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Campus Spotlight: University of Texas Health Science Center San Antonio

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By Nicole Fauteux 

"If you walk into our clinics and you ask the faculty, they can tell you who is struggling, who is doing well, and who is making good progress toward putting it all together," says Prof. Bill Hendricson, Assistant Dean for Educational and Faculty Development at the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School. The trick, he says, is to systematically document these observations to gain a comprehensive "360°" perspective on student performance. This philosophy gave birth to UTHSCSA's multifaceted approach to evaluating overall competency.

Like many dental schools, UTHSCSA uses a group practice model to teach clinical dentistry. Each general practice group (GPG) has 24""28 students supervised by two general dentists, a prosthodontist, and a general dentist who is an operative content expert. Except during community rotations, this quartet observes the same third and fourth year students on a daily basis over the course of two years.

To assess their clinical performance, UTHSCSA begins with daily, non-graded, formative assessments that provide a basis for periodic 360° evaluations of student progress. Faculty members take note of how students are integrating their knowledge, technical skills, problem-solving abilities, and professional behaviors in the course of patient care. Each month, and again at the end of each semester, the GPG faculty meet to compare their daily notes and create progress reports, assessing each student on 20 competencies needed for the entry-level practice of general dentistry. Individual learning plans are developed for students who have not made sufficient progress in any area, and third year students who have deficiencies on the end-of-year comprehensive assessment may not advance.

Where UTHSCSA differs most significantly from other schools is in tasking this same group of GPG faculty members with making the final assessment of students' readiness for independent practice. In addition to their own observations, the quartet reviews ten other measures including grades in 3rd year discipline-based clinical courses and on standardized tests, case presentations, professionalism, and 62 independently performed clinical skills evaluations.

UTHSCSA's confidence in the ability of its GPG faculty to fairly judge each student's readiness for practice stems from the careful way the GPGs are structured. Consideration is given to balancing personality types in assigning faculty to each GPG, and their evaluation skills are calibrated annually. In addition, their assessments are reviewed by the Program Director and overseen by the Chair of the Department of Comprehensive Dentistry, making it possible to identify any outliers among the faculty.

So far, at least, the system appears to be working, with no GPGs disproportionately giving their students high or low marks. In addition, struggling students are being identified earlier.

"All dental schools try to make good decisions about whom they admit," says Dr. Bill Dodge, Vice Dean, "but dentistry isn't for everybody. We feel it is our responsibility to identify those students for whom dentistry is not a good fit and those who show promise but need additional help. The evaluation system we have in place allows us to recognize problems and intervene early with extra experiences and faculty mentoring."

According to Dr. Dodge, UTHSCSA's approach is similar to the way medical and dental residency directors make their assessments. "You don't assess general surgery residents strictly by the numbers of procedures they perform. Instead they are evaluated periodically on how well they perform in the OR, how they treat their patients, how they comply with policy, and how they interact with the attending surgeons and the staff. This method of evaluation is very similar to the one we use to assess our students progress in developing the knowledge, skills, and values required to practice dentistry."

When UTHSCSA piloted its group practices, a decision was made to let the appointment book drive the student activity. The school saw an increased level of productivity among the students. What is more, each member of the original pilot group of students, carefully selected to represent the top, middle, and bottom of the class, performed above the mean on outcome measures with only one exception.

"It convinced me that you can assess competence using the judgment of the faculty," says Dr. Dodge, and more than a decade later, he sticks by that assertion. "Our process has evolved, and so has our faculty. Some are beginning to gain confidence that you can make valid judgments about students in the absence of specific requirements and know that the administration of the dental school will support those judgments."

That said, UTHSCSA currently requires students to complete a minimum amount of procedures in operative, fixed, and removable prosthodontics, and in periodontics and endodontics prior to graduation.

"We think it's important for now," says Dr. Bill Rose, Assistant Professor and one of the school's GPG leaders. "We don't want a student performing well on a crown graded examination and think that he/she is competent in that area based on the one time event."

Dr. Rose, who previously directed the dental school's AEGD program, believes that UTHSCSA students graduate better prepared for practice than many of their peers. Reflecting on his former residents, he notes that, "Some of the students who came from discipline-based programs had really good individual skills, but lacked the ability to put all that together." In his estimation, UTHSCSA's students were better in organizing comprehensive treatment plans, and they were able to improve on their individual skills with more experience. Since implementing the new approach to assessing overall competency, he believes the school's graduates are better prepared than ever.

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