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School of Dental Medicine

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Robert Carter
Dental General Practice Residency
The dental facility is located in the Vidant Medical Center and is adjacent to the East Carolina Heart Institute and Leo Jenkins Cancer Center.

The program’s dental clinic functions as a fee-for-service, three-doctor practice, which enables one resident to be on rotation to other services or otherwise off site while the other residents see patients.  Support staff in the clinic includes three dental assistants, one hygienist, two patient representatives, and one program coordinator.  Teaching faculty supervise residents in general dentistry, hospital dentistry, endodontics, oral and maxillofacial surgery, and orthodontics.

The program is designed to provide training beyond the level of pre-doctoral education in oral health care using applied basic and behavioral sciences. The program emphasizes resident education based on the concept that oral health is an integral and interactive part of total health. The program is designed to expand the scope and depth of the graduates’ knowledge and skills to enable them to provide comprehensive oral health care to a wide range of population groups.

The goals and objectives of this program are to educate and prepare the graduate to:

1.    Act as a primary care provider for individuals and groups of patients. This includes providing emergency and multidisciplinary comprehensive oral health care; providing patient focused care that is coordinated by the general practitioner; directing health promotion and disease prevention activities; and using advanced dental treatment modalities.

2.    Practice general dentistry that involves planning and providing multidisciplinary
oral health care for a wide variety of patients, including patients with special needs.

3.    Manage the delivery of oral health care by applying concepts of patient and practice management and quality improvement that are responsive to a dynamic health care environment.

4.    Function effectively within the hospital and other health care environments.

5.    Function effectively within interdisciplinary health care teams.

6.    Apply scientific principles to learning and oral health care. This includes using
critical thinking, evidence or outcomes-based clinical decision-making, and technology-based information retrieval systems.

7.    Utilize the values of professional ethics, lifelong learning, patient centered care,
adaptability, and acceptance of cultural diversity in professional practice.

8.    Understand the oral health needs of communities and engage in community service.     This includes directing oral and systemic health promotion and disease prevention     activities through participation in community programs focused on improving access     to oral care and the prevention and reduction of oral disease.

GPR achieves these goals by providing exemplary training experiences and practice opportunities through:

•    Supervised clinical experience in recognizing and evaluating clinical manifestations of systemic disease and its relation to dental treatment.
•    Experience with hospital procedures and functions of other hospital departments through emphasis on specific responsibilities in a hospital dental service.
•    Participation in a consulting service as well as on-call emergency care to patients through the teaching hospital.
•    Skilled comprehensive dental care for patients.
•    Opportunities to explore clinical research interests.

Residents receive ongoing training in hospital procedure and protocol, as well as the functions of other hospital departments.  Residents are expected to become familiar with an interdisciplinary approach to health care and are continually involved in consultations with physicians and dental specialists for hospital and ambulatory patients.

Rotations include anesthesiology, otolaryngology, family medicine, physical diagnosis, emergency medicine, and dental specialties.  This balance allows approximately 9 ½ months in the clinic and 2 ½ months on clinical rotation.  Educational opportunities are supplemented through conferences, seminars, tutorial experiences, as well as library research and self-study.

A Competency-based Program

The GPR is a competency-based program which is designed to educate and train the resident to a level of competency in his or her ability to:

1.    Function as a patient’s primary and comprehensive oral health care provider.

2.    Provide patient-focused care using advanced treatment modalities.

3.    Obtain and interpret the patient’s chief complaint, medical, dental, and social history, and review of systems.

4.    Obtain and interpret clinical and other diagnostic data from dental professionals and other health care providers.

5.    Use the services of clinical, medical and pathology laboratories and make referrals to other health professionals for the utilization of these services.

6.    Perform a history and physical evaluation and collect other data to establish a risk assessment for use in the development of a dental treatment plan.

7.    Use accepted health promotion and disease prevention strategies to help patients maintain and improve their oral health and aspects of their systemic health.

8.    Obtain informed consent for dental treatment by discussing with patients, or parents/guardians of patients, the following: findings, diagnoses, risks, benefits, and process of various treatment options, patient responsibilities during and after treatment, and estimated fees and payment responsibilities.

