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UNIVERSITY OF PUERTO RICO MEDICAL SCIENCES CAMPUS

SCHOOL OF DENTAL MEDICINE PREDOCTORAL PROGRAM

SELF-STUDY REPORT

Submitted to the Commission on Dental Accreditation American Dental Association

December 2012

Accreditation Site Visit February 12-14, 2013

UPR-School of Dental Medicine Predoctoral Program Self-Study Report 2012

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This document contains the following types of evidence:

Exhibits Tables and figures included with the text of the report. Numbered sequentially within each standard.

Required Tables Tables 1-16 B sequentially organized

as a section of the Self-Study Report.

Appendixes Supporting materials referenced in the text.

Course Syllabi Bound in three separate volumes

Other documents and materials referenced in the text and not included in the above categories will be available on site.


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TABLE OF CONTENTS

VERIFICATION PAGE ix

FOREWORD 1 STRENGTHS, WEAKNESSES, RECOMMENDATIONS 5AND ACTION PLAN

STANDARDS

Standard 1: Institutional Effectiveness 15

Standard 2: Educational Program 43 Standard 3: Faculty and Staff 139

Standard 4: Student Services 153 Standard 5: Patient Care Services 177

Standard 6: Research Program 207

TABLES 221

Table 1: Persons Responsible for each Standard Table 2: Outcomes Assessment Plan Table 3: Schedule of Courses Table 4: Departmental Course Offerings – Biomedical Sciences Table 5: Departmental Course Offerings – Clinical Services Table 6: Departmental Course Offerings – Behavioral Sciences Table 7: Departmental Listing of Faculty Table 8: Alphabetical Listing of Full-Time Faculty Table 9: Alphabetical Listing of Part-Time Faculty Table 10: Alphabetical Listing of Faculty by Department Table 11: Summary of Basic Sciences Faculty Table 12: Summary of Clinical Sciences Faculty Table 13: Summary of Behavioral Sciences Faculty Table 14: Committee Membership Table 15: Research Grants Table 16 A: Faculty Research Information

Table 16 B: Faculty Publications


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EXHIBITS Standard 1 1.1 Congruence between Goals and Strategic Decisions at the School, Campus, and University System Levels 1.2 Annual Assessment and Planning Cycle 1.3 UPR-SDM Outcome Assessment Diagram 1.4 Itemized School Budget Distribution by Source of Funds, Years 2008-2012 1.5 School of Dental Medicine Distribution of General Funds, Years 2006-2012 1.6 Itemized School Expenses Distribution by Categories, Years 2006-2012 1.7 Percentage Distribution of School Budget and Expenses by Source of Funds, Years 2006-2012 1.8 Estimated Budget for Specific School Initiatives to Secure Funding, Years

2013-2017 1.9 Five Year, Projected School Budget, 2013-2016 1.10 New Program Approval Process Standard 2 2.1 Profile of Entering Classes, 2006 to 2012 2.2 Attrition, Graduation and Retention Rates of Entering Class Cohorts, School of Dental Medicine, Medical Sciences Campus, UPR, 2004-2008 2.3 Advanced Placement Program Applications and Admissions, 2010-2012 2.4 Admissions of Transfer Students, Years 2006-2012 2.5 Socio-Economic Profile of Entering Class, 2006-2011 2.6 Evaluation Anchor Point Definitions 2.7 Assessment Process for Curriculum Improvement 2.8 Total and Average Number of Procedures per Student by Discipline, Class of 2012 2.9 New Patient Flowchart 2.10 New Emergency Patient Flowchart 2.11 Expected Number of Graduates and Graduation Date 2.12 Key Experiences for the Development of Critical Thinking by Course and Academic Year 2.13 Alignment of CODA Competencies and School Competencies 2.14 Independent Assessment towards Competency Attainment 2.15 Passing Rates on Fourth Year Competency Examinations, Academic Year 2008-2009 2.16 Passing Rates on Fourth Year Competency Examinations, Academic Year 2009-2010 2.17 Passing Rates on Fourth Year Competency Examinations, Academic Year 2010-2011 2.18 Passing Rates on Fourth Year Competency Examinations, Academic Year 2011-2012 2.19 Methods of Assessment in Courses Related to Patient Assessment and Diagnosis


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2.20 Methods of Assessment in Courses Related to Comprehensive Treatment Planning 2.21 Methods of Assessment in courses Related to Health Promotion and Disease Prevention 2.22 Methods of Assessment in Courses Related to Informed Consent 2.23 Methods of Assessment in Courses Related to Anesthesia, Sedation, and Pain and Anxiety Control 2.24 Methods of Assessment in Courses Related to Restoration of Teeth 2.25 Methods of Assessment in Courses Related to Replacement of Teeth 2.26 Methods of Assessment in courses Related to Periodontal Therapy 2.27 Methods of Assessment in Courses Related to Pulpal Therapy 2.28 Methods of Assessment in Courses Related to Oral Mucosal Disorders 2.29 Methods of Assessment in Courses Related to Hard and Soft Tissue 2.30 Methods of Assessment in Courses Related to Dental Emergencies 2.31 Methods of Assessment in Courses Related to Malocclusion and Space

Management 2.32 Methods of Assessment in Courses Related to Evaluation of the Outcome of Treatment 2.33 Methods of Assessment in Courses Related to Patients with Special Needs 2.34 Methods of Assessment in Courses Related to Medical Emergencies Standard 3 3.1 Full-Time Faculty by Academic Rank and Department 3.2 Part-Time Faculty by Academic Rank and Department 3.3 School of Dental Medicine Support Staff, 2010-2011 3.4 School of Dental Medicine: Promotions Granted for Academic

Years, 2007-2008 to 2011-2012 Standard 4 4.1 Student Clinical Hours Standard 5 5.1 Quality Assurance Program Standard 6 6.1 Organization of Research within the School of Dental Medicine 6.2 School of Dental Medicine Grant Income from Research, Fiscal Years

2007-2012 6.3 Total Amount of Grants Received, Fiscal Years 2002-2007 and 2007-2012 6.4 Number of Faculty Peer Reviewed Publications: Fiscal Year 2002-2007 and 2007-2012 6.5 Newly Recruited Research Faculty by Degree, Expertise, and Protected Time Release 6.6 UPRSDM Research Pipeline


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APPENDIXES

Standard 1 1.A School of Dental Medicine Strategic Plan 2012-2016

1.B Level of Achievement of the School of Dental Medicine Strategic Plan 2004-2009

1.C Critical Issues for the Development of the Strategic Plan 2012-2016 1.D Institutional Policy for the Request and Receipt of Private Donations (Política

Institucional para la Solicitud y Aceptación de Donativos Privados) 1.E School of Dental Medicine Bylaws

1.F University of Puerto Rico Organizational Chart 1.G Medical Sciences Campus Organizational Chart

1.H School of Dental Medicine Organizational Chart 1.I Certification of Accreditation by the Puerto Rico Council on

Higher Education 1.J Certification of Accreditation by the Middle States Commission on Higher Education

Standard 2 2.A School of Dental Medicine Catalog 2.B Admission Requirements for the Undergraduate Dental Medicine Program of the UPR/Application Form and Packet 2.C Rules and Regulations for the Selection and Admission of Candidates to the School of Dental Medicine 2.D Applicants’ Interview Evaluation Form 2.E Portfolio Rubric 2.F Advanced Placement Program Brochure 2.G Course Syllabus Template 2.H Duties and Responsibilities of the Faculty and Students 2.I Clinic Manual 2.J Clinical Evaluation Criteria Manual 2.K Academic Progress and Performance Rules and Regulations 2.L UPR-SDM Competencies for the New Dentist 2.M Competencies According to Related Courses and Methods of Assessment 2.N Clinical Evaluation Form 2.O Examples of Assessment Form 2.P Trimester Clinical Evaluation of Third Year Students’ Performance 2.Q Trimester Evaluation of Progress towards Competency

2.R Competency Examinations Manual 2.S Course Evaluation Forms: Clinical Courses, Didactic and

Laboratory Courses. 2.T Forms for Peer and Administrative Evaluation of Courses: Course

Coordinator/Participating Faculty/Curriculum Committee Course Evaluation Instruments and Department Director Course Evaluation Instrument

2.U Protocol for the Management of Acute Medical Emergencies in the


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Dental Clinic.

Standard 3 3.A Alphabetical Listing of Ad-Honorem Faculty 3.B Faculty Development Activities Offered by the School of Dental Medicine 3.C Form for Annual Evaluation for Faculty Development. 3.D Faculty Attendance to Professional Development Activities during 2011-2012 3.E MSC Faculty Evaluation Forms for Tenure and Promotion

Standard 4 4.A Blueprints of the School of Dental Medicine Facilities 4.B Student Financial Aid Documents 4.C Samples of Accumulated Debt Report 4.D UPR-SDM Policy on Technical Standards for Dental Students

4.E Student Medical History Form (“Formulario médico de admisión paraestudiantes de nuevo ingreso”)

4.F MSC Self-Identification of Disability Form 4.G UPR Medical Plan Benefits 4.H Student Health Brochure (“Boletín Informativo de Servicios Médicos”) 4.I Hepatitis B Immunization Policy 4.J Immunization Policies for: Tuberculin, Hepatitis B, Rubella, and Varicella 4.K Exoneration Form

Standard 5 5.A Quality Assurance Program Manual 5.B Record Audit Results 5.C Quality Assurance Outcomes Results and Actions Taken Report, 2007-2011 5.D Sample of Patient Satisfaction Results

5.E “Salud Oral: Parte Esencial de su Salud General”5.F General Information for Patients of the Dental Clinic, English and Spanish

Versions 5.G Patient’s Rights and Responsibilities Statement

5.H Patient Appointment Card 5.I Summary Log of Basic Life Support Certifications 5.J Infection Control and Risk Management Protocols 5.K Results of Infection Control Monitoring Program 5.L Sample Monitoring Report Form 5.M HIPAA Forms

Standard 6 6.A UPR-SDM Predoctoral Students Research Projects by Academic Year, 2007-2012 6.B UPR-SDM Predoctoral Students Publications by Academic Year,

2007-2011


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6.C UPR-SDM Post-doctoral Students Publications by Academic Year, 2007-2012

6.D UPR-SDM Post-doctoral Students Abstracts Years 2008-2012 6.E UPR-SDM Post-doctoral Students Ongoing Projects

FOREWORD

In 2007 the institution changed its name to School of Dental Medicine, as a way to emphasize oral health as an integral part of the general health of the individual. The high standards and contribution of the School to the improvement of the oral health of the Island were recognized by ADEA in 2009 by making it recipient of the William J. Gies Award for Outstanding Achievement.

Since the last accreditation visit in 2006, the University of Puerto Rico School of

Dental Medicine (UPRSDM) has experienced some changes, three of which must be highlighted: curriculum, student and institutional assessment, and financial resources.

The curricular changes implemented during the last accreditation period constituted a major curricular reform and were geared towards preparing graduates to meet the challenges of an interdisciplinary and holistic way of treating patients. The integration of basic sciences and dental medicine in the curriculum has also been one of the school’s goals.

In order to achieve a more reliable assessment of students’ clinical work, the senior year evaluation system was modified to include quantitative and qualitative criteria regarding procedures, the preparation of a portfolio of clinical work, and the periodic assessment of students’ progress towards the development of the 13 competencies of the curriculum. Teams of instructors who work on a daily basis with the students have been placed in charge of their assessment. The Student Assessment Committee, created in academic year 2006-2007, has helped students experiencing academic difficulties succeed by means of early interventions, assignment of mentors in some cases, and academic and psychological counseling when needed. In most instances, students have been able to meet the curricular demands and successfully complete their studies.

An important challenge for the school during the period under evaluation has been diversifying its sources of funding so as to rely less on state allocations. The school has successfully survived during these difficult financial times by obtaining funding from its research, service, and academic activities. One such measure was the expansion of the Advanced Placement Program in 2011, which proved to be a successful source of funding. The budget share coming from external sources (other than federal appropriations) increased from 12.62% in fiscal year 2006 to 22.45% in fiscal year 2012, while the proportion of the budget share corresponding to university funds decreased from 60.3% in 2006 to 49.47% in 2012, thus reducing the school’s dependence on state funds.

Changes since the Last Accreditation

Administration

In September 2010, the Board of Trustees, upon recommendation of the Chancellor of

the Medical Sciences Campus appointed Dr. Humberto Villa as Dean of the school. Dr. Villa chose new members on his staff, specifically, the Associate Dean, the Assistant Dean for


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Academic Affairs, the Assistant Dean for Clinical Affairs, and the three department chairs. The Assistant Dean for Student Affairs and the Assistant Dean for Research remained in their positions.

Curriculum

Since the last accreditation visit, the Curriculum and Institutional Assessment

Committees have fine-tuned the curricular reform implemented in 2003-2004 by using the diverse measures of the school’s assessment plan as well as course evaluations. A group of faculty members well trained in assessment conducted a thorough evaluation of the senior year clinical assessment system and created a new system designed to assure that it is competency based. The faculty is proud of the work done in this area and is working on a needed reform in the junior year assessment system.

Facilities and Equipment

The School of Dental Medicine maintains up-to-date physical facilities in order to assure that educational services and research can be offered at optimal levels. The waiting area of the main clinic was remodeled allowing a new patient flow that is more convenient to the patients, students, and clinical support staff. The sterilization area was also remodeled to meet the demands of students in all clinics. Digital radiography has been partially implemented, including radiology equipment and hardware to store the image data. Laboratories for the freshman and sophomore students are being remodeled in order to update some of the old equipment and benches and improve the students’ access to information technology resources.

Research

The advances achieved by the UPRSDM research program during the past seven years have been largely due to the establishment of a research center led by an Assistant Dean for Research. This unit promotes a research culture among faculty and students and supports collaborative and interdisciplinary activities in the Medical Sciences Campus and abroad. Proceeds from the endowment fund, granted by the National Institutes of Health, provided the funds for the recruitment of a magnet investigator who has collaborated with UPR, national, and international investigators in the study of oral-systemic links. The fund also makes available fiscal resources for other scholarly activities.

The number of faculty members with protected time for research has duplicated. The research culture has been strengthened due to the inclusion of research topics at all levels of the curriculum, with a special emphasis on the preparation of a portfolio of clinical patients in the senior year. The center offers faculty development activities in this area in order to motivate participation in research activities in clinical areas.


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Faculty The self-study process helped the faculty reflect on areas that needed improvement,

among these the annual faculty evaluation process and its link to faculty development. It became evident that this process needed more thorough interviews with each faculty member in order explore their professional goals as well as those of the school, and that this had to be put into action by each department chair. A new annual evaluation form for faculty development was implemented. Using this form, the Department Director interviews faculty members and prepares a plan to assist them in their development in the areas of education, service, and research. The professors’ needs and interests are shared with the Assistant Dean for Academic Affairs, who develops courses and activities accordingly. Some faculty members have been offered the opportunity to train outside of the institution in areas such as leadership, oral cancer, and forensic pathology.

A plan for coaching and supporting young faculty in improving knowledge and skills in the areas needed by the school will also be implemented. Their development may include continuing education courses, international meetings in their specialty, and participation in ADEA Leadership Institute, among others.

Community Outreach

Since the previous accreditation, the school has continued to promote student participation in multidisciplinary, collaborative service activities throughout the island. During their junior year, students participate in a total of 15 hours of community oral health activities programmed by the school’s Community Oral Health Section each academic year. During their senior year students participate in 11 additional hours of activities in the community. Voluntary participation is also fostered among students throughout all their academic years. Participation in these activities enhances student awareness and empathy regarding the needs of medically and socio-economically disadvantaged groups.

Previous Site Visit Recommendations

The School of Dental Medicine received no recommendations in its previous site visit and accreditation report.

The school abides by all CODA standards and monitors all aspects of its operation through its Institutional Assessment Committee. Actions taken close the loop and resolve the issues found during data collection. The committee has been instrumental in providing input leading to changes in the curriculum, didactic materials, clinical services, and organizational culture, among others.

Self-Study Process

The School of Dental Medicine began its self-study process by appointing the Steering Committee in April 2011. The committee was chaired by Dr. Darrel Hillman,


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Associate Dean, and included five other faculty members who, because of their experience and expertise, chaired the subcommittees addressing the six standards:

Standard I – Dr. Arlene Sánchez

Standard II- Dr. Darrel Hillman Standard III- Dr. Ana N. López Standard IV- Dr. Aileen Torres Standard V- Dr. Arnaldo Guzmán Standard VI- Dr. Augusto Elías

Dr. Kathleen Crespo, who had recently retired and was the school’s former

Curriculum Director, was appointed as consultant for the coordination of the self-study process and production of the document, thus strengthening continuity between the school’s current and previous accreditation processes. Faculty members from the three school departments were appointed to each subcommittee to collect and analyze the information required for each topic.

The Steering Committee prepared a work schedule and held its first official meeting on May 6, 2011. Meetings were held every other week to monitor the progress of the self-study process and coordinate the data gathering with the appropriate persons. The preliminary self-study findings were presented to the faculty during a workshop in September 2011 and to students and support staff during meetings conducted in January 2012.

The school conducted a mock visit approximately eight months prior to the accreditation visit in which it received feedback from the reviewers that was later analyzed and incorporated in the document as needed. It also conducted a workshop on September 5, 2012 to receive the final input from faculty and students. At that time, faculty and students had the opportunity to comment on the strengths, weaknesses, and corresponding recommendations that resulted from the self- study process. All faculty recommendations were included in the document. The Steering Committee proceeded with the final edition of the document with the assistance of the Director of the Accreditation Office of the campus Deanship for Academic Affairs.

The identified weaknesses were ranked by the Steering Committee as high, medium,

or low priority. An action plan was developed to work in each area. The categories were defined as follows:

High Priority- Areas that do not comply with the accreditation standards and need to be corrected immediately.

Medium Priority – Areas that address non-compliance with school policies, although they comply with accreditation standards.


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Low Priority- Areas in which the school needs improvement but definitely complies with CODA Standards.

The analysis of identified strengths and weaknesses by standard follows:

ANALYSIS OF STRENGHTS, WEAKNESSES, RECOMMENDATIONS, AND

ACTIONS TAKEN

STRENGTHS STANDARD 1 1. A strategic planning process has been in place since 1988. The new plan 2012-2016 is in alignment with the Medical Sciences Campus Strategic Plan (2009-2016) and the University of Puerto Rico President’s Office plan Ten for the Decade (2006- 2016). 2. The school has an ongoing systematic assessment process following an outcomes assessment plan since 1988 that includes assessment activities covering the areas of service, academics, and research. The school revised its Outcomes Assessment Plan and developed a new plan for academic years 2006- 2012. It appointed an Assessment Committee and established it as a standing committee (Art.30, Bylaws) to collaborate with the Institutional and Academic Assessment Office in the analysis of data, dissemination of results, and to propose recommendations to the Curriculum Committee, the Administration Committee, and to the Dean. 3. As part of the systematic assessment process the school conducts several surveys on an ongoing basis to assess institutional effectiveness:

Students’ achievement Students’ satisfaction with institutional services Students’ perception of quality of education Completed and active patients’ perception of quality of care and services Faculty involvement in research and publications Staff and faculty satisfaction with the institutional climate

STANDARD 2 1. The School has demonstrated a strong commitment to curricular changes and innovation based on assessment data. It has developed and implemented several projects such as a new assessment process for senior year students based on their progress in achieving competencies and the organization of third year students in clinical teams. 2. PhD-level scientists with experience in their respective fields teach biomedical sciences courses designed for dental students. 3. The biomedical sciences component is under the Oral Biology Section and taught by two professors with dual DMD/PhD degrees.


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4. A number of dental faculty members have actively participated or are currently involved in cutting-edge research projects related to caries detection, assessment and management of oral cancer, the relationship between oral and systemic diseases, and health disparities. These faculty members participate in clinical and biomedical sciences courses and expose the students to the latest research findings and techniques. They also participate in several school committees offering valuable input. 5. There is a strong behavioral sciences component in the curriculum, as well as structured community experiences that emphasize the philosophy of preventive dentistry. 6. The fourth year clinical assessment system is focused on the student’s achievement of competencies. 7. The UPRSDM’s location in the Puerto Rico Medical Center offers students a large, varied, and constant pool of medically compromised special patients and the opportunity of interaction with a multidisciplinary team of health care professionals STANDARD 3 1. A liaison team was appointed to the ADEA Commission on Change and Innovation (CCI), to help faculty members improve their educational and curricular knowledge in clinical evaluation skills for the Fourth Year Comprehensive Care Clinic. Their work was the first one published in the Journal of Dental Education and was presented at the ADEA Symposium of 2010. 2. A strong faculty development program has been maintained during the last six years with emphasis in development of multimedia instructional materials, research methodology, grants writing, curricular development, and leadership. 3. Periodic faculty meetings and ample participation in committees keep faculty well- informed and promotes their involvement in decision- making processes at all levels. 4. Two new young faculty members with doctoral degrees in behavioral sciences and in public health are NIH fellows pursuing an MS degree in Clinical Research. STANDARD 4 1. The Office of Student Affairs offers in-house, direct counseling by certified psychologists and counselors. 2. Campus recreational services have been significantly improved and expanded, including the creation of a fitness center, along with additional sports and social activities. 3. The Student Ombudsperson Office has proven to be effective in advocating for student rights and in offering mediation, negotiation, and conciliation services to students. 4. There are multiple opportunities for student participation in decisions that affect them.


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5. There is an ongoing process for early identification of students with academic difficulties that allows early intervention and counseling. 6. The school has procured the funds to offer emergency loans to students. STANDARD 5 1. The school has a Comprehensive Care Clinic that follows a general practice model of clinical instruction with clinical teams under a faculty coordinator and faculty representing all dental specialties. This organization facilitates continuity of comprehensive and patient centered care. 2. Appointment of a clinical faculty member as coordinator of each of the five areas of the Quality Assurance Program facilitates the dissemination and implementation of findings. 3. Appointment of an external infection control compliance officer strengthens compliance with clinical policies. 4. Data collected in the Quality Assurance Program are analyzed by the statistics assistant and disseminated at faculty, department, and section meetings. STANDARD 6 1. The progress that the UPRSDM has made in research during the past seven years can be largely attributed to the establishment of the Office of the Assistant Dean of Research, which promotes a research culture among faculty and students and supports research-related activities. In addition, the SDM recruited a magnet investigator that has done a commendable job in working with SDM investigators in collaboration with other researchers at the Medical Sciences Campus and research-intensive universities in the US. 2. The research portfolio themes, quality, and quantity of the research projects conducted so far, the diversity of the research and scholarly activities available to students and faculty, and the availability of funds to support student research projects, and travel to present research projects conducted at the UPRSDM are all great strengths and have provided the initial foundations on which to build a strong research culture. The fiscal resources provided by the NIH Endowment Fund of $15,000,000 that has been established for infrastructure development and research support offers stability and will make it possible for research activities to continue well into the future at the SDM. 3. The increased participation of students in the elective research course and research meetings is an important step in the development of a research culture. Research students at UPR have received recognition and awards for their efforts in basic and clinical sciences research at the campus Annual Research and Education Forum.


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WEAKNESSES, RECOMMENDATIONS AND ACTIONS TAKEN

Standard 2

Priority

Recommendations/Actions Taken

1. There are inconsistencies in the application of the evaluation system of the third year clinical experiences in the different clinical disciplines, affecting its capacity to discriminate between levels of performance.

Medium Revise the evaluation system to assure that it uses well defined criteria and instruments for each discipline, and facilitates its implementation by the faculty. A committee with representation of all the clinical rotations was appointed during academic year 2012-2013 to conduct this re-evaluation.

2. The administrative/peer evaluation of courses has not been a continuous process.

Low Implement administrative/peer evaluation of courses by means of departmental curriculum committees. These committees will have the following responsibilities: • Assure that the content of courses is updated • Promote the use of varied instructional strategies • Assure that the equipment and physical facilities are adequate • Maintain an updated bibliography This recommendation will be implemented during the second semester of academic year 2012-2013.

3. Biomedical sciences courses are taught by discipline and there is a limited integration of clinical topics.

Medium The School of Dental Medicine adopted an integrated approach for the teaching of the biomedical sciences courses by “systems” in 2003-2004. This approach was tested for four years and was commended in the school’s previous accreditation. Nonetheless, through the ongoing outcomes assessment process, it became evident that this approach did not improve the students’ performance in the National Dental Board Examination, and that it did not necessarily help the students integrate basic sciences into the clinical practice. In addition, the approach was creating a number of administrative problems. For these reasons, the systems approach was discontinued, and a number of alternative approaches were evaluated by the Oral Biology Section in collaboration with the Basic Sciences Departments and the Curriculum Committee. The approach selected as the most promising for achieving a more thorough integration of basic and clinical sciences is a “bidirectional”


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approach with two components: clinic into basic sciences and basic sciences into the clinic. The first component consists of increasing the involvement of clinical dental faculty in the teaching of Basic Sciences courses during the Freshman Year. Currently, it is mostly dental faculty with dual DMD/PhD degrees, or with research experience who participate in the courses on biochemistry, cariology and microbiology by discussing topics with relevance to dentistry. The goal is to increase this participation, and to include more clinical faculty, and more topics with clinical applications. For example, oral surgeons have been participating for the last two years in the anatomy course, where they present surgical cases involving craniofacial anatomical structures. This type of participation is welcome by the students and helps increase their enthusiasm in the basic sciences. The second component of the new approach involves the participation of the Biomedical Sciences faculty as consultants in the comprehensive care dental clinics. Consultations are coordinated through the Oral Biology Section for any clinical case with a significant or rare medical or dental condition. It is also a requirement for senior students, as part of the preparation of one of their portfolio cases, to identify a relevant topic related to the biomedical sciences and to prepare a narrative under the guidance of a basic sciences faculty member. The implementation of this bidirectional approach began in August 2012.

4. The amount of time devoted to General Systemic (57 hours) and Oral and Maxillofacial Pathology (64 hours) is considerably less compared to other dental schools according to the CODA survey (mean 95.8 hours, and 92.2 hours respectively).

Low Re- evaluate the number of contact hours and content included in the oral and general pathology components in the curriculum. The Curriculum Committee began this analysis during the current academic year (2012-2013).

5. The first time passing rate of students on the National Boards

Medium Several strategies will be implemented in addition to those already in place, such as


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Dental Examination Parts I and II is below the school’s established outcomes indicator.

advising students on how to prepare for the Boards and orientations to faculty regarding the type of questions and topics included. More emphasis will be given to promote critical thinking skills and evidence based practice in all courses. Workshops will be offered to faculty members so that they learn to prepare board oriented questions in their course assessments. Grand rounds will be developed for discussion of the fundamentals of biomedical sciences as applied to the clinical cases presented by senior year students in their portfolios. These will be open to all students.

6. There are still some faculty members who have not incorporated the use of information technology in their courses (didactic and clinical).

Low A series of workshops have been offered to train faculty in evidence based practice to increase the didactic experiences that require the use of information technology. Since academic year 2012-2013 students’ have been offered additional seminars to improve their skills in evidence based practice and systematic literature review, so that they may apply these into the preparation of their senior year portfolio.

7. Most third year clinical course syllabi do not describe the way comprehensive patient care is addressed in the course.

Medium Improve the documentation of the third year clinical course syllabi regarding comprehensive patient care to make sure that a statement concerning the importance of the comprehensive care of patient is included and applied. For academic year 2012-2013 a paragraph was added to all clinical courses syllabi to reinforce the school’s policy on comprehensive patient care. Third year clinical team coordinators will enforce this policy. In order to monitor compliance, a question regarding students’ perception on comprehensive care of patients will be added to course evaluations at the end of academic year 2012-2013.

8. More structured clinical experiences should be provided where students are exposed to patients with developmental disabilities and significant physical limitations.

Low Students can improve their patient management skills with patients with developmental disabilities and significant physical limitations by assisting residents who routinely treat these patients and/or rotating in centers that offer services to this population. A rotation will also be coordinated with the School of Health Professions clinic that offers services to children and adolescents with disabilities (Proyecto Interdisciplinario de


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Excelencia en Servicios). The coordination of these rotations will begin during academic year 2013-2014.

9. A medical emergency component is not included in the examination of the Prevent and manage medical and dental emergencies competency.

Low Include a medical emergency component in the 4th year examination of the competency on the prevention and management of dental and medical emergencies. A case based examination was prepared and will be offered to senior students as part of the competency examinations in academic year 2012-2013.

Standard 3

Priority


1. For the past six years emergency fiscal policies established by the government and the UPR Board of Trustees in 2009 included freezes on all salary increases, pay for excess accumulated sick leave, promotions in academic rank, and hiring of new personnel, including replacement of retired faculty (except by special request from departments).

Medium The SDM has been active in justifying the need for the replacement of faculty and staff, receiving authorization for the replacement of 7 faculty positions and 4 staff positions (3 dental assistants, 1 hygienist). The school will also develop activities established in its Strategic Plan to increase revenues from non- university sources such as: an increase in student enrollment in the Advanced Placement Program, grant proposal applications, and expansion of the Faculty Practice, among others. The school will also increase its efforts to appoint Ad-Honorem faculty in those areas where a faculty shortage is experienced. The UPR Board of Trustees recently approved promotions in rank for the first two groups of faculty members who had not received their promotions in rank. Four school faculty members received their promotions. The Board has also approved salary increases for university teaching and non-teaching personnel effective 2013.

Standard 4

Priority


1. Some of the school’s physical facilities and equipment have deteriorated. These include:

First and second year laboratories

Dental simulators laboratory

Common areas used by students and patients such

as restrooms Sterilization room Extraction system for filtering

Medium A plan for the renovation of the laboratories and common areas used by students and patients has been coordinated with the Campus Deanship of Administration. Also a request for funding needed for improvements in physical facilities and equipment was presented to the president of the Commission of Financial Affairs of the Puerto Rico House of Representatives. This request included the renovation of the Dental Simulators Laboratory, classrooms, an extraction system for the laboratories in the basement, as well as restroom facilities used by the students. The


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air particulates in the laboratories located in the basement

UPR President’s office assigned funds for the renovation of the Dental Simulators laboratory and the restroom facilities. These renovations are currently in process.

2. The Medical Sciences Campus has experienced delays in the disbursement of student loans.

Medium Present the situation regarding the delay in disbursement of student loans to the Dean of Students of the Medical Sciences Campus. A meeting to discuss the consequences of this delay on the students’ well being and performance was coordinated. The School offers emergency loans to those students in need of immediate funds to cover their expenses.

3. Students do not receive annual reports of accumulated debts from the Institution. These reports are offered only prior to graduation.

High The Campus Fiscal Financial Aid Office corrected this situation and students will begin to receive the corresponding reports yearly beginning academic year 2012-2013.

Standard 5

Priority


1. The oral diagnosis area needs to be reorganized in order to assign patients in a more efficient way to provide students the necessary clinical experiences to achieve competency in the different clinical areas.

Medium A protocol for the evaluation and management of patients is currently being prepared to assure an appropriate assignment of patients to each student. A faculty member has been appointed on a full time basis to supervise the adequate operation of this area.

2. The retirement of employees, especially in the areas of complete and active recall (hygienist and clerical staff) have placed an extra work load on the clinical staff and does not facilitate the proper operation of some clinical areas.

Medium The school has obtained approval for the appointment of 4 positions funded by university funds and one additional position will be financed with funds from Clinic revenues.

3. The Digital Radiographs and Imaging System need adequate servers to manage the amount of information.

Medium The required hardware and software for the operation of digital radiography has been purchased. Training of the support staff and the implementation of security and confidentiality systems is currently in process.

4. An increase in remakes has prompted the need for a reassessment of the Quality Control Program of the Restorative Sciences Department.

Low The Restorative Sciences Department implement a revised protocol for quality control system at the beginning of academic year 2012-2013.

5. The information system to register the number of patients that have completed their treatment does not facilitate the reporting of reliable statistics.

Low An adjustment in the computer system programming was performed and the Clinic team coordinators will make sure that all treatment plans are closed in the information system once patients are completed.


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Standard 6

Priority


1. There is a need to continue emphasizing the importance of evidence- based education. The SDM administrators, faculty, and students require a more in depth understanding of the importance of a research culture and its impact in fortifying the clinical and basic science courses.

Low The number of faculty development activities in epidemiology, statistics and evidence-based practice has been increased. A series of faculty development activities on these topics have been designed by the Research and Academic Affairs Offices and were initiated during the month of April of 2012. Also, seminars on systematic literature review and evidence-based dentistry were incorporated in the third year clinic orientation and the fourth year Comprehensive Care Clinic course (PRET 7400) to promote the students’ application of these concepts to clinical care.

2. The difficulties encountered at the campus administrative level by researchers in hiring personnel to facilitate the conduct of research, contract signing, the manner accounts are handled, as well as preparing invoices for NIH disbursement, frustrate researchers and makes their work more difficult.

Low The Medical Sciences Campus has acknowledged the difficulties encountered by researchers regarding grant management and coordination issues. The Chancellor appointed a committee to determine a plan of action to look for solutions to the above mentioned problems.

3. Occasionally, students encounter a lack of support from faculty members regarding their participation in research activities. Conflicts in schedules of courses or clinical activities frustrate the students.

Medium As part of the school’s efforts to promote a research culture, an administrative order for excusing students for research activities was established and communicated to all faculty members during academic year 2012-2013.

Third Party Comments

An announcement was posted on November 13, 2012 on the School’s web page and

in all clinics concerning the opportunity offered by the Commission on Dental Accreditation to submit comments by students, patients and other interested parties on the accreditation of the University of Puerto Rico School of Dental Medicine.

Complaints

Students are notified annually of the opportunity and procedure to file complaints

with the Commission on Dental Accreditation related to the University of Puerto Rico School of Dental Medicine’s compliance with accreditation standards. The Assistant Dean for Student Affairs is responsible of communicating this to students and of maintaining a record of student complaints


14


15

STANDARD 1 - INSTITUTIONAL EFFECTIVENESS 1-1 The dental school must develop a clearly stated purpose/mission statement appropriate to dental education, addressing teaching, patient care, research and service.

The University of Puerto Rico School of Dental Medicine (UPRSDM) complies with tandard 1-1.

Description The UPRSDM is a unit of the Medical Sciences Campus of the University of Puerto Rico, a multi campus, state supported institution of higher education of the Commonwealth of Puerto Rico. The mission of the University of Puerto Rico, as stated in the University Law of 1966 (available on site), is to “transmit and increase knowledge by means of the sciences and arts, placing these at the service of the community through the actions of its professors, researchers, students, and graduates”. The School of Dental Medicine was established in 1957 as part of the commitment of the Commonwealth to improve and safeguard the health of its people. Since then, it has been the only institution in the island providing training in oral health. The school’s name was changed from UPR School of Dentistry to UPR School of Dental Medicine upon recommendation of the school faculty and approval by the Board of Trustees on December 17, 2007. The new name emphasizes the school’s vision regarding oral health as a key component of the integral health of human beings. It also reflects its mission to educate the dentist as part of the interdisciplinary team that will maintain and improve the health condition of the Puerto Rican community through teaching, research, and service, in agreement with that of the Medical Sciences Campus (Medical Sciences Campus Mission Statement available on site). The school’s Vision and Mission Statements are communicated to all sectors of the academic and general community through the website, catalogs, annual reports, and meetings, among others. They are also posted on the entrance wall of the main clinic. The school’s Vision, Mission, Values, Institutional and Strategic Goals Statements address teaching, service, and research. These statements were examined as part of a strategic analysis process initiated during academic year 2008 – 2009 by the Strategic Planning ad-hoc Committee. The committee developed new goals for the Strategic Plan 2012-2016. The goals and corresponding activities drafted by the committee were reviewed by the faculty of the three school departments and presented in several faculty meetings. The Strategic Plan was approved by the faculty on May 2, 2012. As part of this process modifications were made to the vision, mission, values, and goals.


16

VISION

The School of Dental Medicine of the University of Puerto Rico is a leading pre- and post-doctoral academic institution of higher learning that stimulates intellectual curiosity and critical thinking in its students, who are well-suited for self-learning, with a strong sense of ethics, committed to serving the community, and eager to develop the competencies of the profession. A transforming agent of its environment, the school is committed to responding expeditiously to internal and external demands while addressing the oral health needs of Puerto Ricans as an integral component of the population’s overall well-being. A leader in research in oral health disparities and the oral-systemic relationship, the school is at the forefront of technology and scientific advances worldwide.

MISSION The primary mission of the School of Dental Medicine of the University of Puerto Rico is the education of dentists who will become an integral part of the interdisciplinary team of health care professionals that will address the health needs of the people of Puerto Rico. The school assumes leadership in the teaching and research pertaining to the prevailing oral health conditions.

In order to attain its mission, the School of Dental Medicine is committed to three complementary activities: teaching, research, and service. Its teaching function is geared to offering a doctoral program in dental medicine that will prepare a competent professional who will apply critical thinking and bioethical sensibility in responding to the health needs of patients. This role is complemented by a Post-doctoral and Continuing Education Program directed to dentists from Puerto Rico, Latin America, the Caribbean Basin, and the Hispanic population of the United States. As part of its mission, the School of Dental Medicine also fosters the search for scientific knowledge through research in dental science and its relationship with the biomedical and biosocial sciences, leading to the improvement of oral health conditions in the population. Services are geared to the well-being of patients and the community, and to strengthen academic programs and research activities of the institution. Services are offered at the primary, secondary, and tertiary levels, in on and off campus sites, with particular attention given to education and prevention.

The School of Dental Medicine’s mission has been developed within a framework of

an academic environment that fosters the respect for human, social, and ethical values.

VALUES

Respect for the search for truth, justice, and freedom.

Behavior and lifestyle choices that lead to optimum health and full development of human beings in their physical, social, and mental dimensions.


17

Acquisition and advancement of knowledge, freedom of thought and expression, excellence, creativity, and solidarity.

Freedom of conscience and commitment to the human and ethical principles that enrich

a democratic society.

Open and respectful dialogue, creativity, and tolerance as essential components of academic and university life.

A life-long teaching-learning process that fosters critical thinking, intellectual curiosity,

creativity, and innovation.

Appreciation for diversity and collaborative and interdisciplinary work.

Responsibility and commitment concerning the problems and critical health issues of the Puerto Rican society.

GOALS

1. Train general dentists with the knowledge, skills, and attitudes necessary for

effective, patient centered, and comprehensive oral health care with an emphasis on serving communities in Puerto Rico.

2. Train dental specialists who will improve the health of local communities, as well as those throughout Latin America and the Caribbean Basin.

3. Provide services to the Puerto Rican community geared to prevention and the promotion of oral health as an integral component of individual well-being.

4. Contribute to the advancement of knowledge through research in the different

disciplines of dentistry, as well as research in dental education.

5. Update and improve the skills and knowledge of dental professionals through the Continuing Education Program.

6. Maintain excellence in the educational process through a physical, academic and

administrative environment that promotes an optimal development of the academic community.

Supportive Documentation

1. UPR Mission Statement (Available on site) 2. Medical Sciences Campus Mission Statement (Available on site)


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1-2 Planning for, evaluation of and improvement of educational quality at the dental

school is broad-based, systematic, continuous and designed to promote achievement of institutional goals related to education, patient care, research and service.

