Section I

Core Knowledge and Understanding

Draft prerequisites to achieving agreed Clinical Competences
(This has no formal status)

including

Consideration of = Appropriate Methods of Evaluation of Outcome


Introduction

  1. Student Selection
  2. Length of Course
  3. Assessment of Students and Clinical = Competences
Undergraduate Dental = Curriculum
  1. Basic Biological and Medical Sciences 
  2. Behavioural Sciences including Ethics and = Jurisprudence
  3. Human Diseases 
  4. Clinical Dentistry 
  5. Medical Emergencies (Competence 5.1)
  6. Practice Management 


***This = document has not been finally agreed by the Working Party of the Advisory Committee on the = Training of Dental Practitioners. However it provides useful background material for = dental educators considering curriculum = revision.***


Introduction and Background to this Core = Knowledge Document

The primary aim of dental education is = to ensure that the new graduate is capable of carrying out independent dental practice = without harm to patients using modern, appropriate, effective and currently accepted methods = of treatment. The new graduate must also be capable of implementing suitable preventive = programmes for individuals and groups in the context of community orientated = programmes. In order to achieve that aim dental education must provide the student with a = sound clinical training based on humanitarian, scientific and common sense principles. At = the end of the undergraduate training programme the student must be capable of = carrying out the Clinical Competences set out by the Advisory Committee on the Training of = Dental Practitioners (XV/E/8316/8/93). 

There is no one curriculum appropriate for = Europe and the Advisory Committee on the Training of Dental Practitioners has specifically = avoided imposing detailed regulations. Apart from the required clinical competences, = no one subject or set of subjects should be independent of an overall educational = philosophy in undergraduate education. Emphasis within subjects will vary from school to school = nevertheless, care must be taken to avoid the dominance of certain subjects over others = to the detriment of a comprehensive integrated curriculum. 

It is essential that teaching staff and dental = students, have clearly defined aims and objectives for each course taught. There must be a = central educational philosophy with agreed overall educational goals which must be = achieved by students and subjected to structured assessment methods. 

The rapid expansion in knowledge required of = dental students must be compensated for by reducing students' involvement in less relevant = training programmes and ensuring that excessive or unnecessary detail is not expected of = them in the course of their examinations and assessments. Dental students may need to be = protected from courses which are more relevant to other disciplines. 

The Advisory Committee endorses a process of = international exchange and peer evaluation to promote convergence towards the highest possible = standards in European dental education. 

The existing directives need to be updated. At = this time greater emphasis needs to be placed on outcome rather than content. The = purpose of this document is to examine the essential core information, skills and knowledge = required of a student in order to be competent in those = procedures set out in document XV/E/8316/8/93.

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a) Student Selection

It is important to ensure that those school = leavers who are intent on pursuing a career in dentistry are fully informed about the career = and responsibilities of a dentist, whilst encouraging the most able to consider dentistry as = their chosen career. There is no one universally accepted method or combination of = methods for application in student selection procedures. However it is generally accepted that = intelligence and integrity are two essential qualities. 

Dentists require good physical health and = acceptable eye sight. All dental students should be immunised where possible against those = blood borne viruses which may be an occupational hazard to the dentist. 

While Physics, Chemistry, Biology and = Mathematics are desirable on matriculation from secondary education for the new dental student, = it is also more desirable that their education should be broadly based and not = confined to the sciences. 

b) Length of Course

The undergraduate training programme must be = extended over at least 5 academic years and preferably includes at least fifty per cent of a = student's rostered time practising in a clinical training environment. 

Emphasis should be changed where necessary from = the passive acquisition of knowledge to researching the literature, problem-solving skills = and clinical competence. No single course or group of courses should dominate or = be independent of a cohesive integrated dental training programme. The Advisory = Committee on the Training of Dental Practitioners does not wish to be prescriptive other than = recommending as a basic minimum a sufficient understanding of the medical and biological = sciences essential for understanding human diseases appropriate for a dentist. In the = health sciences there is a continuous rapid expansion of knowledge and students should not be = hindered with excessive detail in any subject to the detriment of a comprehensive training = programme. 

Dental students require a broadly based = educational setting, ideally a university, combined with modern dental clinical facilities where = emphasis on patient care is paramount. The clinical environment not only provides the dental = student with appropriate training facilities but also exposure to the reality of = patients' needs and demands as well as a full range of observations of secondary and = tertiary oral/dental treatment procedures. 

