodically. At any time in the term if the summary sheet reveals that a student is approaching an overall failing grade in a competency or penalty area, the clinical co-ordinator will refer that student for remedial or address the behaviour.

Open Lab opportunities to practice clinical skills/procedures is available to all students in clinic at weekly scheduled times.

At midterm the students are advised of their status in clinic via written letter and orally. The students who are behind and at risk of not completing their requirements are required to meet with the clinical co-ordinator/faculty advisor to discuss a plan of action for the rest of the term.

At the end of the term the Academic Advancement Committee reviews the students’ clinical performance results as well as their performance in the supporting theory courses.

(Reference 1. Clinical Manual Appendix: Academic Level 01

2. Clinical Manual Appendix: Academic Level 02

3. Clinical Manual Appendix: Academic Level 03

4. Student Handbook, “Academic and Due Process Policies”)

During this dental hygiene program enough time is available in pre-clinical and clinical practice to allow students to acquire competence in assessment skills and delivery of oral care specific to client unmet needs at minimal levels or above. When students acquire sound basic skills, an appreciation of the need for continuing competency and good self-assessment skills, as graduates they will be equipped to mature in their profession. As life-long learners and with continued practice and exposure to a variety of clients, their clinical and communication expertise will improve.

ASSESSMENT OF SKILLS and/or PROCEDURES IN CLINICAL SESSIONS

Students request a skill and/or procedure assessment by placing their name and treatment unit number on the board in the dental clinic under the name of the clinical instructor who will perform the evaluation. The instructor will attend to students as soon as possible. Please be patient, each student and client deserves careful attention from the instructors. All requests for evaluation of skill and/or procedure must be placed on the white board 60 minutes before the end of a clinical session

Revised March, 2012

CLINCIAL ASSESSMENT PERFORMANCE CRITERIA

Case Presentation - Minimal Care – permanent dentition

The client chosen must be a DD1 or DD2 level of difficulty. S/he should be in good general health. Oral health status should include the following:

–at least 5 teeth in each quadrant of the mouth

–Scanty to light generalized supragingival and subgingival calculus deposits

–minimal soft deposits

–may present with localized extrinsic stain

–may present with localized 4 – 5mm pockets

For the case to be considered for course requirements students must:

-Complete a modified assessment to determine his/her suitability.

-Advise the supervising dental hygienist that you would like to present this case for credit.

The supervising clinician will:

-Examine the client to determine his/her suitability.

If the client is acceptable, the student must fulfil the requirements below, to be given credit for the case.

If the client is unacceptable for a case presentation the student will complete all treatment and receive a “C” grade to track the number and type of clients the student has treated.

Academic Level 02 / Academic Level 03
Complete independently and successfully the following aspects of client care:
Examinations:
-health history
-dental
-extra-oral
-intra-oral
-occlusal
-periodontal and indices
Dental hygiene care plan
Case decisions.
Ct Ed./OHI / Complete independently and successfully all aspects of client care.
Prescribed radiographs must be completed with a minimum grade of 70%.

Assignment of a failing grade in any of the Professional Development skills categories (document management, work habits, professional conduct, time management, and care of client tissues)or of a Professional MisconductPenalty gradewill result in loss of credit for the case.

If the student does not complete a required component of the case successfully and loses credit for the case presentation, a grade of “F” will be assigned for “adult minimal care case presentation” in the clinical assessment documentation on the day the credit was lost. The student will be required to complete the remaining elements of the case and be assessed in the usual manner.

If the student completes the case successfully, credit for the case will be recorded in the assessment documentation on the day of the final appointment with the client. A “P” or “F” will be assigned.

If at any time if the student’s management of the case poses risk of harm to the client, the supervising clinician will intervene.

Revised March, 2012

Case Presentation - Adult PeriodontallyInvolved

The client chosen must be a DD3 or DD4 level of difficulty. S/he should be in good general health. Oral health status should include the following:

–at least 5 teeth in each quadrant of the mouth

–moderate to heavy generalized supragingival and subgingival calculus deposits

–obvious soft deposits

–moderate, generalized, OR heavy localized extrinsic stain

–generalized 4mm periodontal pockets or greater (>30%)

For the case to be considered for course requirements students must:

-Complete a modified assessment to determine his/her suitability.

-Advise the supervising dental hygienist that you would like to present this case for credit.

The supervising clinician will:

-Examine the client to determine his/her suitability.

If the client is acceptable, the student must fulfil the requirements below, to be given credit for the case.

If the client is unacceptable for a case presentation the student will complete all treatment and receive a “C” grade to track the number and type of clients the student has treated.

Academic Level 03
Complete independently and successfully all aspects of client care.
Prescribed radiographs must be completed with a minimum grade of 70%.
For clients with a degree of difficulty at level 3 or 4, supervising clinicians may provide minimal direction to facilitate treatment interventions unique to the client.

Assignment of a failing grade in any of the Professional Development skills categories (document management, work habits, professional conduct, time management, and care of client tissues)or of a Professional Misconduct Penalty will result in loss of credit for the case.

If the student does not complete a required component of the case successfully and loses credit for the case presentation, a grade of “F” will be assigned for “adult minimal care case presentation” in the clinical assessment documentation on the day the credit was lost. The student will be required to complete the remaining elements of the case and be assessed in the usual manner.

If the student completes the case successfully, credit for the case will be recorded in the assessment documentation on the day of the final appointment with the client.A “P” or “F” will be assigned.