1-3 The dental school must demonstrate the effectiveness of its programs and units

using a formal and ongoing outcomes assessment process to include measures of student achievement.

The University of Puerto Rico School of Dental Medicine complies with Standards 1-2 and 1-3.

Description

1-2 Strategic Planning Planning, evaluation, and improvement of the educational quality at the School of Dental Medicine are attained through strategic planning and an outcomes assessment plan. The school has been involved in strategic planning since 1987, with subsequent plans developed in 1991, 1999, and 2004 to 2009 (Available on site). The School of Dental Medicine Strategic Plan 2012 – 2016 (Appendix 1.A) was developed after a thorough strategic analysis of the external and internal environments and was approved by the faculty on April 30, 2012. This new plan was developed based on the assessment measures for goals and objectives as stated in the outcomes assessment plans for 2006-2012, as well as an assessment of the level of achievement of activities in the previous strategic plan 2004 – 2009 (Appendix 1.B). The assessment of internal and external environments, as well as the Medical Sciences Campus Strategic Plan 2009-2016 (Available on site) were also used as references for the development of the School of Dental Medicine Strategic Plan. The faculty defined six (6) new strategic areas and established objectives, activities and a timetable for their completion. As part of this process, the school’s mission, vision, and goals approved in 1998 were reviewed and some changes made. All strategic decisions were related to the achievement of the school’s general goals. The assessment of internal strengths and weaknesses, as well as threats and opportunities from the external environment, which are part of the strategic planning process, were used to develop the six strategic areas of the plan (Critical Issues for the Development of the Strategic Plan 2012-2016, Appendix 1.C). For example, topics or areas concerning new information technologies, evidence-based practice, new technologies in dental care, logistics of clinical procedures payments, and clinical care for geriatric patients were incorporated in the new Strategic Plan that began in 2012 and will be effective through 2016. The six (6) strategic areas are related to the Medical Sciences Campus Strategic Plan, as well as the University of Puerto Rico plan Ten for the Decade (Available on site). Exhibit 1.1 presents the alignment between the school goals and the strategic decisions at the three


19

levels: School of Dental Medicine, Medical Sciences Campus, and University of Puerto Rico System. The campus-wide planning process is linked to the planning processes at the schools through representatives in the Institutional Planning and Development Committee. The Dean represents the School of Dental Medicine in the committee. Exhibit 1.1 - Congruence between Goals and Strategic Decisions at the School, Campus, and University System Levels

School of Dental Medicine Institutional Goals

School of Dental Medicine Strategic Plan (2004-2009)


Medical Sciences Campus Strategic Plan (2009-2016)

UPR Ten for the Decade Strategic Plan (2006-2016) Operational Lines (OL)

Goal: I Train general dentists with the knowledge, skills, and attitudes necessary for effective, patient centered, and comprehensive oral health care with an emphasis on serving communities in Puerto Rico

Strategic Goal II: Develop and establish new academic and service offerings. Strategic Goal IV: To develop the infrastructure of the School of Dentistry to carry out research on oral health disparities in Puerto Rico. Strategic Goal V: Improve the school’s clinical teaching efficiency and effectiveness

Strategic Goal I Academic Development Strategic Goal II: Financial Resources, Administrative Systems, Processes and Physical Facilities Strategic Goal III: Research Strategic Goal VI: Student Recruitment and Retention

Strategic Goal I: Research Strategic Goal III: Academic Development, Accreditation and Informatics Strategic Goal VII: Community Outreach Strategic Goal VIII: Student Recruitment and Retention Strategic Goal IX: Financial Resources, Administrative Systems, and Physical Facilities

OL #1: Academic Offering OL #2: Research OL #4: Linkages OL #5: Informatics Technology

Goal II: Train dental specialists who will improve the health of local communities, as well as those throughout Latin America and the Caribbean Basin

Strategic Goal II: Develop and establish new academic and service offerings.

Strategic Goal I Academic Development Strategic Goal II: Financial Resources, Administrative Systems, Processes and Physical Facilities Strategic Goal III: Research Strategic Goal VI: Student Recruitment and Retention

Strategic Goal III: Academic Development, Accreditation and Informatics Strategic Goal IX: Financial Resources, Administrative Systems, and Physical Facilities

OL #1 – Academic Offering OL #2 – Research OL #4: Linkages

Goal III: Provide services to the Puerto Rican

Strategic Goal II: Develop and establish new academic and

Strategic Goal I Academic Development

Strategic Goal II: Academic Health Center

OL #3 – Institutional Climate


20






community geared to prevention and the promotion of oral health as an integral component of individual well-being

service offerings. Strategic Goal III: Develop an Intramural Practice Plan for the School of Dentistry (PPIEO).

Strategic Goal II: Financial Resources, Administrative Systems, Processes and Physical Facilities Strategic Goal IV: Community Outreach

Strategic Goal IX: Financial Resources, Administrative Systems, and Physical Facilities

OL #4 – Linkages OL #5 – Informatics Technology OL #6 – Communications OL #7 – Continuous Improvement

Goal IV: Contribute to the advancement of knowledge through research in the different disciplines of dentistry, as well as research in dental education.

Strategic Goal II: Develop and establish new academic and service offerings. Strategic Goal IV: To develop the infrastructure of the School of Dentistry to carry out research on oral health disparities in Puerto Rico.

Strategic Goal I Academic Development Strategic Goal II: Fiscal Resources, Administrative Systems, Processes and Physical Facilities Strategic Goal III: Research

Strategic Goal I: Research Strategic Goal VII: Linkages with the Community

OL #2 – Research OL #4 – Linkages

Goal V: Update and improve the skills and knowledge of dental professionals through the Continuing Education Program

Strategic Goal I: Develop the Alumni Affairs Office and fundraising activities.

Strategic Goal I Academic Development Strategic Goal II: Fiscal Resources, Administrative Systems, Processes and Physical Facilities Strategic Goal IV: Community Outreach

Strategic Goal III: Academic Development, Accreditation and Informatics Strategic Goals IV, V and VI: Organizational Culture, Image and Alliances

OL #1 – Academic Offering OL #4 – Linkages OL #6 – Communications OL #7 – Continuous Improvement

Goal VI: Maintain excellence in the educational process through a physical, academic and administrative environment that promotes an

Strategic Goal III: Develop an Intramural Practice Plan for the School of Dentistry (PPIEO). Strategic Goal V: Improve the school’s clinical teaching efficiency and

Strategic Goal II: Fiscal Resources, Administrative Systems, Processes and Physical Facilities Strategic Goal V:

Organizational Structure and

Strategic Goal IV, V and VI: Organizational Culture, Image and Alliances Strategic Goal VIII: Student Recruitment and Retention Strategic Goal IX: Financial Resources,

OL #3 – Institutional Climate OL #6 – Communications OL #7 – Continuous Improvement


21






optimal development of the academic community

effectiveness

Culture

Administrative Systems Processes, and Physical Facilities

Annual Planning At the end of each academic year, the Dean and staff prepare the annual operational plan for the next academic year. This plan includes activities for those areas in which assessment measures indicate there is need for improvement/strengthening and those that must be completed for the achievement of the Strategic and Assessment Plans. The annual assessment and planning cycle is presented in Exhibit 1.2. Exhibit 1.2 - Annual Assessment and Planning Cycle Time frame Process Responsibility All year long Data collection & reports Institutional and Academic Assessment and

Academic Affairs Office Department chairs Program / Office Directors

Dec. and May of academic year and as required by department chairs or committees

Dissemination & analysis of outcomes

Institutional Assessment Committee Curriculum Committee Administration Committee Quality Assurance Committee Academic Performance Committee Student Assessment Committees Faculty meetings

May-June Department / program planning

Department chairs Program directors

June-July School-wide operational and budget planning for next academic year

Dean Administration Committee

August of the following year

Implementation Dean Department chairs Program / office directors

At the beginning of the academic year, the offices and departments present an annual

report summarizing their achievements based on the operational plan developed for the previous year. The information collected in the reports is used for the school’s Outcomes Assessment Plan, as well as for the Medical Sciences Campus Assessment Plan (Available on


22

site). The integrated school Annual Report is forwarded to the Institutional Research, Planning, and Assessment Office under the Campus Deanship for Academic Affairs, which prepares the campus annual report.

1.3 Outcomes Assessment The school’s six main goals are evaluated by means of the Outcomes Assessment Plan. As presented in Table 2 (See Required Tables section), several outcome measures are stated for each goal, which include expected results, actual results, dissemination, and actions for improvement. The Office of Academic Affairs is in charge of collecting and analyzing the data and reporting the results to the Dean, Administration Committee, faculty, administrative personnel, and the appropriate standing committees so that they may develop actions and/or make recommendations for improvement. The Assistant Dean for Academic Affairs meets on a regular basis with the Dean and the Associate Dean to discuss findings from the assessment process. The Administration Committee is responsible for the follow-up of all planning activities and for taking actions concerning the overall performance of the school. The Dean presides over the committee, which is composed of all academic administrators and faculty representatives from each department. At the beginning of each academic year, or at any other time the Dean considers necessary, the committee discusses the results of the Outcomes Assessment Plan, Strategic Plan, Annual Report and any other report requested and develops recommendations for improvement (see Exhibit 1.3). The Curriculum Committee is in charge of analyzing and making recommendations regarding improvements in the content and sequence of the courses. The committee also discusses course evaluations in its meetings. Each course coordinator and appointed faculty is evaluated by the students using an electronic survey instrument. The new Academic Senate Certification 035 (2011-2012) establishes that all schools must use the instrument developed by the Medical Sciences Campus titled: Student Perception of Faculty’s Performance in the Course. This new instrument substitutes the current questions related to the evaluation of the professor’s performance used in course evaluations. All information concerning student outcomes assessment is collected and analyzed on a regular basis. In academic year 2005-2006, the Student Assessment Committee was established to facilitate and expedite the gathering of information on student achievement. The committee analyzes each student’s performance every three to four months and establishes an action plan when necessary to help students complete their course work at a satisfactory level. Recommendations related to curricular modifications as a result of the work of this committee are referred to the Curriculum Committee for deliberation and final decisions (See Standard 2-4). A faculty member was appointed as the Institutional and Academic Outcomes Assessment Office Director in January 2006. Also, a statistics officer was hired in order to conduct outcome assessment activities in a timely and efficient way. The school Institutional

Exhibit 1.3 UPR-SDM Outcome Assessment Diagram

SDM Mission Vision

Alignment

with UPR and

MSC Mission and

Vision

Outcome Assessment

Plan Institutional

Goals and

Strategic Plan

Information gathering

Annual Report SDM/MSC

Assessment Report Quarterly

accomplishment of Goals Report

ADEA Survey Student Perception

of faculty performance

Course evaluations Entering Class

Survey Competency Exams NBDE I and II

results Licensure Quality reports Active and recall

patient evaluations Patient satisfaction

survey

Dissemination and Recommendations Institutional

Assessment Committee

Administration Committee

Curriculum Committee

Academic Progress and Performance Committee

Quality Assurance Committee

Student Assessment Committee

Faculty meetings Student meeting Administrative

Staff meetings

Action Taken Dean Associate

Dean Department

Chair Chair of

Standing Committee

Assessment of Improvement

Assessment Committee was established as a school standing committee to collaborate with the Institutional and Academic Assessment Office in the analysis and dissemination of assessment results. The results of the Outcomes Assessment Plan are obtained using a variety of direct and indirect measures of student learning at the course and institutional level. Some examples are passing rates in the NBDE Parts I and II, self-assessment of competency (ADEA Senior Survey), evaluation of clinical procedures in the Quality Control Program for completed and recall patients, and students’ performance on licensure examinations.

Faculty, students and staff discuss outcomes at meetings and establish strategies for their improvement when needed. The Curriculum Committee evaluates the collected information and recommends appropriate modifications in curricular content, sequence, and organization. An example of this is the modification in the organization and clinical experiences of third year rotations, as well as improvements in the organization of the senior year clinical experiences (see Standard 2-10). The school has conducted a thorough assessment of student performance on the National Board Dental Examination due to the fact that, for the 2010 and 2011classes, a decline in the first time passing rate below the 80% expected results was observed in both Part I and II. The faculty implemented different measures in order to improve results. These included presenting strategies to the 2011, 2012, and 2013 student classes on how to prepare for the Boards. New Dental Decks were made available and loaned to students. The results of the students’ performance on the National Boards Dental Examination Part I were discussed by the biomedical sciences faculty in order to establish new strategies for improvement. Among the strategies they discussed were assuring that the content and format of course evaluations were similar to those presented in the Boards. For this purpose, the School distributed NBDE review materials to the biomedical faculty. Students were also required to purchase their textbooks in electronic format (Vital Source Library) beginning with the class of 2012. Improvement in the NBDE Part I passing rate was observed. The first time passing rate for the class of 2012 was 82% and 76% for the class of 2013.

A required course to prepare for the National Board Dental Examination Part II has

been in place since 2006 and a mock board test is offered as part of the course. Students receive their mock test results and they are able to discuss strategies for improvement. Also the results of students’ performance were presented at a faculty meeting in order to implement strategies at course level, including board-like questions and use of electronic textbooks, among others. An improvement was observed for first time passing rate for the year 2012 (76%) as compared to 2010 (45%) and 2011 (70%) (See Table 2- Required Tables Section). Supportive Documentation

1. University Law of 1966 (Available on site) 2. Medical Sciences Campus Mission (Available on site) 3. School of Dental Medicine Strategic Plan 2012-2016 (Appendix 1.A) 4. School of Dental Medicine Strategic Plan 2004-2009 (Available on site)


25

5. Ten for the Decade (Available on site) 6. Level of Achievement of the School of Dental Medicine Strategic Plan 2004-2009

(Apprendix1.B) 7. Medical Sciences Campus Strategic Plan 2009-2016 (Available on site) 8. University of Puerto Rico Strategic Plan (Available on site) 9. Critical Issues for the Development of the Strategic Plan 2011-2016 (Appendix

1.C) 10. Medical Sciences Campus Assessment Plan (Available on site) 11. Table 2: Outcomes Assessment Plan 2005-2011 (Required Tables section)

1-4 The financial resources must be sufficient to support the dental school’s stated purpose/mission, goals and objectives.

The University of Puerto Rico School of Dental Medicine complies with Standard 1-4.

Description

Financial Resources and Budgetary Process The UPR is a non-profit, land grant institution of the Commonwealth of Puerto Rico.

The University of Puerto Rico SDM receives funds for its operational budget from four major sources: state funds, federal funds, other external funds, and dental school clinics.

State appropriations are the principal source of revenues of the university and are

mandated by Law No. 1 of January 20, 1966, as amended. Under this law, the Commonwealth allocates to the university an amount equal to 9.60% of the average gross income collected by the government in the two fiscal years immediately preceding the year of the assignment. The UPR’s institutional financial statements are prepared on the accrual basis of accounting following the accounting and financial reporting guidelines recognized by the American Institute of Certified Public Accountants Industry Audit Guide – Audits of Colleges and Universities, as amended. Financial decision making rests ultimately with the Board of Trustees, which approves the budget. Once the budget is assigned, campus and school officials have considerable authority over the assigned discretionary and operational funds. The school budget is prepared as part of the annual planning and assessment cycle in which the school administration establishes the priorities for the allocation or reallocation of funds according to the Strategic Plan. The UPR General Funds include all monies assigned to the university by the Government of the Commonwealth of Puerto Rico. During the past six years, the government


26

and consequently the UPR has encountered significant fiscal constraints. To manage this situation, the UPR implemented various cost reduction measures including: a freeze on vacant positions, salary increases for faculty and non-teaching personnel, and faculty promotions in rank; nonpayment for excess sick leave; and limited travel expenses. Also, during fiscal year 2010-2011, the University of Puerto Rico approved a financial stabilization fee paid by the students in order to help defray increasing operational costs and maintain the quality of programs.


27

Exhibit 1.4 DETAILED SCHOOL BUDGET DISTRIBUTION BY SOURCE OF FUNDS, YEARS 2008-2012

YEARS 2006 2007 2008 2009 2010 2011 2012 UPR Appropriations

General Funds $8,000,221 $8,475,013 $8,916,377 $9,472,713 $9,742,843 $9,366,342 $9,352,462

Federal Appropriations

Research Grants $1,096,970 $751,118 $1,413,440 $713,787 $275,717 $813,798 $1,330,174

Training Grants $534,280 $217,588 $903,588 $1,208,767 $1,069,911 $1,251,873 $1,873,451

Service Grants $50,000 $172,293 $50,000 $49,126 $49,126 $49,126 $0

Pass Through Contracts $196,786 $255,604 $159,092 $139,593 $203,121 $127,897 $0

ARRA $0 $0 $0 $0 $177,553 $539,136 $0

Endowment Fund $0 $200,000 $228,704 $374,863 $474,228 $444,684 $621,021

Clinical Services

Main Dental Clinic $1,317,325 $1,458,097 $1,758,040 $1,391,543 $1,641,805 $1,793,457 $2,032,145

UPR Hospital Dental Clinic $134,750 $227,333 $182,438 $211,757 $202,172 $220,580 $251,112

Faculty Practice $78,031 $100,000 $184,013 $67,148 $255,409 $257,448 $173,215

Medical Center Oral Surgery $185,000 $178,800 $208,501 $214,000 $275,000 $275,000 $330,000

Other External Sources

Continuing Education $73,000 $98,680 $80,578 $96,403 $111,827 $85,967 $89,562

Student Fees $59,500 $82,500 $83,000 $83,000 $125,970 $103,473 $111,500

International Advanced Placement Program $0 $0 $0 $0 $0 $240,000 $600,000

State Allocations by Law $1,334,562 $1,334,562 $1,334,562 $1,334,562 $2,470,000 $2,470,000 $2,470,000

Lutheran Hospital $0 $0 $0 $0 $150,000 $150,000 $300,000

Private Grants and Contracts $26,400 $71,500 $7,000 $90,000 $225,000 $120,000 $155,707

Chancellor’s Academic Fund $70,000 $70,000 $70,000 $70,000 $70,000 $70,000 $70,000

Student Kits (materials, books, equipment) $0 $0 $0 $0 $600,00 $750,000 $600,000

Gifts and Donations $110,582 $91,380 $140,699 $74,994 $68,075 $14,180 $3,015

TOTALS $13,267,407 $13,784,468 $15,720,032 $15,592,256 $17,587,757 $19,142,961 $20,363,364


28

The General Fund is composed of recurrent funds that cover employees’ salaries and other operational categories and non-recurrent funds assigned to cover special expenses such as renovations of clinical facilities, classrooms, laboratories, and equipment repair. This allocation of funds evidences the commitment of the University of Puerto Rico and the Medical Sciences Campus to the achievement of the School of Dental Medicine's vision, mission, and goals. As shown in Exhibit 1.4, General Funds increased 21.78% during fiscal years 2006 through 2010. As compared to 2010, there was a decrease of 3.86% and 4.01% in fiscal years 2011 and 2012 respectively, due to the cost containment policy. It is expected that the UPR Central Administration will maintain the funding level relatively constant over the next few years. Exhibit 1.5

As observed in the above table, (Exhibit 1.5) 90% of UPR appropriations were used

to cover salaries from 2006 to 2009, but in the last two fiscal years, the percentage increased to 99% of the General Fund. Operational funds have been used to cover salaries in order to compensate for the reductions experienced in years 2011 and 2012. External sources are being used to cover operational expenses. The School of Dental Medicine is also actively seeking funds through submission of grant proposals. As shown in Exhibit 1.4, the school has relatively constant and diverse sources of federal funds. During the period under analysis, it received several research, training, and service grants, as well as a grant to establish an endowment fund. Relatively constant funding was received for research projects, except for fiscal year 2010, when two grant awards ended. A significant growth in federal funds is observed when compared to $1,878,036 received in fiscal year 2006 with $3,824,646 received in 2012. In this category, training grants show the largest increase from $534,280 in 2006 to $1,873,451 in 2012. This growth was mainly achieved by the school’s efforts in promoting scientific writing and

School of Dental Medicine Distribution of General Funds, Years 2006-2012

2006 2007 2008 2009 2010 2011 2012

UPR Appropriations

Salaries

$7,213,235

90.16%

$7,541,510

88.99%

$7,923,908

88.87%

$8,398,700

88.66%

$8,780,075

90.12%

$9,334,476

99.66%

$9,285,195

99.28%

Operational Expenses

$786,986

9.84%

$933,503

11.01%

$992,469

11.13%

$1,074,013

11.34%

$962,768

9.88%

$31,866

0.34%

$67,267

0.72%

TOTAL

$8,000,221

$8,475,013

$8,916,377

$9,472,713

$9,742,843

$9,366,342

$9,352,462


29

research projects. These efforts allowed the school to identify areas to expand service and training opportunities according to the latest research findings, therapies, and technology. Interaction of the school with other universities in the area of research helped establish funded collaborations. In fiscal year 2007 a $15 million Endowment Fund was granted to the school to create a research infrastructure with the Medical Sciences Campus Graduate School of Public Health. The Endowment Fund received $5 million annually until fiscal year 2009 when it was fully disbursed. After the endowment was fully disbursed, the proceeds amounted to over $400,000 per year. Federal funds are restricted according to the grant’s goals and objectives and cannot be redirected to cover school operational expenses not related to the grant. Funds remaining at the end of the fiscal year are normally requested for carryover and are used to conduct the unfinished activities from the previous year. Another important source of funds is the clinical services offered by students and faculty members. As observed in Exhibit 1.4, the clinical services budget showed an increase of 54.26% in fiscal year 2012 as compared to fiscal year 2006. The UPR Hospital Dental Clinic, the Faculty Practice and the Medical Center Oral Surgery have shown a percentage increase of 86.35%, 121.98% and 78.38% respectively. This source of funding has allowed the school to recruit and retain personnel. It also serves as a reserve account when funds generated are not completely used because they are unrestricted. The unused funds are normally allocated for equipment and materials replacement, to purchase new equipment, remodeling, and renovations of infrastructure, among other needs. The school also receives funds from other external sources as presented in Exhibit 1.4. The Continuing Education Program generates income by offering courses and workshops to dental professionals. Funds from student fees are strictly used to improve the students’ academic experience in the classroom, laboratories, and clinic. The Advanced Placement Program was established in 2011 with an enrollment fee of $40,000 per student per year, producing a yearly average amount of $600,000. The largest source of funding observed in this line is the state allocation mandated by the State Legislature to cover expenses related to the Post-Graduate Programs.

In fiscal year 2010 the school began purchasing the student instrument kits. This activity has allowed students to save up to 30% in dental instruments costs through discounts obtained by purchasing in bulk amounts. During this period income from all sources increased, except gifts and donations that experienced a decrease. Activities to increase gifts and donations were incorporated in the Strategic Plan beginning in fiscal year 2012. In general, other external funds have increased the school budget from $1,674,044 (12.62%) in fiscal year 2006 to $4,399,784 (21.61%) in 2012.


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Exhibit 1.6

Detailed School Expenses Distribution by Categories, Years 2006-2012

YEARS 2006 2007 2008 2009 2010 2011 2012

Expense Description

Salaries and Fringe Benefits $9,383,313 $9,831,865 $11,387,928 $11,998,700 $11,836,956 $11,976,595 $11,956,995

Office Supplies $175,299 $205,867 $209,792 $184,362 $211,880 $208,776 $206,665

Communication Expenses $97,326 $105,964 $116,019 $100,446 $103,552 $111,180 $108,710

Memberships and Dues $56,366 $60,891 $62,010 $62,269 $65,874 $68,755 $69,333

Professional Services $209,348 $269,781 $272,843 $222,112 $298,352 $292,763 $285,280

Laboratory Expenses $124,239 $144,694 $182,048 $147,150 $254,209 $270,602 $317,144

Dental Materials $465,898 $522,601 $932,681 $866,131 $1,195,058 $1,244,753 $1,333,326

Dental Instruments $13,876 $12,173 $38,306 $13,168 $816,545 $815,872 $818,327

Equipment $34,556 $105,322 $194,251 $36,757 $257,640 $452,015 $967,089

Renovations $45,627 $49,854 $260,122 $75,676 $161,608 $287,966 $573,765

Equipment Maintenance $34,060 $98,793 $123,452 $68,576 $89,407 $112,044 $153,222

Travel 95,896 $115,074 $99,231 $88,453 $81,242 $69,786 $69,993

Stipends $1,319,264 $1,365,846 $1,398,659 $1,440,256 $2,256,921 $2,259,321 $2,264,128

Federal Subcontracts $285,675 $298,762 $353,674 $267,422 $319,651 $301,827 $478,534

Meeting Expenses $69,765 $89,231 $79,438 $68,959 $57,568 $57,231 $57,655

Research Patient Incentives $51,225 $151,830 $196,540 $12,565 $159,365 $185,365 $195,260

Other Expenses $27,564 $20,660 $32,138 $24,437 $26,342 $26,783 $30,162

TOTAL $12,489,297 $13,449,208 $15,939,132 $15,677,439 $18,192,170 $18,741,634 $19,885,588


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Exhibit 1.6 shows the expenses by categories incurred by the SDM during fiscal years 2006- 2012. The salaries and fringe benefits category is the largest with a total of $11,956,995 from which $9,285,195 are allocated from UPR appropriations. The SDM has been actively seeking other sources of funds to offset funding reductions and supplement the General Fund. During the reported fiscal years the school’s operation has shown an increase in clinical expenses. Clinical expenses include, but are not limited to, laboratories, dental materials, dental instruments, equipment and equipment maintenance. The increase in clinical expenses is due to an increase in productivity of the main dental clinic, and the opening of graduate clinics, such as the Advanced Educational General Dentistry (AEGD) and the Endodontics clinics in 2010. Other major expenses shown are the stipends provided to the graduate students by a legislative assignment from the Commonwealth of Puerto Rico, which increased from $1,319,264 in 2006 to $2,264,128 in 2012.

The dental instruments category shows a major increase due to the replacement of dental instruments in the clinics, and the purchasing of the students’ instruments since fiscal year 2010 (2011 for the Advanced Placement Program students).

During the period under study, the SDM was actively involved in replacing major and

minor equipment, such as the boiler for the sterilization room and digital x-ray machines. Clinical areas, laboratories, patient waiting room, and restrooms have been remodeled. Renovations are financed by means of reallocation of funds at the school and campus levels, as well as the procurement of additional sources. These include funds allocated by the Chancellor’s Office. The expenses related to renovations have increased constantly since 2008. As can be observed, the school managed to diversify its funds and budget its resources according to its established academic priorities and goals.


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Exhibit 1.7 – Percentage Distribution of School Budget and Expenses by Source of Funds, Years 2006-2012

Percentage Distribution of School Expenses by Source of Funds, Years 2006-2012

2006 2007 2008 2009 2010 2011 2012

UPR Appropriations $8,000,221 64.06% $8,475,013 63.01% $8,916,377 55.94% $9,472,713 60.42% $9,742,843 53.85% $9,366,342 49.98% $9,352,462 47.03%

Federal Appropriations $1,415,446 11.33% $1,382,891 10.28% $2,791,045 17.51% $1,994,213 12.72% $2,716,349 15.01% $3,252,065 17.35% $3,523,696 17.72%

Clinical Services $1,744,756 13.97% $1,899,043 14.12% $2,275,502 14.28% $1,904,390 12.15% $2,420,004 13.38% $2,505,505 13.37% $2,760,563 13.88%

Other External Sources $1,328,874 10.64% $1,692,261 12.58% $1,956,208 12.27% $2,306,123 14.71% $3,212,974 17.76% $3,617,722 19.30% $4,248,867 21.37%

Totals $12,489,297 100% $13,449,208 100% $15,939,132 100% $15,677,439 100% $18,092,170 100% $18,741,634 100% $19,885,588 100%

Percentage Distribution of School Budget by Source of Funds, Years 2006-2012

2006 2007 2008 2009 2010 2011 2012

UPR Appropriations $8,000,221 60.30% $8,475,013 61.48% $8,916,377 56.72% $9,472,713 60.75% $9,742,843 55.40% $9,366,342 48.93% $9,352,462 45.93%

Federal Appropriations $1,878,036 14.16% $1,596,603 11.58% $2,754,824 17.52% $2,486,136 15.94% $2,249,656 12.79% $3,226,514 16.85% $3,824,646 18.78%

Clinical Services $1,715,106 12.93% $1,964,230 14.25% $2,332,992 14.84% $1,884,448 12.09% $2,374,386 13.50% $2,546,485 13.30% $2,786,472 13.68%

Other External Sources $1,674,044 12.62% $1,748,622 12.69% $1,715,839 10.91% $1,748,959 11.21% $3,220,872 18.31% $4,003,620 20.91% $4,399,784 21.61%

Totals $13,267,407 100% $13,784,468 100% $15,720,032 100% $15,592,256 100% $17,587,757 100% $19,142,961 100% $20,363,364 100%


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Exhibit 1.7 presents a summary of the percentage distribution of the school’s budget and expenses by source of funding during fiscal years 2006 to 2012. For fiscal year 2011-2012, the total budget for the SDM was estimated at $20,363,364. The funds received from external sources represent 54.07% compared to 45.93% from the General Fund. The most important change in budget distribution has been the increase in the budget share coming from other external sources, which increased from 12.62% in fiscal year 2006 to 21.62% in fiscal year 2012. In 2011 the International Advanced Placement Program was established providing additional funds. The total school budget increased during this period due to efforts to obtain external funding. The proportion of the budget share corresponding to university funds shows a decreasing trend during fiscal years 2006 to 2012, from 60.3% in 2006 to 45.93% in 2012, while the proportion of the budget share from federal appropriations and clinical services has increased during this period.

Five-Year Plan to Secure Funding and Financial Stability

During the past years, the school’s focus has been on securing funding for recruiting and retaining personnel, maintenance of dental equipment, maintaining optimal levels of supplies of dental materials, and improving physical facilities. Its priority is to guarantee the academic excellence of its programs and secure adequate funding. As part of this effort the school has established the following financial initiatives in compliance with its Strategic Plan goals:

Exhibit 1.8

Estimated Budget for Specific School Initiatives to Secure Funding, Years 2013-2017

2013 2014 2015 2016 2017 Clinical Services Oral and Maxillofacial Surgery Operating Room

$25,000 $50,000 $75,000 $112,500 $168,750

Periodontics and Geriatric Dentistry $0 $0 $100,000 $200,000 $250,000

Faculty Practice $850,500 $1,701,000 $1,842,750 $1,984,500 $2,126,250 Other External Sources Continuing Education $112,000 $113,120 $114,251 $115,394 $116,548 Advanced Placement Program $600,000 $600,000 $600,000 $600,000 $600,000 Gifts and Donations $10,000 $20,000 $40,000 $80,000 $100,000 TOTALS 1,597,500.00 2,484,120.00 2,772,001.00 3,092,394.00 3,361,548.00

The plan for the next five years includes the development of the Continuing

Education Office, specifically the Fellowship Program, which primarily enrolls students who are dentists from South and Central America seeking specific clinical experiences. Efforts to expand the marketing of this program to the United States, Canada, and Eastern Europe are in place. This expansion is expected to increase the revenues of the Continuing Education Office by 25%.


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One of the most profitable programs has been the two-year Advanced Placement Program that admits dentists who have graduated from non-accredited universities. Tuition fees in this program are $40,000 per year. The school accepts a maximum of ten students per year.

The most ambitious upcoming project will be the establishment of the Faculty Practice in a new 8,000 sq. ft. facility close to the UPR Río Piedras Campus. In this clinic, faculty and graduate students from all dental specialties will offer services to the community. The clinic will service the school’s current patient surplus and also the UPR’s biggest campus, with nearly 22,000 students, over 3,000 employees, as well as the surrounding communities. This activity is expected to generate $1 million per year.

Along with the Faculty Practice Clinic, another major project is the Oral and Maxillofacial Surgery Operating Room. This operating room will be located on school facilities where faculty and students will be able to perform dental and medical procedures.

Another initiative is the establishment of post-graduate programs in periodontics and geriatric dentistry beginning in academic year 2015. Both programs will enhance clinical services, teaching experiences, and contribute to the school main clinic revenues.

There is also a plan to establish a dental laboratory during this period. This laboratory will help to train and enhance the students’ experience in laboratory case management. It is expected to reduce school laboratory costs by 20%.

State and federal appropriations are expected to remain relatively constant. Continuous support to faculty members will be offered through protected time and seed monies so that they continue to seek external funding (Exhibit 1.9). The Research Endowment Fund is expected to grow according to the investment market performance. This endowment fund has been instrumental in creating the necessary infrastructure for the development of research and submission of new proposals.


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Exhibit 1.9

Projected School Budget Distribution by Source of Funds, 2013-2016

YEARS 2013 2014 2015 2016 2017 UPR Appropriations

General Funds $9,014.999 44.4% $9,285,449 43.7% $9,378,303 42.6% $9,472,086 42.8% $9,566,807 42.1% Federal Appropriations

Research Grants $937,192 4.6% $563,037 2.7% $937,246 4.3% $610,063 2.8% $719,983 3.2% Training Grants $800,000 3.9% $840,000 4.0% $882,000 4.0% $926,100 4.2% $972,405 4.3% Service Grants $200,000 1.0% $200,000 0.9% $200,000 0.9% $200,000 0.9% $200,000 0.9% Pass Through Contracts $250,000 1.2% $250,000 1.2% $250,000 1.1% $250,000 1.1% $250,000 1.1% Endowment Fund $600,000 3.0% $618,000 2.9% $636,540 2.9% $655,636 3.0% $675,305 3.0% Clinical Services

Main Dental Clinic $2,300,000 11.3% $2,369,000 11.2% $2,440,070 11.1% $2,513,272 11.4% $2,588,670 11.4% UPR Hospital Dental Clinic

$300,000

1.5%

$309,000

1.5%

$318,270

1.4%

$327,818

1.5%

$337,653

1.5%

Faculty Practice $850,500 4.2% $1,701,000 8.0% $1,842,750 8.4% $1,984,500 9.0% $2,126,250 9.4% Medical Center Oral Surgery

$300,000

1.5%

$309,000

1.5%

$318,270

1.4%

$327,818

1.5%

337,653

1.5%

Other External Sources

Continuing Education $112,000 0.6% $113,120 0.5% $114,251 0.5% $115,394 0.5% $116,548 0.5% Student Fees $120,000 0.6% 123,600 0.6% $127,308 0.6% $131,127 0.6% $135,061 0.6% International Advanced Placement Program

$600,000

3.0%

$600,000

2.8%

$600,000

2.7%

$600,000

2.7%

$600,000

2.6%

State Allocations by Law

$2,470,000

12.2%

$2,470,000

11.6%

$2,470,000

11.2%

$2,470,000

11.2%

$2,470,000

10.9%

Lutheran Hospital $300,000 1.5% $300,000 1.4% $300,000 1.4% $300,000 1.4% $300,000 1.3% Private Grants and Contracts

$250,000

1.2%

$300,000

1.4%

$300,000

1.4%

$300,000

1.4%

$300,000

1.3%

Chancellor ‘s Academic Fund

$70,000

0.3%

$70,000

0.3%

$70,000

0.3%

$70,000

0.3%

$70,000

0.3%

Student Kits (materials, books, equipment)

$800,000

3.9%

$800,000

3.8%

$800,000

3.6%

$800,000

3.6%

$800,000

3.5% Gifts and Donations $10,000 0.0% $20,000 0.1% $40,000 0.2% $80,000 0.4% $160,000 0.7% TOTAL $20,284,691 100.0% $21,241,206 100.0% $22,025,009 100.0% $22,133,815 100.0% $22,726,335 100.0%


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1-5 The sponsoring institution must ensure that support from entities outside of the institution does not compromise the teaching, clinical and research components of the program.


The University of Puerto Rico ensures that support from entities outside of the institution does not compromise the teaching, clinical, and research components of its programs. The UPR Board of Trustees, upon the recommendation of the UPR President, approved Certification 37 (2009-2010) on September 26, 2009 titled Institutional Policy for the Request and Receipt of Private Donations (Política Institucional para la solicitud y aceptación de donativos privados- Appendix 1.D). This policy establishes that support from entities outside the institution must guarantee that their purpose has academic or administrative merit, is in accordance with the needs and priorities of the university, and does not interfere with the achievement of the objectives of the program that receives the support. Acceptance of the support will not impose conditions that will in any way limit the commitment of the university to the principle of academic freedom, or are contrary to the University Law or its bylaws. Support cannot be conditioned to the sponsoring of any product or service, nor create a conflict of interest. Each institutional unit must assure an effective information system for data gathering and reports concerning the support received, and assure dissemination of the information at the unit and system level.

In addition, all school affiliation or contractual agreements with external institutions contain clauses establishing that the responsibility for the teaching, service, and research components rests with the school. Supportive Documentation

1. Política Institucional para la solicitud y aceptación de donativos privados (Appendix 1.D )


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1-6 The authority and final responsibility for curriculum development and approval, student selection, faculty selection and administrative matters must rest within the sponsoring institution.

The University of Puerto Rico School of Dental Medicine complies with Standard 1-6. Description

Curriculum Development and Approval There are several levels of curriculum development and approval. Major changes such as the creation of a new academic program begin at the department level and must be approved by the campus and university system academic and administrative governing bodies. Minor changes are approved by the Deanship for Academic Affairs of each campus. The final authority for approval of new programs resides with the Board of Trustees of the University of Puerto Rico according to Certification 80 (2005-2006) Rules for the Creation of Academic Programs in the University of Puerto Rico (Available on site). This new certification assures the formal integration of indicators of excellence from the design stages up to the implementation of academic initiatives. Once created by the university, all programs must be licensed by the Puerto Rico Council on Education. The Office of UPR President is responsible for requesting the Council’s licensing of newly approved programs. Exhibit 1.9 depicts the curriculum development and approval process of new programs at the Medical Sciences Campus. Exhibit 1.10 - New Program Approval Process

Department

School

Academic Senate

Administrative Board

University Board

Board of Trustees

Puerto Rico Council on Education

UPR Central Administration/ President’s Office

Planning and Development

Office

Academic Affairs Office


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Student Selection

Student selection is the responsibility of the Admissions Committee of the School of Dental Medicine, a standing committee whose responsibilities are established in the School of Dental Medicine Bylaws (Appendix I.E). The Admissions Office of the Medical Sciences Campus screens all applications to the predoctoral and post-doctoral programs to assure they are complete and that candidates meet the established requirements. The records of candidates who meet the requirements are referred for evaluation to the school Admissions Committee for the final selection decision.

Faculty Selection

The recruitment process is initiated at the department level. Candidates interested in becoming faculty members of the School of Dental Medicine must submit a letter of intent to the Dean or Department Chair, who refers them to the appropriate department Personnel Committee for consideration. The duties and responsibilities of personnel committees concerning the evaluation of potential candidates for academic appointments are established in the University of Puerto Rico General Bylaws (available on site). The Department Personnel Committee evaluates the interested candidate, verifies that he/she is qualified for the available position, conducts interviews, and prepares a report based on the candidate’s experience and credentials. The committee submits the report to the department chair, who makes a recommendation to the Dean. The Dean forwards all documents to the School Personnel Committee that verifies that the candidate is qualified for the available position and that the selection process has been fair and unbiased. The School Personnel Committee then submits its recommendation to the Dean. The Dean recommends candidates for appointment to the Chancellor and the Administrative Board, who have the final authority over the appointment.