In addition it is desirable that dental = students gain experience in other settings such as community dental clinics, private practices, = general hospitals, accident and emergency departments, exchange programmes outside = their own country, specialist departments, etc. 

Integration with medical education is desirable = but should not simply be to serve logistical exigencies by combining large groups of = students for lectures in preclinical subjects where there is little integration in the = context of shared clinical experiences. The object of integration with other disciplines in the = health sciences particularly medicine, is to provide dental students with a better = and broader understanding of human diseases. 

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c) Assessment of Students and Clinical = Competences

Assessment methods should be complimentary to = the educational/learning experience of students. Assessment should be structured in order to = determine whether students are achieving the stated educational objectives in = didactic, practical laboratory and clinical courses. Assessments and examinations are too = frequently considered by students to be end points in themselves. Assessments and examination = methods are strongly influenced by the priorities of the member states competent = authorities and the examination structures of each dental school's university or = institute of learning. The most comprehensive approach is probably represented by a combination = of continuous and end of course assessments. Examinations must not be used simply as a = means of motivating students. 

Assessment methods should support, reflect and = act as a means of monitoring the teaching/learning in the subjects taught. Methods of = evaluation range from traditional essays and multiple choice questions to computerised = interactive assessment programmes, practical tests, clinical competence assessments and = other innovative assessment methods. Whatever means is adopted the marking system = must be transparent, known to the student, objective and constructive in its application = to the educational process. Examination which results in high failure rates or = excessively high marks being awarded must be seriously questioned. 

The implementation of clinical competency tests = should be integrated with the particular assessment system in operation in any dental = school. Clinical Competence as defined in this document is more than the ability to = complete a procedure with the aid of an instructor. It implies that a person is capable = of carrying out the procedure safely and independently as in dental practice. It also = implies appropriate understanding of the related theoretical knowledge. It is = recommended that the gradual inclusion of competency testing should be accompanied by the = exclusion of some existing assessments where there is overlap. 

Insofar as possible, it is recommended that = dental schools in Europe should develop their competency tests on the following basis: 

  1. The scientific/biological basis for the clinical competence = should be incorporated in the test/examination. 
  2. The student must be able to explain the procedures to be = adopted, including appropriate application of clinical principles in patient care. 
  3. There should be formal certification and recording of = successful completion of clinical/practical elements of the competence test. 

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Undergraduate Dental = Curriculum

The undergraduate curriculum should be = seen as a whole. It may be broadly divided into: 

  1. the Basic Biological and Medical Sciences; = Chemistry, Physics, Biology (Biochemistry, Molecular Biology, Anatomy and Physiology) 
  2. Behavioural Sciences (mainly Psychology and Sociology = and also Ethics and Jurisprudence) 
  3. Human Diseases; General Medicine and Surgery, = Pathology, Microbiology and Pharmacology, appropriate to the needs of a dental practitioner =
  4. Clinical Dentistry - patient care, prevention, = diagnosis, treatment and rehabilitation of oral/dental diseases and their consequences. = This includes the application of Biological, Medical Sciences and Human Diseases = in the oral manifestation of systemic disease and the implication of oral and dental = pathology and treatment complications in systemic disease 

1 Basic Biological and Medical = Sciences

The basic biological and medical = sciences comprise macroscopic and microscopic anatomy, physiology, biochemistry, at a whole body = as well as cellular and molecular levels. These should be learned to a standard appropriate = for an understanding of oral biology and human diseases avoiding unnecessary detail. = Also, they introduce students to the principles of scientific logic and argument = including the critical appraisal of scientific design, statistics, biometry and published = research. 

General objectives of the course in basic = medical sciences

On completion of their courses related to basic = biological and medical sciences, in addition to being informed on recent research = developments pertinent to human diseases in dentistry, students must have an understanding and = knowledge of: 

the principles of Chemistry and Physics = appropriate to materials science, ionising radiation and the biological sciences. 

Biochemistry
To a level of detail sufficient to understand molecular biology, = physiology, microbiology, pharmacology, pathology and human diseases, cell structure, function = and division. 

Viruses
Immunology including antigens and antibodies, structure and = function; complement system; T-cells, their subclasses and activation; cell interactions and the = immune system. 

Embryology
To include development of the embryo; differentiation of = blastocytes, origin of tissues, and the development of the head and neck, particularly oral and = dental tissues. 