9.    Assess, diagnose and integrate multiple disciplines into individualized, comprehensive treatment plans for a wide variety of patients, including patients with special needs, in a manner that considers and integrates those patients’ medical, psychological, and social needs.

10.    Understand and demonstrated the application of the principles of ethical reasoning, decision making and professional responsibility as they pertain to the academic environment, research, patient care, and practice management.

11.    Evaluate and treat patients with intra-oral dental emergencies and infections.

12.    Evaluate and manage patients with extra-oral and orofacial dental emergencies and infections.

13.    Manage medical emergencies that may occur during dental treatment.
14.    Restore teeth with a wide variety range of materials and methods.

15.    Treat patients with missing teeth using removable restorations of varying levels of complexity.

16.    Treat patients with missing teeth using fixed restorations of varying levels of complexity.

17.    Manage patients with missing teeth using uncomplicated dental implant restorations.

18.    Place restorations and perform techniques to enhance patient’s facial esthetics.

19.    Restore endodontically treated teeth.

20.    Manage occlusal disorders.

21.    Perform non-surgical anterior endodontic therapy of varying levels of complexity.

22.    Perform non-surgical posterior endodontic therapy of varying levels of complexity.

23.    Manage endodontic emergencies and complications.

24.    Perform surgical and non-surgical extraction of teeth given varying levels of complexity.

25.    Manage patients requiring surgical extraction of impacted teeth given varying levels of complexity

26.    Manage patients requiring uncomplicated pre-prosthetic surgery.

27.    Diagnose and manage post-surgical complications.

28.    Manage traumatic injury, to include facial, dentoalveolar and soft tissue trauma.

29.    Manage periodontal disease of varying levels of severity.

30.    Manage the periodontal needs of patients requiring dental implants.

31.    Manage oral mucosal dieeases.

32.    Manage patients presenting with temporomandibular disorders and orofacial pain.

33.    Perform dental consultations and request medical consultations for hospitalized patients and patients in other health care settings.

34.    Use behavioral and pharmacologic techniques in the management of pain and anxiety in dental patients.

35.    Understand the management of pain and anxiety in the conscious patient through the use of parenteral conscious sedation techniques.

36.    Prevent, recognize, and manage complications related to use and interactions of drugs, local anesthesia, and conscious sedation.

37.    Direct oral and systemic health promotion and disease prevention activities through participation in community programs focused on improving access to oral care and the prevention and reduction of oral disease.

38.    Provide dental care as a part of an interdisciplinary health care team such as that found in a hospital, institution, or community health care environment.

39.    Make referrals to, and obtain consultations from, professional colleagues for the treatment of dental, medical, psychological, and social problems presented by dental patients.

40.    Critically evaluate scientific literature and use information in the literature in making professional decisions.

41.    Assess patient’s cultural background and expectations for dental care and perform patient care consistent with that assessment.

42.    Be able to manage and work effectively with allied dental professionals and other office personnel in providing dental care.

43.    Understand and participate in quality management and the peer review process.

44.    Understand the basic principles of practice management and practice development.

45.    Apply principles of jurisprudence, risk management and professional ethics in the practice of dentistry.

46.    Understand how dental care is managed in alternative health care delivery systems.

47.    Understand the basic principles of managed care.

48.    Use information retrieval systems and information technology in dental practice.

Assessment and Evaluation

Residents complete the American Association of Hospital Dentist exam (AAHD) as a pretest at the beginning of the program to assess individual needs.  Scores are reviewed in six curricular areas: hospital administration and organization, medical risk management, medically compromised patients, inpatient/outpatient surgery, pharmacology, medical/dental emergencies, pathology, and infection control.  A similar exam also serves as a posttest at the end of the program.

Patient charts are reviewed after every initial exam, and the program director conducts random reviews of charts to assess the quality of patient care and documentation.  Performance evaluations by attendings for each rotation measure residents’ progress.  Faculty review these evaluations quarterly with residents.  Residents also evaluate rotations and preceptors to assist in continuous program improvement.