Administrative Matters As stated in the School of Dental Medicine Bylaws, decisions concerning major administrative matters must be approved by the Administration Committee (Appendix 1.E). Changes in department organization or creation of new programs must be approved by the Academic Senate of the Medical Sciences Campus and the Board of Trustees (University of Puerto Rico General Bylaws).

The organizational charts of the University of Puerto Rico, as well as of the Medical Sciences Campus and the School of Dental Medicine are included (Appendices F, G, H). These show the administrative and organizational levels of the school, campus, and university system. Supportive Documentation

1. Rules for the Creation of Academic Programs in the University of Puerto Rico (Available on site)

2. School of Dental Medicine Bylaws (Appendix 1.E)


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3. University of Puerto Rico General Bylaws (Available on site) 4. University of Puerto Rico Organizational Chart (Appendix 1.F) 5. Medical Sciences Campus Organizational Chart (Appendix 1.G) 6. School of Dental Medicine Organizational Chart (Appendix 1.H)

1-7 The dental school must be a component of a higher education institution that is accredited by a recognized accrediting agency.


The School of Dental Medicine of the University of Puerto Rico is a unit of the Medical Sciences Campus. It is one of the six schools that comprise the campus, which are: School of Medicine, School of Pharmacy, School of Dental Medicine, School of Health Professions, School of Nursing, and the Graduate School of Public Health. The most recent license to operate as a higher education institution was granted to the University of Puerto Rico by the Puerto Rico Council on Higher Education (now Puerto Rico Council on Education) on August 2, 2007 Certification 2007-097 Appendix 1.I). The Medical Sciences Campus was last accredited by the Middle States Commission on Higher Education (MSCHE) on June 23, 2011 (Appendix 1.J). Supportive Documentation

1. Certification of Accreditation by the Puerto Rico Council on Higher Education (Appendix 1.I)

2. Certification of Accreditation by the Middle States Commission on Higher Education (Appendix 1.J)


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1-8 The dental school must show evidence of interaction with other components of the higher education, health care education and/or health care delivery systems.

The University of Puerto Rico School of Dental Medicine complies with Standard 1-8. Description The School of Dental Medicine interacts with other components of the health care delivery system, community organizations, other local components of higher education, and USA institutions of higher education.

Health Care Delivery System The Medical Sciences Campus of the University of Puerto Rico and the Department of Health, the Puerto Rico Medical Center Administration, and the San Juan Municipal Government have written agreements by which students of medicine, dental medicine, and other health related professions use the University District Hospital, University Pediatric Hospital, and the San Juan City Hospital as clinical sites. The first two are operated by the Puerto Rico Department of Health, while the San Juan City Hospital is operated by the San Juan City government. Specifically, the school uses those sites for the training of predoctoral students in hospital based dentistry and post-doctoral Pediatric Dentistry, Oral and Maxillofacial Surgery, Prosthodontics, and General Practice residents.

Community Service There are nine (9) extramural centers located throughout the island in which the predoctoral dental students rotate. These include: the Council of Integral Family Health Services of Loíza, the Corporation of Health Services and Advanced Medicine of Cidra, Corporation of Health Services and Advanced Medicine of Las Piedras, the Corporation of Health Services Advanced Medicine of San Lorenzo, and the Migrant Health Center of Mayagüez. These five facilities have affiliation agreements for three year periods. The Center of Family Health Dr. Julio Palmieri Ferri, Inc. in Arroyo and the Health Council of the Community of the Playa de Ponce have four year affiliation agreements. The University of Puerto Rico Mayagüez Campus Dental Clinic and the University of Puerto Rico Hospital in Carolina Dental Clinic have yearly affiliation agreements. Another site is the Colegio San Gabriel, where fourth year dental students and pediatric dentistry residents provide services to hearing-impaired children (Affiliation agreements available on site).

Other Components of Higher Education

The faculty of the School of Dental Medicine actively participates in the governing boards of the Medical Sciences Campus and in numerous campus and system-level committees. Four members of the faculty are elected to the campus Academic Senate. The


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appointment of faculty to campus committees provides an opportunity for close interaction with faculty of other campus schools.

Medical Sciences Campus Administrative Board

Dr. Humberto Villa – Dean

Committee on Educational Integration and Planning

Dr. Darrel Hillman - Associate Dean for Academic Affairs

Medical Sciences Campus Academic Senate: Dr. David Malaret Dr. Rodulfo Gauthier Dr. Héctor Quesada Dr. Ángel Pagán

Institutional Planning and Development Committee Dr. Humberto Villa – Dean

Institutional Assessment Committee

Dr. Arlene Sánchez - Assistant Dean for Academic Affairs

Organizations Related to Higher Education The School of Dental Medicine is a member of the American Dental Education Association (ADEA). The school encourages attendance to the Annual Convention of the ADEA and AADR as well as to other group meetings. A member of the faculty is a member of the Council of Faculties of ADEA. The Dean participates regularly in the ADEA deans’ meetings. Interaction between the School of Dental Medicine of the University of Puerto Rico and other USA higher education institutions in the area of research has been established by means of formal agreements or letters of collaboration (Available on site). These include the Universities of Indiana, Kentucky, New York, Alabama, California, Michigan, Minnesota, and Harvard University. The school has also established collaborative agreements with higher education institutions in the Dominican Republic and Costa Rica for teaching and research projects. Through these collaborations, the school has established faculty exchange agreements to offer courses or seminars in the various specialty areas. Supportive Documentation

1. Affiliation agreements (Available on site)


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STANDARD 2 - EDUCATIONAL PROGRAM

Admissions 2-1 Specific written criteria, policies and procedures must be followed when admitting predoctoral students.

The University of Puerto Rico School of Dental Medicine complies with Standard 2-1. Description The Medical Sciences Campus (MSC) abides by the University’s General Policy on Admissions as established by Certification 116 (1978-1979) of the Council on Higher Education (Available on site). Due to the diversity of academic programs on campus and in compliance with accreditation standards, each school has established specific school and program requirements for admission within the framework of Certification 116. These specific requirements and selection procedures, as well as future modifications, must be approved by the school faculty and the MSC Academic Senate prior to their implementation.

The recruitment and admissions process of the school is a shared responsibility of the Office for Student Affairs and the campus Dean of Students, specifically the campus Admissions Office. Admission criteria, policies, procedures, and application forms to the SDM are available to potential candidates through the UPR MSC Bulletin (Available on site), the School of Dental Medicine Catalog (Appendix 2.A), a special publication titled Admission Requirements for the Undergraduate Dental Medicine Program of the UPRSDM (Appendix 2.B), Rules and Regulations for the Selection and Admission of Candidates to the School of Dental Medicine (Appendix 2.C) and at the school’s website (http://dental.rcm.upr.edu). In recent years, the school has promoted its website as the most effective tool to inform potential candidates about admission requirements, policies, criteria, tuition costs, and other relevant facts necessary for a well informed decision. Information is also disseminated at predental group meetings, recruitment fairs, and open houses held at the school. The Office for Student Affairs implements its strong recruitment plan throughout the year. Its main activities include visits to private and public high schools and universities and promoting visits from interested students. The school also offers a summer program for public high school students in June with the purpose of stimulating the interest of disadvantaged students in a career in dentistry. In order to be considered for admission to the UPRSDM, applicants must submit an application prior to the established deadline through the American Association of Dental Schools Application Service (AADSAS), take the Dental Admission Test (DAT), and


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complete the MSC application form available at the school website. Applicants must apply by December 1st of the academic year preceding the year of admittance. In addition, candidates must present an official academic record (transcript) from an accredited college or university, a recent 2x2 photograph, two letters of recommendation, and the required fees. The Central Admissions Office of the MSC processes and screens applications for the School of Dental Medicine. Candidates must have satisfactorily completed 90 semester credit hours in a USA accredited university. They must have approved the following courses among the total 90 semester credit-hours: Spanish- 12 semester credit hours English- 12 semester credit hours Physics- 8 semester credit hours General Chemistry- 8 semester credit hours Biology or Zoology- 8 semester credit hours Organic Chemistry- 8 semester credit hours Social and Behavioral Sciences- 6 semester credit hours The Admissions Committee, a school standing committee, evaluates candidates for admission on four criteria: academic performance (overall grade point average), DAT scores, personal attributes (as evidenced by an interview and the candidate’s portfolio), and the number of science credits approved beyond the 32 minimum required. As a state-supported institution whose mission is to educate the dentists who will address the oral health care needs of the people of Puerto Rico, preference is given to residents of the island. Nevertheless, the school is aware of the growing Hispanic and Puerto Rican population in the mainland and evaluates some candidates from out of state who meet the criteria, are bilingual in Spanish and English, and demonstrate knowledge of Hispanic culture as assessed in an interview. Academic performance is determined by the academic grade point average during predental studies, with the understanding that a minimum final grade of C (in a scale of A=4.00) is mandatory in every required course, and by the number of courses repeated, withdrawn, deficient, and failing grades evidenced in the official academic report. Although there is no minimum score for the DAT, the average score for students admitted in the last four years has been 16 or higher for both academic average and perceptual components. After an initial screening by the Central Admissions Office, candidates are invited for an interview at the School of Dental Medicine with a member or members of the Admissions Committee. Results of the interview are recorded on the Applicant’s Interview Evaluation Form (Appendix 2.D). The candidate must also present his/her portfolio, a folder with a listing of extracurricular activities, recognitions, awards, publications, and other pertinent information evidencing cognitive and non-cognitive skills, abilities, and achievements. The results of the portfolio evaluation are recorded in the Portfolio Rubric (Appendix 2.E) and added to the total points received in the interview. Applicants accumulate points based on each of the factors included in the admissions formula up to a maximum of 2,000. The admission decision is based on the following formula:


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CRITERION WEIGHT

DAT Scores Academic 30% DAT Scores Perceptual 10% Grade Point Average 40% Interview (including portfolio) 15% Extra Science Credits 5%

The formula leads to a ranking of candidates that guides but does not limit the decision of the Admissions Committee. The Campus Admissions Office prepares a “master list” with the ratings of all candidates and the Admissions Committee goes over the scores on the list. The school has a total of 40 seats available per year, plus an extra seat reserved for a DMD-PhD student. This seat is assigned to a student with a firm interest and commitment to pursue dual doctoral degrees in dental medicine and basic sciences in conjunction with the University of Rochester. The Admissions Committee submits the recommended candidates with a list of possible alternate candidates to the Dean, who has the ultimate responsibility for admissions and signs all admission letters. Rejection letters are sent out as well to candidates who do not meet program criteria. The formula has proven useful to predict success in dental studies, as evidenced by the school’s low attrition rate, student’s success in passing the National Boards, and the successful placement of graduates in post-graduate programs. Four hundred seventy four (474) candidates applied for admission to the UPRSDM for the 2012-2013 academic year. One hundred and one (101) were invited for an interview, and 42 were admitted. Exhibit 2.1 shows entering classes profiles for the last seven academic years. Exhibit 2.1- Profile of Entering Classes, 2006 to 2012

Year Accepted Students

# of Applicants

# Applicants considered

Average GPA

Average DAT

Acad. Percep.

2006 41 303 80 3.45 15 16 2007 42 381 86 3.35 15 16 2008 38 401 77 3.54 15 16 2009 41 397 87 3.53 16 16 2010 45 435 134 3.57 16 17 2011 42 357 127 3.47 17 18 2012 42 474 101 3.51 17 18

The Admissions Committee is comprised of three faculty members representing the school’s departments, the Assistant Dean for Graduate Programs, a member of the basic sciences faculty, one retired faculty member representing the interests and needs of the community and the profession, a student representative from the predoctoral program, the Office for Student Affairs’staff (psychologist, counselor, and recruiter), and three alternate


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faculty members. The MSC Dean of Students and the school’s Dean are ex-officio members. The Assistant Dean for Student Affairs chairs the committee. The names and titles of the Admissions Committee members are contained in Table 14 of the required tables section. The committee meets monthly from October to December and twice a week from January to April. Modifications to the admissions policy or criteria are the responsibility of the Assistant Dean for Student Affairs and the Admissions Committee. Any modification or proposal is reviewed by the Administration Committee, the school faculty and the Campus Academic Senate. Throughout the years, the admissions criteria have been under discussion at the SDM, particularly the relative weight given to the GPA and DAT scores and the possibility of giving a higher weight to non-cognitive criteria. The possibility of assigning weight to factors such as maintaining a job or serving the community has been discussed. Others argue, with the supporting literature, that the current criteria have enabled the school to recruit a qualified student body and that the admitted students perform well academically. Efforts have been made to attract students from disadvantaged backgrounds through a strong recruitment plan. (Admissions Committee meeting minutes, available on site). The staff of the Office of the Assistant Dean for Student Affairs carefully advises students who do not meet the admission criteria or do not have a competitive profile. They examine the academic record of these candidates to identify deficiencies and suggest a specific plan for score improvement.

Attrition Rates The Office of the Associate Dean and the Assistant Dean for Academic Affairs monitor attrition rates. The Academic Progress and Performance Committee, a standing committee, evaluates student performance at the end of each academic year and recommends promotion and/or graduation. An ad-hoc committee to this working group is the Student Assessment Committee that was created to provide ongoing follow-up of students throughout the year. The Student Assessment Committee meets three times a year (October, February, and May) with course coordinators to monitor the academic and clinical performance of students. Those with academic problems are identified early in the academic year, informed of their deficiencies, and referred for counseling and/or support to be provided by the school counselors, assigned mentors, or to receive tutorials/remedial assistance. These early interventions have proven to be effective in helping students achieve academic progress to the next level of study, as seen in the SDM’s high retention rates (Exhibit 2.2). All cases are handled under strict confidentiality protocols. Professors and teaching assistants offer tutorials and review sessions to students exhibiting academic difficulties in any given course. Students are also assigned to professors for mentoring in order to help them in their academic development. Also, through the Teaching Assistants Program, tutoring and mentoring sessions are available to all students. The school offers special curricular arrangements to dental students who have evidenced academic deficiencies. A leave of absence may also be considered when there is a need to take time off and solve a personal or health issue. The student may return and complete the academic program within a specific time period. In order to assist potentially high risk


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entering students in adapting to the demands of the dental curriculum, the MSC Deanship of Student Affairs designed a form for students with disabilities (Disability Self- Identification Form) in which they may voluntarily identify their difficulties. This allows rapid identification of students with special needs so that reasonable accommodation or remedial activities can be arranged. The main goal is to retain students, allow them time to manage their particular problems, and enable them to successfully complete their academic program. Exhibit 2.2 shows attrition, graduation, and retention rates for the SDM in the last five years.

Attrition, Graduation, and Retention Rates of Entering Class Cohorts, School of Dental

Medicine, Medical Sciences Campus, University of Puerto Rico, 2004-2008

Entering Class

Class Size

Graduated as of 2012 Attrition

Readmitted or still in School %

Retention No % Non

Academic Academic

2004 40 38 95 1 1 - 95 2005 45 43 95 1 - 1 98 2006 42 35 83 1 3 3 90 2007 44 37 84 - 5 2 89 2008 37 30 a 81 4 - 3 89

a) 3 students are pending completion of graduation requirements and are expected to finish before the end of 2012.

As observed in the above table, an average of 1-2 students leaves the school due to

academic or non-academic reasons (illness, vocational, financial, and family situations). Nevertheless, in the last three years, the school has experienced a higher attrition rate due to academic reasons that school officials are trying to assess. In 2007-08, the freshman class suffered an attrition of five students that were not academically successful. In 2008-09, four freshmen withdrew from the school due to non-academic reasons. School officials are evaluating the admissions process and formula to determine possible causes for this situation. Students in the subsequent classes have been admitted with higher and more competitive credentials than those in the years in which a higher attrition rate was eventually observed.

2-1.1 Admission of students with advanced standing must be based on the same

standards of achievement required by students regularly enrolled in the program.

The University of Puerto Rico School of Dental Medicine offers an Advanced Placement Program for internationally trained dentists. Upon completion of the program, they receive a Doctor of Dental Medicine degree. In April 2010 the Advanced Placement


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Program admissions criteria were modified (see Proposal for the Revision of the Advanced Placement Program, available on site). Before the modifications, the candidate was admitted to the second or third year of dental school based on the recommendation of the Admissions Committee of the program and began studies at the beginning of the academic year. Currently, the program includes a five-week summer course prior to the two years of full-time dental curriculum comprising the third and fourth years of the school’s regular curriculum. Graduation requirements are the same as those for the regular junior and senior year academic program, and students must evidence the achievement of competencies as stated in the school’s curriculum. The revision of the program was approved by CODA in February 2011 (Available on site). The Preparatory Clinical and Academic Integration for International Students (PRET 7300) course (available on site) consists of a series of lectures, seminars, demonstrations, and laboratory exercises related to the diagnosis, prevention and treatment of diseases, disorders, and conditions of the oral cavity. The general objective of this course is to offer students the opportunity to integrate their previous knowledge and skills with the clinical and academic philosophy of the UPR School of Dental Medicine, as well as to become familiar with the criteria, equipment, and armamentarium used at the school. Other changes that were implemented in the program were: increasing enrollment from two students up to ten per academic year, appointing a program director, and eliminating Part II of the National Board Dental Examination (NBDE) as an admissions requirement.

Requirements for admission include: satisfactory completion of an academic program of studies culminating in a degree, diploma, or certificate in dentistry recognized by the appropriate civil authorities of the country in which the school is located; submission of credentials to an international credential evaluation service for proper evaluation; pass Part I of the National Board Dental Examination and have the official score report sent to the Office of Admissions; and take the Test of English as a Foreign Language (TOEFL) and have the official score report sent directly to the Office of Admissions of the University of Puerto Rico Medical Sciences Campus (see Advanced Placement Program Brochure- Appendix 2.F). Proficiency in the Spanish language is required, as well as good knowledge of English.

The candidate must also comply with the following:

A minimum grade point average of 2.00 (on a scale where A=4.00) from a dental school, or its equivalent, is mandatory.

Three letters of reference (preferably from dental school faculty) Attested copies, with English translation, of dental school diploma and dental

school transcripts Copy of visa or immigration status Curriculum Vitae Personal statement or essay


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This program is open to U.S. citizens who have graduated from foreign schools,

permanent residents, as well as international students, but it mainly targets dentists with dental degrees from Spanish speaking international dental schools. Proficiency in the Spanish language is assessed during the interview process.

All applications to the School of Dental Medicine are filed through the ADEA

Centralized Application for Advanced Placement for International Dentists, (CAAPID). The school also requires a supplemental application with the corresponding fees.

After a review of all applications, those candidates selected for interview are

contacted in writing or electronically to schedule a personal interview and a Skills Test (Bench Test) where a set of standard dental procedures is assessed. Applicants admitted to the Advanced Placement Program are those that score higher in the admission formula (GPAs, Boards, Bench Test, Interview, etc.). Candidates applying to the Advanced Placement Program wishing to apply for licensure to practice dentistry in Puerto Rico after completing the program must comply with the licensure requirements of the Puerto Rico Dental Board in order to practice dentistry in the Commonwealth of Puerto Rico. Exhibit 2.3 - Advanced Placement Program Applications and Admissions, 2010-2012 YEAR APPLICANTS

TOTAL APPLICATIONS SUBMITTED

APPLICANTS INVITED FOR INTERVIEW

CANDIDATES ADMITTED

2010 14 14 14 6 2011 89 57 21 8 2012 97 70 20 9 2-1.2 Transfer students with advanced standing must receive an appropriate

curriculum that results in the same standards of competence required by students regularly enrolled in the program.

The University of Puerto Rico School of Dental Medicine complies with Standard 2-1.2. The SDM admits transfer students only from USA-CODA accredited institutions. For

the past seven years, very few students have been admitted as transfer students to either the second or third year (Exhibit 2.4). Admission is subject to space availability and requirements such as official school transcript, minimum GPA of 2.00, dean’s letter stating that the student is in good standing, approval of the first part of the National Board Examination for students


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applying to third year, and filing the Application for Admission for Transfer Students available at the Office for Student Affairs. The Advanced Standing and Transfer Committee evaluates the candidates, conducts an analysis of the applicant’s record in terms of courses approved and the current curriculum at the UPRSDM. It may recommend practical examinations in different clinical areas and repeating courses. After this process is completed, the committee submits its recommendations to the Dean who makes a decision. Students are not admitted beyond the junior year as required by UPR regulations, according to which no more than 50% of graduation requirements can be completed in another academic institution. Admitted transfer students must comply with the same requirements as regular students in terms of curriculum and clinical performance. Exhibit 2.4 - Admission of Transfer Students, Years 2006-2012

Academic Year Applications Accepted

2006 2 2 2007 1 1 2008 0 0 2009 1 0 2010 0 0 2011 0 0 2012 0 0


1. UPR-MSC Bulletin (available at www.rcm.upr.edu) 2. UPR-School of Dental Medicine Catalog (Appendix 2.A) 3. Admissions Requirements for the Undergraduate Dental Medicine Program

/Application Form and Packet (Appendix 2.B) 4. Rules and Regulations for the Selection and Admission of Candidates to the School of

Dental Medicine (Appendix 2.C) 5. Applicant’s Interview Evaluation Form (Appendix 2.D) 6. Portfolio Rubric (Appendix 2.E) 7. Advanced Placement Program Brochure (Appendix 2.F) 8. Proposal for the Revision of the Advanced Placement Program (Available on site) 9. CODA Letter of Approval of the Advanced Placement Program (Available on site)


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2-2 Admissions policies and procedures must be designed to include

recruitment and admission of a diverse student population.


Institutional policies at the UPRSDM guarantee equal opportunity of admission to all its applicants. With its establishment in 1957, the School of Dental Medicine became the only institution in the island providing training in oral health to the Puerto Rican population. Since then, it is also the only dental school in the United States in which education is conducted in Spanish, the native language of the majority of Puerto Ricans and of many Hispanics living in the U.S. mainland. Because of language and culture, the school has a tradition of training nationals from Central and South America and the Caribbean, providing a gateway to collaborative initiatives with other countries from which many minority groups in the United States originate. The definition of diversity in Puerto Rico is somewhat different from that of the United States, where diversity is defined in racial or ethnic terms. In Puerto Rico, 99% of the population is Hispanic. Diversity is described in terms of different socioeconomic levels and backgrounds, not necessarily by race or ethnicity. As a matter of fact, information on race is seldom collected. Over 90% of the students entering the UPRSDM are born in Puerto Rico. They are from diverse socio-economic backgrounds, religions, geographic areas, and educational experience, including public and private school graduates. The current SDM Recruitment Plan, Policies and Procedures promote admission of students from diverse backgrounds. The UPRSDM follows institutional policies that state the University of Puerto Rico guarantees equal admission opportunities to all applicants. Recruitment activities are conducted throughout the different geographic regions of the island. School personnel visit public and private universities and high schools to offer information about school programs and admission requirements.

Disadvantaged students are defined by the Admissions Committee according to the following criteria: first generation university students, one parent with twelve or less years of schooling, and a family yearly income of less than $20,000. The Student Portfolio (Sample available on site) required for submission at the candidate’s interview is the tool used by the committee to assess accomplishments and life experiences achieved by the candidate. In this way, the committee takes into consideration other factors besides GPA and DAT scores and the candidate may gain points in the formula. Currently, 20% of the student body is composed of disadvantaged students according to the federal definition. Exhibit2.5 (Socio-Economic Profile of Entering Class) illustrates the composition of the entering class in terms of gender and socio-economic variables. During the last five academic years, over 80% of the school’s students received some type of financial aid and 15


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or 37% were considered disadvantaged as defined by HRSA. Classes in recent years have included mostly students from the state's public university system. An increasing number of women have been admitted to the school, reaching 68% as opposed to 32% males. This is consonant with the general trend in Puerto Rico according to which more women than men are pursuing higher education degrees. Also, due to the increasing number of Hispanics and Puerto Ricans living in the mainland, the UPRSDM has been proactive in considering students from out of state who will eventually serve low income and shortage areas in Hispanic communities in the mainland. In the last seven years, each class has had an average of three students from out of state (Hispanics living in the mainland and/or other American citizens). This also contributes to diversity in the classes. In 2003-2004, the UPRSD received a grant from the Health Resources Services Administration (HRSA) to develop a Hispanic Center of Excellence (HCOE). One of the objectives of the HCOE was to increase the competitive applicant pool with special emphasis on student recruitment from dental shortage areas and disadvantaged socioeconomic backgrounds. Although it no longer receives funds for this program, the school has maintained and expanded its recruitment efforts. They have been expanded in scope by improving the quality of activities, as well as placing emphasis on recruiting students from disadvantaged backgrounds and health shortage areas. An example of these activities is the summer program held in June for high school students from public schools. The summer program consists of one week of activities during which visiting high school students receive basic lectures in dentistry, conferences on how to write a resume, how to carry out a good interview, and how to design a college program of studies and make it attractive to a dental school. They also visit the laboratories and perform dental wax-ups, take dental impressions on each other, pour off models, and learn how to operate a dental hand piece on an extracted tooth. This summer activity, currently in its fourth year, is the responsibility of the Office for Student Affairs. Its staff, along with first year students, work to make this an exciting event for these young students who may view dentistry as an unreachable goal in their lives. Out of 60 students reached, three have joined the UPRSDM research pipeline and are currently working in specific projects, enriching their college careers and preparing to apply to dental school in the near future.


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Exhibit 2.5 - Socio-economic Profile of Entering Classes, 2006-2011

Legend:

NE- North East (San Juan Metropolitan Area) NW- North West E- East S- South W- West WI- West Interior EI- East Interior US- Continental United States

Entering Class

Total Accepted

Gender High School Family Income

Geographic Area 19,999 or Less 20,000-49,999 50,000 or More M F Private Public Freq % Freq. % Freq. % NE NW E S W WI EI US

2006 41 15 26 34 7 7 19.44 12 33.33 17 47.22 22 0 3 4 5 1 4 2 2007 42 18 24 36 6 15 36.59 3 7.32 23 56.10 24 4 0 5 2 1 1 0 2008 38 7 31 22 16 10 27.03 13 35.14 14 37.84 16 4 1 6 3 1 5 2 2009 41 11 30 31 10 9 21.95 14 34.15 18 43.90 17 2 2 5 4 1 8 2 2010 45 19 26 26 15 11 24.44 12 26.67 22 48.89 25 6 0 3 4 1 4 3 2011 42 16 26 30 12 6 14.29 14 33.33 22 52.38


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1. Admission Committee Minutes (Available on site) 2. Preparatory Clinical and Academic Integration for International Students (PRET 7300) course (Available on site) 3. Sample of Student Portfolio (Available on site)

Instruction

2-3 In advance of each course or other unit of instruction, students must be provided written information about the goals and requirements of each course, the nature of the course content and the method(s) of evaluation to be used.


Description

Instruction

The Office of Academic Affairs is in charge of monitoring course syllabi development and availability. A Course Syllabus Template (Appendix 2.G) was designed to help professors develop their syllabi, which are distributed to students at the beginning of each course, as established by institutional policies stated in the UPR Student Bylaws, Articles 2-10, available on site). This policy was established through MSC Academic Senate Certifications 028, 1995-1996; 031, 2007-2008; and 078, 2010-2011 under the section of Duties and Responsibilities of the Faculty and Students (Appendix 2.H ). These institutional policies state the syllabus sections and the time frame for its discussion and distribution. These policies are distributed and discussed with new faculty members at an orientation activity held by the MSC Deanship for Academic Affairs at the beginning of each academic year.

Professors must prepare, distribute, and discuss a written syllabus with students

during the first week of each course. Syllabi include all items in Standard 2-3. Additional information required by the MSC is also included. One of the questions in the student course evaluation form is directed to confirm that professors comply with this institutional requirement.

Students receive the Clinic Manual (Appendix 2.I), which contains all the

information related to clinic rules and regulations, at a clinical orientation session during the first weeks of junior year. All procedures and evaluation policies (Clinical Evaluation Criteria Manual) are distributed and explained (Appendix 2.J).


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Supportive Documentation 1. Course Syllabi (Separate volumes)

2. Course Syllabi Template (Appendix 2.G) 3. Duties and Responsibilities of the Faculty and Students, MSC Academic

Senate Certification 078, 2010-2011 (Appendix 2.H) 4. Clinic Manual (Appendix 2.I) 5. Clinical Evaluation Criteria Manual (Appendix 2.J)

2-4 If students do not meet the didactic, behavioral and/or clinical criteria as

published and distributed, individual evaluations must be performed that lead to an appropriate decision in accordance with institutional due process policies.


Description Policies regarding student progress and performance are stated in the document Academic Progress and Performance Rules and Regulations. Copy of this document is included in Appendix 2.K. The document is distributed and discussed by the Associate Dean with all freshmen during orientation week and at the beginning of their third year. It is also available at the Office of the Associate Dean for review. It is revised frequently to incorporate rules and recommendations needed to respond to curricular change. An example of this is the recently implemented rule for approving NBDE Part I just before entering the junior year of the curriculum. Course coordinators establish academic standards for each course and these are included in the course syllabi. The Office of the Assistant Dean for Academic Affairs maintains a copy. Participating faculty members are responsible of assigning scores and/or grades to all students in their courses based on criteria established in the course syllabi. Course coordinators are also responsible of warning students who are not meeting academic standards for the course and must file a report to the Associate Dean. This warning is given as early as possible during the course, once some scores/grades have been collected. The Academic Progress and Performance Committee recommends promotion, repeating courses or the year, graduation, and dismissal of students. The committee also assesses student professional behavior and recommends students for graduation when they have successfully fulfilled the 13 competencies to receive the DMD degree. This committee is composed of eight members: the Associate Dean (who chairs the committee), the Assistant Dean for Clinical Affairs, the Assistant Dean for Student Affairs, the three department chairs, the Chief of the Oral Biology Section, and the Assistant Dean for Academic Affairs.


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Early and ongoing assessment of student performance is achieved through a Sub-committee on Student Assessment that facilitates the compilation of information for decision making by the Academic Progress and Performance Committee (Appendix 2.K). The Student Assessment Sub-committee includes the course coordinators for each academic year, the Chief of the Oral Biology Section, who is a member of the first and second year committees, and the directors of the Academic Affairs and Institutional Evaluation Offices. Both directors are consultants to the committee regarding assessment, curricular or academic measurement issues, and provide advice on teaching strategies and development of assessment instruments. The Associate Dean chairs the sub-committee and the members of the Academic Progress and Performance Committee are always invited. The sub-committee meets three times a year and has the following responsibilities:

Collect data on student performance in all curricular experiences for the corresponding academic level

Establish a baseline of student performance Assess student progress and make recommendations for remedial measures, if

needed Provide information to the Curriculum Committee to assess curricular

experiences and submit recommendations for modification of courses or other curricular experiences

Submit recommendations for promotion, remedial measures, dismissal, and graduation decisions to the Academic Progress and Performance Committee

The Academic Progress and Performance Committee evaluates students at the end of each academic year. They must meet the academic and professional behavior criteria established in the Academic Progress and Performance Rules and Regulations (Appendix 2.K). If students do not meet these criteria, possible actions include repeating the course and/or year, or academic dismissal. The committee recommends students for graduation if they have approved all courses, have a GPA of 2.0 or higher, and have passed Part I & II of the NBDE. When a student experiences academic difficulties, the Student Assessment sub-committee will recommend to the course coordinator the actions needed to remedy the difficulties. Students are notified in writing of the deficiencies noted. Recommendations such as assigning a mentor, additional practice under the supervision of a post-graduate resident, and additional clinical experiences are examples of these actions. The Office for Academic Affairs also coordinates additional sessions and exercises for these students. Students may appeal a decision of the Academic Progress and Performance Committee following the due process described in the Academic Progress and Performance Rules and Regulations document (Appendix 2.K). The Dean must approve all committee decisions.


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1. Academic Progress and Performance Rules and Regulations (Appendix 2.K)

Curriculum Management 2-5 The curriculum must include at least four academic years of instruction or its equivalent.


Description

The curriculum consists of four academic years. The first year consist of 42 weeks,

the second and third years of 44, and the fourth of 40 weeks. The curriculum contains 4,487 hours of instruction, including 144 hours in elective courses. Supportive Documentation See the following tables in the Required Tables section:

1. Table 3 – Schedule of Courses 2. Table 4 - Departmental Course Offerings-Biomedical Sciences 3. Table 5 - Departmental Course Offerings-Clinical Sciences

4. Table 6 - Departmental Course Offerings-Behavioral Sciences

2-6 The stated goals of the dental education program must include the preparation

of graduates who possess the knowledge, skills and values to begin the practice of general dentistry.

The University of Puerto Rico School of Dental Medicine complies with Standard 2-6 Description The Mission of the School of Dental Medicine regarding the dental education program states:


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In order to attain its mission, the School of Dental Medicine is committed to three complementary activities: teaching, research, and service. Its teaching function is geared to offering a doctoral program in dental medicine that will prepare a competent professional who will apply critical thinking and bioethical sensibility in responding to the health needs of patients. One of the six goals of the school establishes the following:

1. Train general dentists with the knowledge, skills, and attitudes necessary for effective, patient centered, and comprehensive oral health care with an emphasis on serving communities in Puerto Rico.

2-7 The dental school must define the competencies needed for graduation, which

must be focused on educational outcomes.

The University of Puerto Rico School of Dental Medicine complies with Standard 2-7

Description

The document Competencies for the New Dentist states the 13 competencies that were developed for the school’s new curriculum, implemented in academic year 2003-2004. This document describes the knowledge, skills, and values a graduate must possess to practice general dentistry (UPR-SDM Competencies for the New Dentist, Appendix 2.L). Competencies are based on dentists’ roles, responsibilities, and frequently performed tasks for the current practice of general dentistry. They follow the format recommended by the American Dental Education Association (A.D.E.A.). Each course syllabus distributed to students contains the competencies that the specific content of the course will develop, as well as the outcomes for the specific course. In the clinic orientation period before the beginning of the junior year, competency statements are presented and explained to students. Starting in August 2012 competency statements will also be distributed to incoming students during the freshmen orientation period. Supportive Documentation

1. UPR-SDM Competencies for the New Dentist (Appendix 2.L)


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2-8 The dental school must employ student evaluation methods that measure the

defined competencies.


Description

Student progress toward competency is assessed throughout the four years of the curriculum (UPR-SDM Competencies for the New Dentist, Appendix 2.L). Each learning experience in the curriculum contributes to the acquisition of knowledge and skills and to the development of the necessary values to achieve competency. Diverse evaluation methods are employed to assess student progress toward competency and eventually its achievement (Competencies According to Related Courses and Methods of Assessment, Appendix 2.M). In the first and second years, foundational knowledge in the biomedical, dental, and behavioral sciences is evaluated through written examinations, problem based, and case based examinations. Foundational and preclinical dental skills are evaluated through formative and summative examinations using standardized patients, laboratory projects, objective structured clinical examinations (OSCE), and preclinical skill examinations performed in simulators.

In the third year, student progress toward competency is evaluated through formative

and summative evaluations (Clinical Evaluation Form, Appendix 2.N). Each clinical discipline calls for a number of formative evaluations according to minimum clinical experiences and faculty expectations of the quality of the students’ performance. The purpose of this type of evaluation is to provide feedback to students and promote a dialogue between professors and students. Summative evaluations are conducted when students feel they have attained a satisfactory level of performance or faculty determine that students are ready. Each clinical discipline determines the specific way in which grades are computed. These are based on either patterns of performance or accumulated daily scores in addition to end-of-year examinations. Qualifying or promotion exams are offered at the end of the year in most disciplines in order to assess the students’ progress towards competency (Examples of Assessment Forms, Appendix 2.O). In most cases there is more than one evaluator present to assure a more rigorous assessment process.

Defined criteria for each clinical discipline are distributed to all students in written form at the beginning of their clinical experiences. An orientation is also conducted to explain the entire evaluation system in detail. Students are required to know the evaluation criteria for the clinical procedures they are performing.

The third year clinical evaluation system is based on performance criteria definitions for each aspect of patient care, developed by each discipline (Clinical Evaluation Criteria Manual, Appendix 2.J). Rubrics with performance criteria are indicators of competency achievement. A rating scale from 0 to 3 is used in most clinics to assess student performance in each criterion. Anchor point definitions in the rating scale are as follows:


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Exhibit 2.6 - Evaluation Anchor Point Definitions

Acceptable

3

Excellent Excellent quality which meets high standards expected of an experienced general practitioner.

2

Satisfactory Clinically acceptable as presented. Improvements are possible and/or recommended.

Not Acceptable

1

Corrigible Cannot be accepted as presented. Improvements/ corrections are required.

0

Not Corrigible or Grossly Inadequate Errors are evident which are not corrigible, or which demonstrate a significant lack of skills and/or preparation. If not an irreversible procedure, it must be redone.

During academic year 2010-2011 the school assigned students to clinical teams in order to improve the coordination of third year students’ work in the different clinical rotations. A faculty member was appointed as mentor/ clinical team coordinator with the responsibility of overseeing student progress in the different clinical disciplines. At least every three months the mentor assesses the student’s overall performance based on a report prepared by each clinical rotation course coordinator. This report includes an assessment of the number of procedures performed by each third year student (Trimester Clinical Evaluation of Third Year Students’ Performance- Appendix 2.P).

In 2006, the Curriculum Committee of the school identified the clinical assessment system as an area in the curriculum that needed revision. The general perception among both faculty and students was that the system was not being used optimally. The assessment methods were not truly competency-based, faculty resisted use of the computer program and rubrics, and the majority of daily evaluations consisted indiscriminately of assigning the highest available number on the scale. The task of initiating this revision was assigned to the school’s ADEA CCI liaisons. The work done produced a revision of the assessment system for the fourth year comprehensive care clinic.

The senior year Comprehensive Care Clinic course is composed of 1,000 hours

distributed between clinical work, skills development seminars, and community rotations. Fourth-year students take the course throughout the entire year. Students are divided into five clinical teams, with a coordinator, assigned faculty, and two dental assistants per clinical team.

Before changes were implemented, the types of assessment activities for this course included daily clinical evaluations that had to be entered into a computer system, the completion of a portfolio of patient cases, and the approval of discipline-based competency tests.

The trimester clinical evaluations (once every three months), along with daily oral

feedback, substituted daily clinical evaluations that were found to be non-effective. The trimester evaluations are based on the 13 competencies of the curriculum (Trimester Evaluation of Progress towards Competency, Appendix 2.Q). The change to trimester evaluations began in academic year 2008-2009.


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Trimester evaluations are usually done in October, January, and April. The clinical team faculty participates in a group meeting where each student is evaluated. After reaching consensus, each clinical team member signs the student’s evaluation. Students receive the evaluation both verbally and in writing, along with a written work plan to correct and/or improve the clinical work where specific deficiencies were identified. This is done with the purpose of helping them achieve all competencies.