Anatomy
Sufficient to provide a detailed understanding of anatomy of = particular relevance to the practising dentist combined with a general overview of human anatomy = as necessary to understand the physiology and pathology of the systems of the body. =

Physiology
including:
Structure and function and histology of tissues, particularly = oral/dental; secretions with an emphasis on blood and blood forming elements; muscle, nerve, = neuromuscular physiology, hormonal mechanisms, cardiovascular system, circulatory system, = oxygen and carbon dioxide transport oral physiology, nutrition and metabolism, acid-base = balance avoiding excessive detail but sufficient to understand human diseases and particular = consideration of those conditions relevant in the practice of dentistry and holistic or = comprehensive patient care for the needs of a practising dentist. 

Histology
With particular reference to oral tissues 

Assessment

There is a diverse approach throughout Europe = in assessing the Biological Sciences. It is essential to avoid detail and irrelevant = information to the understanding of the biological sciences as a basis for studying = human diseases. 

Wherever possible, the assessment of the = biological sciences should also be incorporated into the clinical part of the programme in = order to stress the relevance of the biological sciences. 

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2. Behavioural Sciences = including Ethics and Jurisprudence

Almost all decisions taken have some = ethical dimension. The complex world in which the new dentist will practice demands a = sensitivity towards not alone their ethical and professional responsibilities but also their = wider social responsibilities both as health caring professionals as well as = individual members of the community. For many, ethics has been relegated to the principles of = jurisprudence and while there is a very complex relationship between the two it is = important that our educational system should ensure students have an appreciation of a = code of ethics that is not simply bound by jurisdiction. 

It is important that students have a proper = understanding of beneficence (doing the best one can), non-maleficence (first do no = harm), respect for the views and rights of the individual patient, principles of social = justice and an equitable distribution of the benefits of health care. In all respects = students should be exposed to this learning process without prescription and free from any = particular political dogma. 

It goes without saying that students must also = have an understanding of what is necessary in respect of record-keeping, patient = confidentiality, informed consent for treatment and all that is necessary in order to avoid negligence = in the care of patients. 

This subject must be broadly based and is not = narrowly focused. The area encroaches on the principles of the behavioural sciences in = patient care and communication. Those disciplines lend themselves to a = multi-disciplinary approach. Behavioural science and ethics require time for thinking and = reflection, independent opinion and encouragement to articulate that opinion. These = principles go back to four hundred years BC with the Hippocratic code of conduct for doctors = and the Socratic approach to education. 

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3. Human Diseases

General = medicine and surgery and their allied subjects (pathology, microbiology and pharmacology) should be = learned and experienced in appropriate clinical surroundings and integrated, insofar as is = practical, throughout the students' training programme. It is essential that dentists be fully = aware of the implications of general medicine and surgery as they apply to the = practice of dentistry. 

These subjects provide the basis for a = dentist's comprehension of oral health and disease as one facet of general health and disease. In = addition to gaining experience in general hospitals and observation in operating = theatres, it is recommended that students be given the opportunity to observe and assist in more = relevant settings to general dental practice such as general medical practice and = community clinics. Generally a dentist must be able to assess signs and symptoms of relevant = diseases from the medical history and extra oral signs visible in a fully clothed patient. In = many dental schools experience and training is gained by incorporating dental students = with groups of medical students in ward rounds and clinics. Often, however, insufficient = attention is given to the needs of dental students with little opportunity to make maximum = use of limited exposure to this critical part of their training programme. Without = sufficient training in human diseases, comprehensive patient care, communication and = awareness of the importance of lifestyle and stress related conditions, the dentist would be = unable to provide a holistic approach to the care of his or her patients. 

Practical classes on manikins in = cardio-pulmonary resuscitation is essential for a modern training programme. Dental students also must = be competent in First Aid. 

Pathology
including:
Inflammation and repair; granulomatous response; thrombosis, = embolism and infarction; oedema; shock; atrophy, hyperplasia, hypertrophy, metaplasia; = neoplasia including its aetiology, progression, classification; atheroma; aneurysms and = other vascular pathology; hypertension/failure; genetic, congenital and inborn errors in = development; calcification; amyloid and pigmentation; rheumatic heart disease and infective = endocarditis, cardiac pathology; specific pathology of the oral/dental tissues; pathology = of other systems: nose, nasopharynx, larynx and trachea, respiratory and = cardiovascular system, emphysema, asthma, pneumonia, gastro-intestinal system, immune system. = endocrine system, blood and blood forming elements, vitamin deficiencies, bone, genito-urinary = system, brain and CNS including trauma, strokes, tumours and other principles appropriate = for a practising dentist. 