The evaluation form measures the development of each competency, based on how

the students meet the expectations for each one. Prior to each evaluation, the student performs a self-assessment of his/her progress towards the development of each competency. The suggestions and experiences of both the faculty and students have been used to modify and fine-tune the assessment instruments. In addition, group meetings are excellent calibration activities for the faculty.

Faculty members provide meaningful verbal feedback to the students on a daily basis.

This has eliminated the pressure and tension associated with daily grading. Faculty does not have to enter a paid status or a grade into the computer system, only a completed status regarding the clinical procedure done by the student. This has decreased the time faculty members spend on the computer system.

The school began a reorganization of the competency tests to incorporate new

assessment methods in a 2008 Summer Faculty Workshop. The process was completed during academic year 2008-2009. Competency examinations include: clinical examinations using patients, laboratory examinations on mannequins and models, clinical case presentations, written examinations, students’ self-assessment of performance, and a portfolio.

A manual prepared to formally guide both faculty and students in the competency

examination process includes a description of each examination, the coordinators and faculty involved, examination dates, rubrics, and evaluation forms. The digital portfolio was revised to incorporate critical thinking and EBD. It includes a personal reflection by the student on his/her development of the 13 competencies, three patient cases documented from diagnosis to completion with a self-assessment of each case, and a special report about a treatment decision based on scientific evidence. Each student has to make an oral presentation of one of the portfolio’s components. The school implemented the new and revised competency tests and portfolio in academic year 2009-2010 (Competency Examinations Manual- Appendix 2.R).

Students are responsible for the comprehensive treatment of their patients, although

there are certain minimum clinical requirements. This was incorporated after observing deficiencies in competency and licensure examinations. It is the responsibility of students and clinical team coordinators to assure that students work on developing every competency during each trimester. An adequate pool of patients is required and recruited at the beginning of the year. Additional patients may be assigned during the year to cover areas of deficiencies.


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Supportive Documentation 1. Clinical Evaluation Criteria Manual (Appendix 2.J) 2. UPR-SDM Competencies for the New Dentist (Appendix 2.L) 3. Competencies According to Related Courses and Methods of Assessment (Appendix 2.M) 4. Clinical Evaluation Form (Appendix 2.N) 5. Examples of Assessment Forms (Appendix 2.O) 6. Trimester Clinical Evaluation of Third Year Students’ Performance (Appendix 2.P) 7. Trimester Evaluation of Progress towards Competency (Appendix 2.Q) 8. Competency Examinations Manual (Appendix 2.R) 2-9 Biomedical, behavioral and clinical science instruction must be integrated and of

sufficient depth, scope, timeliness, quality and emphasis to ensure the achievement of the curriculum’s defined competencies.


Description

The UPRSDM curriculum is designed to integrate biomedical, behavioral, and clinical sciences. In order to facilitate this integration the curriculum is organized around four curricular areas. These areas were defined according to the knowledge, skills, and values needed to achieve the competencies of a general dentist. Biomedical Sciences instruction includes fundamental knowledge of structure, function, mechanism, and disease development in the human body. Assessment and Diagnosis comprises knowledge, skills, and values related to the assessment of normal structures and diagnosis of abnormalities, diseases, and dysfunctions of the orofacial complex in children, adolescents, adults, and geriatric and special needs patients. Prevention and Treatment includes knowledge, skills, and values related to the health promotion, prevention, and treatment of abnormalities, diseases, and dysfunctions of the orofacial complex of children, adolescents, adults, and geriatric and special needs patients. Professional Development and Management of the Dental Practice is related to the development of individuals as oral health professionals and their role in the community. It includes, among others, the concepts of practice management, professional, ethical and legal concepts; dental utilization, infection control and risk management, and supervision skills (See Course Syllabi).


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Biomedical Sciences Dental school faculty participates actively in the biomedical sciences courses by discussing topics of clinical relevance to dentistry and offering clinical correlations so that students may understand the clinical application of concepts. For example, in Biochemistry (CBIO 7100) dental faculty with dual DMD/PhD degrees discuss topics such as extracellular matrix proteins; salivary proteins; saliva as a diagnostic fluid; applications of genomics, metagenomics, transcriptomics and proteomics in personalized dentistry; genes involved in oral cancer; and clinical cases of connective tissue anomalies. In the nutrition part of the same course the topics of baby bottle tooth decay, anorexia nervosa, nutritional supplements, fluoride, and mercury toxicity are discussed. Gross Anatomy (CBIO 7110) offers clinical correlations in which oral and maxillofacial surgeons present craniofacial surgeries and discuss the involved anatomical structures. Pharmacology (CBIO 7180) discusses the oral and systemic interactions of medications and their possible side-effects. Microbiology (CBIO 7150) includes various clinical topics. Dental faculty also participates in this course discussing the microbiology of dental plaque and caries, periodontal disease, and infections of the maxillofacial region. Cariology (PRET 7106) covers in depth a number of oral biology concepts, such as the composition and physiology of saliva, chemical aspects of dental caries, and the composition and dynamics of the oral microbial ecology. The course also discusses modern alternative approaches for the prevention and management of dental diseases, such as caries vaccines, replacement therapy and probiotics, among others. In the same course, students have the opportunity to visit the Oral Biology Laboratory where they see a variety of commercially available and experimental methods for early caries detection (FOTI, QLF) and biological tests for caries risk assessment.

Behavioral Sciences During the first year, students are exposed to behavioral aspects in dentistry in the course Human Development and Behavioral Management (EVDI 7115). This course integrates social, psychological, nutritional, biomedical, and dental aspects important in patient management. Part of the course is taught using the Problem Based Learning strategy. Cases analyzed by students are designed to include social, psychological, biomedical, and dental learning issues. In the course Introduction to Assessment and Diagnosis of the Patient (EVDI 7105), students are introduced to communication skills and the art of patient interviewing. They are also introduced to the concepts of cultural competence in oral health service provision. They learn about vital signs and basic cardiac life support protocols. Students apply knowledge and practice skills learned in this course in the context of a standardized patient exercise (Available on site). Two other courses taught during the first year are Preventive Dentistry (PRET 7116) and Cariology (PRET 7106). The Preventive Dentistry course discusses prevention concepts, the philosophy of preventive dentistry, levels of prevention, and primary preventive measures. Oral prophylaxis instrumentation, instrumentation techniques, and application of nutritional concepts as part of primary prevention and oral health maintenance are also presented in the course. Students are exposed to the importance of motivational and behavioral modification techniques in order to encourage their patients to continue an oral health preventive routine. In the Cariology course, students learn fundamental biological, epidemiological, and clinical aspects of dental


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caries. This knowledge is essential for understanding the rationale behind preventive, diagnostic, and therapeutic methods for the control of dental caries.

Professional Development I (DESP 7117) introduces first year students to the professional life of the dentist and to his/her role in community health. In Professional Development II (DESP 7127) they are introduced to risk management, federal and local regulations, infection control procedures, ergonomic principles, dental assistant utilization, and expanded auxiliary management.

Integration of Clinical, Behavioral, and Biomedical Sciences During the first year, students learn fundamental knowledge and skills in biomedical sciences, assessment and diagnosis, prevention and treatment, and professional development areas. The course sequence in the biomedical sciences tracks has been designed to facilitate the integration of the most basic scientific concepts into the more complex biological levels and normal and abnormal biological processes, and eventually into the clinical management of patients. Students learn sequentially the basic structure of molecules in Biochemistry (CBIO 7100), of tissues in General Histology (CBIO 7120) and Oral Histology and Embriology (CBIO 7140), and of organs in Gross Anatomy (CBIO 7110). They learn the function of the organ systems under normal conditions in Basic Physiology for Dental Students (CBIO 7160) and pathological aspects in General Systemic Pathology (CBIO 7170). In the sophomore year the students begin to apply this knowledge into the clinical management of patients with Dental Pharmacology (CBIO 7180), Introduction to Assessment and Diagnosis of the Patient (EVDI 7105), and Dental and Craniofacial Imaging (EVDI 7135). Finally, Integration of Basic Sciences into Dental Practice (CBIO 7190) applies this knowledge into the clinical dental management of patients with systemic conditions.

In the preclinical courses the professors discuss the specific biological and scientific concepts related to the clinical problems and treatments included in their courses. For example, Dental Anatomy and Functional Occlusion (EVDI 7125) includes a review of the histology and embryology of dental tissues, while Dental and Craniofacial Imaging (EVDI 7135) presents the theoretical aspects of dental radiology, which includes the physical nature of X-ray radiation and radiation health. Concepts in radiographic processing techniques, quality evaluation, and rectification procedures are also taught. In the second semester of the first year, in the Clinical Applications of Dental Skills (PRET 7136) course, students are exposed to a clinical experience in which they have the opportunity to apply the knowledge and practice the skills learned in most first-year courses in the areas of radiology, preventive dentistry, and functional occlusion.

Most preclinical dental courses are offered during the second year (Endodontics, Periodontics, Orthodontics, Oral Surgery, Pediatric Dentistry, Diagnostic Sciences, Removable and Fixed Prosthodontics). In preclinical courses, the integration of knowledge in biomedical and behavioral sciences in order to make adequate clinical judgments is emphasized. For example, the Oral Diagnosis and Treatment Planning (EVDI 7265) course is an integrated course in which faculty from several disciplines presents the diagnostic


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process for different dental diseases. This course relates basic, behavioral, and clinical sciences by integrating knowledge derived from multiple disciplines in comprehensive patient evaluations (See Course Syllabi).

The Apprehension and Pain Control (PRET 7286) course integrates the physiology, anatomy, and microanatomy involved in pain perception applied to the trigeminal nerve. Anatomical landmarks are studied in relation to the application of local anesthesia. The pharmacology of narcotics and non-narcotic analgesics, sedatives, tranquilizers, and ataractics is also discussed. The course Development of the Orofacial Complex (EVDI 7245) integrates foundation knowledge on human anatomy, physiology, general and oral histology, and embryology (See Course Syllabi). The Endodontics (PRET 7296) course integrates knowledge of microbiology, pathology, and pharmacology for the treatment of endodontically involved teeth. In periodontal preclinical and clinical courses, the etiology of periodontal disease is studied in relation to its microbiology, immunology, pathology, and histopathogenesis. In these courses, gross, histological and ultrastructural morphology, biochemistry, and the physiology of the periodontium are studied in-depth (See Course Syllabi).

Clinical instruction is conducted during the third and fourth years. Behavioral and biomedical knowledge is emphasized throughout didactic and clinical experiences in the third year clinical rotations as well as in the Comprehensive Care Clinic (PRET 7400). Several other courses also integrate biomedical and clinical knowledge. The Medical Emergency (PRET 7356) course integrates concepts of pathophysiology and pharmacology in managing medical and dental emergencies in the dental practice. In the course Clinical Occlusion and TMD Management (PRET 7346), the anatomy and physiology of the stomatognathic system is discussed as applied to procedures for examining and diagnosing occlusion, masticatory muscles, vascular and cranial nerve pathology, or temporomandibular joint dysfunction. In the courses Assessment and Diagnosis of the Child and Adolescent (EVDI 7275) and Pediatric Dental Treatment (PRET 7277), behavioral, clinical, and biomedical concepts are integrated as applied to children and adolescent diagnosis and treatment. The Geriatric Dentistry (PRET 7376) course promotes the understanding of the biological, clinical, economic, psychological, sociological, demographic, and administrative aspects of services provided to the elderly. The course Dental Care for Special Patients (PRET 7316) also integrates biomedical, behavioral, and clinical aspects of patients with special needs. Topics related to physical, mental, and emotional conditions of handicapped patients are analyzed in an integrated fashion (See Course Syllabi).

Behavioral, practice management, and clinical skills are integrated in didactic and

clinical courses from the beginning of the dental curriculum. These courses are presented to students in a programmed, sequential manner. During the freshman year, they take (DESP 7117) Professional Development I (Introduction to Dental Practice, Ethics); (DESP 7127) Professional Development II (Infection Control, Risk Management, and Ergonomics, including DAU);, and (DESP 7357) Professional Development III (Practice Management). Please refer to Standards 2-16, 17, 18, 19, 20, 21 for more in-depth information. Clinical experiences integrating behavior, practice management, and clinical skills begin at the junior


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year with (PRET 7398) DAU Clinical Rotation and continue in the senior year with a simulated private practice experience with their assigned clinical team. The Preventive Dentistry Clinical Rotation (PRET 7348) includes experiences for health education and promotion in a clinical setting. All clinical rotation courses as well as the senior year Comprehensive Care Clinic (PRET 7400) also include practical experiences that develop interpersonal and communication skills in the clinical setting. During their third year, students are required to participate in community activities offering oral health promotion education and cancer screenings to the participants. They must coordinate with faculty and auxiliary personnel and complete 15 hours in the junior year and 18 hours in the senior year of direct service to the community. During their fourth year, students rotate in an extramural setting (DESP 7467) Dental Practice Externship in which they further apply the knowledge and skills in community service experiences. Supportive Documentation 1. Course Syllabi (Separate volumes) 2. Standardized Patient Exercise (Available on site)

3. Table 3 – Schedule of Courses (Required Tables section) 4. Table 4 - Departmental Course Offerings-Biomedical Sciences (Required

Tables section) 5. Table 5 - Departmental Course Offerings-Clinical Sciences (Required Tables

section) 6. Table 6 - Departmental Course Offerings-Behavioral Sciences (Required

Tables section) 2-10 The dental school must have a curriculum management plan that ensures: (address separately)

a) an ongoing curriculum review and evaluation process which includes input from faculty, students, administration and other appropriate sources;

b) evaluation of all courses with respect to the defined competencies of the school to include student evaluation of instruction; and

c) elimination of unwarranted repetition and outdated and unnecessary material, incorporation of emerging information and achievement of appropriate sequencing.



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Description

The Curriculum Committee of the UPRSDM is the official body that advises the Dean on the design, implementation, and evaluation of the Predoctoral Program (DMD). This committee evaluates the DMD program with respect to school goals and objectives, competencies defined for graduates, needs of the Puerto Rican community, and trends in the profession. It emphasizes curriculum integration and coordination in all its dimensions and conducts an ongoing curricular review and evaluation process that includes input from faculty, students, administration, and other appropriate sources.

The objectives of the ongoing curriculum review processes are the following:

To assess each predoctoral curriculum course in relation to the competencies defined for graduates, student course evaluations, and data collected in the outcome assessment process

To make recommendations for curriculum changes based on findings from

course assessment

To follow-up the implementation of changes in the predoctoral curriculum based on the recommendations

The Curriculum Committee is composed of two faculty members from each department

(for a total of six), three student representatives, the chief of the Oral Biology Section, the Assistant Dean for Research, and a representative from the MSC library. The three department chairs and the Assistant Dean for Clinical Affairs are ex-officio members of the committee, which is chaired by the Assistant Dean for Academic Affairs.

The Curriculum Committee has established a systematic and ongoing process to evaluate each course. Students evaluate all courses according to a schedule prepared by the Office of Academic Affairs (see Course Evaluation Forms, Appendix 2.S). The schedule is prepared so each course is evaluated every other year or according to specific needs identified by either the course director or the Curriculum Committee. Course evaluations are conducted online using CourseEval, a tool for developing and processing assessment instruments. Evaluation results are provided to the course director and the corresponding department chair. The Curriculum Committee discusses the results of course evaluations when findings point to areas that may need improvement and makes recommendations to the Course Coordinator or Department Chair when needed. The Assistant Dean for Academic Affairs is in charge of the coordination and distribution of course evaluation results to the course director, the Department Chair and Curriculum Committee.

As previously indicated, the scheduling of courses for evaluation is established at the

beginning of each academic year. The selection of the courses to be evaluated by the Curriculum Committee is random, or in cases in which student evaluations report unfavorable results in over 40% of any of the evaluation criteria, or when they show an unfavorable tendency compared to previous course results. This evaluation includes the Course


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Coordinator’s self-evaluation and the Department Director, peer faculty, and student evaluations. An instrument has been designed according to a series of criteria such as course content, materials, hours, scheduling, and teaching. Also, respondents must include a summary at the end of the instrument of specific comments and recommendations to be used for improvement of the course (Forms for Peer and Administrative Evaluation of Courses, (Appendix 2-T). The Curriculum Committee discusses findings with student representatives and the course coordinator. Possible changes based on these course evaluations include content, curriculum sequence, and faculty assigned to the course, among others. The last evaluation includes Dental Anatomy and Functional Occlusion (EVDI 7125), Fixed Prosthodontics (PRET 7276) and Development of Orofacial Complex (EVDI 7245). A recent example of actions taken as a result of these assessments is the Dental Anatomy and Functional Occlusion (EVDI 7125) course in which more faculty was assigned, improving the student faculty ratio, rubrics were created for each procedure in the course, and the course was delayed three weeks in August to ensure that students have all the necessary instruments available.

The process for curriculum review and evaluation includes analyzing data and the subsequent use of results for the development, implementation, and follow-up of recommendations for curriculum changes. The data for analysis consists of the results of the student and peer course evaluations previously explained, senior survey, NBDE I and II results, and State Board Examination results. Exhibit 2.7 illustrates the assessment process for curriculum improvement.


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Exhibit 2.7

Faculty members develop special projects to evaluate areas of the curriculum as

recommended by the Curriculum Committee and/or academic administrators. An example of this is the recent evaluation of the Clinical Assessment System conducted with the leadership of the ADEA Commission on Change and Innovation (CCI) liaisons at the school. For the purpose of assessing the need for change during academic year 2007-08, the school prepared and sent digitally to all faculty members involved in the clinical evaluation of students an online questionnaire regarding the clinical assessment system. The survey included five areas of interest: rubrics for clinical evaluation, performance patterns, the computerized clinical system (ACO), competency examinations, and portfolio. Faculty participation in the survey was 72%. Survey results indicated some lack of knowledge and confusion among faculty regarding all five areas addressed. The faculty also found the computerized system too time-consuming.

Analysis of the 2006-07 clinical evaluations for third- and fourth-year students

revealed that 87% of the scores were at the highest level on the scale, and 12% were at the second highest. A 2005-2006 student satisfaction survey was also studied. Students reported some dissatisfaction with faculty feedback and calibration. As part of the project, the CCI Liaisons conducted an analysis of the clinical course syllabi that revealed a need to integrate critical thinking, evidence-based dentistry, and multiple assessment methods, as well as the need to focus student learning on the development of competencies.


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In general, the results indicated: some lack of knowledge about the different components of the clinical assessment system, poor motivation, reluctance to use the system correctly, a need for some documents and examinations to focus on competencies, and a need for inclusion of critical thinking, evidence-based dentistry, adequate student feedback, and multiple assessment methods focusing on student learning. The results of the analysis were presented and discussed with the Dean and academic administrators, as well as with the faculty in various meetings.

The School’s Office of Academic Affairs organized a faculty workshop in August of

2008 to discuss topics and exercises such as review of the concepts of competencies and rubrics, presentation of different methods of assessment, and a pilot project for the senior students’ clinical assessment. Group exercises were conducted with the faculty to begin a transformation in the methods used for the evaluation of competencies, specifically those related to examinations, and to develop adequate rubrics for this purpose. Creative new ideas for harmonizing assessment methods with the competency-based curriculum were suggested by the faculty groups participating in the workshop. The ideas were presented in writing in the form of tables, and rubrics were drafted according to the proposed tests.

After the workshop, a group of faculty leaders from each department was selected to

continue the work begun in the faculty workshop. They were charged with the responsibility of reorganizing the competency examinations. For each competency, a leader was chosen. It was recommended that they each meet with representatives from other departments to revise the methods. They presented their work and received additional input from faculty at a workshop in March 2009. The results of this evaluation process were a modification in the clinical assessment system, as well as the assessment instruments and competency examinations at the senior level. These are described in Standard 2-8.

Some changes to address the findings mentioned above as they pertain to the third year clinic evaluations are still in progress. In 2009-2010, a team of faculty under the direction of the Curriculum Director, the Assistant Dean for Clinical Affairs, the Associate Dean and representatives of clinical non-teaching staff, developed the concept of clinical teams for the third year clinic. The teams would be composed of a director and faculty from several specialties assigned to supervise a group of 12-15 students in the different clinical areas. Instead of rotations, students would perform the clinical procedures under the supervision of this faculty group. The main purpose of this project was to improve the comprehensive care of the patient and improve the supervision and communication with students in the third year clinic. This concept was partially implemented in academic year 2011-2012 when students were assigned to a clinic group director who monitored their clinical performance and verified that they were progressing adequately in the different clinical rotations. The full concept was not implemented due to the limited availability of faculty in most specialty groups that could join the team. This presented logistical problems for the supervision of students by faculty in the specialty areas, as well as resistance to allow non-specialists to supervise the students’ work.

Elimination of unwarranted or unnecessary material, incorporation of new or emerging concepts or techniques, and achievement of appropriate sequencing are conducted


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regularly according to data obtained from assessment instruments such as the senior survey and the student and administrative course evaluations.

The school underwent a comprehensive curricular revision that was implemented in

2003-2004. One of the goals of that revision was a reduction in contact hours in order to provide students time for independent study, the elimination of unwarranted repetitions, and the integration of knowledge. The overall total time reduction in the four years was 15% after completing the revision. Time in the first year was reduced by almost 83 hours and by 216 hours in the second year. This was achieved by performing a content analysis of existing courses with respect to defined competencies, which resulted in the integration of some of the courses and the deletion of outdated material. The purpose of course merging was to achieve better integration of biomedical, clinical, and biosocial sciences. As a result of the assessment processes after the implementation of the revised curriculum, some of the adjustments that were made included the elimination of unstructured time, the need to add contact hours to some courses, and the restructuring of biomedical sciences courses. Unfortunately, the integration of the Pharmacology, Physiology, General Pathology, and Integration of Biomedical Sciences to Dental Practice courses proved to be a very difficult endeavor and was not achieved in a way that satisfied faculty and students. After extensive discussions in the Curriculum Committee during academic year 2008-2009, the courses were separated according to content areas and sequencing was altered. Integration of concepts is expected to be achieved by the discussion of clinical topics in each course and in the Integration of Biomedical Sciences to Dental Practice course offered in the sophomore year.

The following are additional examples of actions taken to revise and update the

curriculum:

The variety of 4th year selective courses was increased with the addition of a course on Microscope Dentistry, Forensic Dentistry and Endodontically Treated Teeth.

After an evaluation of curricular content in the Introduction to Restorative Dentistry pre-clinical course (PRET 7126) in 2006-07, content pertaining to class three anterior amalgam restorations was eliminated and more time was assigned to class 2 restorations. Contents on temporary restorations for inlay and onlay cast metal was also eliminated.

During academic year 2006-07, an implant dentistry curriculum was implemented. This implicated a restructuring of the curricular content related to dental implants throughout the four years, and the addition of a clinical third year rotation in implant dentistry (PRET 7306).

In the Fixed Prosthodontics course (PRET 7276) a content analysis was

performed by the department to eliminate or reduce time on topics related to the technical aspects of prosthetic procedures. Specific topics eliminated were: laboratory work for the construction and solder of two all metal crowns, reduction of time dedicated for the construction of porcelain fused to metal


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restorations, reduction of the time used for the construction of working casts with dies, reduction of time in topics on investment, casting defects in the different steps of metal casting construction ,and metallurgy (diagrams of phases and microstructure of metals)

A project for implementing digital radiography and digital imaging began with the purchase of equipment and modifications to the information management infrastructure, as well as training for faculty and students.

Based on recommendations made by students, the second year course Dental

Treatment for the Child and Adolescent was divided in two courses: Pediatric Dental Treatment and Orthodontic Treatment Planning. This change responded to the need to improve the students’ structuring of concepts in the two disciplines included in the previous course. In this development stage, students apparently need to focus on the concepts as two different disciplines that will later be integrated as they treat patients in the third and fourth year clinics.

After receiving recommendations from students and discussing the issue with

course coordinators and the Assistant Dean for Clinical Affairs, the sequence of didactic courses in the third year was modified to allow more clinic time in the second half of the year.

As part of the assessment of student learning the school closely monitors the

students’ performance on the National Board. As one of the strategies to improve their first time passing rate on the NBDE Part I, a change of sequence in the first and the second year courses was implemented during academic year 2011-2012. This change will allow students to take the Board in the summer of their first year. This change was based on several considerations. Fifty to sixty percent (50-60%) of the questions are at the comprehension cognitive level (American Dental Association Joint Commission on Dental Examinations, 2009), which means that memorization plays an important role in the students’ performance. At this stage students will have recently covered the topics included in the Board in their courses, thus making it easier for them to recall data and concepts. Also, if students do fail, they will have a chance during their sophomore year to retake the exam before beginning their clinical years. At the end of the first and second year, students have more available dedicated time during the summer to study, which is a factor that has been found to improve their performance on the Board (Hawley N, Johnson D, Packer K, Ditmyer M & Kingsley K, 2009).

As part of the assessment of students’ performance on the National Boards

Part I, the Gross Anatomy course was modified to reduce emphasis on limbs, in favor of more time on head and neck. A clinical application of concepts was incorporated with lectures by oral surgery faculty.


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After an evaluation conducted by the Curriculum Committee, the contact hours were increased in the courses (PRET 7266) Oral Surgery and (PRET 7106) Cariology. In the Cariology course a laboratory for caries risk assessment, observation of a caries exam, and demonstrations on caries detection methods were incorporated. In the Oral Surgery course, extra time was added to expand on the topics of principles of complicated exodontias, biopsies, suture materials and techniques, post surgical patient management, and prevention and management of surgical complications. Another example is the course (PRET 7126) Introduction to Restorative Dentistry and Principles of Intracoronal Restorations in which 40 contact hours were added to allocate more supervised laboratory hours. These changes were implemented in academic year 2012-2013.

After a systematic analysis conducted by a specialist in geriatric dentistry,

topics on the dental and medical care of geriatric patients have been added in several preclinical courses in order to better prepare students to serve an aging population. A senior year rotation in a geriatric care facility is being planned for academic year 2013-2014.

As a result of the students’ performance on the second year OSCE exam, that

assesses their patient assessment and diagnostic knowledge and skills, a greater emphasis has been placed on radiographic interpretation in preclinical courses.

During Academic year 2011- 2012 a series of seminars was added to the

fourth year curriculum to better prepare students for the licensure examination. This was based on recommendations of the Committee for Institutional Assessment that identified the students’ performance on this test as an area that needed improvement.

. Supportive Documentation

1. Student Course Evaluation Forms (Appendix 2.S) 2. Forms for Peer and Administrative Evaluation of Courses (Appendix 2.T)

References

1. American Dental Association Joint Commission on Dental Examinations (2009). Technical Report. The National Board Dental Examinations, page 24.

2. Hawley N, Johnson D, Packer K, Ditmyer M & Kingsley K. Dental Students’ Preparation and Study Habits for the National Board Dental Examination Part I. J Dent Educ. 2009; 73 (11):1274-78.


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2-11 The dental school must ensure the availability of adequate patient experiences

that afford all students the opportunity to achieve its stated competencies within a reasonable time.


Description The UPRSDM ensures the availability of patient experiences for its students. Over 3,500 new patient records are opened each year, with an average of 18,000 patient encounters. Third year students are assigned an initial pool of patients by the Diagnostic Sciences faculty. The Diagnostic Sciences Section maintains a pool of patients who have been screened, from which students may be assigned new patients, if needed, according to the procedures required to attain clinical competencies. The Clinical Team Coordinator also helps students find patients when needed. The school offers reduced fees in all clinical procedures and performs special screening activities throughout the year to help ensure an adequate pool of patients. The total number of procedures and average number of procedures performed per student of the 2012 graduating class are presented in the following exhibit. Exhibit 2.8- Total and Average Procedures per Student by Discipline, Class of 2012 Discipline Procedures Average number of

procedures per student Oral Diagnostics 1,662 29.7 Preventive 1,167 25.4 Operative 3,919 85.2 Endodontics 199 4.3 Periodontics 1254 27.3 Removable Prosthodontics 619 13.5

Fixed Prosthodontics 1350 29.3 Oral Surgery 2,757 59.9 Orthodontics 2,392 52.0 Pediatric Dentistry 1,873 40.7 Radiology 3,294 71.6 Implants 240 5.3 Patients are categorized in the Clinic as regular or emergency. The processes for the admission and assignment of regular and emergency patients are illustrated in the flow charts presented in Exhibits 2.9 and 2.10.


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Exhibit 2.9 NEW PATIENT FLOWCHART

PATIENTS ARE GIVEN APPOINTMENTS FOR FULL EXAMINATIONS AND TREATMENT PLANNING IN THE CLINICAL AREA Rev. November 2012

PATIENT COMES IN FROM 7:00 AM TO 2:00 PM

PATIENT REGISTERS AT THE DATA ENTRY DESK

PATIENT IS SCREENED AND TREATMENT NEEDS ARE

IDENTIFIED

PATIENT IS DISMISSED WITH OPTIONS

PATIENT IS INSTRUCTED ON THE RIGHTS AND

REGULATIONS OF THE SCHOOL

PATIENT IS CLASSIFIED ACCORDING TO TREATMENT

NEEDS AND ASSIGNED TO

PRE-DOCTORAL STUDENTS’

CLINIC

GRADUATE PROGRAM’S

CLINICS

FACULTY CLINIC


WON’T AGREE

AGREES

NOT ACCEPTED FOR TREATMENT

ACCEPTED FOR TREATMENT


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Exhibit 2.10

NEW EMERGENCY PATIENT FLOWCHART

AFTER HOURS EMERGENCY PATIENTS ARE SEEN BY RESIDENTS OF THE GPR AND ORAL SURGERY PROGRAMS AS DESCRIBED IN THE PROTOCOL Rev. November 2012

PATIENT COMES IN FROM 7:00 AM TO 2:00 PM

PATIENT REGISTERS AT THE DATA ENTRY DESK

PATIENT IS SCREENED AND EMERGENCY TREATMENT

NEED IS IDENTIFIED

TREATED FOLLOWING THE NEW PATIENT PROTOCOL

PATIENT IS INSTRUCTED ON HIS RIGHTS AND THE

REGULATIONS OF THE SCHOOL

PATIENT SENT FOR TREATMENT IN THE

APPROPRIATE CLINICAL SETTING


D-4 PRE-DOCTORAL MODULES

GRADUATE PROGRAMS CLINICS

FACULTY CLINIC

WON’T AGREE

AGREE

PRIMARILY D-4 STUDENTS

ACCEPTED FOR TREATMENT AS EMERGENCY


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The number of students who have graduated on schedule in the last six years is presented in Exhibit 2.11 Exhibit 2.11 - Expected Number of Graduates and Graduation Date

Class Expected

number of graduates

Graduated on Schedule (degree

conferred in June)

Graduated After Degree Conferring Date

December One Year

Two or more Years

Total

2007 32 28 3 1 4 2008 40 ᵃ 36 1 1 1 3 2009 47 43 1 1 2 4 2010 34 ᵇ 28 2 2 1 5 2011 38 33 - 5 - 5 2012 46 ͨ a) One student did not approve NBDE II b) One student pending approval of NBDE II c) Five students pending approval of NBDE II

Biomedical Sciences

2-12 Biomedical science instruction in dental education must ensure an in-depth

understanding of basic biological principles, consisting of a core of information on the fundamental structures, functions and interrelationships of the body systems.


Description

Biomedical Sciences

Biomedical Sciences comprise the first of four academic tracks in the curriculum of the UPRSDM. The objective of this curricular component is for students to obtain an in-depth knowledge and understanding of fundamental structures, functions, and interrelationships of body systems and the application of this knowledge to the practice of dentistry. Biomedical Sciences courses and laboratories are taught by the faculty of the corresponding departments of the UPR Medical Sciences Campus. However, the courses are specifically designed for the School of Dental Medicine under the supervision and direction of the Oral Biology Section, and they are exclusively taught to dental students.


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The Biomedical Sciences Track consists of 726 contact hours. It is divided into two

parts, namely Basic Sciences I: Structure and Function, and Basic Sciences II: Function and Disease. Basic Sciences I extends from August through March of the freshman year. It includes (CBIO 7100) Biochemistry; (CBIO 7110) Gross Anatomy; (CBIO 7120) General Histology; (CBIO 7130) Neuroanatomy; (CBIO 7140) Oral Histology and Embryology; and (CBIO 7150) Microbiology (See Course Syllabi). Courses in the Basic Sciences I track are sequentially arranged as independent blocks in the above order. The objective of these courses is to provide fundamental knowledge of the development, structure, and functions of the human body. Basic Sciences II begins in the spring semester of the freshman year with the courses (CBIO 7160) Basic Human Physiology for Dental Students, and (CBIO 7170) General Systemic Pathology and it continues through the fall semester of the sophomore year with the courses (CBIO 7180) Oral Pharmacology and Therapeutics; and (CBIO 7190) Integration of Biomedical Sciences into Dental Practice. The sequence in the courses of the Basic Sciences II allows the students to first learn the normal functions of the human body systems, and then use this knowledge to understand the mechanisms of disease and the pharmacological treatment of pathological conditions. Finally, the dental management of patients presenting related medical conditions, or using related medications is discussed in the (CBIO7190) Integration of Biomedical Sciences into Dental Practice course by faculty from the Oral Surgery Department. This allows students to integrate the biomedical sciences knowledge into the clinical management of dental patients.

In addition to the Biomedical Sciences Track (Basic Sciences I and II), a number of

topics related to Oral and Craniofacial Biology are discussed in-depth in various courses throughout the curriculum, such as (PRET 7106) Cariology (biochemistry and physiology of saliva, chemical aspects of dental caries, oral ecology, biological caries risk factors), and (EVDI 7245) Development of the Craniofacial Complex. Finally, the importance and the scientific methodology for understanding the biological processes that determine oral health and disease are emphasized in the course (DESP 7237) Evaluation of Scientific Literature and Epidemiology. These topics contribute an additional 46 hours to the biomedical sciences curriculum, for a total of approximately 772 hours. Overall, the biomedical sciences comprise 18.3 % of the total curriculum hours; this proportion is comparable to the median for dental schools nationwide, which according to CODA is 16.9%.

Supportive Documentation 1. Course Syllabi (Separate volumes)


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2-13 The biomedical knowledge base must emphasize that the oro-facial complex is

an important anatomical area existing in a complex biological interrelationship with the entire body.


Description

Courses in Biomedical Sciences are specifically designed for dental students and emphasize the importance of the orofacial complex as an integral part of the human body. Courses stress the importance of treating the patient’s dental needs taking into consideration medical management factors, as well as the importance of the oral cavity in the etiology and diagnosis of human diseases.

Biochemistry (CBIO 7100) includes a number of topics directly related to oral

biology, such as salivary proteins and extra cellular matrix proteins, connective tissue calcification, saliva as a diagnostic fluid for systemic diseases, and the applications of genomics, metagenomics, and proteomics in personalized dentistry. Gross Anatomy (CBIO 7110) devotes 78 contact hours to head and neck anatomy. General Histology (CBIO 7120) and Oral Histology and Embryology (CBIO 7140) emphasize the histology and embryology of oral tissues. Microbiology (CBIO 7150) discusses all bacteria groups, viruses, fungi, and parasites that can cause oral infections or systemic infections with oral complications. Microbiology also devotes considerable teaching time exclusively to the microbiology of dental plaque and caries, periodontal diseases, endodontic infections, and all types of maxillofacial infections. The course also includes twelve hours of laboratory exercises devoted primarily to oral biology-related topics, such as plaque formation and synthesis of extracellular polysaccharides from sucrose by oral bacteria. The complex interrelationship between the orofacial complex and the entire body is further emphasized in Basic Sciences II. Basic Human Physiology for Dental Students (CBIO 7160) emphasizes the interrelationship of the orofacial complex with the body systems, while (CBIO 7170) General Systemic Pathology discusses the oral findings associated with systemic diseases. Oral Pharmacology and Therapeutics (CBIO 7180) discusses medications used for the management of oral diseases and emphasizes indirect effects of other types of medications in oral health. Finally, in Integration of Biomedical Sciences into Dental Practice (CBIO 7190), students have the opportunity to integrate this information into the clinical practice of dentistry by discussing special considerations involved in the dental management of patients with medical problems. Supportive Documentation

1. Course Syllabi (Separate volumes)


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2-14 In-depth information on abnormal biological conditions must be provided to

support a high level of understanding of the etiology, epidemiology, differential diagnosis, pathogenesis, prevention, treatment and prognosis of oral and oral-related diseases.


Description

Understanding the mechanisms of disease and disease processes is essential for effective diagnosis and treatment. The biological basis for understanding the etiology, pathogenesis, and treatment of pathologic conditions is provided initially in the courses of the Basic Sciences I: Structure and Function (CBIO 7100) Biochemistry; (CBIO 7110) Gross Anatomy; (CBIO 7120) General Histology; (CBIO 7130) Neuroanatomy; (CBIO 7140) Oral Histology and Embryology; and (CBIO 7150) Microbiology and in (CBIO 7160) Basic Human Physiology for Dental Students, and in Basic Sciences II: Function and Disease (CBIO 7160) Basic Human Physiology for Dental Students, and (CBIO 7170) General Systemic Pathology. It continues through the fall semester of the sophomore year with the courses (CBIO 7180) Oral Pharmacology and Therapeutics and (CBIO 7190) Integration of Biomedical Sciences into Dental Practice.

In the (CBIO 7170) General Systemic Pathology course, students acquire in-depth

knowledge of the biology of basic pathological processes and how they produce disease. The natural history of diseases is explained and students develop an understanding of those that require special dental treatment. In the second year, the (EVDI 7255) Oral Pathology course develops the students’ comprehension of abnormalities in soft and hard tissues of the orofacial and the dento-alveolar complex. Topics include terminology, description of abnormalities, oral manifestations of systemic diseases, oral manifestations that are effects of medical treatment, and lesion treatment and abnormalities. The biological processes leading to oral diseases are also discussed in other courses such as Introduction to Assessment and Diagnosis of the Patient (EVDI 7105) and Cariology (PRET 7106) in the first year. In the second year, courses such as Oral Diagnosis and Treatment Planning (EVDI 7265); Assessment and Diagnosis of the Child and Adolescent (EVDI 7275); Preventive Dentistry (PRET 7116); Periodontics (PRET 7257); Endodontics (PRET 7296); and Oral Surgery (PRET 7266) also present topics on abnormal biological conditions and etiology of dental disease. The epidemiology of these conditions is presented in the course (DESP 7237) Evaluation of Scientific Literature and Epidemiology later in the third year, as part of evidence-based-learning. Supportive Documentation



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2-15 Biomedical sciences knowledge must be of sufficient depth and scope for

graduates to apply advances in modern biology to clinical practice and to integrate new medical knowledge and therapies relevant to oral health care.


Description

Biomedical Sciences knowledge offers the foundations required to interpret and apply advances in modern biology and therapies to clinical practice. In the Biochemistry (CBIO 7100) course students develop the necessary knowledge to understand the biological basis of oral phenomena. In this course, special emphasis is given to the application of molecular biology into the detection, prevention, and treatment of medical/oral conditions. Relevant topics include genetics of oral cancer, the uses of saliva as a diagnostic fluid for oral and systemic conditions, and the applications of genomics, metagenomics, transcriptomics, and proteomics in personalized dentistry. The Cariology (PRET 7106) course discusses in-depth the chemical and biological phenomena involved in the pathogenesis of dental caries and gives students the opportunity to understand the biological basis behind conventional and novel approaches for the diagnosis, prevention, and treatment of dental caries such as caries vaccines, replacement therapy, and probiotics. The course also discusses epidemiological and biological approaches to caries risk assessment, and novel caries detection methods, such as QLF and ICDAS.

New preventive dentistry therapies, products, and their biological mechanisms of

action are presented in the Preventive Dentistry (PRET 7116) course. (CBIO 7180) Oral Pharmacology and Therapeutics discusses all new types of medications as they continue to develop, while new dental materials are discussed in all the appropriate clinical courses. The anatomy, physiology, and biology of periodontal disease are reinforced in the Periodontics (PRET 7257) course, in which students are exposed to periodontal treatment, including the application of new periodontal surgical procedures. The relationship between periodontal disease and other chronic, systemic inflammatory diseases, such as cardiovascular disease and diabetes, and the importance of periodontal treatment as a means to reduce the risk for these diseases is also discussed. Advances in implantology are also discussed in this course, emphasizing biological principles. The osseointegration of dental implants is discussed in the Oral Surgery (PRET 7266) and in Implant Dentistry (PRET 7366), which integrate basic sciences and clinical disciplines in order to present a clear view of the scientific basis for successful treatment with dental implants, including the use of growth factors and bone grafting for the regeneration of tissue needed for placement of implants. The principles of implant restoration are also covered in the Removable and Fixed Prosthodontics courses (PRET 7246 and 7276).


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Students also receive training in reading and interpreting scientific literature through the Evaluation of Scientific Literature and Epidemiology (DESP 7237) course, in which they develop basic skills to interpret and evaluate literature and the application of information to improve the patient’s oral health. Supportive Documentation


Behavioral Sciences 2-16 Graduates must be competent in the application of the fundamental principles

of behavioral sciences as they pertain to patient-centered approaches for promoting, improving and maintaining oral health.

2-17 Graduates must be competent in managing a diverse patient population and

have the interpersonal and communications skills to function successfully in a multicultural work environment.

The University of Puerto Rico School of Dental Medicine complies with Standards 2-16 and 2-17.

Description

Basic behavioral sciences concepts are introduced in didactic courses beginning the first year and continuing throughout the predoctoral curriculum. The curriculum also provides several formal didactic and clinical experiences in which students develop the necessary knowledge and skills to manage a diverse patient population. During their first year, students take three courses (EVDI 7105) Introduction to Assessment and Diagnosis of the Patient; (EVDI 7115) Human Development and Behavioral Management; and (PRET 7116) Preventive Dentistry that enable them to develop a core of knowledge related to human growth and development from the bio-psychosocial perspective and to apply those concepts to establish proper rapport with patients. These experiences are reinforced with hands-on practice in exercises using standardized patients, in interviews with subjects at different age stages at individual and community level, as well as during their early clinical experiences. In the first year, in Introduction to Assessment and Diagnosis of the Patient (EVDI 7105), students are introduced to knowledge and skills for effective communication and interviewing and cultural competence principles.

Problem Based Learning (PBL) as a teaching methodology is used in the Human

Development and Behavioral Management (EVDI 7115) course to expose freshmen students


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in a hypothetical manner to a diverse patient population. PBL cases are designed to contain learning issues related to cultural, age, socioeconomic, and gender diversities.

Behavioral concepts as they pertain to the promotion of oral health are also analyzed

in two second year courses Introduction to Community Dentistry (DESP 7247) and Assessment and Diagnosis of the Child and Adolescent (EVDI 7275). In the first course, students have the opportunity to visit an underprivileged community to develop an oral health needs assessment after conducting interviews with people living in the community and community leaders. They also visit organizations established within the community to collect data and learn more about the community’s socio-cultural environment. Students are required to develop a presentation of the experience and make recommendations based on their findings. The analysis of data collected about the community and the oral health needs assessment findings are presented to community leaders and senior students that are enrolled in the Oral Health Promotion in Special Communities (PRET 7405) elective course. The senior students then design a community intervention using the data collected by the sophomore class. In this way, the disadvantaged community’s specific oral health needs are followed-up. In these visits students have the opportunity to apply their interpersonal and communication skills, as well as their skills in management of scientific data. In Assessment and Diagnosis of the Child and Adolescent (EVDI 7275), students learn behavioral principles applied to children and adolescent patients. They are also exposed to their characteristics and needs, as well as the issues of child abuse and neglect.

As a way to assess the development of competency in this area, evaluations in the above mentioned courses are used as formative evaluations. Among the strategies used for this process are written examinations, essays, analysis of PBL cases, standardized patient exercises, observation, and direct feedback of student/patient interaction through case presentations and seminars.

In the third year course Dental Care for Special Patients (PRET 7316), students are

also exposed to behavioral principles as they apply to patients of diverse ages, as well as to patients with mental, systemic, and chronic conditions and disabilities. In the course on Geriatric Dentistry (PRET 7376), also taught in the third year, students learn about psychosocial concepts and principles related to the aging patient. Students have the opportunity to apply these concepts in the junior and senior year clinical experiences. A clinical rotation in a geriatric care facility in which senior students will have the opportunity to further apply this knowledge is being planned for academic year 2013-2014.

In their junior and senior years students integrate their knowledge and understanding

of the behavioral sciences concepts into their daily clinical activities. They apply these principles in the junior year Preventive Dentistry Clinical Rotation (PRET 7348), in which they develop a plaque control program that must include a preventive treatment plan, counseling patients on oral health maintenance, nutrition, and tobacco control, if needed. They must also complete 11 hours of community-based experiences in which, as part of the evaluation, they are asked to prepare a reflection on how to integrate this experience into their clinical work. They may also be asked to prepare educational modules and/or brochures tailored to the needs of the communities visited.


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During their fourth year, students apply their behavioral sciences knowledge and skills in ten periods recreating a simulated private practice environment. These experiences are performed in the general clinic, using the auxiliary personnel of the clinical team that the student is assigned to. During these experiences concepts such as communication skills, adequate delegation of procedures, patient rapport, behavioral management, organization, and planning are specifically emphasized. Students are assessed as they integrate these concepts in the delivery of dental care and management of a dental practice. An examination is offered in order to assess the students’ level of competency in this area. If students do not reach the established level of competency, they must repeat the experience until they attain the competency.

Students are also expected to apply behavioral sciences concepts in their intervention with patients regarding patient education and the prevention of oral diseases. Such services include the initial examination, recall examination, oral prophylaxis, fluoride application, oral hygiene instructions, and dietary counseling. Specifically, students are required to demonstrate competency in the following areas:

Establishment of an effective and productive dentist/patient relationship Recognition of patient needs, expectations, and values Recognition of psychological needs and development in patient management Recognition of disruptive and/or abnormal patient behavior

The level of competency in these areas is evaluated through direct observation and feedback. If students do not reach the established level of competency, they have to repeat the experience until they acquire it.

In addition, senior students’ competency in the application of knowledge and skills in the behavioral sciences is assessed daily. In the trimester evaluations students’ communication and interpersonal skills are also assessed. This criterion is evaluated in the encounters they have with their patients, faculty, and staff. Students must reach the minimum level of competency in all criteria, or go through additional experiences until they demonstrate competency.

During the third and the fourth years, students provide care to the diverse patient

population that visits the UPRSDM clinic. In addition, they are exposed to different population groups and communities in the Dental Practice Externship Course (DESP 7467) during their senior year, in which they are assigned to different clinics around the island to provide care for a period of four weeks. The clinics are located in communities of different socio-economic levels, thus enabling students to provide services to a diverse patient population. Currently, all the centers are under Section 330 of the Public Health Act (HRSA), except for the UPR-Hospital Dental Clinic. Under Section 330, these centers must provide primary health services to medically underserved populations and are governed by a community board. The centers are located in Loíza, Cidra, San Lorenzo, Las Piedras, Ponce, and Mayaguez. Senior students also have the experience of providing care to special needs patients in a school for deaf children as part of the preventive and community rotations. They are also required to participate in a minimum of 30 hours in community experiences in which


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they must interact with a diverse population (elderly, children, special needs, drug addicts, and homeless, among others).

In the clinical setting, analysis and evaluation of student/patient interaction is

assessed daily through direct observation. The student’s ability to motivate and encourage patients to assume responsibility for their health is assessed through patient education activities and observation of student/patient interaction. An example of this assessment occurs during the active and completed recall clinical rotations in which students assess their work and that of their peers and encourage patients to maintain and improve their oral health. If students do not reach the established level of competency, they must go through additional experiences until they perform at the established level.



Practice Management 2-18 Graduates must be competent in evaluating different models of oral health care

management and delivery. 2-19 Graduates must understand the basic principles and philosophies of practice

management, and have the skills to function successfully as the leader of the oral health care team.

The University of Puerto Rico School of Dental Medicine complies with Standards 2-18 and 2-19. Description Competency 3 (Develop and manage a general dentistry practice) addresses Standards 2-18 and 2-19. The curriculum includes several courses that present different models of oral health care management and delivery. First year students are taught introductory concepts of efficiency and health care management in the course Professional Development II (DESP 7127). During the third year, students are required to take the course Professional Development III (DESP 7357), which covers topics such as setting practice goals and determining location, financing, management, business regulations, and marketing of a practice. Students are required to do field research on actual private practices on topics such as marketing, human resources, dental insurance, and professional organizations. They also engage in the discussion of effective communication skills and how to establish rapport with patients. Exercises are included to confirm students have used the Internet, including the A.D.A. web page, to find information about the dental profession and dental practice. They


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are evaluated through written examinations and projects designed to assess their comprehension of practice management concepts.

Fourth year students attend a seminar on oral health care delivery models as an important component of their extramural experience, in which they thoroughly discuss different oral health care models. The school also offers elective courses in Management and Financial Aspects of Dental Practice (DESP 7406) and Prepaid Dental Plans in Dentistry-(DESP 7407).

In the dental auxiliary utilization clinical rotation DAU Clinical Rotation (PRET 7398) and the Professional Development II (DESP 7127) courses, didactic and clinical experiences are provided as foundation to the development of practice management clinical skills. This experience is designed to develop the necessary skills to work effectively with a chair side dental assistant using ergonomic principles. Students are evaluated in areas such as: professional attitude, infection control, posture, and instrument transfer following ergonomic principles. The curriculum also provides them experience in a simulated private practice environment during their senior year, designed to further familiarize dental students with dental assistants with expanded functions and how to delegate daily tasks. As part of this experience students schedule their daily clinical work using more than one dental unit per each AM/PM period, and delegate all reversible dental care to the assistants. Students are evaluated in leadership and supervisory skills, decision-making, time management, and productivity, among other criteria. All senior students must complete 10 periods of three hours in this experience and be evaluated by a behavioral sciences expert.

The senior year Dental Practice Externship (DESP 7467) course develops awareness and a better understanding of the dental health problems of the people of Puerto Rico, as well as the development of a positive attitude and willingness to contribute to the solution of such problems. In the extramural clinical rotations in centers located throughout the island, students are exposed to the different clinical scenarios of Puerto Rico’s health care delivery models. Students also have the opportunity to practice and improve communication and manual skills in these scenarios. In order to guarantee the reliability of the extramural experience, uniform evaluation criteria have been developed for all centers. These include quantity and quality of clinical procedures completed and professional attitude. Also, as part of this experience, students are required to write reflective essays (one per week). In these essays, students must reflect on their experiences and comment on the provision of oral health care in Puerto Rico. Supportive Documentation



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Ethics and Professionalism 2-20 Graduates must be competent in applying ethical, legal and regulatory concepts

to the provision and/or support of oral health care services. 2-21 Graduates must be competent in the application of the principles of ethical reasoning and professional responsibility as they pertain to patient care and practice management.

The University of Puerto Rico, School of Dental Medicine complies with Standards 2-20 and 2-21.

Description Ethics and professionalism are fully addressed by Competency 1 (Manage professional, ethical, social, and legal issues associated with the practice of dentistry). Students are provided with structured experiences in professional, legal, and ethical issues associated with dentistry. In the first year, they are introduced to these topics in the course Introduction to Professional Development I (DESP 7117). Professional responsibilities of dentists are discussed from an ethical, social, and legal perspective. The course introduces first year students to ethical dilemmas relevant to academic honesty and integrity in order to help them develop ethical reasoning skills. The school believes that if the situations presented are relevant to the students’ academic life, the objective is more effectively attained. The purpose of introducing students to ethical reasoning at this level is to foster professional and ethical attitudes in them that will help them face challenging situations, even before graduation. At the beginning of the first year, students participate in the white coat ceremony. Students are invested with white coats, signifying the responsibility they are assuming by deciding to become health professionals. A dentist who has excelled in the dental profession is invited as guest lecturer in the ceremony.

The Professional Development II (DESP 7127) course discusses federal and local laws concerning occupational hazards, infection control in the work place, and risk management. The course Professional Development III (DESP 7357), offered in the third year, includes concepts and principles of practice management, ethics, and law. Exercises are provided to integrate all three areas. The dental law component emphasizes legal problems that may arise in the provision of oral health care. Students are introduced to the US legal system and laws applicable to dentists. They must also demonstrate knowledge of the Dental Act of the Commonwealth of Puerto Rico and other regulations affecting the practice of dentistry in Puerto Rico. The importance of understanding the Dental Act of the state in which they plan to practice, if not in Puerto Rico, is also stressed. As the course progresses, concepts related to professional liability, malpractice, informed consent, and standard of care principles are discussed. The Socratic Method, commonly used in law schools, is used to encourage critical thinking in the analysis of actual legal cases. Federal laws (such as OSHA, HIPAA, federal employment laws, regulations, antitrust, and others) are discussed in class.


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Students must pass a written examination on the Puerto Rico Dental Act and Torts Law. They must analyze hypothetical situations and recognize the legal issues present in such cases. Situations are carefully designed to test the students’ knowledge of important dental law concepts.

Students are also exposed to learning experiences to fully integrate the concepts of

ethics, law, and practice management, such as visits to dental clinics, movies, videos, reviews, and guest lecturers. As students progress through their clinical experiences, increasing emphasis is placed on diverse aspects of appropriate treatment plan presentation, proper referrals, and coordination of patient treatment.

Students are exposed to a series of ethical issues in dentistry and given opportunities

to apply them to clinical situations. They are encouraged to find their own answers based on principles recognized by the dental profession, as stated in the works of ethics scholars and professional codes of conduct (ADA, ADEA, local associations, and others). Critical thinking and analysis are strongly fostered.

Correlations are constantly made between ethical “solutions” and legal obligations. Students are urged to morally commit themselves to protect and promote the patients’ best interests and recognize the importance of observing a professional attitude when practicing dentistry. Situations are analyzed in small groups and later discussed and presented in class. Ethics discussions are based on the model of Professional Ethics Decision-Making established by the American College of Dentists. Students are expected to debate and demonstrate ethical reasoning. At the end of the course, they are required to reflect on the meaning of professionalism and ethics in their professional practice. This essay is evaluated by the professor in order to assess the students’ level of competency in ethical reasoning. In 2007 students approved a code of ethics developed by the entering class of 2003-2004. Since academic year 2007-2008, the students’ code of ethics has been signed by all students once they are admitted to the school.

During their clinical experience, students are encouraged and expected to apply ethical concepts in their daily work. In the clinical evaluation system, a professional development criterion has been included across all clinical disciplines. If students receive a score of 0 or 1 in professional development they must repeat the clinical procedure they are performing. In the fourth year this is part of the competency assessment in the trimester evaluations. There is also a competency examination that students must pass as part of the Comprehensive Clinic Course (PRET 7400).




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2-22 Graduates must recognize the role of lifelong learning and self-assessment in

maintaining competency.


Description Lifelong learning and self-assessment are addressed in Competency 2 (Value the role of lifelong learning, self-assessment, and critical thinking as an integral part of professional behavior). The importance of lifelong learning and self-assessment in maintaining competency is well established in the school’s curriculum. To reinforce its importance, students are encouraged to read, discuss, and evaluate relevant literature along their four years of study.

In PBL experiences in the first year course Human Development and Patient Management (EVDI 7115), students learn how to search for appropriate literature to sustain hypotheses, as developed in case discussions. They also learn to evaluate sources of information as they research learning issues identified in each case.

In the second year course Evaluation of Scientific Literature and Epidemiology

(DESP 7237), students develop skills to interpret and evaluate published scientific literature. They also develop a group exercise using the PICO format (patient with problem, intervention, comparison, and outcome) and prepare a systematic literature review to make a recommendation on the clinical problem formulated. They are required to make a presentation and discuss their findings before their classmates and a group of professors. In the Dental Care for Special Patients (PRET 7316) course students are required to present a term paper on a specific topic, evidencing a literature review.

Seminar sessions on the review of literature for clinical decision-making were

introduced in the junior year in academic year 2011-2012 to further develop the student’s understanding of the concepts of evidenced based practice. A literature review regarding the care of a clinical case is required in the senior year portfolio. Beginning in academic year 2011-2012 this requirement evolved into a systematic literature review on a clinical problem.

Some pre-clinical courses include student self-assessments as part of the laboratory

component. An example of this is the course Introduction to Restorative Dentistry and Principles of Intracoronal Restoration (PRET 7126). Self-assessment is also emphasized throughout the clinical courses. The clinical evaluation system provides for student self-evaluation after completion of procedures and before the professors’ evaluations. Self-assessment is also stressed during the active and completed recall clinical rotations in which students assess their work and that of their peers.


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In their senior year, before their trimester evaluations, students are required to complete a self-assessment of their clinical performance in each competency. Also, for the senior year portfolio they must prepare a reflection on their process or journey in developing their competencies for the practice of dentistry. They must also include a self-assessment of their portfolio cases.

In addition, recognizing the importance of the role of lifelong learning and self-

assessment, the school promotes active participation of students in courses, conferences, seminars, forums, hands on activities, and workshops offered by the Continuing Education Program. Students are encouraged to participate in professional meetings such as those of the American Association of Dental Research (AADR), International Association of Dental Research (IADR), or local forums to present research findings, table clinics, and posters.

Students also participate in organizations such as the International Association of

Dental Students (IADS) and the Annual Convention of the Puerto Rico College of Dental Surgeons. Through these experiences, they also become aware of the importance of lifelong learning. Supportive Documentation


Information Management and Critical Thinking

2-23 Graduates must be competent in the use of critical thinking and problem solving related to the comprehensive care of patients.


Critical thinking and problem solving skills related to the comprehensive care of patients are stressed throughout the curriculum (see Exhibit 2.12). First year students begin developing skills in critical thinking and problem solving in courses such as Professional Development I (DESP 7117); Introduction to Assessment and Diagnosis of the Patient (EVDI 7105); and Human Development and Behavioral Management (EVDI 7115). Critical thinking and problem solving skills are assessed in the second year courses Introduction to Community Dentistry (DESP 7247); Evaluation of Scientific Literature and Epidemiology (DESP 7237); and Oral Diagnosis and Treatment Planning (EVDI 7265). Learning experiences in these courses are designed to initiate dental students in the necessary thought processes to develop skills in clinical decision-making, taking into consideration the patient’s health status. During their clinical experiences, students are exposed to increasingly complex


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cases in which higher order thinking skills are required to provide comprehensive patient care. During their daily clinical evaluation, students’ critical thinking and problem solving skills are assessed in the professional development criterion. In the course Professional Development III (DESP 7357), critical thinking is encouraged by using the Socratic Method. In the senior year trimester evaluations this area is assessed in the competency pertaining to lifelong learning, self-assessment, and critical thinking as an integral part of professional behavior.

Students have to include various cases that showcase clinical knowledge and a final reflection about their experience in the senior year portfolio. This portfolio is monitored and evaluated by the students’ Clinical Team Coordinator. At the end of the academic year they are required to present their portfolio to a group of faculty and fellow students and are expected to answer questions from the audience. The portfolio has various critical thinking components. Students must show the process followed in making treatment decisions in their cases and their literature review must be based on a treatment decision. As part of their competency examinations at the end of the year, students are assessed in their achievement of competency in this area using a rubric prepared for this purpose. Exhibit 2.12 - Key Experiences for the Development of Critical Thinking by Course and Academic Year

Year Course/s Critical Thinking Strategies

1st Year

Professional Development I (DESP 7117)

Introduction to Assessment and Diagnosis of the Patient (EVDI 7105)

Human Development and Behavioral Management (EVDI 7115).

Problem solving tasks Standardized patient

exercise for medical and dental history taking

Essays Case based learning

2nd Year

Introduction to Community Dentistry (DESP 7247)

Evaluation of Scientific Literature and Epidemiology (DESP 7237)

Oral Diagnosis and Treatment Planning (EVDI 7265)

Essays and planning of a community intervention.

Formulating a clinical problem using a PICO format

Systematic literature review (Triple Jump Exercise)

Case based learning

3rd Year

Professional Development III (DESP 7357)

Clinical rotations

Socratic Method Essays Diagnosis and treatment

planning Clinical decisions in

patient treatment


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4th Year

Comprehensive Care Clinic (PRET 7400)

Diagnosis and treatment planning

Clinical decisions in patient treatment

Developing and preparing a portfolio

Literature review of treatment options on a patient case

Oral presentation of portfolio cases

Supportive Documentation 1. Course Syllabi (Separate volumes) 2-24 Graduates must be competent in the use of information technology resources in

contemporary dental practice.


Description

The use of information technology for patient care, practice management, and

professional development is addressed in Competency 3 (Develop and manage a general dentistry practice). During the last five years the UPR School of Dental Medicine has used the services of the VitalSource Library. Students have all the books they use during their four years in a digitized format and updated.

Students are introduced to diverse information technology resources such as

computerized library resources and the Internet in the orientation sessions for new students and in the courses Human Development and Behavioral Management (EVDI 7115) and Evaluation of Scientific Literature and Epidemiology (DESP 7237). The Basic Sciences courses such as (CBIO 7100) Biochemistry and (CBIO 7110) Gross Anatomy use Blackboard to present course material, as well the preclinical courses Introduction to Restorative Dentistry and Principles of Intracoronal Restoration (PRET 7126), and Removable Prosthodontics (PRET 7246). Other courses use the Blackboard platform either to present material or for examinations.

Preclinical courses in the first and second year use information technology resources

to present content and to enhance the students’ learning process. For example, the Tooth


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Morphology 3D material is used in the Dental Anatomy and Functional Occlusion (EVDI 7125) course.

Third and fourth year students must learn how to use the clinic’s administrative

information system in order to schedule patient appointments and enter approved treatment plans. Each student has a password to access the school Intranet and is assigned an e-mail account by the Medical Sciences Campus. Using this account, students may have remote access to clinical information systems through the Internet. Students also have access to the campus library information resources and other libraries of the University of Puerto Rico System. They can also access other information resources through the Medical Sciences Campus website.

In 2011-2012 digital radiology technology was introduced throughout the curriculum.

The clinical radiology facilities at the school clinic have been equipped for this purpose and students are required several experiences in the use of digital radiographs for patient care as a transition to fully digital radiography.

Creative use of technology is also stressed in the preparation of the senior year

portfolio. This has been incorporated as an evaluation criterion for this purpose. Supportive Documentation 1. Course Syllabi (Separate volumes) 2-25 At a minimum, graduates must be competent in providing oral health care within the scope of general dentistry as defined by the school, for the child, adolescent, adult, and geriatric patient, including: (address separately) a. patient assessment and diagnosis; b. comprehensive treatment planning; c. health promotion and disease prevention; d. informed consent; e. anesthesia, pain and anxiety control; f. restoration of teeth; g. replacement of teeth; h. periodontal therapy; i. pulpal therapy; j. oral mucosal disorders; k. hard and soft tissue surgery; l. dental emergencies; m. malocclusion and space management; and n. evaluation of the outcomes of treatment.


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Description

Clinical Sciences

The mission of the School of Dental Medicine is to prepare professionals in the oral health field with the necessary knowledge, skills, and values to effectively serve the dental health needs of the Puerto Rican population. The school’s defined competencies include the areas addressed in this standard. The learning experiences structured as part of the curriculum are designed to achieve these competencies and the school goals. The following table presents the school competencies that address this standard’s areas of competency.

Exhibit 2.13 - Alignment of CODA Competencies and School Competencies

CODA Competency School Competencies Addressing CODA Competency

a Patient assessment and diagnosis

Competency 4: Assess, interpret, and integrate findings geared towards diagnosis and prevention of oral conditions of patients of all ages.

b Comprehensive treatment planning

Competency 5: Develop, present, and discuss a treatment plan for patients of all ages.

c Health promotion and disease prevention

Competency 9: Provide preventive dentistry service to patients of all ages according to their needs.

d Informed consent Competency 1: Manage professional, ethical, social, and legal issues associated with the practice of dentistry. Competency 5: Develop, present, and discuss a treatment plan for patients of all ages.

e Anesthesia, pain, and anxiety control

Competency 6: Manage apprehension and pain in patients of all ages.

f Restoration of teeth Competency 13: Provide restorations to reestablish form, function, and esthetics to patients of all ages.

g Replacement of teeth Competency 13: Provide restorations to reestablish form, function, and esthetics to patients of all ages.

h Periodontal therapy Competency 10: Manage patients with periodontal diseases. i Pulpal therapy Competency 12: Prevent and treat pulpal and periapical diseases

in primary and uncomplicated anterior and premolar permanent teeth.

j Oral mucosal disorders Competency 4: Assess, interpret, and integrate findings geared towards diagnosis and prevention of oral conditions of patients of all ages.

k Hard and soft tissue surgery

Competency 8: Perform oral surgical procedures and use pharmacological agents.


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l Dental emergencies Competency 7: Prevent and manage dental and medical emergencies.

m Malocclusion and space management

Competency 11: Manage occlusal abnormalities of primary, mixed, and permanent dentitions.

n Evaluation of the outcomes of treatment

Competency 2: Value the role of lifelong learning, self- assessment, and critical thinking as an integral part of professional behavior.

Dental students are exposed to clinical experiences throughout the four years of their

predoctoral studies. In their freshman and sophomore years they participate in early clinical experiences which complement their pre-clinical courses. In their junior and senior years, students have clinical courses and experiences which provide them enough opportunities to develop and apply knowledge and motor skills. There are also specific courses that deal with special patient populations, including children, adolescents, geriatric patients, and those with special needs.

During their third year, students provide clinical care to patients in assigned rotations within a team or clinical group coordinated by an assigned faculty member. These coordinators supervise administrative aspects of the students’ work, as well as patient assignment and follow-up on the completion of treatments. There are 13 clinical rotation courses, each with a coordinator responsible for assigning grades. Aside from the daily feedback and evaluations they receive from their supervising faculty in each clinical rotation course, students must approve several tests in order to be promoted to the fourth year. These promotion examinations are independent assessments that measure the progress of the students towards achieving several competencies. In the fourth year, students take the competency examinations that measure their competency in all areas.

During their senior year, students provide comprehensive clinical care for patients in a

team clinical group, also coordinated by a faculty member, but following a model resembling a private practice. All comprehensive clinical experiences are grouped into a single clinical course, (PRET 7400) Comprehensive Care Clinic. The course is divided into five sections, corresponding to five clinical groups, each coordinated by the clinical group coordinator. The students’ clinical progress is assessed every three months (trimester evaluations). Their final evaluation in the course also includes a portfolio and the fourth year competency examinations.

The trimester evaluations measure the student’s capacity of working independently in

the clinic, based on the amount of faculty intervention required for the student to complete satisfactorily the clinical procedures of each competency. These evaluations are done in a meeting every three months, through consensus by the team coordinator and the group of faculty members that usually supervise each team’s clinical work. The students’ deficiencies in each competency are determined and a work plan is designed and discussed with them to help them attain the competencies in a specified amount of time.

The competency examinations are individual assessments, performed without faculty

intervention in the procedures. The examinations include written case-based and portfolio


96

assessments, and laboratory and clinical examinations. The varied evaluation methods and instruments give the faculty the opportunity to assess if students have accomplished the established competencies expected of a new dental graduate. All the competency examinations must be approved as one of the requirements for approving the Comprehensive Care Clinic (PRET 7400) course. Students who fail the competency examinations have to repeat them until they pass them. Based on the student’s performance, the coordinators of each examination will determine the additional preparation, including additional clinical experiences that each student must undertake prior to repeating the examinations. In the case of special situations, when a student presents multiple failures, the school’s Office of Academic Affairs will help the coordinator determine the appropriate course of action.

The faculty is prepared to evaluate the students’ daily clinical activities and

independent assessments through faculty workshops, retreats, and meetings. The latest clinical assessment criteria standardization activities for the faculty were in August 2006, during several months in academic year 2009-2010, in June 2010, and in June 2012. In addition, most of the clinical faculty and examination graders are participating lecturers and staff of the preclinical courses of the disciplines they evaluate.

The following table presents a list of the individual assessments that students must

approve as their competency examinations during their third and fourth years. They measure the students’ progress towards competency. The assessments are grouped according to the competency measured and the population treated (child/adolescent or adult/geriatric). The third year examinations are described in detail in the corresponding course syllabi. The fourth year assessments are described in detail in the Competency Examinations Manual for Fourth Year Students. The manual includes the rubrics for the assessments. The critical errors leading to failure are specified in the rubrics.


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Exhibit 2.14 - Independent Assessments towards Competency Attainment

CODA Competency

Independent Assessments towards Competency

Child/Adolescent

Independent Assessments towards Competency Adult/Geriatric

Fourth Year Third and Fourth Years a Patient assessment

and diagnosis Case presentation of child/adolescent patient with patient and parents or legal guardians present

Third Year Promotion Test: Case presentation of ASA II patient with multiple clinic needs with patient present Fourth Year Competency Exam: Case presentation of ASA II patient with multiple clinic needs with patient present Case presentation special needs patient

b Comprehensive treatment planning

c Health promotion and disease prevention

Recall visit of pediatric patient (includes periodic evaluation, education, oral prophylaxis and fluoride application)

Third Year Promotion Test: Diagnosis, treatment plan, education and prophylaxis in single patient visit Fourth Year Competency Exam: Active recall patient (includes periodic evaluation and oral prophylaxis)

d Informed consent Presentation of treatment plan to patient and parents or legal guardians for consent after case presentation to faculty

Third Year Promotion Test: Presentation of treatment plan to patient for consent after case presentation to faculty Fourth Year Competency Exam: Case-based Competency 1 examination (includes informed consent case) Presentation of treatment plan to patient for consent after case presentation to faculty

e Anesthesia, pain, and anxiety control

Written case based examination Third Year Promotion Test: Assessed during extraction of tooth Fourth Year Competency Exam: Assessed during extraction of tooth

f Restoration of teeth Class I amalgam preparation and restoration in patient

Third Year Promotion Test: Class I amalgam preparation and restoration

in patient Written examination of fixed prosthodontics

concepts 3 crown preparations (porcelain fused to

metal, ceramic, cast metal) in acrylic permanent teeth on dental simulator

Fourth Year Competency Exam: Class II amalgam preparation and

restoration in patient Class III composite preparation and

restoration in patient Crown preparation on dental simulator


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CODA Competency

Independent Assessments towards Competency

Child/Adolescent

Independent Assessments towards Competency Adult/Geriatric

Fourth Year Third and Fourth Years g Replacement of

teeth Third Year Promotion Test:

Written examination of removable prosthodontics concepts

Construction of acrylic tray, border modeling and final maxillary impression in edentulous patient

Written exam fixed prosthodontics concepts Fourth Year Competency Exam:

Design of removable partial denture on given model and laboratory prescription for the prosthesis

Fixed bridge preparations on dental simulator

h Periodontal therapy Recall visit of pediatric patient (includes oral prophylaxis) Written case-based examination

Third Year Promotion Test: Root planning and scaling 1 quadrant Periodontics three months recall

Fourth Year: Written exam periodontics concepts Periodontics case presentation with patient

present Root planning and scaling 1 quadrant Periodontics three weeks reevaluation with

patient present i Pulpal therapy Written case-based examination Third Year Promotion Test:

Endodontic treatment permanent anterior acrylic tooth Fourth Year Competency Exam:

Written case based examination of endodontic concepts

Endodontic treatment acrylic premolar with two roots

j Oral mucosal disorders

Fourth Year: Competency Exam: Identification of oral mucosal disorders presented on slides

k Hard and soft tissue surgery

Written case-based examination Third Year Promotion Test: Extraction of one tooth Fourth Year Competency Exam: Procedure that involves soft tissue surgery Extraction of one tooth

l Dental emergencies Written case-based examination Fourth Year Competency Exam: Assessment and treatment of one patient with a dental emergency

m Malocclusion and space management

Third Year Promotion Test and Fourth Year Competency Exam: Written case-based examinations

n Evaluation of the outcomes of treatment

Recall evaluation of pediatric patient

Fourth Year Competency Exam: Active recall patient (includes evaluation of

procedures done in school) Completed recall patient (includes

evaluation of procedures done in school) Portfolio self-assessment of 3 cases


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The following tables present some of the passing rates of the fourth year independent assessments: Exhibit 2.15-Passing Rates Competency Examinations Fourth Year, Academic Year 2008-2009

CODA Competency Examination First Attempt

Second Attempt

Third Attempt

Patient assessment and diagnosis

Case presentation of ASA II patient with multiple clinic needs with patient present

100%

Comprehensive treatment planning Health promotion and disease prevention

Active recall patient (includes periodic evaluation and oral prophylaxis)

Recall visit of pediatric patient 100%

Informed consent Case-based Competency 1 exam (includes informed consent case)


100%

Anesthesia, pain and anxiety control

Assessed during extraction of tooth

Restoration of teeth Class II amalgam preparation and restoration in patient

4% 96%

Class III composite preparation and restoration in patient

50% 40% 10%

Crown preparation on dental simulator 21% 79% Replacement of teeth Design of removable partial denture on

given model and laboratory prescription for the prosthesis

38% 62%


Periodontal therapy Written exam periodontics concepts Periodontics case presentation with patient present Root scaling 1 quadrant Periodontics reevaluation with patient present

64% 36%

Pulpal therapy Written exam of endodontic concepts Endodontic treatment acrylic premolar with two roots

77% 19% 4%

Hard and soft tissue surgery Extraction of one tooth Dental emergencies Assessment and treatment of one patient

with a dental emergency

Malocclusion and space management

Case presentations for transfer of patients 76% 24%

Evaluation of the outcomes of treatment

Active recall patient (includes evaluation of procedures done in school)

Completed recall patient (includes evaluation of procedures done in school)

Portfolio self-assessment of 3 cases Recall visit of pediatric patient 100%


100

Exhibit 2.16 - Passing Rates Competency Examinations Fourth Year, Academic Year 2009-2010 CODA Competency Examination First

Attempt Second Attempt

Third Attempt

Fourth Attempt



100%



100%

Recall visit of pediatric patient 90% 5% 5%


100%


100%

Anesthesia, pain, and anxiety control

Assessed during extraction of tooth

100%

Restoration of teeth Class II amalgam preparation and restoration in patient Class III composite preparation and restoration in patient

9%

26%

51%

14%

Crown preparation on dental simulator

55% 27% 18%

Replacement of teeth Design of removable partial denture on given model and laboratory prescription for the prosthesis

70% 27% 3%


55% 27% 18%


86% 14%

Pulpal therapy Written exam of endodontic concepts

100%

Endodontic treatment acrylic premolar with two roots

71% 29%

Hard and soft tissue surgery

Extraction of one tooth 100%

Dental emergencies Assessment and treatment of one patient with a dental emergency

100%


Case presentations for transfer of patients

100%


101



100%


100%

Portfolio self-assessment of 3 cases

95% 5%


Exhibit 2.17 - Passing Rates Competency Examinations Fourth Year, Academic Year 2010-2011

CODA Competency Examination First Attempt

Second Attempt

Third Attempt



97% 3%



100%



100%


97% 3%


Assessed during extraction of tooth 100%


81% 19%



100%


87% 13%


94% 6%


97% 40%

3% 57%

3%

Hard and soft tissue surgery Extraction of one tooth 100% Dental emergencies Assessment and treatment of one patient

with a dental emergency 100%


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Case presentations for transfer of patients 97% 3%



100%


100%

Portfolio self-assessment of 3 cases 100% Recall visit of pediatric patient 100%

Exhibit 2.18 - Passing Rates Competency Examinations Fourth Year, Academic Year 2011-2012

CODA Competency Examination First

Attempt Second Attempt

Third Attempt



100%



100%



97% 3%


100%


Assessed during extraction of tooth 100%


49% 51%



100%


78% 19%


100%


79.5% 65%

20.5% 33%

2%

Hard and soft tissue surgery Extraction of one tooth 100% Dental emergencies Assessment and treatment of one patient

with a dental emergency 100%

Malocclusion and space Case presentations for transfer of patients 100%


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management Evaluation of the outcomes of treatment


100%


100%

Portfolio self-assessment of 3 cases 100% Recall visit of pediatric patient 100%

In the following sections, the individual assessments that address each area of

competency are described in more detail. The students’ progress towards achieving competency is also described from first to fourth year through the components of the main courses that deal with the competency. a. Patient assessment and diagnosis This area is addressed in the following UPRSDM Competencies:

Competency 4: Assess, interpret, and integrate findings geared towards diagnosis and prevention of oral conditions of patients of all ages. Independent Assessments for Competency 4 in Child/Adolescent population: Case presentation of child/adolescent patient with patient and parents or legal guardians present. Independent Assessments for Competency 4 in Adult/Geriatric population: The students must present an ASA II patient with treatment needs in at least 4 clinics to one oral diagnosis faculty and one clinical team faculty. The patient must be present in the clinic. The rubric used for this independent assessment is presented in the Competency

Examinations Manual (Appendix 2.R). A student must obtain a value of 3 or 2 in each criterion in order to pass the examination. A value of 1 or 0 obtained in any criterion will result in failure. A major error or omission is an error that will alter the treatment plan. A minor error or omission is an error that will not alter the treatment plan.

The following table presents the main courses that help prepare the students in the

development of this competency. The activities and assessments related to the competency in each course are also presented.


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Exhibit 2.19 - Methods of Assessment in Courses Related to Patient Assessment and Diagnosis

Year Course Methods of Assessment Independent

Assessments towards Competency

1 EVDI 7105 Class participation exercises: standardized patient in clinical setting, laboratory Written examination Attendance

N/A

1 PRET 7136 Clinic and laboratory exercises (alginate impressions, casts, articulation, full mouth x-rays, oral prophylaxis) Attendance

N/A

2 EVDI 7265 Participation in clinic exercises Case discussions (assigned cases) Written examinations OSCE

N/A

2 EVDI 7275 Written examinations Quizzes Professional development Attendance

N/A

3 PRET 7396 Daily evaluations clinical experiences (formative and summative)

Promotion test Adult/Geriatric: Case presentation of ASA II patient with treatment needs in four or more clinical areas

4 PRET 7400 Trimester evaluations of clinical experiences Portfolio (cases component)

Child/Adolescent Clinical Examination: Case presentation of child/adolescent patient with patient and parents or legal guardians present Adult/Geriatric Clinical Examination: case presentation of ASA II patient with multiple clinic needs with patient present

Basic sciences courses establish the foundation knowledge for this competency.