Surgery
Principles of surgery; including differential diagnosis of swellings = of the head and neck; principles governing management of malignancy of head and neck; = principles of vascular surgery; management of acute trauma, haemorrhage, shock and = interruption of breathing; principles of gastro-intestinal surgery; principles governing = operation of an operating theatre; principles and implications of transplant surgery, = including oral/dental complications. 

Medicine
Ability to obtain a comprehensive medical history from a patient; = recognition of the history, signs and symptoms of systemic disease relevant to patient = care in a dental practice including the following:- hypertension, angina, myocardial = infarction, rheumatic fever and other relevant endocardial pathology, vascular disease; = bacterial endocarditis, heart valve disease, heart failure, congenital heart defects, = pericarditis; respiratory failure, asthma, pneumonia; tuberculosis; carcinoma of the lung; = sarcoiditis; alveolitis and other lung pathologies; oesophagitis, carcinoma of the = oesophagus and stomach; malabsorption, liver and bile pathology; epilepsy; meningitis, = cerebrovascular diseases; multiple sclerosis; peripheral neuropathy, acute subacute and = chronic arthritis; cardiorespiratory arrest; anaphylactic shock; unconsciousness; acute = asthmatic attack; inhalation of foreign body; diabetes and diabetic coma; disorders of = the pituitary, adrenal, and thyroid glands; anaemia; bleeding disorders; leukaemia; = lymphoma; skin and mucocutaneous disorders; infection; sexually transmitted diseases; = psychiatric disorders, their implications and principles of care; drug induced diseases; = including addiction; HIV; Hepatitis and other blood borne infections; carry out = cardiorespiratory resuscitation; write prescriptions; administer drugs; carry out = first aid including CPR; promotion of healthy lifestyle; tobacco related illnesses. 

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Microbiology
Microbiology is central to a dental student's understanding of = viral, bacterial, fungal and prion based infection and transmission of disease as well as = sterilisation and cross infection control and anti microbial therapy. This should be learned = in appropriate settings avoiding unnecessary detail and non-essential practical = experience, concentrating on those essential features for modern dentistry. Microbiology = should preferably be taught as an integrated part of Human Diseases with general pathology and = immunology in a well structured co-ordinated course. 

Students should have a knowledge and = understanding of the principles involved in the pathogenesis, diagnosis, treatment and prevention of = infectious diseases with particular emphasis on infections relevant to the practice of = dentistry. Based on laboratory, practical, clinical and theoretical courses the new = graduate must understand and be able to carry out and/or describe the following:- = sterilisation and disinfection; the sources, portals and spread of infection; normal human = microflora; pathogenic mechanisms of bacteria; infections of the mouth and perioral = tissues; susceptibility and risk factors in infectious diseases; infections of bacteria, = viruses, fungi, protozoa and prions appropriate to the dental patient; antimicrobial, antiviral, = antifungal, antibiotic agents and their mode of action. 

Pharmacology
including:
An appropriate understanding of pharmacology and therapeutics is = required of a dentist for the safe practice of dentistry. Pharmacology and Therapeutics is a = rapidly changing discipline. Dental graduates need to be aware of sources of = information rather than learn excessive details and long lists of drugs. Dental students need to = be aware of the indications, contra-indications, potential side effects, adverse = reactions and interactions of therapeutic agents with other drugs and of those = therapeutic agents used commonly in the dental surgery. . 

The dental student should understand the = principles of drug absorption, distribution, metabolism, excretion, and mode of action, = particularly of those agents relevant to the practice of dentistry. Implicit in this is an = understanding of the routes of administration, side effects, drug interactions, precautions with = different age groups and their use in pregnancy. 

Dental students must be capable of writing a = prescription for those drugs commonly used in dental practice. It is essential that = graduates have ease of access to reference material to update their information on pharmacology = and therapeutics. 