Dental students are exposed to these concepts from the beginning of their first year, in the course Introduction to Assessment and Diagnosis of the Patient (EVDI 7105). In this course, students practice their communication and interviewing skills utilizing a standardized patient. Students are also exposed to theoretical knowledge and practice of skills in basic life support measures and taking vital signs. The course Clinical Applications of Dental Skills (PRET 7136), also in the first year, gives the students the opportunity to participate in several oral diagnosis early clinical experiences.

During the second year, the concepts related to patient assessment and diagnoses are

taught in the course Oral Diagnosis and Treatment Planning (EVDI 7265). This is an integrated course in which students learn the process of a comprehensive evaluation and


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patient diagnosis. Faculty members from various disciplines discuss the assessment and diagnosis of different conditions. Students practice their assessment and diagnostic skills through clinical exercises and participation in case presentations and discussions. In the course Assessment and Diagnosis of the Child and Adolescent (EVDI 7275) students learn these concepts applied to children and adolescents.

In the third year, students provide care to patients in different clinical rotations and

apply and integrate their knowledge and skills for a comprehensive assessment and diagnosis. The Oral Diagnosis Clinical Rotation (PRET 7396) is designed to provide students with enough patient experience for the development of clinical competence in the area of oral diagnosis and the development of a treatment plan. Students examine, gather, record, and evaluate information that contributes to the identification of abnormalities of the head and neck region that relate to the total health of the patient. The purpose of this information is to establish a diagnosis in order to formulate a rational treatment plan.

In the fourth year, students have the opportunity to apply assessment and diagnosis knowledge and skills when they provide comprehensive patient care in the Comprehensive Care Clinic (PRET 7400). Before beginning the treatment of a patient, students must perform the diagnostic procedures necessary to develop and present to a faculty member and the patient an appropriate treatment plan based on the needs of the patient. The diagnostic procedures include medical and dental histories, vital signs, intraoral and extraoral examinations, radiographs, diagnostic models, vitality tests, periodontal chartings, diagnostic wax ups, and medical consultations, among others. They must also approve the examination for Competency 4 (Assess, interpret, and integrate findings geared towards diagnosis and prevention of oral conditions of patients of all ages).

b. Comprehensive treatment planning This area is addressed in the UPRSDM Competency 5:

Competency 5: Develop, present, and discuss a treatment plan for patients of all ages.

Independent Assessments for Competency 5 in Child/Adolescent population: Case presentation of child/adolescent patient with patient and parents or legal guardians present. Independent Assessments for Competency 5 in Adult/Geriatric population: The students must present an ASA II patient with treatment needs in at least 4 clinics to one oral diagnosis faculty and one module faculty. The patient must be present in the clinic. The rubric used for this independent assessment is presented in the Competency

Examinations Manual (Appendix 2.R). The following table presents the main courses that help prepare students in the development of this competency. The activities and assessments related to the competency in each course are also presented.


106

Exhibit 2.20 - Methods of Assessment in Courses Related to Comprehensive Treatment Planning

Year Course Methods of Assessment Independent Assessments

towards Competency 1 EVDI 7115 PBL discussions

Written Examinations N/A

1 PRET 7116 Attendance Quizzes Exercises Special report or clinical case Clinic experience Written examination

N/A


N/A

3 PRET 7396 Daily evaluations of clinical experiences Promotion Test Adult/Geriatric: Summative case presentation Promotion test: case presentation of ASA II patient with treatment needs in four or more clinical areas

3 PRET 7328 Daily evaluations of clinical experiences Promotion activities

N/A

3 PRET 7338 Case presentations and participation in seminars Clinical performance Quantity of clinical performance

Promotion Test: Written case-based examination

4 PRET 7400 Trimester evaluations of clinical experiences Portfolio (cases component)

Child/Adolescent Clinical Examination: Case presentation of child/adolescent patient with patient and parents or legal guardians present Adult/Geriatric Clinical Examination: case presentation of ASA II patient with multiple clinic needs with patient present

Students are provided with ample opportunities to develop their competency in

treatment planning and case presentation. During the first year, this concept is initially presented in the course Human Development and Behavioral Management (EVDI 7115). This course studies the human being in his/her life cycle. It recognizes the human being as an integral self in which the psychosocial and bio-physiologic aspects are equally significant. Understanding these two dimensions is of vital importance in the process of establishing a treatment plan that satisfies the patients' bio-psychosocial needs. In the course Preventive Dentistry (PRET 7116), also in the first year, students have an early clinical experience where they discuss a clinical case and design an individual plaque control program according to the patient's needs.


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During the second year of the dental curriculum, pre-clinical courses provide content in treatment planning in areas such as surgery, orthodontics, pediatric dentistry, periodontics, endodontics, operative, and fixed and removable prosthodontics. At the end of the second year, students have the opportunity to diagnose and prepare a treatment plan with clinical exercises, case based discussions, and an Objective Structured Clinical Examination in the course Oral Diagnosis and Treatment Planning (EVDI 7265).

During the third and fourth years, clinical training and experiences include preparing

appropriate, sequenced, and individualized treatment plans. Students are encouraged to present an ideal treatment plan and appropriate alternatives. Before they begin working with their regular or special patients, the treatment plan must be approved by an assigned faculty and the patient.

In the third year, students have comprehensive treatment planning experiences in their

Oral Diagnosis Clinical Rotation (PRET 7396), Pediatric Clinical Rotation (PRET 7328), and Orthodontic Clinical Rotation (PRET 7338). Patients whose treatment is not completed during the third year are continued during the student’s fourth year until their treatments are completed. Patients whose treatment is completed during the third year are sometimes seen during the fourth year in recall appointments. Other patients with completed treatments are discharged or transferred to the school's recall system.

In the fourth year, as part of the course Comprehensive Care Clinic (PRET 7400),

students have comprehensive treatment planning experiences with all their assigned patients. They are also responsible for the completion of all their assigned patients during their fourth year. The clinical group coordinators supervise the adequate management of the patients’ treatments by the students within the clinical group. As part of the course, the students must approve the examination of Competency 5 (Develop, present, and discuss a treatment plan for patients of all ages). c. Health promotion and disease prevention This area is addressed in the UPRSDM Competency 9:

Competency 9: Provide preventive dentistry service to patients of all ages according to their needs. Independent Assessment for Competency 9 in Child/Adolescent population: The student will perform a recall assessment on a pediatric patient. This visit includes the periodic evaluation, oral prophylaxis, and fluoride application. Independent Assessments for Competency 9 in Adult/Geriatric populations: During the third year, the student must perform a diagnosis, treatment plan, oral prophylaxis, and oral hygiene education in a single patient visit. During the fourth year, the student will perform an active recall assessment in a patient. This visit includes the periodic evaluation and the oral prophylaxis.


108

The rubrics used for these independent assessments are presented in the Competency Examinations Manual (Appendix 2.R). A student must obtain a score of 3 or 2 in each criterion in order to pass the examination. A score of 1 or 0 in any criterion will result in failure. Students who do not approve will repeat the examination in another patient visit until they attain the competency.

The following table presents the main courses in which students develop the health promotion and disease prevention competency, including the activities and assessments related to the competency in each course. Exhibit 2.21 - Methods of Assessment in Courses Related to Health Promotion and Disease Prevention

Year Course Methods of Assessment Independent Assessments towards

Competency 1 PRET 7116 Attendance

Quizzes Special report or clinical case Clinic experience Written examination

N/A

1 PRET 7136 Clinic and laboratory exercises in functional occlusion, radiology and preventive dentistry Attendance

N/A

2 DESP 7247 Attendance Oral group presentation Written report

N/A

3 PRET 7348 Daily evaluations of clinical experiences (formative and summative) Approval of community and educational activities

Promotion Test Adult/Geriatric: Diagnosis, treatment plan, education and prophylaxis in single patient visit

4 PRET 7400 Trimester evaluations of clinical experiences Approval of community and educational activities

Child/Adolescent: Recall visit of pediatric patient (includes periodic evaluation, education, oral prophylaxis, and fluoride application) Adult/Geriatric: Active Recall patient (includes periodic evaluation and oral prophylaxis)

4 PRET 7405 Participation in community intervention Journal presentation Presentation of community intervention Attendance

N/A

Since prevention is part of the philosophy of the school, it is present in all

instructional activities in the curriculum. It is emphasized throughout all the pre-clinical and clinical courses through multiple learning experiences provided for the development of competencies.

The curriculum provides three pre-clinical courses which deal specifically with preventive dentistry. These are: Preventive Dentistry (PRET 7116), Clinical Applications of Dental Skills (PRET 7136), and Introduction to Community Dentistry (DESP 7247).


109

Students are also exposed to different learning concepts of preventive dentistry in other disciplines, including operative dentistry, prosthodontics, endodontics, periodontics, and orthodontics.

In the first year course Preventive Dentistry (PRET 7116), the concepts of prevention, philosophy of preventive dentistry, levels of prevention, and primary preventive measures are discussed. Emphasis is given to the maintenance of oral hygiene by education, products, and techniques. Oral prophylaxis instrumentation techniques and application of nutritional concepts as part of primary prevention and oral health maintenance are also presented in the course. The course Clinical Application of Dental Skills (PRET 7136), also in the first year, provides the opportunity for students to apply some of these concepts on a classmate in the clinic.

In the second year, the course Introduction to Community Dentistry (DESP 7247), gives students the opportunity to analyze a community as the focus of health care delivery. Health promotion activities are conducted in the community to present the means available for the maintenance of sound oral hygiene.

In the third year course Preventive Dentistry Clinical Rotation (PRET 7348) students

provide preventive patient care applying the knowledge and skills learned in previous courses. Before beginning in the clinic, students perform an instrumentation activity on a classmate. They rotate a minimum of 20 appointments to complete a preventive plaque control program in at least six patients during the academic year. Although six patients are evaluated for the grade, it is expected that students provide preventive services to all their assigned patients. Progress towards competency is evaluated through a clinical test, which consists of the following procedures: diagnosis, treatment plan, prophylaxis, and education performed in a single visit.

As part of the Comprehensive Care Clinic (PRET 7400), fourth year students provide

primary preventive care in the control of oral diseases to all their patients who are under active treatment at the school. Students perform comprehensive and periodic oral evaluations, education, oral prophylaxis, fluoride treatments, sealants, and any other preventive measure indicated for the prevention or arrest of oral disease. They have the opportunity to evaluate the efficacy of preventive methods during their active treatments and through recall appointments. They also participate with faculty in evaluating active and completed patients in the School Quality Assurance Program (Active and Completed Recall experiences).

Third and fourth year students are required to participate in various health promotion

community activities, where they provide oral health education to underserved groups and populations with special needs such as the elderly, handicapped children, children with learning disabilities, and drug addicts. Third year students dedicate a minimum of 15 hours to these activities, while fourth year students dedicate a minimum of 22.5. Third year outreach experiences include community services and the presentation of an educational module of any preventive dentistry topic, or a PowerPoint presentation of a preventive or health promotion topic for a specific population (special needs or age). Among the fourth


110

year activities which are part of the Comprehensive Care Clinic (PRET 7400), students provide preventive treatment to deaf children at the dental clinic of the Colegio San Gabriel.

As part of the Comprehensive Care Clinic (PRET 7400) during the fourth year, students are required to approve various clinical examinations that are part of the assessment of their competency in providing preventive dentistry service. These examinations include an active recall visit and a pediatric recall visit.

The elective course Oral Health Promotion in Special Communities (PRET 7405) is offered to fourth year students who apply their knowledge and skills in developing a preventive and educational program for a disadvantaged community. They present the results of an oral health promotion intervention to the professor, classmates, and community representatives. d. Informed consent: This area is addressed in the UPRSDM Competencies 5 and 1:

Competency 5: Develop, present, and discuss a treatment plan for patients of all ages. Competency 1: Manage professional, ethical, social, and legal issues associated with the practice of dentistry.

Independent Assessments for informed consent in Child/Adolescent population: Presentation of treatment plan to patient and parents or legal guardians for consent after case presentation to faculty. Independent Assessments for informed consent in Adult/Geriatric population: Presentation of treatment plan to patient for consent after case presentation to faculty. Independent assessment for Competency 1: Written case-based examination. The rubric used for this independent assessment is presented in the Competency

Examinations Manual (Appendix 2.R). A student must obtain a score of 3 or 2 in each criterion in order to pass the examination. A score of 1 or 0 obtained in any criterion will result in failure. A major error or omission is an error that will alter the treatment plan. A minor error or omission is an error that will not alter the treatment plan.

The following table presents the main courses that help prepare the students in the

development of this competency and the activities and assessments related to the competency.


111

Exhibit 2.22 - Methods of Assessment in Courses Related to Informed Consent Year Course Methods of Assessment Independent Assessments towards

Competency 1 EVDI 7105 Class participation exercises:

standardized patient in clinical setting, laboratory Written examination Attendance

N/A

1 DESP 7117 Online quizzes Professionalism Class participation Attendance

N/A


N/A

2 EVDI 7275 Quizzes Written examinations Professional development Attendance

N/A

3 DESP 7357 Written examinations Group project Professionalism

N/A

3 PRET 7396 Daily evaluations of clinical experiences (formative and summative)

Promotion Test Adult/Geriatric: Presentation of treatment plan to patient for consent after case presentation to faculty

4 PRET 7400 Trimester evaluations of clinical experiences

Child/Adolescent: Presentation of treatment plan to patient and parents or legal guardians for consent after case presentation to faculty Adult/Geriatric: Case-based Competency 1 written examination (includes informed consent case) Presentation of treatment plan to patient for consent after case presentation to faculty

The School of Dental Medicine has a written consent or acceptance form that must be

signed by patients before receiving treatment from dental students. If the patient is eighteen years of age or less, a parent or guardian must sign the consent form. During their clinical years, students must obtain informed consent from patients, or their parents or tutors, before they complete their treatment plan and engage in actual treatment. After presenting a treatment plan to an assigned faculty member and obtaining approval, students have to discuss this approved treatment plan with the patient. When the patient agrees with the treatment, he/she signs the form consenting to receive treatment as presented. Emergency patients are also required to sign a consent form prior to receiving dental treatment.

Students learn the importance of explaining the treatment plan to patients and obtaining their consent for procedures in various pre-clinical courses. During the first year, the course Introduction to Assessment and Diagnosis of the Patient (EVDI 7105) teaches


112

students to recognize the importance of a signed authorization for assessment and diagnosis. Professional Development I (DESP 7117), also in the first year, emphasizes the importance of applying ethical and legal principles in the profession.

During the second year, in the course Oral Diagnosis and Treatment Planning (EVDI

7265), students discuss the rationale for informed consent for treatment. Also, in Assessment and Diagnosis of the Child and Adolescent (EVDI 7275) a parental consent demonstration is given.

In the third year, the course Professional Development III (DESP 7357) continues to

develop the students’ understanding of informed consent. The course covers the origins, history, legal development, and doctrine of informed consent. The subject is discussed with a detailed study of actual legal cases. Students do a learning activity in the classroom to fully understand the requirements of an appropriate informed consent. They are presented a hypothetical scenario in which they have to individually present all the information deemed necessary- based on legal standards- to obtain an informed consent. They must also differentiate between informed consent and medical malpractice. A written individual examination is used to measure their knowledge of this topic.

During the second semester of the 4th year, students must take a competency

examination on legal issues. This is part of the examination for Competency 1 (Manage professional, ethical, social, and legal issues associated with the practice of dentistry). It is an individual examination in which a hypothetical case is presented. Students must recognize the relevant legal issues in that case and explain how they relate to the situation. The topics included in the competency examination are informed consent, medical malpractice, and the state Dental Act.

Competencies 1 and 5 are examined as part of the fourth year course Comprehensive

Care Clinic (PRET 7400). e. Anesthesia, sedation, and pain and anxiety control This area is addressed in the UPRSDM Competency 6:

Competency 6: Manage apprehension and pain in patients of all ages.

Independent Assessments for Competency 6 in Adult/Geriatric populations: This competency is assessed during the extraction of a tooth. Aside from the evaluation of the use of anesthesia, students are required to discuss appropriate apprehension and pain control techniques, including appropriate medications and/or sedation techniques, such as oral, inhalation, and intravenous modalities. Independent Assessments for Competency 6 in Child/Adolescent population: Written case based examination.


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The rubric used for this independent assessment is presented in the Competency Examinations Manual (Appendix 2.R). The following table presents the main courses that help prepare the students in the development of this competency and the activities and assessments related to it.

Exhibit 2.23 - Methods of Assessment in Courses Related to Anesthesia, Sedation, and Pain and Anxiety Control


Competency 1 CBIO 7130 Written examinations N/A 1 CBIO 7180 Written examinations N/A 2 PRET 7266 Written examination

Quizzes Attendance

N/A

2 PRET 7286 Written examinations Quizzes Clinic exercise (anesthesia between peers) Attendance

N/A

3 PRET 7318 Daily evaluations of clinical experiences (formative and summative)

N/A

3 PRET 7328 Daily evaluations of clinical experiences

N/A

3 PRET 7358 Daily evaluations of clinical experiences Number of clinical experiences Production Completed patients Attendance

Promotion Test Adult/Geriatric: Anesthesia criteria included in Class I amalgam preparation and restoration in patient

3 PRET 7368 Daily evaluations of clinical experiences N/A 3 PRET 7386 Daily evaluations of clinical experiences

(formative and summative) Number of surgical procedures

Promotion Test Adult/Geriatric: Anesthesia criteria included in extraction of tooth

4 PRET 7415 Written examinations Clinical experiences

N/A


Adult/Geriatric: Assessed during extraction Child/Adolescent: Written case based examination.

Pain and anxiety control is introduced during the first year of the curriculum in the course Neuroanatomy (CBIO 7130). In Oral Pharmacology and Therapeutics (CBIO 7180), clinical correlations covering the more commonly used drugs in dental practice are included.

In the second year course Apprehension and Pain Control in Dentistry (PRET 7286),

students are introduced to the application of the psychological and chemical modalities for the prevention and treatment of pre-operative and post-operative patient apprehension and for pain control. They have demonstrations and must be able to perform a physical evaluation of the patient prior to the administration of a local anesthetic. In the course Oral Surgery (PRET 7266), topics related to pain control are also discussed, including the management of operative and post-operative pain and the prescription of medications.


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In the clinic, students become competent and confident in managing apprehension, administering local anesthetics, and in writing prescriptions for drugs utilized in dentistry. Third year students are evaluated daily in the management of their patients during the clinical rotations, including the use of anesthesia Endodontics (PRET 7318), Pediatric Dentistry (PRET 7328), Operative Dentistry (PRET 7358), Fixed Prosthodontics (PRET 7368), Oral Surgery (PRET 7386). Some of the clinical promotion tests include anesthesia as an evaluation criteria. Students are allowed to administer nitrous oxide sedation to several patients if they participate in the elective course Nitrous Oxide Inhalation Sedation in Dentistry (PRET 7415), taken by over 75% of the class. The examination for Competency 6 (Manage apprehension and pain in patients of all ages) is part of the course Comprehensive Care Clinic (PRET 7400).

f. Restoration of teeth This area is addressed in the UPRSDM Competency 13:

Competency 13: Provide restoration to reestablish form, function, and esthetics to patients of all ages.

Independent Assessment for restoration of teeth in Child/Adolescent populations: Class I amalgam preparation and restoration in pediatric patients. Independent Assessments for restoration of teeth in Adult/Geriatric populations: During their third year the students have the following independent assessments: Class I amalgam preparation and restoration in patient, written examination of fixed prosthodontics concepts, and 3 crown preparations (porcelain fused to metal, ceramic, cast metal) in acrylic permanent teeth on dental simulator. During their fourth year the students have the following independent assessments: Class II amalgam preparation and restoration in patient, Class III composite preparation and restoration in patient, and a ceramic crown preparation on dental simulator.

The rubric used for this independent assessment is presented in the Competency Examinations Manual (Appendix 2.R). The following table presents the main courses that help prepare students in the development of this competency and the activities and assessments related to it.


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Exhibit 2.24 - Methods of Assessment in Courses Related to Restoration of Teeth

Year Course Methods of Assessment Independent Assessments towards Competency

1 EVDI 7125 Written examinations Laboratory examinations Quizzes Daily evaluations Attendance

N/A

1 PRET 7106 Written examinations Laboratory assignments Attendance

N/A

2 PRET 7126 Written examinations Laboratory examinations in dental simulator Daily evaluations of laboratory work Clinical exercise (rubber dam between peers) General appraisal

N/A

2 PRET 7277 Written examinations Quizzes Laboratory exercises Professional development

N/A

3 PRET 7358 Daily evaluations of clinical experiences Number of clinical experiences Production Completed patients Attendance

Promotion Test Adult/Geriatric: Class I amalgam preparation and restoration in patient

3 PRET 7368 Daily evaluations of clinical experiences Promotion Test Adult/Geriatric: Written examination of fixed

prosthodontics concepts Examination of 3 crown

preparations (porcelain fused to metal, ceramic, cast metal) in acrylic permanent teeth on dental simulator

3 PRET 7328 Daily evaluations of clinical experiences Promotion activities

N/A


Child/Adolescent: Class I amalgam preparation and restoration in patient Adult/Geriatric:

Class II amalgam preparation and restoration in patient

Class III composite preparation and restoration in patient

Crown preparation on dental simulator

In pre-clinical and clinical courses, students are exposed to a wide variety of learning experiences necessary in order for them to perform restorative procedures on patients. During the first year, the curriculum includes the Dental Anatomy and Functional Occlusion (EVDI 7125) course. In the first part of the course, students have the opportunity to learn the morphology and anatomy of human teeth, their function and their immediate associated parts.


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During the laboratory component students reconstruct in wax the coronal portion of permanent maxillary and mandible teeth following their correct contour and morphology. The second part of the course presents the basic knowledge of occlusion. During the laboratory component students mount study casts in a semi-adjustable articulator and wax-up opposing posterior quadrants on the casts. The cast is waxed to the functional occlusion using a modified addition waxing technique according to the setting of the articulator. There is also a dental materials component. The first year course Cariology (PRET 7106) introduces the fundamental biological, epidemiological, and clinical aspects of dental caries. As part of the course activities, the students perform a caries detection and scoring laboratory exercise. The Introduction to Restorative Dentistry and Principles of Intracoronal Restoration (PRET 7126) pre-clinical course consists of a series of lectures, laboratories with natural and ivorine teeth, dental simulator laboratories and clinical experiences, intended to provide the students with the basic knowledge and skills necessary for an adequate performance in the field of Operative Dentistry during their clinical practice. Students acquire knowledge on the basic treatment of carious lesions that need to be restored with composite resin, amalgam, cast gold, and porcelain dental materials, from minimally invasive interventions to more complex situations of severely affected teeth. The course includes fissure sealants, vital bleaching techniques, and an overview on new materials for preventive and aesthetics considerations. Students have six dental simulation examinations, including Class I Amalgam and Cement Placement, Class II Amalgam, Class III Resin Based Composite, Class IV Resin Based Composite, Gold Onlay, and an examination that includes both Class III Resin Based Composite and Class II Amalgam. In this course, they also have an early clinical experience in which they place a maxillary and a mandibular rubber dam on each other.

Restoration of primary teeth is taught in the course Pediatric Dental Treatment (PRET 7277). The course is designed to provide the sophomore dental student with all the contemporary concepts in managing the oral health of non-medically compromised children and adolescents. It includes topics on restorative techniques and local anesthesia techniques applied to pediatric dentistry. The course includes theoretical and laboratory instruction activities. Laboratory experiences are conducted using pediatric dental simulators in which students perform various exercises related to the preparation and restoration of primary teeth, such as Class I and Class II amalgams and stainless steel crowns.

The Operative Dentistry Clinical Rotation (PRET 7358), provides the third year student with the initial clinical experiences in operative dentistry necessary for the development of the competencies expected of graduates. Each student must complete the operative treatment of five patients. The following minimal clinical experiences are expected of the students: four Class I, six Class II, four Class III, four sedative fillings, four Class IV, four Class V, two indirect restorations, and two bleachings. In addition, students must pass a Class I amalgam clinical examination. The clinical restorative treatment of children and adolescents begins in the third year course Pediatric Dentistry Clinical Rotation (PRET


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7328), in which students apply the knowledge acquired in pre-clinical courses and continue developing skills in techniques related to this age group.

Fourth year dental students’ experiences in operative dentistry take place in the

Comprehensive Care Clinic (PRET 7400). As students complete their assigned patients, they perform a variety of operative experiences that include at least 5 Class I, 10 Class II and 5 Class V restorations in amalgam, 5 Class II, 10 Class III, 5 Class IV, and 5 Class V restorations in resin-base composite, 2 indirect restorations, and 4 arches of bleaching. The students are also required to follow-up their pediatric patients from the third year at least every six months. They may be assigned new patients. In addition, pediatric dentistry experiences are offered through rotations at the UPR Hospital in Carolina and the Center for Maternal-Infant Oral Health (CSOMI) dental clinic.

As part of the course Comprehensive Care Clinic (PRET 7400), students must approve several examinations in order to meet Competency 13 (Provide restoration to reestablish form, function, and esthetics to patients of all ages). The operative component consists of two clinical competency examinations similar to the Puerto Rico State Board examinations. One is a Class III preparation restored with composite and the second is a Class II preparation restored with amalgam. These examinations are part of the competency examinations, which students must pass in order to approve the course.

The fixed prosthodontics curriculum, which also addresses this area, is discussed in detail in the following section. g. Replacement of teeth This area is addressed in the UPRSDM Competency 13.

Competency 13: Provide restorations to reestablish form, function, and esthetics to patients of all ages. Independent Assessments for Competency 13 (replacement of teeth component) in Adult/Geriatric population: During the third year students have the following independent assessments in this area of competency: Written examination of removable prosthodontics concepts, construction of acrylic tray, border modeling and final maxillary impression in edentulous patient, and written examination on fixed prosthodontics concepts. During the fourth year, students have the following independent assessments in this area of competency: Design of removable partial denture on given model and laboratory prescription for the prosthesis, and 3 unit bridge preparation on dental simulator. The rubric used for this independent assessment is presented in the Competency

Examinations Manual (Appendix 2.R). The following table presents the main courses that


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help prepare the students in the development of this competency and the activities and assessments related to it.

Exhibit 2.25 - Methods of Assessment in Courses Related to Replacement of Teeth


Competency 2 PRET 7276 Written examinations

Quizzes Attention tests Laboratory examinations Daily projects Attendance

N/A

3 PRET 7368 Daily evaluations of clinical experiences Promotion Test Adult/Geriatric: Written examination of fixed

prosthodontics concepts Examination of 3 crown

preparations (porcelain fused to metal, ceramic, cast metal) in acrylic permanent teeth on dental simulator

2 PRET 7246 Written examinations Quizzes Laboratory projects Professional attitude Attendance

N/A

3 PRET 7388 Written examination Formative minimum experiences

Promotion Test Adult/Geriatric: Complete maxillary final impression in patient


Design of removable partial denture on given model and laboratory prescription for the prosthesis


Fixed Prosthodontics

In the pre-clinical course Fixed Prosthodontics (PRET 7276), all basic crown and fixed prosthodontics dental preparation and restoration techniques are discussed, studied, demonstrated and done in a laboratory in order to prepare the student for an optimal clinical performance in the comprehensive treatment of dental patients. The course emphasizes the mechanical, biological, and dental materials considerations related to fixed prosthodontics.

In the laboratory portion of the course, students perform dental preparations and impressions on ivorine teeth mounted on simulators. They mount the working casts obtained from the simulator on a semi adjustable articulator. The laboratory experiences include several types of dental preparations, a surgical splint for implant placement, a flexible working cast for implant rehabilitation, a fixed detachable temporary crown for implant, a porcelain fused to metal anterior crown, conventional fixed temporary restorations (4 bridges and 2 single crowns), a fixed detachable implant supported crown, 2 working casts for


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conventional and implant supported fixed partial dentures, interocclusal records, and diagnostic wax-ups, among other procedures.

As part of the Fixed Prosthodontics second year course, students must pass various

laboratory examinations. These include the following: a mandibular premolar abutment for full crown metal retainer, a mandibular molar abutment with buccal groove for full crown metal retainer, a three unit provisional bridge, a maxillary molar abutment for full crown metal retainer, a maxillary premolar abutment for porcelain fused to metal crown retainer, a three unit provisional bridge, a maxillary canine abutment for full crown porcelain fused to metal retainer, a maxillary central abutment for an all ceramic crown retainer, a three unit provisional bridge, a dental preparation and intraradicular resin pattern for a post and core on a natural tooth, a single crown provisional restoration with intraradicular retention, a dental preparation and cementation of a prefabricated post with a composite resin reconstruction on a natural severely damaged tooth, a maxillary molar “3/4” crown preparation, a mandibular molar “1/2” crown preparation, preparations for an anterior resin bonded bridge, and preparations for one posterior resin bonded bridge. In the Fixed Prosthodontics Clinical Rotation (PRET 7368), third year students have clinical practice experiences in the construction of fixed partial prostheses. The minimum number of clinical experiences that students must complete include: two single crowns, two three-unit fixed bridges, and two units of post and cores or restorative bases. Students are exposed to these experiences through a clinical rotation in which they complete at least 80 hours of clinical work. They must pass a Promotion Practice Test, which is evaluated by three faculty members. The examination consists of preparations of a porcelain fused to metal, a ceramic, and a cast metal crown. Students must also pass a written Promotion Review Test, which assesses their knowledge of fixed prosthodontics concepts. Fixed prosthodontics clinical experiences are part of the Comprehensive Care Clinic (PRET 7400). As the students complete their assigned patients' treatment plans, they perform all the fixed prostheses needed by their patients. The experiences include 10 preparations and 2 – 3 posts (2 posterior bridges with a maximum of 4 units, 1 anterior bridge with a maximum of 6 units, simple and/or ferulized crowns, at least one post should be custom made, and 1 prefabricated). Students must pass a fixed prosthodontics mannequin examination that resembles the Puerto Rico State Board examination on fixed prosthodontics. This examination is part of the examination for Competency 13 (Provide restoration to reestablish form, function, and esthetics to patients of all ages). Students also perform clinical experiences in implant dentistry. Third year students must present and surgically treat a patient who needs a dental implant. The implant is restored during the senior year. The treatment should consist of one single unit posterior implant crown or a simple implant supported overdenture. Removable Prosthodontics

During the second year, the curriculum provides a series of learning experiences in replacement of missing teeth in the Removable Prosthodontics (PRET 7246) course. This


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lecture and laboratory course provides the preclinical dental student with the necessary knowledge of the clinical and laboratory procedures in order to design and construct removable complete dentures, partial dentures, immediate dentures, and overdentures . The laboratory component is taught by using study models and/or dentoforms, to expose the students to simulated partially and completely edentulous clinical situations. Some procedures are demonstrated by the teaching staff, either directly or with audiovisual aids. Students have laboratory experiences and examinations related to the fabrication of a set of complete dentures, an immediate complete denture, and a removable partial denture.

During the third year, the Removable Prosthodontics Clinical Rotation (PRET 7388)

course is designed to provide the students the opportunity to develop their skills in the treatment of patients needing removable complete and partial dentures. Patients are selected from a general pool generated by the screening done by the Diagnostic Department and accepted by the Removable Prosthodontics faculty. Students must be able to complete 6 units by the end of the third year. The experiences should include: a maxillary complete denture with a mandibular removable partial denture, or a maxillary removable partial denture with a mandibular removable partial denture, or maxillary immediate denture replacing at least 5 anterior teeth with a mandibular complete denture, or a mandibular removable partial denture.

During the fourth year, as part of the Comprehensive Care Clinic (PRET 7400), students rehabilitate patients with removable prostheses. They complete 8 units (4 complete dentures, immediate dentures or overdentures and 4 RPDs). Valplast material can only be used in combination with a metal framework and with the permission of a prosthodontics faculty member. Towards the end of the fourth year, a removable prosthodontics competency examination is administered, which includes the design and laboratory prescription of a given case and is part of the examination for Competency 13 (Provide restoration to reestablish form, function, and esthetics to patients of all ages).

Even though most of the laboratory phase is performed by a commercial laboratory,

students and faculty are responsible for the supervision of the laboratory work. There is a Quality Control Committee in the Restorative Sciences Department, which along with students and faculty in charge of the case evaluates every phase or intermediate step of the fixed or removable work performed by the commercial laboratory. Students use a specially designed form to register approval of each step prior to continuing work in the clinic. h. Periodontal therapy This area is addressed in the UPRSDM Competency 10.

Competency 10: Manage patients with periodontal diseases. Independent Assessments for Competency 10 in Child/Adolescent population: Written case based examination. Independent Assessments for Competency 10 in Adult/Geriatric population:


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During the third year, students are assessed in root planning and scaling 1 quadrant, and a periodontics three-month recall. During the fourth year, students are assessed in a written examination in periodontics concepts, periodontics case presentation with patient present, root planning and scaling 1 quadrant, and a periodontics three-week reevaluation with the patient present. The rubric used for this independent assessment is presented in the Competency

Examinations Manual (Appendix 2.R). The following table presents the main courses that help prepare the students in the development of this competency and the activities and assessments related to it.

Exhibit 2.26 - Methods of Assessment in Courses Related to Periodontal Therapy


towards Competency 2-3 PRET

7257 Written examinations N/A

3 PRET 7308

Daily evaluations of clinical experiences (formative and summative) Minimum experiences Completion of cases

Promotion Test Adult/Geriatric: Root planning and scaling 1

quadrant Periodontics three-month recall

with patient present

4 PRET 7400

Trimester evaluations of clinical experiences

Child/Adolescent: Written case-based examination Adult/Geriatric:

Written examination in periodontics concepts

Periodontics case presentation with patient present

Root planning and scaling 1 quadrant

Periodontics three-week reevaluation with patient present

Beginning in the sophomore year and continuing through the third year, students take

an introductory course in Periodontics (PRET 7257). This course provides the knowledge and understanding of the biology and pathology of the periodontium essential for the development of the necessary diagnostic skills to perform initial periodontal therapy according to the concept of comprehensive dental care, and to understand the importance of periodontal surgical procedures in the outcome of the overall treatment.

During the clinical courses, students are responsible for the periodontal health of their

patients, including those who only need prophylaxis and oral hygiene instruction. They provide initial periodontal therapy, as well as three-week and three-month periodontal


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reevaluations. They also perform the surgical procedures that may be necessary after the initial therapy. As part of the quality protocol in the Restorative Sciences Department, students have to get approval or clearance for periodontal procedures before starting a fixed or removable restoration.

In the third year course Periodontics Clinical Rotation (PRET 7308), students provide

the initial phase of treatment to two periodontal patients that will include prophylaxis and oral hygiene education with four quadrants of scaling and root planning, and a periodontal reevaluation. In order to be promoted to the senior year, students are examined in one three-month recall and the planning and scaling of one quadrant.

During the senior year, as part of the course Comprehensive Care Clinic (PRET 7400),

students must provide all the periodontal treatment that their patients need. They must work in a minimum of eight quadrants. They must take a written examination and several clinical periodontics examinations in the fourth year as part of their examination for Competency 10 (Manage patients with periodontal diseases). Failure to approve the competency examinations may require additional periodontal clinical experiences. i. Pulpal therapy This area is addressed in the UPRSDM Competency 12.

Competency 12: Prevent and treat pulpal and periapical diseases in primary and uncomplicated anterior and premolar permanent teeth.

Independent Assessment for Competency 12 in Child/Adolescent population: Written case based examination Independent Assessments for Competency 12 in Adult/Geriatric population: During the third year, students are assessed in this competency by a root canal treatment on an anterior acrylic tooth mounted in a dentoform on a pole in a laboratory setting simulating a clinical case. During the fourth year, students are assessed on a written exam on theoretical and clinical endodontics concepts using clinical cases where diagnosis and treatment planning in endodontics are also evaluated, and a root canal treatment on an acrylic premolar with two roots mounted in a dentoform on a pole in a laboratory setting simulating a clinical case. The rubric used for these independent assessments is presented in the Competency



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Exhibit 2.27 - Methods of Assessment in Courses Related to Pulpal Therapy


2 PRET 7296 Written examinations Quizzes Daily evaluations of laboratory work Laboratory examination Professional development

N/A


N/A

3 PRET 7318 Daily evaluations of clinical experiences (formative and summative) Didactic component:

Written test Root canal treatments in acrylic

and extracted teeth including molars

Case discussions

Promotion Test Adult/Geriatric: Endodontic treatment on an anterior acrylic tooth mounted in a dentoform on a pole in a laboratory setting simulating a clinical case.

3 PRET 7358 Daily evaluations of clinical experiences N/A 4 PRET 7400 Trimester and daily evaluations of

clinical experiences Child/Adolescent: Written case-based examination Adult/Geriatric:

Written case-based test Endodontic treatment in acrylic

premolar with two roots mounted in a dentoform

During the second year, in the Endodontics course (PRET 7296), students obtain the theoretical background related to the prevention and treatment of pulpal and periapical diseases. Concurrent with this didactic course, a laboratory portion includes exercises to perform conventional root canal therapy and non-surgical re-treatment. Acrylic and natural extracted teeth are used in the exercises.

In the course Pediatric Dental Treatment (PRET 7277), second year students learn pulpal therapies as indirect pulp capping, direct pulp capping, and management of other pulpal disorders of traumatic origin in the primary and in the young permanent dentition.

Junior and senior students are exposed to clinical experiences that substantiate their

theoretical background in endodontics, mainly in the treatment of pathological pulpal and periapical problems. The clinical courses also correlate endodontics with other fields of dentistry, with special emphasis on its importance in the conservation of a healthy stomatognathic system.

The third year course Endodontics Clinical Rotation (PRET 7318) has didactic, laboratory, and clinical components. The didactic component consists of a series of lectures related to the prevention and treatment of pulpal and periapical diseases, endodontics clinical


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topics like vital pulp therapy, success and failure of endodontic treatments, surgical and non-surgical re-treatments, endodontic-periodontic relationships, and management of traumatic injuries, among others. The laboratory part consists of root canal treatments on an anterior, maxillary two-rooted premolar, maxillary molar and mandibular molar, either acrylic or extracted teeth. During the month of August students have four three-hour clinical periods to work on the laboratory part. The clinical component exposes students to diagnosis, access openings, working length determination, instrumentation, master point adaptation, and obturation in anterior teeth and premolars. The student may also be exposed to emergency treatment of acute pulpal and periapical conditions. During the third year, students complete a minimum of two clinical cases on anterior or premolar teeth. The assessments include a written test on endodontics clinical topics like vital pulp therapy, success and failure of endodontic treatments, endodontic-periodontic relationships, among others, root canal treatments in acrylic and natural teeth including molars, a case discussion of a clinical case with the student’s self-assessment , a summative endodontic clinical case on an anterior or premolar tooth, and a promotion test (root canal treatment on an anterior acrylic tooth mounted in a dentoform on a pole in a laboratory setting simulating a clinical case).