Assessment of = Human Diseases

In addition to the assessment methods referred = to in respect of the Biological Sciences it is essential to include practical clinical = components to the assessment methods adopted in this part of the programme It may be = difficult for some schools to provide access to general clinics and hospitals where = patients with the particular conditions may be seen. Nevertheless, assessment of = clinical competence is best carried out in real life situations rather than using simulation = although the value of the latter is not questioned. Assessment of the human diseases lends = itself to Objective Structured Clinical Examination (OSCE) and other innovative = assessment techniques. It is important to ensure that the assessment methods are directly related = to the educational objectives and that the information sought is at an appropriate = level in the context of the knowledge and expertise required of a practising dentist. = Students should not be subjected to assessment of excessively detailed or irrelevant = knowledge 

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4. Clinical = Dentistry

Before graduation, dental students must = demonstrate their ability to complete the clinical competences set out in = XV/E/8316/8/93 which is included in section II of this document. The aim of training in clinical = dentistry must be broader than the acquisition of specific clinical competences. 

Clinical dentistry should be initiated as early = as possible in the undergraduate curriculum. 

Traditionally dental students in many dental = schools acquire clinical skills using simulation such as mannikin heads and prosthetic = laboratory exercises. Although useful, they can never be a substitute for clinical = experience, biological orientation and experience in patient care and behavioural = influences. 

Patient care is of paramount importance in = clinical dentistry and should never be relegated to a means of training students. Students = must not be permitted to gain clinical skill or experience to the detriment of patient = care. Holistic patient care should be exemplified in dental training institutions and = students training should embrace that principle. The practice of clinical dentistry within = dental schools should exemplify all the principles of ethical practice under safe, = appropriate, hygienic and environmentally friendly clinical conditions 

It is within these parameters that the clinical = competences were established, not as separate entities, rather as segments within a = comprehensive framework of patient care and health maintenance. In the following sections = clinical competences are repeated from document XV/E/8316/8/93 using the numbers from the = original (see also in part II of this document). Each set of related competences is = followed by a set of skills and knowledge which are believed to be essential components if a = student is to be considered competent. 

Pre-requisite Knowledge and Core = Understanding for Competences in Diagnosis and Treatment Planning

1.1 Taking a proper case history, including a = medical history, carrying out an oral examination, recognising deviations from normal, = diagnosing oral and dental diseases and formulating a long-term treatment plan and carrying out = appropriate treatment or referral if necessary. This includes the craniomandibular joints. =

1.2 Recognition and appropriate management = and/or referral of patients who have oral manifestations of systemic disease. 

1.3 Demonstrating an appreciation of the = general health of the patient and the relationship between general health and disease of the oral = cavity and the implications of general diseases on planning dental treatment. 

1.4 Searching or screening for oral diseases = including cancer. 

1.5 Diagnosing and recording developmental = anomalies and oral diseases using an internationally accepted classification. 

1.6 Diagnosis and management and appropriate = referral of patients with oro-facial, dental and cranio-mandibular related pain. 

1.7 Diagnosis and management or appropriate = referral of common oral and dental disease including cancer, mucosal lesions and bone pathology. =

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Eliciting and/or recognising and understanding = the significant and relevant details from: 

  • a patient's history 
  • knowing how such information can be indicative of patients' = attitudes to health and disease 
  • eliciting a social and family history 
  • recognising extra-oral signs of disease 
  • recognising intra-oral signs of disease including all of the = soft tissues, periodontal tissues and teeth and particularly serious pathology such as = malignancy and pre-malignancy 
  • recognising oral manifestations of systemic diseases 
  • applying commonly used indices of gingival, periodontal and = dental diseases, such as CPITN and DMFTS 
  • applying commonly used and internationally recognised = orthodontic indices 
  • recognising predisposing factors to and early signs of dental, = periodontal and oral diseases, as well as trauma, = physical/chemical/thermal/irradiation damage 
  • carrying out special tests including referral as appropriate = for special tests and understanding the basis for commonly used tests in dental = practice 
  • inter-relating all relevant factors in the analysis of a = patient's presenting problem in order to formulate a rational treatment plan for each patient = according to their needs 
  • recognising the potential for iatrogenesis in the treatment of = patients 
  • understanding the edentulous and partly edulous complications = in the restorative care of edentulous and partly dentate patients 
  • understanding occlusion, articulation and signs of pathology = in the chewing system including the temporomandibular joints 
  • recognising the signs and symptoms of inadequate prosthetic = and/or orthodontic appliance therapy 
  • interpretation of radiographic examination and to safely carry = out all facets of dental radiography commonly used in a dental practice 
  • recognising those conditions which require referral to another = dental or medical colleague for diagnosis or treatment 
  • being fully aware of the necessary maintenance and preventive = programmes appropriate for a particular patient 
  • setting priority of treatment in respect of patients' needs = and requirements 
When the full history, examination, case = analysis and treatment plan have been established, the new dentist must be capable of: 
  • explaining the condition to the patient, the cause of the = problems and the treatment proposed, the complications of doing or not doing that = treatment, so that the patient or the patient's guardian is fully informed and capable of giving = consent to the treatment proposed 
  • explaining the cost of treatment proposed 
  • modifying treatment according to the patient's preference and = requirements 
Competences include the following:

1.1 Taking a proper case history, including a = medical history, carrying out an oral examination, recognising deviations from normal, = diagnosing oral and dental diseases and formulating a long-term treatment plan and carrying out = appropriate treatment or referral if necessary. This includes the craniomandibular joints. =

1.2 Recognition and appropriate management = and/or referral of patients who have oral manifestations of systemic disease. 

1.3 Demonstrating an appreciation of the = general health of the patient and the relationship between general health and disease of the oral = cavity and the implications of general diseases on planning dental treatment. 

1.4 Searching or screening for oral diseases = including cancer. 

1.5 Diagnosing and recording developmental = anomalies and oral diseases using an internationally accepted classification. 

1.6 Diagnosis and management and appropriate = referral of patients with oro-facial, dental and cranio-mandibular related pain. 

1.7 Diagnosis and management or appropriate = referral of common oral and dental disease including cancer, mucosal lesions and bone pathology. =

Assessment of Competences in Diagnosis and Treatment = Planning

Inevitably there will be a diversity in the = methods of assessment in the clinical skills. However, if each student is to be deemed = competent in competences 1.1 - 1.7 inclusive, it is necessary to design theoretical and clinical = assessment methods which demonstrate the students' ability to competently carry out = each section referred to under diagnosis and treatment planing. Such structured tests may be = applied to a continuous or end of term examination basis or certified as complete = on a log book system. Assessment methods should confirm to examiners that future dentists = not alone are able to carry out properly patient examination, including appropriate = medical and dental histology, recognition of deviations from normal, diagnosis, case = analysis and treatment plan, but also to ensure that they have the theoretical clinical and = scientific knowledge appropriate to carry out the clinical exercise. This applies in = respect of all competences. 

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Pre-requisite core knowledge for competences = in radiography

In order to be competent in 1.8 and 1.9 the new = graduate, in addition to those conditions set down in respect of competences 1.1 - 1.7 = inclusive above, should also understand and be competent to apply where appropriate :- 

  • the principles which underlie dental radiographic techniques = and the use and understanding of the equipment employed 
  • the nature, physics, tissue responses to, and hazards of = ionizing radiation 
  • regulations in force in the EU and the particular member state = in respect of ionizing radiation 
  • minimising dosage of radiation 
  • quality control in radiography/ radiology 
  • common techniques involved in dental radiography 
  • equipment monitoring and safety assurance 
  • normal radiographic features of the head and neck with = particular expertise in oral/dental radiographic interpretation and deviations from = normal, their interpretation and differential diagnosis 
  • clinical audit procedures 
  • cephalometrics 
  • in addition the new graduate should keep abreast of the = possibilities of alternative imaging techniques 
Pre-requisites for Core Knowledge and Understanding for = Competence in Medical Emergencies

It is essential that the dental student be = competent to administer CPR and resuscitation for patients. In many schools separate courses in = CPR and first aid are provided by outside agencies early in the course such as the Red = Cross or St John's Ambulance Brigade. Where these exist they are to be encouraged. = Competence in CPR requires hands-on practical courses on manikins or other simulated means. =

5. Medical Emergencies = (Competence 5.1)

5.1 Carrying out cardio-pulmonary resuscitation = (CPR) and first aid. 

Assessment

Demonstration of CPR on manikins 

6. Practice = Management

6.1 Working as a leader of a health care = team using the full range of available dental auxiliary personnel. 

In order to acquire competence in this area = innovations are encouraged to help gain experience for students in general dental practice in = order to give the student a realistic understanding of what is expected on graduation. =