As the senior students complete their patients in the Comprehensive Care Clinic

(PRET 7400), they perform at least two additional endodontic treatments (one must be on a premolar tooth). The examination for Competency 12consists of two parts: a case-based written test and a laboratory examination on an acrylic premolar with two roots mounted in a dentoform on a pole in a laboratory setting simulating a clinical case. During the senior year, students must have successfully completed at least two endodontic treatments on patients prior to taking the laboratory component of the competency examination.

In the Operative Clinical Rotation (PRET 7358) and the Comprehensive Care Clinic

(PRET 7400), students also have clinical experiences providing pulp protection, performing pulp cappings, diagnosing pulpal pathology, and providing pulpal emergency treatments. During their pediatric dentistry rotations in the fourth year, they also have the opportunity of performing pulpotomies in primary teeth on pediatric patients.

j. Oral mucosal disorders This area is addressed in the UPRSDM Competency 4.

Competency 4: Assess, interpret, and integrate findings geared towards the diagnosis and prevention of oral conditions of patients of all ages. Independent Assessment for oral mucosal disorders: Slides examination. The rubric used for this independent assessment is presented in the Competency

Examinations Manual (Appendix 2.R). The following table presents the main courses that help prepare students in the development of this competency and the activities and assessments related to it.


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Exhibit 2.28 - Methods of Assessment in Courses Related to Oral Mucosal Disorders


1 CBIO 7140 Written examinations Laboratory examinations Quizzes

N/A

2 EVDI 7255 Class participation Attendance Oral and written examinations

N/A

3 PRET 7326 Mock National Dental Board II Attendance

N/A


Slides examination

Students are exposed to different learning experiences in relation to the diagnosis and

treatment of oral mucosal disorders. During freshman year they take the Oral Histology and Embryology (CBIO 7140) course in which the normal and abnormal tissue structures are presented. In the sophomore year, in the Oral Pathology (EVDI 7255) course, they study the different oral mucosal disorders and manifestations. In the third year, they take the course Review for National Board Dental Examination II (PRET 7326), which prepares them for the National Board Dental Examination Part II. Short lectures on the topics covered in the examination, discussion of board type questions, and practice exams are provided. Among the topics covered in the course are oral pathology and oral medicine. At the end of the course, a mock examination is administered. During their third and fourth year clinical courses and as they recruit and treat patients in the clinic, students identify, diagnose, and manage oral mucosal disorders in their patients, as well as any other oral pathological lesion they present.

k. Hard and soft tissue surgery

This area is addressed in the UPRSDM Competency 8.

Competency 8: Perform oral surgical procedures and use pharmacological agents. Independent Assessment for Competency 8 in Child/Adolescent population: Written case based examination. Independent Assessments for Competency 8 in the Adult/Geriatric population: A procedure involving soft tissue surgery and a dental extraction in the oral surgery clinic.

The rubrics used for clinical Competency 8 examinations are presented in the Competency Examinations Manual (Appendix 2.R). Students apply for the exam after the summative experiences of the year (1 per semester). Both the summative and the competency examination must be supervised by an Oral Surgery Clinic faculty member. The student will fail the exam if he/she obtains a score of 1 or 2 in any of the rubric’s criteria.


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The following table presents the main courses that help prepare students in the

development of this competency and the activities and assessments related to it.

Exhibit 2.29- Methods of Assessment in Courses Related to Hard and Soft Tissue Surgery


Competency 2 PRET 7266 Written examinations

Quizzes Attendance

N/A

3 PRET 7336 Written examinations Quizzes Attendance

N/A

3 PRET 7386 Daily evaluations of clinical experiences Summative extractions Number of surgical procedures

Promotion Test Adult/Geriatric: Extraction

4 PRET 7400 Trimester evaluations of clinical experiences Summative extraction first semester

Child/Adolescent: Written case-based examination Adult/Geriatric:

Clinical procedure involving soft tissue surgery

Extraction The School of Dental Medicine curriculum provides pre-clinical and clinical

experiences to develop competency in oral surgery. A basic course, Oral Surgery (PRET 7266), is offered during the sophomore year. This course presents and discusses the correct method for removal of erupted teeth and fractured roots, as well as assessment of surgical risk patients and complications that might result. Pre-prosthetic surgical techniques, biopsy, and the management of uncomplicated infections within the oral cavity are taught, as well as proper record filling and prescriptions.

In the third year course Advanced Oral Surgery (PRET 7336), students are exposed to the special considerations that should be taken into account in the diagnosis, management, and treatment of oral and maxillofacial pathology, trauma, temporomandibular joint / temporomandibular dysfunction, dentofacial deformities, and pre-prosthetic surgery. At the end of the course, students should be able to recognize and diagnose oral and maxillofacial pathology, trauma, and deformities and recognize which conditions they can treat or refer to an oral and maxillofacial surgeon, or to the corresponding dental, medical, or surgical specialist.

As part of the clinical courses Oral Surgery Clinical Rotation (PRET 7386) and

Comprehensive Care Clinic (PRET 7400), junior and senior students work in the Oral Surgery Clinic, where they perform surgical treatment on their patients. They are exposed to non-medically and medically compromised patients for evaluation and surgical treatment who may require complicated extractions, pre-prosthetic surgery, emergency treatment of acute dental and orofacial conditions, pathology and trauma, alveolectomy, treatment for tooth impaction, exostosis excision, biopsies, and other hard and soft tissue surgical procedures. They also


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develop skills in post-operative treatments that could include suture removal and any other palliative treatment needed by the patient.

Third year students are required formative and summative experiences, which include

20 simple extractions, 1 surgical extraction, 2 pre-surgical evaluations, 6 post-operative treatments, 1 implant surgery, 2 summative extractions, and 1 oral surgery clinical examination, which consists of an extraction. Fourth year students are required to perform 50 oral surgery procedures. Fourth year students also perform periodontal surgeries on their patients as part of their periodontal clinical experiences in the fourth year Comprehensive Care Clinic (PRET 7400).

At the end of the second semester of the senior year, students must approve the

examinations for Competency 8 (Perform oral surgical procedures and use pharmacological agents) and the written examination that is part of the examination of Competency 10 (Manage patients with periodontal diseases), which also addresses periodontal surgery. These examinations are part of the Comprehensive Care Clinic (PRET 7400) course.

l. Dental emergencies This area is addressed in the UPRSDM Competency 7.

Competency 7: Prevent and manage dental and medical emergencies. Independent Assessments for Competency 7 in Child/Adolescent population: Written case based examination. Independent Assessment for Competency 7 in the Adult/Geriatric population: During the fourth year, students are examined during the evaluation and treatment of one patient with a dental emergency. Before taking the examination, the student must have a minimum of 10 previous dental emergency experiences.

The rubric used for this independent assessment is presented in the Competency



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Exhibit 2.30- Methods of Assessment in Courses Related to Dental Emergencies


1 EVDI 7105 Class participation exercises: standardized patient in clinical setting, laboratory Written examination Attendance

N/A


N/A

2 PRET 7296 Written examinations Quizzes Daily evaluations of laboratory work Laboratory examination

N/A

3 PRET 7356 Written examinations Quizzes Participation in emergency room duty Mock emergency situation Attendance

N/A

3 PRET 7318 Daily evaluations of clinical experiences (formative and summative) Didactic component Experiences in extracted teeth Case discussions

N/A


Child/Adolescent: Written case-based examination Adult/Geriatric: Assessment and treatment of one patient with a dental emergency

Students are responsible for managing the dental emergencies of their assigned

patients if they arise. They receive the foundation knowledge for the management of dental emergencies in several pre-clinical courses. The first year course Introduction to Assessment and Diagnosis of the Patient (EVDI 7105), introduces students to the art of medical history taking and patient interviewing. They develop skills in communication that enable them to establish proper rapport with patients and arrive at an initial assessment.

The second year course Oral Diagnosis and Treatment Planning (EVDI 7265),

initiates students in extra and intraoral examinations, chartings, records, diagnostic aids, and the development of treatment plans. The course Endodontics (PRET 7296) exposes second year students to the causes of pulpal injury and the theory that underlies the principles of endodontic treatment.

The third year course Medical Emergencies (PRET 7356) provides theoretical

knowledge regarding the prevention and treatment of common dental emergencies: periocoronitis, acute alveolar abscess, dry socket, stomatitis, cellulites, soft tissue injury, trauma to bone, broken needles, aspiration of instruments, displacement of teeth and roots to surrounding tissues, and maxillary sinus involvement. Students also participate in a hospital emergency room rotation with oral and maxillofacial residents.


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In the Endodontics Clinical Rotation (PRET 7318), third year students are expected

to provide emergency treatment for acute pulpal and periapical conditions in their assigned patients. During the fourth year, students are also required to evaluate and treat the dental emergencies of 10 patients who are not part of their assigned patient pool. The school's Oral Diagnosis Clinic receives patients with dental emergencies on a daily basis. After an initial assessment by a faculty member in this clinic, patients are referred to a fourth year student in a clinical group. A schedule is established in each fourth year clinical group, and students on duty are required to evaluate and manage the dental emergency patients that are referred to them by the Oral Diagnosis Clinic. This helps them develop competency in assessing, diagnosing, and treating dental emergencies. The Comprehensive Care Clinic (PRET 7400) course includes a competency examination which involves the evaluation and management of a dental emergency patient.

m. Malocclusion and space management This area is addressed in the UPRSDM Competency 11.

Competency 11: Manage occlusal abnormalities of primary, mixed, and permanent dentitions.

Independent Assessments for Competency 11: Third and fourth year written case-based examinations.



Exhibit 2.31 - Methods of Assessment in Courses Related to Malocclusion and Space Management


Competency 1 EVDI 7125 Written examinations

Laboratory examinations Quizzes Daily evaluations Attendance

N/A

1 PRET 7136 Clinic and laboratory exercises in functional occlusion, radiology and preventive dentistry Attendance

N/A

2 EVDI 7245 Written examinations Quizzes

N/A


N/A

3 PRET 7346 Written examinations Quizzes Laboratory projects

N/A


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Professional attitude Attendance

3 PRET 7338 Case presentations and participation in seminars Clinical performance Quantity of clinical performance

Promotion Test: Written case-based examination


Written case-based examination including all populations

As part of the Dental Anatomy and Functional Occlusion (EVDI 7125) course, first

year students learn about different concepts related to normal occlusion and malocclusion. They also take the course Clinical Applications of Dental Skills (PRET 7136), in which they have several early clinical experiences. One of the clinical activities involves taking and pouring alginate impressions to make diagnostic models, preparing for and taking a face bow, centric relation and interocclusal registrations, and mounting the casts on a semi-adjustable articulator.

During the second year, students take a didactic course, Development of the Orofacial

Complex (EVDI 7245) that provides the basic concepts of the physical growth and development of the craniofacial complex. As part of this course, they study the growth and development of craniofacial structures and the eruption of permanent dentition. This constitutes essential knowledge for the practice of dentistry, especially in the disciplines of Orthodontics, Dentofacial Orthopedics, and Pediatric Dentistry.

The course Orthodontic Treatment Planning (PRET 7298) is designed so that the

junior students can develop the basic knowledge in the treatment of malocclusions in the deciduous and mixed dentition of the child and adolescent. Furthermore, they develop knowledge in the identification and referral of corrective orthodontic malocclusion treatments in the permanent dentition. Several laboratory exercises help them develop skills in the construction of simple orthodontic removable and fixed appliances, as well as in taking measurements on study casts and radiographs.

In the third year course Clinical Occlusion and TMD Management (PRET 7346),

students learn the basic anatomy and physiology of the stomatognathic system and methods of examining the patient in pain and dysfunction. Procedures for diagnosing temporomandibular joint, occlusal, mandibular muscle, vascular, and cranial nerve pathology or dysfunction are outlined, as well as methods for solving occlusal problems.

In the third year clinical course, Orthodontic Clinical Rotation (PRET 7338), students

are assigned one patient with mild orthodontic problems. The patient can present para-functional habits. Students analyze the case using previously collected information, make a diagnosis, design a treatment plan and prepare a problem list and specific objectives for treatment. The cases are presented in seminar fashion consisting of small groups of students in which it is intended that every student have an active participation in the discussion. After treatment approval, students are responsible for the case. They are expected to see their patient on a monthly basis once the patients are in active therapy. Every patient must be checked by a faculty member during each visit. Students have a promotion test which consists of a written case-based examination.


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In their fourth year as part of the Comprehensive Care Clinic (PRET 7400), students continue treating their third year patients, in addition to two more patients transferred from the graduating seniors. They take an examination of Competency 11 (Manage occlusal abnormalities of primary, mixed, and permanent dentitions) at the end of the senior year as part of the course. n. Evaluation of the outcomes of treatment This area is addressed in the UPRSDM Competency 2.

Competency 2: Value the role of lifelong learning, self assessment, and critical thinking as an integral part of professional behavior. Independent Assessments for Competency 2 (self-assessment component) in Child/Adolescent population: Pediatric recall visit. Independent Assessments for Competency 2 (self-assessment component) in Adult/Geriatric population: active recall patient (includes evaluation of procedures done in school), completed recall patient (includes evaluation of procedures done in school), and the portfolio self-assessment of 3 completed cases. Students evaluate three patients in the Active Patient Recall Program during the

academic year. Their competencies are evaluated with the third case presentation. The rubric used for this independent assessment is presented in the Competency Examinations Manual for Fourth Year Students. A minimum score of 2 is required in all areas to be evaluated. Students who do not meet the score requirement must evaluate and present another patient until they attain the competency.

Students evaluate two patients in the Completed Patient Recall Program during the academic year. Their competencies are evaluated with the second case presentation. The rubric used for this independent assessment is presented in the Competency Examinations Manual (Appendix 2.R). A minimum score of 2 is required in all areas to be evaluated. Students who do not meet the minimum score requirement will repeat another case presentation until they attain the competency.

Students will reevaluate the treatment of one of their pediatric patients during a recall visit in the fourth year to assess this competency. The rubric used for this independent assessment is presented in the Competency Examinations Manual (Appendix 2.R). Students will fail the exam if they obtain a score of 1 or 0 in any of the rubric’s criteria.

In the student’s fourth year digital portfolio there is a component of self-assessment

of 3 completed patient cases. This assessment is part of the Competency 2 examination. The rubric used for this independent assessment is presented in the Competency Examinations Manual (Appendix 2.R).


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The following table presents the main courses that help prepare the students in the development of this competency and the activities and assessments related to it. Exhibit 2.32 - Methods of Assessment in Courses Related to Evaluation of the Outcomes of Treatment


towards Competency 3 PRET 7328 Daily evaluations of clinical experiences

Promotion Activities N/A

3 PRET 7388 N/A 3 PRET 7348 Daily evaluations of clinical experiences

(formative and summative) Approval of community and educational activities

N/A

4 PRET 7400 Trimester evaluations of clinical experiences Portfolio

Child/Adolescent: Recall of pediatric patient Adult/Geriatric:



Portfolio self-assessment of 3 cases

During their clinical experiences, students are expected to perform comprehensive

patient care. While they are completing the treatments, students perform self-assessments of the treatment provided. This contributes to the evaluation and discussion of their performance with the professor and the treatment outcome.

As part of the removable prosthodontics experiences in the clinic, students, along with

the patients and the faculty members supervising the cases, make an assessment of the completed treatment and all three sign a form certifying that the treatment is acceptable and that they are satisfied with the treatment outcome.

As part of the pediatric dentistry clinical experiences, students are assigned several

patients for comprehensive treatment. Patient re-evaluation by the students and faculty in charge is performed after completing treatment, giving students the opportunity to evaluate their own work.

Students also have the opportunity to evaluate treatment outcomes as part of the

Preventive Dentistry Clinic Rotation (PRET 7348). A recall visit for previously treated patients is scheduled after three months to evaluate the results of the preventive treatment performed.

During the third and fourth years, students are required to do three-week and three-

month periodontal reevaluations after their patients’ initial periodontal therapy has been


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completed. They evaluate the patient's response to the treatment and make decisions regarding necessary surgical procedures and maintenance care.

As part of the fourth year Comprehensive Care Clinic (PRET 7400), students

participate in the school's Quality Assurance Recall Program which includes the Active Patients Recall and Completed Patients Recall groups. In this program, students perform self-assessment, peer assessment, and evaluation of outcomes of treatment. For each recall group there is a clinical examination that is part of the examination on Competency 9: (Provide preventive dentistry service to patients of all ages according to their needs).

At the end of fourth year, students must transfer or discharge their orthodontics

patients. They must prepare a case presentation which reviews the patients’ treatment and outcomes to date, along with the future management of the cases.

The attainment of Competency 2 (Value the role of lifelong learning, self assessment,

and critical thinking as an integral part of professional behavior), is examined with the students’ digital portfolio prepared for the Comprehensive Care Clinic (PRET 7400) course. The portfolio includes the documentation of three, fourth-year patient cases from the diagnostic phase to the completion of the treatment plan. Each student presents a self-assessment of three completed cases as part of the documentation. Supportive Documentation

1. Course Syllabi (Separate Volumes) 2. Academic Progress and Performance Rules and Regulations (Appendix 2.K) 3. Competency Examinations Manual (Appendix 2.R)

2-26 Graduates must be competent in assessing the treatment needs of patients with special needs.


This standard is addressed in the UPRSDM Competency 4.

Competency 4: Assess, interpret, and integrate findings geared towards the diagnosis and prevention of oral conditions of patients of all ages. Independent Assessments for Competency 4, special needs component: Case presentation of special needs patient, with the patient present at the San Gabriel School for Deaf Children.


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Patients with special needs: Those patients whose medical, physical, psychological, or social situations make it necessary to modify normal dental routines in order to provide dental treatment for that individual. These individuals include, but are not limited to, people with developmental disabilities, complex medical problems, and significant physical limitations (CODA.)

The rubric used for this independent assessment is presented in the Competency

Examinations Manual (Appendix 2.R). Students must obtain a score of 3 or 2 in all criteria in order to approve the examination. Students who fail the assessment will be required to repeat it after an additional experience with a special needs patient.



Exhibit 2.33 - Methods of Assessment in Courses Related to Patients with Special Needs


1 CBIO 7190 Written examinations Attendance and participation

N/A

2 EVDI 7275 Written examinations Quizzes Professional development Attendance

N/A


N/A

2 PRET 7266 Written examinations Quizzes

N/A

3 PRET 7376 Written examinations Quizzes

N/A


N/A

3 PRET 7316 Term paper Oral examination Written examination Class participation and attendance

N/A


N/A

3 PRET 7396 Daily evaluations of clinical experiences N/A 4 DESP 7467 Formative and summative evaluations

Discussion of activities Community project Professional attitude Attendance

N/A


Case presentation of special needs patient in San Gabriel Clinic


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Students are exposed to cases of patients with special needs from the pre-clinical through the clinical years. The first year course Integration of Biomedical Sciences into Dental Practice (CBIO 7190), provides dental students with the opportunity to correlate basic sciences course topics with the dental clinical management of patients presenting medical conditions. The course is conducted using the case based learning strategy.

Theoretical knowledge for the assessment and diagnosis of children, adolescents, and geriatric patients is provided in the courses Assessment and Diagnosis of the Child and Adolescent (EVDI 7275) and Geriatric Dentistry (PRET 7376).

In Pediatric Dental Treatment (PRET 7277), students are again exposed to a special

population that requires modification of the usual dental treatment. In the pre-clinical Oral Surgery (PRET 7266) and Advanced Oral Surgery (PRET 7336) courses, they learn about treatment modification for medically and physically compromised patients.

In the third year, the Dental Care for Special Patients (PRET 7316) course prepares

dental students to identify, develop communications skills, and learn treatment modalities for physically and psychologically disabled patients, such as those with mental retardation, autism, neuromuscular disorders, victims of child abuse, cardiac and hemolytic conditions, AIDS, cancer, renal conditions, and others. Additionally, the Medical Emergencies in the Dental Practice (PRET 7356) course provides the future graduate intensive learning experiences about the evaluation, consultation, and treatment modifications of medically compromised patients, and about the management of medical emergencies in this type of patient. Third year students also learn about the special oral health needs of the elderly in the Geriatric Dentistry (PRET 7376) course.

During their clinical experiences, students have many opportunities to work with

patients with special needs. The UPRSDM is located at the Puerto Rico Medical Center, the largest and most important tertiary medical center in the island. This offers students one of the largest and constant pools of medically and physically compromised patients. A large portion of the patient pool is composed of geriatric patients. Students also rotate in community clinics and participate in community health fairs, where they are exposed to additional special needs populations.

As stated earlier, one of the community rotations is in the dental clinic of the San

Gabriel School for Deaf Children. The San Gabriel School is the only school in the island providing education to deaf children from age two to their fourth year of high school. All students come from a low socioeconomic level and many come from foster homes. The San Gabriel rotation exposes students to the management of patients with significant physical limitations and developmental disabilities. Aside from deafness, the dental students see other conditions such as cerebral palsy, ADD, Treacher Collins Syndrome, and blindness, among others. The Dental services rendered are free of charge thanks to donations from the School of Dental Medicine and private organizations.

All fourth year students rotate once a year in the San Gabriel clinic. There they have

the opportunity of providing dental services and develop sensitivity towards a socially


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isolated and needy community. Each student evaluates and performs an oral prophylaxis on at least two patients per session. Students are evaluated on their communication, diagnosis, and treatment planning skills, as well as their proficiency in providing preventive services to their patients. Prior to their rotation, they receive an orientation and an overview of clinic facilities and how to manage the special needs patients.

In the Oral Surgery Clinic, third and fourth year students are exposed to a wide

variety of patients with medical, physical, psychological, and social special needs. Each student must comply with thorough pre-surgical evaluations and treatment modifications, if necessary. In the Oral Diagnosis Clinical Rotation (PRET 7396), third year students are required to evaluate, present, and manage at least two medically compromised patients.

As a fourth year requirement in the Comprehensive Care Clinic (PRET 7400),

students rotate in the external dental clinic at San Gabriel School described earlier, where they must interact, teach, and treat deaf patients. They also rotate during their fourth year in a community geriatric dental clinic and two pediatric clinics. In the Dental Practice Externship (DESP 7467), students also have the opportunity to treat socially and culturally disadvantaged and medically compromised patients.

Competency 4 (Assess, interpret, and integrate findings geared towards the diagnosis

and prevention of oral conditions of patients of all ages) involves the assessment of all patients, including those with special needs. An independent assessment is conducted at the San Gabriel School during the students’ interaction with their second patient. Failure to comply with the evaluation criteria in the examination will result in the assignment of a second rotation in which the student must see at least one more patient before repeating the examination.


1. Course Syllabi 2. Competency Examinations Manual (Appendix 2.R)

2-27 Graduates must be competent in providing appropriate life support measures for

medical emergencies that may be encountered in dental practice.


This standard is addressed in the UPRSDM Competency 7.

Competency 7: Prevent and manage dental and medical emergencies.


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Independent Assessments for Competency 7, medical emergencies component: Each student is given a hypothetical case of a medical emergency situation in the Oral Surgery Clinic during a real surgical procedure. The student must resolve the problem in a given amount of time.

Description

The following table presents the main courses that help prepare students in the development of this competency and the activities and assessments related to it.

Exhibit 2.34 - Methods of Assessment in Courses Related to Medical Emergencies


Competency 1 EVDI 7105 CPR Practice Exercise

CPR certification N/A


N/A


N/A


Hypothetical medical emergency case during real surgical procedure

As part of the curriculum, dental students undergo extensive training in the prevention,

diagnosis, and management of dental and medical emergencies. Through various pre-clinical courses, students develop the necessary knowledge, skills, and attitudes to cope with life threatening situations that may arise in the dental office. Gross anatomy, neurosciences, physiology, and pharmacology courses introduce students to the basic structure and functions of the human body, which prepares them to identify and manage medical emergencies. In the first year course Introduction to Assessment and Diagnosis of the Patient (EVDI 7105), students learn the basics of Cardio Pulmonary Resuscitation (CPR) and are certified by the American Heart Association.

The second year course Apprehension and Pain Control (PRET 7286) provides

lectures on history taking and physical evaluation as a means of preventing and treating emergencies. Students learn about adverse reactions in patients due to local anesthetics and interactions with other drugs. They must discuss possible situations encountered while anesthetizing oral structures and means for resolution. They must be able to diagnose and treat reactions and complications arising from the administration of chemical agents used for pain and apprehension control. This course also presents basic CPR procedures. Prior to clinical courses, students are required to take the basic CPR course and approve it in order to treat patients.


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The third year course Medical Emergencies (PRET 7356) is designed to provide dental students with resources to cope with life threatening emergencies that may arise in the dental office. Students must be able to minimize the occurrence of medical emergencies and are expected to perform life saving procedures in emergency situations. They must become competent in preventing, diagnosing, and performing the immediate emergency treatment in anaphylactic shock, acute anxiety crisis, hyperthyroidism, hypoglycemia, hypertension, angina pectoris, and acute myocardial infarction, among others. Lectures also cover the proper way of maintaining airway by non-surgical means, in giving advanced cardiac life support, and how to prepare an office emergency kit. As part of the course, students have an emergency room duty with oral and maxillofacial residents and are expected to participate actively in the management of the emergencies that may arise during the rotation. They are evaluated with a case based written examination.

In the beginning of the third year, students receive a CD with several clinical manuals

in digital form. One is the Protocol for the Management of Acute Medical Emergencies in the Dental Clinic (Appendix 2.U). During the third year orientation and prior to beginning the clinical treatment of patients, the manuals are discussed with the students.

In order to prevent medical emergencies during the dental treatment of their patients,

students must make all necessary medical consultations before presenting their cases and beginning treatment. Before oral surgery procedures, they must also perform a pre-surgical evaluation, which includes vital signs and a review of the patient's medical history.

During the fourth year, as part of the Comprehensive Care Course (PRET 7400),

students take an examination on Competency 7, which includes a hypothetical emergency situation which they must resolve at a given time.


1. Course Syllabi (Separate Volumes) 2. CPR certifications (Available on site) 3. Protocol for the Management of Acute Medical Emergencies in the Dental

Clinic (Appendix 2.U) 4. Competency Examinations Manual (Appendix 2.R)


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STANDARD 3 –FACULTY AND STAFF

The University of Puerto Rico School of Dental Medicine complies with standard 3-1. Description The School of Dental Medicine has sufficient and adequately distributed faculty and staff to efficiently comply with its mission and goals. The school has 185 faculty members, 80 (43.2%) on a full-time basis and 105 (56.8%) part-time (see Exhibits 3.1 and 3.2). Forty-nine (49) ad-honorem faculty members complement the school’s salaried faculty (see Appendix 3.A). During the past four years, there has been a change in the number of tenured positions for faculty and staff. The university policy of freezing the positions of those who retire may affect the faculty-student ratio, the retirement fund, and the availability of tenured faculty to fill administrative and committee positions at the school and university level. The school’s administration is replacing faculty by hiring non-tenured faculty through contractual agreements.

Faculty members described in Tables 7 to 13 are responsible for the administrative, clinical, research, didactic, and behavioral sciences components of the curriculum. The school continuously assesses that all curricular needs are met with sufficient number of faculty members. This is done through different means such as faculty meetings, annual surveys, course evaluations, and committee meetings.

The ratio of faculty members to students in the preclinical didactic courses is 1: 41, 41 being the number of students per class. The ratio of faculty members to students in laboratory and clinical courses is approximately of 1:10. Exhibit 3.1 - Full-Time Faculty by Academic Rank and Department

ACADEMIC RANK

ECOLOGICAL SCIENCES

SURGICAL SCIENCES

RESTORATIVE SCIENCES

TOTAL

Professor 14 16 12 42 Associate Professor 9 4 7 20 Assistant Professor 7 3 6 16 Instructor 2 0 0 2

Total 32 23 25 80

3-1 The number and distribution of faculty and staff must be sufficient to meet the dental school’s stated purpose/mission, goals and objectives.


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Exhibit 3.2 - Part-Time Faculty by Academic Rank and Department

ACADEMIC RANK

ECOLOGICAL SCIENCES

SURGICAL SCIENCES

RESTORATIVE SCIENCES

TOTAL

Professor Emeritus 1 0 2 3 Professor 3 1 1 5 Associate Professor 7 3 2 12 Assistant Professor 33 25 29 87

Total 44 29 34 105 The following faculty members have administrative responsibilities:

Dr. Humberto J. Villa Professor and Dean

Dr. Darrel Hillman Professor and Associate Dean

Dr. Arlene Sánchez Associate Professor and Assistant Dean for Academic Affairs

Dr. Aileen M. Torres Professor and Assistant Dean for Student Affairs

Dr. Arnaldo J. Guzmán Associate Professor and Assistant Dean for Clinical Affairs

Dr. Augusto Elías Professor and Assistant Dean for Research

Vacant Director of Institutional and Academic Evaluation Office

Dr. Fernando J. Haddock Associate Professor and Director, Continuing Education Office

Dr. Ferdinand Lugo Associate Professor and Chair, Surgical Sciences Department

Dr. Viviana Garri Professor and Chair, Ecological Sciences Department and Ortho-Pedodontics Section Chief

Dr. Santos L. Lebrón


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Professor and Chair, Restorative Sciences Department All administrative officers are full-time faculty members with release time for their

administrative workload. Nonetheless, some faculty members in administrative positions maintain some teaching responsibilities in their areas of expertise. A description of the administrative duties inherent to each position will be available on site.

Faculty rights and responsibilities are stated in the University of Puerto General Bylaws and the Medical Sciences Campus Faculty Manual (Available on Site). Besides teaching, faculty members can be assigned to administrative positions, research, mentorship of students, and committees. The School of Dental Medicine strongly supports the involvement of faculty in research and different leadership scenarios. Faculty must make arrangements with their supervisors or department chairs in order to assure that academic responsibilities are met. The School of Dental Medicine support staff is described in Exhibit 3.3. Other support personnel is provided by the MSC, including security, cleaning, and maintenance, as well as the support and professional staff in units such as the Registrar, Library, Center for Technology Integration in Academia, and the Information Systems Office, among others.


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Exhibit 3.3 - School of Dental Medicine Support Staff, 2010-2011

SUPPORT STAFF Position Number Dental and Auxiliary Personnel Dental Assistant I Dental Assistant II Dental Hygienist I Radiology Technicians Medical Recorder Technician Data Recorders Health Educator Nurse Sterilization Technician Dental Equipment Mechanic Secretaries Administrative Administrative Assistants Accounting Clerks Electronic Systems Programmer Receptionist Photocopy Machine Operator Collector Handyman Purchase and Supplies Property Assistant Research Assistants Research Assistant Statistician Research Technician Medical Technologist Total

46 3 29 3 1 2 2 1 1 1 3 29 20 8 4 1 1 1 2 1 1 1 7 3 1 2 1 102


1. Alphabetical Listing of Ad-Honorem Faculty (Appendix 3.A) 2. Departmental Listing of Faculty (Table 7 Required Tables Section) 3. Alphabetical Listing of Faculty (Tables 8-10 Required Tables Section) 4. Summary of Faculty (Tables 11-13 Required Tables Section) 5. School of Dental Medicine Organizational Chart (Appendix 1.H)


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6. Description of Duties of Administrative Positions (Available on site) 7. University of Puerto Rico Rules and Regulations (Available on site) 8. Medical Sciences Faculty Manual (Available on site)

3-2 The dental school must show evidence of an ongoing faculty development process.


Description The Medical Sciences Campus Deanship for Academic Affairs is in charge of the new faculty orientation workshops given on an annual basis to new faculty and those faculty members hired within the preceding five years. The deanship also offers continuing education courses on education and research in the health sciences. The School of Dental Medicine has a faculty development program that is coordinated through the Office of Academic Affairs. The faculty development program addresses three main areas: organizational, instructional, and professional skills. These courses are offered strictly to the faculty and are tailored to strengthen organizational, management, and leadership skills and update knowledge and skills in teaching methodologies and technological advances, as well as evidence based dentistry. Others are designed to improve knowledge and skills related to the dental profession. Another goal of the program is to develop faculty skills in research, publishing, and other scholarly activities. The school fully finances these development activities, as presented in Appendix 3-B Faculty Development Activities Offered by the School of Dental Medicine. Faculty involvement in development and scholarly activities is evaluated at the school level using the Form for Annual Evaluation for Faculty Development (Appendix 3.C) which was implemented by the department directors during 2011. The results of these evaluations are used as input in preparing the annual faculty development plan. Plans also address the areas in which the administration perceives there is needed for improvement based on the trends in dental education and clinical advances. The school also offers faculty members continuing education courses free of charge. Through its faculty development program it assesses faculty interests and needs and invites visiting professors to offer retreats and seminars. It receives regular visiting professors from the United States, Europe, and Latin America. There are also other local continuing education providers, among them, the Puerto Rico College of Dental Surgeons and the Puerto Rico College of Physicians (both local professional associations). Faculty members continuously improve their clinical skills by participating in the wide variety of courses offered. See Faculty Attendance to Professional Development Activities during 2011-2012, Appendix 3-D).


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Faculty also practices and improves clinical skills working at the Intramural Faculty Clinic where they try new materials and clinical procedures, sometimes with residents, in the treatment and follow-up of patients seeking specialized treatments. The clinic will be moved to bigger facilities next to the main university campus in Río Piedras, a short drive from the Medical Sciences Campus and next to a major urban metro station. The new facilities will be state-of-the-art and should be ready during academic year 2013-2014. The school has encouraged and often paid for faculty members’ participation in leadership, academic, and research institutes according to the particular needs of the school or the professor. Due to budget cuts in the last few years, these opportunities have been reduced. In addition to the activities programmed by the Office of Academic Affairs in the annual faculty development plan, faculty members are free to choose their own activities according to their areas of interest and are encouraged to attend meetings, seminars, and courses in their fields. Faculty members often present and discuss their experiences with other faculty members sharing the same interests either in departmental meetings or at a particular faculty meeting. Department directors, administrators, or faculty members recommend candidates to pursue further studies when new technologies, clinical applications, or innovations in any of the dental specialties merge. New faculty members interact with senior faculty in clinics and in didactic and laboratory courses in an informal form of mentoring. New faculty members are progressively assigned responsibilities and are allowed to actively participate in medical and dental campus-wide activities. Through 2003-2007 the School of Dental Medicine established and operated the Hispanic Center of Excellence and Learning Technology Center founded by a HRSA grant. The center offered a variety of technological and audiovisual learning resources and provided faculty training in the development of instructional materials. As a result of this experience, faculty members were instructed in the use of technology in teaching. Many created new computerized learning resources such as videos, digital conferences, the digitization of clinical paperwork for the junior year clinical modules, and Blackboard courses. Although the HRSA grant ended, the center is still an important facility for teaching and learning.

In November 2006, the school strongly supported ADEA’s Commission on Change and Innovation in Dental Education initiative by appointing campus liaisons to the Commission. The liaisons (five faculty members) have worked on curricular innovation at the school level, publishing in the Journal of Dental Education (JDE), and presenting their work in several ADEA and CCI annual meetings. The group has lead faculty retreats for the discussion of topics in educational methodologies, assessment, and curricular changes. The end product of their work was a major change in the clinical assessment of the senior year Comprehensive Care Clinical Course. The school supported this endeavor fully for approximately four years. One of the most productive faculty development activities is the annual faculty retreat, in which all faculty members are invited to share their thoughts and discuss topics of


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interest and priority issues at the school. Through the years, faculty retreats have been well- attended and an effective method to discuss curricular revisions, accreditation processes, and faculty development and evaluation, among other topics. Supportive Documentation

1. Faculty Development Activities Offered by the School of Dental Medicine (Appendix 3.B)

2. Form for Annual Evaluation for Faculty Development (Appendix 3.C) 3. Faculty Attendance to Professional Development Activities during 2011-2012

(Appendix 3.D )

3-3 Faculty must be ensured a form of governance that allows participation in the school’s decision-making processes.


Description

MSC faculty participates in institutional governance as it relates to teaching, research, services and resources, and curriculum development. It also has decisional roles in the standing committees of the school/department level and deliberative and advisory roles in the Academic Senate and the Administrative Board at the campus level. Thus, faculty has input and representation in campus-wide academic matters, administrative processes, and financial planning. Schools are organized in departments, within which faculty members exercise their prerogatives in academic affairs such as: creation of new programs, curricular revisions, and admission and academic progress of students. The University of Puerto Rico General Bylaws mandate that all schools have at least personnel, curriculum, and faculty affairs committees, which are advisory to the deans regarding administrative, curricular, and faculty issues. Faculty members are elected by their peers to serve on these school committees and, in some schools, in the corresponding department-level committees. The University recognizes participation in committees and governing bodies as essential to the achievement of institutional goals. Indeed, institutional service is one of the faculty’s primary responsibilities, reflected in the workload distribution stated in the Bylaws, which assigns four hours a week to meetings and committee work.

The School of Dental Medicine is represented by four academic senators at the campus

Academic Senate. Academic senators are elected for a period of three years. The Academic Senate, once constituted at the beginning of each academic year, elects members to represent faculty in the Administrative Board (two members) and the University Board (one elected


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and one alternate member from each campus). Faculty representation system-wide is also guaranteed at the Board of Trustees. Faculty participation at school-level is achieved through its standing and ad-hoc committees. Faculty participation in ad-hoc committees is requested by the school’s administration as needed. The school’s standing committees are:

Administration Committee- Serves as advisory body to the Dean in the exercise of his/her academic and administrative duties and responsibilities. The committee reviews and make recommendations on areas such as strategic planning, annual budget and operational plans, new and revised programs, rules and regulations of the dental school, teaching and research philosophy, annual reports, and other matters that the Dean may consult.

Curriculum Committee- Advises the Dean on the design, implementation, and evaluation of all academic programs of the school. It evaluates programs with respect to the school’s mission and goals and according to the needs and demands of the Puerto Rican community and the trends in the profession.

Admissions Committee – Reviews and evaluates the applications for admission to the predoctoral program and recommends to the Dean those applicants that should be admitted on the basis of the admissions policy. It is responsible of reviewing the admissions policy and recommend changes to the Dean.

Admissions Committee for Graduate Programs – Same duties as the committee for the undergraduate program, but for graduate programs.

Academic Performance Committee – Conducts an early and on-going assessment of the students’ academic progress, evaluates and guides academic achievement and professional development of all undergraduate students, evaluates the students’ performance for promotion and is concerned with all aspects of their activities that may have an implication on their professional development. It offers academic guidance to those students with academic difficulties and make recommendations for promotion, remediation, retaking of courses, repeating the academic year, academic dismissal, and graduation.

Academic Performance Committee for Graduate Programs – Same function as the undergraduate performance committee, but for the graduate program.

Research Committee – Serves as an advisory committee on research related matters, advises on policies to promote research, and the allocation of available funds.

Advanced Placement and Transfers Committee – Conducts written and practical examinations for advanced placement of graduates from foreign dental schools who seek admission in advanced standing for the predoctoral program. It also reviews applications of transfer students from accredited schools and recommends actions to the Dean.


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Faculty Affairs Committee – Studies, evaluates, and discusses matters which concern the faculty.