Consideration should be given in each region to = provide their graduates with an appropriate understanding of: 

  • the economics of health care
  • understanding of record keeping
  • practice expenses
  • health and safety regulations in force
  • equipping and furnishing a practice
  • legal complications of purchasing, leasing, acting as an = assistant associate or a principle in dental practice
  • employment legislation
  • running a small business
  • principles of accounting for the dental surgery
  • computerisation and data collection
The newly qualified or newly registered dentist = must be capable of carrying out treatment as appropriate on adults, children, = medically, physically and mentally compromised patients in the context of whole patient care = appropriate to the expectations of a general dentist. These basic competences are not = restrictive and should constitute only part of the educational and training objectives of a = dental school's curriculum in the European Union. In their capacity as team leaders = dental students should be exposed to this important facet of training which includes task = analysis, scheduling and delegation of tasks, prescription and monitoring of results. It = includes training in appropriate team work with dental laboratory technicians, = hygienists, nurses and other auxiliaries. 

Assessment

Continuous clinical assessment

General Prerequisites for = competences

A dentist could not be considered clinically = competent unless he or she is sufficiently well informed and is capable of carrying out the = task within currently acceptable clinical parameters. The following prerequisites apply = before a dentist can be considered competent. 

  1. Having a sufficient understanding of the basic, biological, = behavioural and medical sciences on which modern oral health care and maintenance of = health is based. 
  2. Practising the full range of general dentistry in the context = of whole patient care without harm to the patient or the environment. 
  3. An understanding of the dentist's moral and ethical = responsibilities in patient care, as an individual and within the context of the community. 
  4. Prioritising care according to need, and participating with = others in setting attainable targets in reducing oral diseases within the community. 
  5. Knowledge of the aetiology, principles of the molecular = biological processes, pathogenesis, demographic features, prevention and treatment of = oral and dental diseases. 
  6. Being familiar with the pharmacology of drugs directly and = indirectly related to the practice of dentistry and understanding the implications of drug = therapy for systemic conditions in respect of dental treatment. This implies = competency in safely prescribing appropriate drugs for dental patients. 
  7. Knowledge of the biomaterial sciences as required for the = practice of dentistry. 
  8. Providing dental care within the ethical and medico-legal = constraints of the member state in which the dentist practices. 
  9. Controlling cross infection and preventing physical, chemical = or microbiological contamination in the practice of dentistry. 
  10. As appropriate to a dentist application of the full range of = modern safe pain and anxiety control methods when carrying out dental treatment. =
  11. Being aware of the importance of continuing professional = development and education in order to keep abreast of relevant advances in all facets of = dental practice. 
  12. As a member of a health sciences discipline to participate in = health promotion in the community with specific responsibility to promote oral and = dental health. 
  13. On graduation a new dentist must be capable of objectively = judging the quality of care provided for patients under his or her care. 
In addition the new dentist must be capable of carrying out = comprehensive appropriate care and management of both adult and child patients including those = with physical, medical and mental disabilities. Appropriate experience is desirable = to develop the necessary skills in child management. 

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Care of Child Patient (Paediatric = Dentistry)

Although there are no specific competences = described for paediatric dentistry they all apply to caring for the child patient. The newly = qualified dentist must be capable of providing all facets of care, maintenance and = prevention for the child patient. This requires appropriate training in behavioural = psychology, management of children with special needs and an integrated approach in = orthodontic treatment with paediatric dentistry and prevention and an understanding of growth = and development. The social and psychological factors of ill-health, medically and = socially disadvantaged children must be part of a modern dental curriculum. The development = of child management skills is an essential component of a modern dental curriculum. 

Prevention and Community Dentistry

Prevention is the dominant principle in all = facets of dental care on an individual, group and community basis. It is essential that all = programmes should have a basis in prevention and community care. Epidemiological principles, = biostatistics and special group care programmes should be incorporated in each of the = disciplines referred to within the context of required clinical competency. Specific = community and preventive projects are to be encouraged. 

Integrated or Comprehensive Patient = Care

Integrated patient care is the guiding = principle of modern dentistry reducing the segregated departmental approach. No one curriculum is = appropriate for Europe. Innovations are to be encouraged provided they fulfil the = essential requisite competences and are subject to objective analysis of the advantages = and inevitable disadvantages inherent in all curricula. Clinical experience must = always be set in a context of comprehensive holistic patient care. 

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