Personnel Committee – Reviews all faculty candidates for appointment, promotions in rank, and tenure. The committee follows the rules and regulations for the evaluation of teaching personnel as they are approved and amended by the Academic Senate. It is composed of the presidents of the three departmental personnel committees, the directors of the three school departments and a faculty member appointed by the Dean. The chair and secretary are elected by the members.

Awards Committee- Recommends student awards for outstanding achievement at the dental school.

Legislation Committee- Advises the Dean concerning regulations and trends in the external environment that may affect the future of the profession and reviews federal laws that may impact the school’s operation.

Student Liaison Committee – Provides feedback on student life at the school and plans activities that provide enriching experiences for students. Helps identify problems that affect students and provide alternatives for their solution.

Outcomes Assessment Committee – Performs periodic evaluations of the institution’s assessment plan, outcome measures, and expected results and recommends modifications. Reviews data and recommends steps to enhance institutional effectiveness in achieving the mission and goals. Recommends policies and reviews mechanisms for institutional assessment. Collaborates in the development of surveys or institutional assessment projects according to identified needs.

Quality Assurance Committee – Develops a formal system of quality assurance for the patient care program, develops and revises standards of patient care, develops and conducts mechanisms to determine causes of treatment deficiencies, reviews patient records to assess the need for, appropriateness, and quality of care provided. Develops patient review policies, procedures, outcomes, and corrective measures.

Faculty participation is also guaranteed by periodic faculty meetings, held approximately twice per semester. There are also extraordinary faculty meetings convened by the Dean in order to address specific issues. Faculty governance is stated in the School of Dental Medicine Bylaws (Appendix 1.E). Supportive Documentation

1. Minutes of faculty meetings for the last 3 years (Available on site) 2. Table 14: Committee Membership (Required tables section) 3. School of Dental Medicine Bylaws (Appendix 1.E) 4. University of Puerto Rico General Bylaws (Available on site)


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3-4 A defined process must exist that ensures objective measurement of the performance of each faculty member in teaching, patient care, scholarship and service.


Description The evaluation of faculty for tenure and promotion in rank is conducted using the Medical Sciences Campus evaluation instruments. The instrument measures the performance of each faculty member in teaching, service, and research. Guidelines for promotion and tenure provide a uniform system for faculty evaluation based on academic merit. It is under the scope of the University of PuertoRico General Bylaws.

The MSC is currently implementing a new system that complies with the University of PuertoRico General Bylaws and has content and structural elements that will be uniform for all academic personnel, including: professors, researchers, librarians, psychologists, social workers, counselors and academic administrators. There is a common evaluation instrument to be completed by all faculty members and special instruments applicable to their specific academic functions. The multiple components (faculty roles) and criteria (skills/tasks) are defined in the new system according to the specific MSC academic workloads.

The MSC evaluation system has the following components: 1) Self-evaluation, 2)

Peer evaluation, 3) Faculty evaluation by students, and 4) Academic evaluation guidelines. The system gives credit for teaching, research, and service and allows flexibility in the percentage weight assigned to each area according to the faculty member’s workload (Appendix 3.E). Current faculty evaluation criteria for tenure and promotion include:

• Creation of teaching material • Quality of teaching • Number and quality of research projects/grants/publications in peer reviewed

journals • Participation in clinical and community activities and in institutional affairs • Commitment to work and university activities • Compliance with faculty duties and responsibilities • Professional development: continuing education and membership in

professional organizations, and attendance/participation in national and international meetings

• Lectures in area of expertise • Publications, workshops, special lectures, and similar activities


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• Awards and recognitions • Evaluations by students, peers, and supervisors • Professional attitude and commitment to participate in professional activities

Students evaluate faculty at the end of the course. The faculty member may ask for an annual evaluation of his/her course or the course may be evaluated as part of the evaluation conducted by the Office for Academic Affairs every two years (see Course Evaluation Forms, Appendix 2.S). The evaluation results are given to the faculty member and Department Director. Results are discussed with the professor once the grades have been turned in and are presented anonymously. The results are part of the faculty evaluation system for curricular management, but are also used for tenure and promotion. Faculty development and scholarly activities are evaluated at the school level by the Department Directors on an annual basis. The School of Dental Medicine Annual Faculty Evaluation for Development (Appendix 3.C) instrument was implemented in 2010. The results of these evaluations are used as input for developing the annual faculty development plan, as well as providing individual faculty development opportunities. Supportive Documentation

1. School of Dental Medicine Annual Faculty Evaluation for Development (Appendix 3.C)

2. Course Evaluation Forms (Appendix 2.S) 3. MSC Faculty Evaluation Forms for Tenure and Promotion (Appendix 3.E)

3-5 The dental school must have a stated process for promotion and tenure (where tenure exists), that is clearly communicated to the faculty.


Faculty promotion and tenure rules are stated in the University of Puerto Rico General Bylaws. Rules pertaining to promotion are stated in Article 47 of the Bylaws. According to Certification 133 (1999-2000) of the Board of Trustees, faculty will be considered for promotion after a specified number of years at each rank. Regulations guarantee a review process, not an automatic promotion. The UPR System’s polices regarding tenure are stated in Article 46 of the Bylaws. In order to be considered for tenure, faculty must hold a full-time, tenure-track appointment and have served at least five consecutive years at the institution. The Department Personnel Committee receives and reviews documents from the interested candidates and prepares a report with recommendations to the Department Director, based on the candidates’ merit and supporting documents. The Director reviews the


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Committee’s report and submits his/her recommendations to the Dean, who forwards all pertinent documents to the School’s Personnel Committee for its review. The Committee reviews each case and submits its recommendations to the Dean. According to the University of Puerto Rico General Bylaws, the Department and School Personnel Committees only have an advisory role to the Dean, who presents the candidates for appointment to the Chancellor and the Administrative Board. The Board grants the promotion (or tenure). Faculty members may appeal Administrative Board decisions to the University Board and Board of Trustees. During the past three years and due to the university system’s financial situation, candidates were reviewed by the Administrative Board and those who qualified for promotion were placed in waiting lists for funding. This created a temporary backlog of cases that is gradually being resolved by the allotment of funds to the first two groups of faculty members who were eligible for promotion.

Faculty receives information pertaining to promotion and tenure in various ways. New faculty participates in orientation sessions offered by the Campus Deanship for Academic Affairs and by the school’s administration and departmental personnel committees. Young faculty members are advised by the department chairs and personnel committees on how to meet the criteria for promotion and tenure. The Faculty Manual is a compilation of documents and certifications that contain faculty members’ duties and rights and relevant processes that may apply to their professional life on campus. The document is available online at the campus webpage www.rcm.upr.edu. The following exhibit summarizes promotions granted to the School of Dental Medicine faculty for academic years, 2007-2008 to 2011-2012. Exhibit 3.4

SCHOOL OF DENTAL MEDICINE: Promotions Granted by Academic Year 2007-2008 2008-2009

Name Promotion Name Promotion Nydia Chéverez Rodríguez

Assistant Professor Eric X. Torres Pérez Associate Professor

Ramón González García Professor Rosana Hanke Herrero Associate Professor Wilda Guzmán Colón Professor Nilda Sánchez Jaime Associate Professor Divya Colón Alcaráz Professor José R. Matos Pérez Associate Professor Aileen Torres Maymí Professor Yolanda Heredia Matos Professor Ana R. López Dávila Professor Rodulfo Gauthier Portuondo Professor Atilano León Torres Associate Professor Nadgie Ortiz Díaz Associate Professor Elba Díaz Toro Associate Professor Damaris Molina Negrón Associate Professor Pedro Hernández Cott Associate Professor Noel Aymat Santana Associate Professor

Emilio Agrait Defillo Professor 2009-2010 2011-2012

Promotion in ranks were not granted due to the budget crisis at the University or Puerto Rico

Arlene Sánchez Castellano Associate Professor Arnaldo Guzmán García Associate Professor

2010-2011 Lina Larotta Sánchez Professor Promotion in rank were not granted due to the budget crisis at the University of Puerto Rico

Lidia Guerrero Rodríguez Professor


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1. Faculty Manual (Available on site and on campus webpage) 2. University of PuertoRico General Bylaws (Available on Site)


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STANDARD 4 - STUDENT SERVICES

4-1 The dental school must provide adequate and appropriately maintained facilities and learning resources to support the purpose/mission of the dental school and which are in conformance with applicable regulations.

The University of Puerto Rico School of Dental Medicine complies with Standard 4-1

Medical Sciences Campus Facilities The facilities of the School of Dental Medicine are located in the main building of the Medical Sciences Campus (MSC), adjacent to the Puerto Rico Medical Center (PRMC). The campus is located in the City of San Juan, the capital and largest metropolitan area of the Commonwealth of Puerto Rico. It has approximately 2,500 employees and 2,400 enrolled students. The MSC main building houses the School of Medicine, School of Dental Medicine, Graduate School of Public Health, Deanship for Academic Affairs, Deanship of Administration, and Chancellor’s Office. An adjacent building houses the Library, the Center for the Application of Technology in Academia (CATA), and the Information Systems Office. The School of Medicine’s faculty practice is located outside campus within walking distance. The School of Health Professions and School of Nursing buildings were recently remodeled, while a new building was constructed for the School of Pharmacy. The Deanship for Student Affairs, Registrar, and additional administrative offices are located in a five-story building adjacent to the School of Nursing building, which also houses an auditorium-gymnasium. The Student Center and a cafeteria are located next to the main building, along with parking facilities for faculty and handicapped persons.

Medical Sciences Campus Main Teaching Hospitals The hospitals of the Puerto Rico Medical Center are interconnected and within walking distance of the campus building. The hospitals serve the medically indigent of San Juan and medically compromised patients requiring specialized health care not offered in other health institutions in Puerto Rico. The center is a Level 1 trauma center. The proximity of the MSC to the Medical Center offers faculty and students the advantage of hands-on training and exposure to groups requiring specialized services, both adult and pediatric. Dental undergraduate students, Oral and Maxillofacial Surgery, Pediatric Dentistry, General Practice and Prosthodontics residents rotate in some hospital facilities for


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courses and clinical experiences. The hospitals are also available to undergraduate dental students for non-compulsory experiences.

University Hospital

The University Hospital is a 241-bed general hospital, which serves as a referral hospital for tertiary and supra-tertiary cases from other island institutions. It is accredited by the Joint Commission. The participation of the School of Medicine in health care at the University Hospital exposes students to patients with numerous conditions. This hospital has a Dental Department directed by a faculty member from the School of Dental Medicine. Dental undergraduate students, OMFS, General Practice, and Prosthodontics residents rotate in the hospital for courses and clinical experiences.

University Pediatric Hospital

The University Pediatric Hospital is a 144- bed hospital and the main facility for service, teaching, and research in pediatrics in Puerto Rico. It is located at the Puerto Rico Medical Center, adjacent to the University Hospital. Its philosophy of care is based on a comprehensive approach, multidisciplinary participation, and constant awareness of patient rights regardless of age. It is accredited by the Joint Commission. The Pediatric Hospital is organized into five clinical departments: Pediatrics, Surgery, Dentistry, Radiology, and Clinical Pathology. Highly specialized pediatric services are available including: neonatal and pediatric intensive care units, radiology, endocrinology, cardiology, pneumology, neurology, infectious diseases, nephrology, genetics, developmental pediatrics, a psychiatric day center unit for children, and special laboratories. This hospital has four operating rooms and is the main teaching hospital for pediatric dentistry residents.

The University of Puerto Rico Hospital The University of Puerto Rico Hospital in Carolina is a 201-bed health facility that offers services to the municipalities of Carolina, Trujillo Alto, Río Grande, and Canóvanas. Operated by the University of Puerto Rico, it provides primary and secondary health care in the areas of internal medicine, cardiology, gastroenterology, anesthesiology, general surgery, orthopedics, otolaryngology, radiology, pediatrics, obstetrics and gynecology, emergency medicine, and dentistry. It is accredited by the Joint Commission. The UPR Hospital’s Dental Clinic provides state-of-the-art dental care in the areas of general dentistry, endodontics, periodontics, oral and maxillofacial surgery, and fixed and removable prosthodontics. The faculty, GPR residents, and predoctoral students from the School of Dental Medicine offer services throughout the year. The clinic consists of nine dental cubicles, digital x-ray units, and portable dental units used to provide dental care outreach services. GPR residents offer dental emergency services on a 24-hour basis and comprehensive dental care under general anesthesia in the operating room.


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Puerto Rico Diabetes Center

The Puerto Rico Diabetes Center is a public corporation created by the government by Law No. 166 of August 12, 2000 to reduce diabetes prevalence, mortality, and morbidity in the island. The center offers the services of nutritionists, endocrinologists, podiatrists, pediatricians, retinologists, cardiologists, psychologists, nephrologists, and health care counselors in diabetes to approximately 3,000 patients. It is also responsible for implementing public policy on diabetes health care education and treatment in Puerto Rico. This clinic exposes general practice residents to a special care population that needs oral health services. The dental clinic has two operatories with digital x-ray equipment.

Other Off-Campus Dental Care Facilities Predoctoral students rotate at several off-campus facilities besides the University of Puerto Rico Hospital. These are mentioned in Standard 1.8.

School of Dental Medicine Facilities School of Dental Medicine – First Floor

The School of Dental Medicine is located on the first floor and part of the basement of the Medical Sciences Campus main building, with two additional classrooms on the second floor (Appendix 4-A, Blueprints of the School of Dental Medicine Facilities). All school and campus facilities, including parking, accommodate disabled persons. The ramp entrance to the building gives direct access to the first floor of the school, the Main Clinic, recently renovated restrooms, and five elevators that provide access to the rest of the building. The waiting area of the Main Clinic seats approximately 40 people.

Other units and offices located on the first floor are:

• Dental Plans Billing Office • Record Room • Cashiers • Administrative Offices • Office of the Dean, Associate and Assistant Deans • OMFS Meeting and Operating Rooms • Laboratories • Sterilization room • Continuing Education Office • Research Office Center • Prosthodontics Residency • Intramural Practice Facilities • Faculty offices • Dental History Display • Pediatric Dentistry Program • Orthodontics Residency Program


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• Lutheran Medical Center AEGD and Endodontics Program Facilities School of Dental Medicine Clinics The School of Dental Medicine has several clinics. In addition to the Main Clinic, there are special clinics devoted specifically to individual phases of dentistry such as Oral Surgery, Oral Diagnosis, Oral Radiology, Research, and the graduate clinics of Pediatric Dentistry, Oral and Maxillofacial Surgery (OMFS), Orthodontics, Prosthodontics, and the collaborative AEGD and Endodontics programs, each with its dental cubicles, sterilization area, dispensing and storing rooms, administrative offices, x-ray facilities, and reception area. There are five complete functional treatment clinics that are used for preclinical and clinical instruction in patient care. These are Main Oral Diagnosis, Oral Surgery, Radiology, and Faculty Practice Clinics. The other clinics are mainly used by residents and faculty, and are available for observation by undergraduate students. Some undergraduate students make individual arrangements with faculty members to do certain procedures under their supervision in the specialized clinics. The Main Clinic is equipped with 90 dental cubicles for individualized clinical training in general dental procedures. All first and second year early clinical experiences, the clinical rotations, as well as the Comprehensive Care Clinic utilize the facilities of the Main Clinic. Approximately 40 cubicles are used by fourth year students in the Comprehensive Care Clinic. The remainder is usually used by third year students in the clinical rotations. Each individual dental cubicle in the Main Clinic is equipped with the following: • a complete dental unit • fixed cabinet for storage of instruments • a movable cart • x-ray viewer • one sink for every four cubicles There are two intra-oral x-ray machines in the Main Clinic for use by undergraduate students, as well as computers and printers. A recent addition is a digital Pan-Ceph. Efforts are underway to eliminate the use of dark room facilities and manual x-ray processing and convert the clinic to completely digital technology. The central dispensing area in the Main Clinic has an elevator that connects it to the general storing and dispensing area located in the basement. The central sterilization and stock dispensing rooms recently renovated, serve all clinical areas of the school and multidisciplinary laboratories. In front of the Main Clinic sterilization facilities, there is a cleaning and packing area where students prepare their instruments for sterilization. This area includes three ultrasonic machines, three sinks, windows to access the sterilization envelopes and for instrument trays, dispensers for sterilization envelopes and an area for disposing contaminated material. The sterilization facilities include an electric boiler (Electro-steam Generator Corp.) and the main sterilizer. Two instrument dental washer disinfection units were recently installed.


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Other clinical facilities on the first floor are the Intramural Faculty Clinic, which is shared with the Lutheran Medical Hospital AEGD Program, and the Lutheran Medical Hospital Endodontics Residency Program Clinic. The facilities for the Oral Diagnosis Clinic are located on the first floor, adjacent to the main waiting room. It consists of two dental units and chairs and three offices for administrative staff and faculty. Two desktop computers for the staff and students are also available. The instruments and supplies in this area are adequate and clinical facilities meet all access standards for patients with special needs. The school plans to remodel this area in the near future. The Oral Surgery Clinic is adjacent to the Oral Diagnosis Clinic. Its renovation will be finished by December 2012. It will be equipped with the following:

Seven cubicles with dental units and chairs for use by undergraduate students and residents

Monitors and equipment for nitrous oxide and intravenous sedation Implant equipment Central dispensing room and state-of-the-art sterilization facilities Operating room adjacent to the clinic with recovery area

The main facilities and all clinics comply with radiological regulations of the Department of Health, as well as access regulations for patients with special needs. The Radiology Clinic complies with the standards of the Radiological Health Section of the Department of Health, and is equipped with the following: four intra-oral X-ray machines with nine intra oral digital sensors, one digital panoramic and cephalometric X-ray machine, one panoramic analog machine, CT-Scan machine, nine portable intra oral x-ray machines, dark room facilities with two PeriPros, and a room for X-Ray interpretation equipped with viewers. Radiation protection equipment such as X-Ray aprons and cervical collars are available in the area. The Research Clinic is located in the Research Department facilities, adjacent to the Oral Diagnosis Clinic, on the first floor. This clinic has two dental units and chairs, a waiting room, a reception area, and four research faculty offices. The senior and junior laboratory facilities are located in the area behind the Main Clinic. This area has 21 benches for student laboratory work and rooms for different laboratory purposes (porcelain lab, stone model prep lab). It is equipped with model trimmers, vibrators, vacuum mixer, Sta-Vac machines, casting machines, ball bearing lathe, plaster and stone bins, and a burn-out oven, all inside different rooms and cubicles.


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School of Dental Medicine Basement

The School of Dental Medicine has several facilities located in the basement of the MSC main building. Among these is the Office of Counseling and Psychology, consisting of three small offices and a reception area. The freshman and sophomore multidisciplinary laboratories and classroom facilities, designed for 50 students, are also located in the basement. Stock and dispensing rooms, student lounge, locker rooms, Learning Technology Center, faculty offices, conference rooms, facilities for dental equipment maintenance and repair, and the administrative offices of the General Residency Program are also in the basement. The Learning Technology Center of the School of Dental Medicine was established to increase information resources, provide technological support to faculty and students, and enhance self-learning. The Center has a computer lab for use by students and faculty. It is equipped with the following: • Ten computers with Windows XP & MS Office • Advanced multifunction systems for copying and printing • Scanners with transparency adapters • Digital photography and film cameras The first year laboratory uses a lecture room equipped with two monitors, two projection screens, and a laboratory area with 55 benches. Equipment in this laboratory also includes vacuum mixers, model trimmers, plaster and stone bins, and regular vibrators. It also has gas and air installations, air filters, and is equipped with bench-work mannequins. The second year laboratory is equipped with 55 benches with gas and air installations and air filters. Each working area is equipped with stools, lamps, and cabinets. The laboratory is also equipped with one projector screen, one X-ray unit, three sinks, one model trimmer, one vibrator, and one plaster bin. The school is currently in the process of installing a digital X-Ray unit in the laboratory, which should be available for use during academic year 2012-2013. Adjacent to the first year laboratory is the simulators laboratory with 50 units, which will be renovated during academic year 2012-2013. The facility will be equipped with new simulators, new monitors for every two students, a digital network video camera, and a computer. This laboratory is used for several first and second year courses, examinations, workshops, as well as for third and fourth year students who require additional experiences for the development of competencies. Located between the first and second year laboratories is the storing and dispensing area. This area is used for receiving, storing, dispensing, and distributing dental materials, dental equipment, and other supplies that are needed in the school. These facilities are equipped with a safety box, two refrigerators, and an elevator that connects with the clinic dispensing room. This facility has two windows for dispensing of materials for both preclinical laboratories.


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Other Facilities The Basic Sciences multidisciplinary laboratories, classroom facilities, amphitheater, computer centers, library, and animal resource center located in other areas of the main building are shared with other schools of the Medical Sciences Campus. School of Dental Medicine Facilities Renovations The following school facilities have been built or renovated in the last seven years:

1. Dental Plans Billing Office 2. Graduate Prosthodontics Clinic 3. Data entry offices 4. Information and reception area 5. Office of Academic Affairs 6. Dean’s Office 7. Intramural Faculty Clinic 8. Nine additional dental units at the University of Puerto Rico Carolina Hospital 9. Graduate Orthodontics Clinic 10. Oral Surgery Clinic- in process; scheduled to be finished by December 2012. 11. Sterilization room at Main Clinic 12. Senior and junior students’ laboratory facilities 13. Simulators laboratory (currently under renovation) 14. Graduate Prosthodontics Program Laboratory

Maintenance of Equipment and Facilities The school has established procedures for maintenance of clinical equipment, facilities, and laboratories. Annually, the Assistant Dean for Academic Affairs and the school administrator evaluate the needs for equipment and facilities maintenance and renovations. Based on this information, they develop an annual plan according to the school’s Strategic Plan priorities and available funds. Throughout the academic year and as the need arises, each department submits requests for maintenance of its physical facilities and information systems using the campus intranet. The Department of Physical Resources and the Office of Information Systems receive the requests and offer the corresponding service. The departments may also request supplies and equipment to the school administrator and purchasing agent. These are granted if the requests are justified and funds are available. The dental equipment technicians periodically assess the clinical equipment for repair or replacement needs. They have a preventive maintenance plan for all areas. The Assistant Dean for Clinical Affairs approves all requests for supplies and dental equipment technician services.


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Personnel Responsible for Assessment of Facilities and Equipment

Dental equipment technicians Clinic Supervisor Department Chairs Assistant Dean for Clinical Affairs Executive Assistant to the Dean of Administration MSC Department of Physical Resources Office of Information Systems MSC Engineering Department MSC Dean of Administration

Use of the Dental Clinics Exhibit 4.1 shows the hours spent by students in clinics. Exhibit 4.1 - Student Clinical Hours YEAR

COURSES WITH CLINICAL COMPONENT

CLINICAL HOURS

1 PRET 7136 Clinical Application of Dental Skills 54 1 PRET 7117 Professional Development 2 1 PRET 7116 Preventive Dentistry 12 2 PRET 7286 Apprehension and Pain Control 1 2 PRET 7126 Introduction to Restorative Dentistry and Principles

of Intracoronal Restorations 15

3 PRET 7386 Oral Surgery Clinical Rotation 49 3 PRET 7396 Oral Diagnosis Clinical Rotation 69 3 PRET 7308 Periodontics Clinical Rotation 64 3 PRET 7318 Endodontics Clinical Rotation 47 3 PRET 7328 Pediatric Dentistry Clinical Rotation 58 3 PRET 7338 Orthodontics Clinical Rotation 60 3 PRET 7348 Preventive Clinical Rotation 40 3 PRET 7358 Operative Dentistry Clinical Rotation 86 3 PRET 7368 Fixed Prosthodontics Clinical Rotation 60 3 PRET 7378 Oral Radiology Clinical Rotation 39 3 PRET 7388 Removable Prosthodontics Clinical Rotation 90 4 Comprehensive Care Clinic* 1000 *(See Table 3) Sharing of Clinics

The Oral Surgery Clinic is shared by undergraduate students and OMFS residents. There is an appointment coordinator for the scheduling of surgical procedures in the clinic.


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When the residents are not in the clinic, students may use all available dental units. The usual schedule is the following:

• Mondays - Residents and students • Tuesdays - Residents and students • Wednesdays - Residents • Thursdays - Residents and students • Fridays - Residents and students The Intramural Faculty Clinic with 10 dental chairs is shared with the residents from the AEGD Program and the Dental Assisting Program. Also nine dental chairs in the Dental Assisting Program located to left of the main clinic are shared with third year students. Library and Information Technology Resources

The Conrado F. Asenjo Library (CFAL) [http://rcm-library.rcm.upr.edu] of the Medical Sciences Campus (MSC) [http://www.rcm.upr.edu] of the University of Puerto Rico (UPR) [http://www.upr.edu] is the main health sciences information resource in the island. The CFAL occupies five levels of a six- story building and houses one of the most comprehensive collections of its kind in the Caribbean. Office and stack areas measure 38,044 square feet with a seating capacity for 388 users.

The CFAL is adjacent to the MSC main building and next to the Puerto Rico Medical

Center area, near all the hospitals that constitute this supra-tertiary medical facility. The Library is a unit under the Deanship for Academic Affairs. Librarians with master’s degrees participate actively in the teaching, learning, and research processes, providing health services and promoting patient health. They provide access to sources of quality information and educate users on how to access and make critical use of health information.

The CFAL building recently went through a full renovation of the 2nd, 3rd, and 6th

floors. The purpose of this renovation was to meet and satisfy the patrons’ learning styles and needs. The renovations included new group meeting rooms, two LCD interactive “smart board” systems, 24/7 study area (called “La Veranda”), new furniture, improved lighting fixtures, photocopy rooms, computer work stations with Internet connection, and a computer laboratory. There are also two multipurpose computer classrooms with projector, screen, podium, and desktop computer, with room for 15 persons each. Theses rooms can be reconfigured to make one big room with seating for 30 persons.

Library Affiliations and Collaborative Agreements

As a resource library of the National Network of Libraries of Medicine (NN/LM) of the National Library of Medicine (NLM) it is also a member of the Consortium of Southern Biomedical Libraries (CONBLS) [http://www.lhl.uab.edu/conbls/]. Thru these affiliations, the library is a participant on a document delivery program through which the materials that are not available in the collection are obtained via electronic transmittal from other health


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sciences libraries using the Ariel® Interlibrary Loan (ILL) Document Transmission Software [http://corporate.infotrieve.com/ariel] or by FAX (787-759-6713).

There are also local collaborative agreements with the Veterans Administration (VA)

Caribbean Healthcare System (http://www.caribbean.va.gov/) and with other libraries in the UPR System (among them the Néstor M. Rodríguez Rivera Library (http://bcn.uprrp.edu/index.html), of the College of Natural Sciences (http://natsci.uprrp.edu/) of the Río Piedras Campus. Library Services

The library opens 78 hours a week. During this service time, it offers a variety of

services to students, faculty, and researchers from the Schools of Dental Medicine, Health Professions, Medicine, Public Health, Nursing, and Pharmacy. It also serves the UPR Hospital and adjacent hospitals in the Puerto Rico Medical Center.

Technological services include a wireless environment, end-user searching areas,

access to the Internet and the Library’s biomedical information databases installed in the local area network. Other services include FAX and electronic transmittal of documents. Its resources are available offsite to authorized users by means of an EZ Proxy Server [http://136.145.90.90:2048/login].

The Reference Section offers a strong information literacy program in collaboration

with professors from the campus schools that formally integrate the teaching of information skills into courses. As a result, these activities are integrated into the course syllabi. Besides participating in formal courses, reference librarians also offer workshops and individual training in the use of library resources.

Reference services are also offered online through the Virtual Reference Service

[http://refvirtual.upr.edu/]. The Library opens daily, except on Sundays and Holidays. Online access is also provided to approximately 17,000 journals, newsletters, and Open Access publications available through the University Libraries Consortium, which includes publications in the Social Sciences, Humanities, and Education, besides titles in Biomedical Sciences. Library Personnel

The CFAL personnel works under one of following eight library sections: Library Director’s Office

o Administrative Office o Electronic Resources and Services o Emergent Technologies o Local Area Network (LAN) Administration

Circulation, Reserve and Theses Collection Reference, Virtual Reference, and Information Competencies Collection Development and Administration


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Serial Publications and Interlibrary Loans Special Collections

o Puerto Rican Collection o Bailey K. Ashford Collection o History of Medicine

Multimedia Resources and Services Center Institutional Historical Archives

Library personnel include 12 professional librarians who hold academic rank and 18

other staff members. Library faculty members participate in teaching, the campus Academic Senate, institutional committees, and accreditation processes. Library Liaisons Program

There is at least one liaison librarian for each campus school who, in most schools, also sits in the Curriculum Committee. This promotes faculty participation in the selection of information resources, maintains the faculty informed of new services and library resources, and keeps the library aware of new courses and trends in the schools.

Library Collections and Dentistry Resources

Interdisciplinary in nature, the collections are developed using selected lists of print books and journals, as well as electronic versions of these materials. Faculty is active in the selection process. Books are organized in open stacks using the National Library of Medicine Classification Scheme [http://www.nlm.nih.gov/class//] and the Library of Congress Classification Scheme [http://www.loc.gov/catdir/cpso/lcc.html].

The media collection includes slides, films, cassettes, CD-ROMs, DVDs and VHS

programs from sources like Films on Demand, Medical Media Systems, and NCME-TV. All these materials cover the fields offered by the campus academic programs.

The collection compromises 43,080 book titles, 1,045 active journal subscriptions

(some available online thru EBSCO EJS [Electronic Journals Service]), and 1,146 multimedia (excluding 1,415 additional titles from a Films on Demand subscription).

The Library has access to over 700 e-books and 3,000 additional e- journal titles

through databases such as ACS Publications, Annual Reviews, Books@OVID (under OvidSP), EBSCOHost, The Clinics (from MD Consult), MD Consult, OvidSP Databases, ProQuest, ScienceDirect, Scopus and Springer Link - Medicine Books, YourJourmals@OVID (under OvidSP).There are other full text resources such as Micromedex and InfoTrac (Encyclopedias and Databases) and full access to the National Library of Medicine databases.


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The CFAL Dentistry Collection complies with 91% of the recommended core titles list of Stowers and Galbraith (2004)1.

The Library website includes links to open dentistry databases and websites, such as:

ADA (American Dental Association) Center for Evidence-based Dentistry [http://ebd.ada.org/Default.aspx]

Archive of Procedures and Methods Used in Oral Health Surveys [http://apps.nccd.cdc.gov/dohdrc/Catalog/searchArchive.asp]

BBO (Dentistry) [http://bases.bireme.br/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&base=BBO&lang=i&form=F]

Catalog of Surveys Related to Oral Health [http://apps.nccd.cdc.gov/dohdrc/Catalog/searchSurvey.asp]

ClinicalTrials.gov [http://www.clinicaltrials.gov/] Cochrane Library (BIREME)

[http://cochrane.bireme.br/cochrane/main.php?lang=en] Data Tables for Oral Health Indicators [http://drc.hhs.gov/indicators.htm] Dental, Oral and Craniofacial Data Resource Center Data Query System

[http://drc.hhs.gov/create_query.htm] Medical Device Safety

[http://www.fda.gov/MedicalDevices/Safety/default.htm] National Guideline Clearinghouse [http://www.guideline.gov/] National Institute of Dental and Craniofacial Research

[http://www.nidcr.nih.gov/] Librarians and Problem Based Learning (PBL) at the School of Dental Medicine

Librarians participate as facilitators in Problem Based Learning (PBL) seminars in the course EDVI 7115: Human Development and Behavior Management of the School of Dental Medicine. This has been an excellent experience that has contributed to strengthening the bond between librarians, school faculty, and students. PBL has also increased the use of the library and has helped in the development and evaluation of the collection.

Center for the Integration of Technology in Academia

The Center for the Integration of Technology in Academia (CATA, for its Spanish

Acronym) is the unit of the Deanship for Academic Affairs responsible for offering technical support to faculty and students in the production of promotional and educational materials and for the operation of the campus TV channel. Technical support in the production of instructional materials includes graphic arts services and photography, as well as the application and use of audiovisual media. The television and communications section assists

1 Stowers, E. and Galbraith, G. M. (2004). Building a dental sciences collection in a general academic

library. Articles (Libraries). Paper 324. Available online at: http://digitalcommons.library.unlv.edu/lib_articles/324.


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campus faculty and students in the production of instructional videos, TV programs, video recording of classes and special events, videoconferencing, Internet streaming, and transfer of older audiovisual materials to newer formats.

CATA is responsible for the technical support to the campus Annual Research and

Education Forum, in which faculty and students present their research work in lectures, oral presentations, and poster sessions. As mentioned in Standard 6, Research Program, this event is important in the dissemination of research work conducted on campus by faculty and students, and one in which the School of Dental Medicine has a significant participation

Computer Resources The Information Systems Office (OSI, for its Spanish acronym) oversees the campus’ information technology infrastructure. OSI supports the administrative and academic processes by maintaining all essential services, including the wireless system, electronic mail, and security. The School of Dental Medicine Clinics Administrative System (ACO for its Spanish acronym) uses a Microsoft SQL Server 2000 application for its database. Three modules with Internet access were developed using Microsoft.Net. These include: patients, administration, clinical rotations, and clinical evaluations modules. ACO is designed to manage the students’ clinical practice at the School of Dental Medicine. The system creates lists of procedures and registers patients, students, faculty, and days of group and individual work. ACO stores the patients’ treatment history, from their initial evaluation to treatment appointments, status of the procedures, faculty evaluation, and payment of treatment. The campus wireless network (WLANRCM) connects computers and other equipment to the campus communications network by means of access points installed in strategic areas. At the School of Dental Medicine, there are access points in the Main Clinic, classrooms, and laboratories. The user must have a campus email account in order to access the system. Student Satisfaction with Equipment and Facilities Satisfaction surveys of the last graduating classes (Class of 2009, 2010, and 2011) reveal different levels of satisfaction with equipment and facilities (See Table 2- Outcomes Assessment Plan- Required Tables Section). Library resources were rated by 73% as excellent or good in 2009 and improved to 91% in 2011. Laboratory facilities were rated by 55% as excellent or good and decreased to 47% in 2011; 61% rated the clinical facilities as excellent or good in 2009 and 72% in 2011. Classrooms were rated as excellent or good by approximately 70% of students during the mentioned period. Efforts have been made by the school to procure funds to improve facilities. During academic year 2012-2013 the University of Puerto Rico Central Administration assigned funds for the modernization of classrooms and laboratories.


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1. Blueprint of the School of Dental Medicine Facilities (Appendix 4.A ) 2. Table 2-Outcomes Assessment Plan (Required Tables Section)

4-2 Student Services must include the following:

a. Personal, academic and career counseling of students b. Assuring student participation on appropriate committees; c. Providing appropriate information about the availability of financial aid and

health services; d. Developing and reviewing specific written procedures to ensure due process

and protection of student rights; e. Student advocacy

The University Of Puerto Rico School Of Dental Medicine complies with Standard 4-2.

Description Student Services

Personal, academic, and professional counseling of students

The school makes every effort to identify as soon as possible those students who are

experiencing academic difficulties. Usually, professors or course coordinators are the first to suggest academic counseling, tutoring, and support. The school has also developed its own mechanism for early identification of academic deficiencies through the Student Assessment Committee. This is an ad-hoc committee to the Academic Performance Committee that conducts periodic monitoring of the students’ academic performance in order to identify those with academic problems and refer them for tutoring or academic counseling at an early stage. It meets three times a year to assess the students’ performance and identify those in need of academic or personal counseling.

Once a student is identified, he/she may be assigned an academic counselor by the

Associate Dean for Academic Affairs or referred to the school’s Office for Student Affairs for academic advising, or to the school’s counseling services for identification of probable root causes of problems or deficiencies. The Counseling Office, located in the basement of the building, is open from 7:00am to 3:00pm. It is staffed by a full-time licensed psychologist, one full-time, and one part-time counselor. They offer support to students dealing with issues such as academic difficulties, personal problems, and career issues.


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Students may also be referred to the campus Center for Counseling and Psychological Services (CECSI, for its Spanish acronym), or other off-campus mental health professionals. The CECSI staff consists of several professional counselors and a psychologist. The Center offers individual and group counseling, career counseling, job fairs, orientation activities, and workshops on various topics related to student personal and professional development. Among the topics of interest to students who request services are: stress management, depression, eating disorders, time management, and networking for job placements. Other services include the administration of standardized tests such as vocational aptitude tests, referrals to boarding houses and child care facilities, and advising students and faculty regarding reasonable accommodation for persons with disabilities.

The campus’ Wellness and Quality of Life Office develops programs to promote a healthy and safe environment for the university community. It promotes prevention of drug and alcohol abuse, violence, sexually transmitted diseases, sexual assault, and sexual harassment. It collaborates actively in the implementation of the campus safety policy to ensure compliance with federal regulations and the Jeanne Clery Act. In association with the Puerto Rico Traffic Safety Commission, it directs a federal program known as FIESTA XIV, whose mission is to prevent student driving while under the influence of alcohol and to promote secure and responsible behavior on the road. The Wellness Office has an advisory committee composed of representatives of the six schools who collaborate in promotional efforts and participate in policy and standards revisions. The office coordinates special events such as educational fairs, community service, dance lessons, and special interest workshops. The Student Center for Counseling and Psychological Services works closely with the Wellness Office in activities that promote social responsibility of students towards the community, such as visits to homes for children and the elderly.

Early interventions have proven to be effective in helping students achieve academic

progress to the next level of study, as seen in the school’s high retention rates (Exhibit 2.2). All cases are handled under strict confidentiality protocols. Professors or teaching assistants offer tutoring services and review sessions to students exhibiting academic difficulties in any given course. Students may also be assigned a professor as an academic counselor to monitor their progress. Also, through the Teaching Assistance Program (Programa de Ayudantía), students receive tutoring and mentoring from post-graduate dental students. Most students receiving help or who are placed in remedial activities go on to graduate as evidenced by the School’s retention rate (Exhibit 2.2). In some circumstances, the school offers special curricular arrangements to dental students who have evidenced academic deficiencies. The main goal is to retain students, allow them time to manage their particular problems, and enable them to successfully complete their academic program. A leave of absence may be offered to students when there is a need to take time off and resolve a serious situation. The student may return and complete the academic program within a specific time period.

In order to promote the students’ well-being, the school and campus also offer stress

releasing extracurricular activities such as cultural and social activities and the campus sports program. Every effort is made to schedule cultural events during the designated “universal hour” (Wednesdays from 11:00am to 1:00pm) when the school does not schedule formal academic activities. Dental students actively participate in various sport tournaments,


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competing with students from other campus schools, residents, and faculty. Sports include volleyball, basketball, ping-pong, indoor soccer, and softball. A Fitness Center is also available and offers its services in an extended schedule, Mondays through Fridays, from 5:30am to 9:00pm.

Student Participation in Appropriate Committees Student participation in the decision-making process of the school is assured through their active participation in the following standing committees: Curriculum, Admissions, Research, Quality Assurance, Student Liaison, and Institutional Assessment. They also participate in ad-hoc committees for specific tasks such as the evaluation of candidates for the position of Dean. Students are elected to committees either by their classmates at the Student Council or are appointed by the Assistant Dean for Student Affairs. The number of students in each standing committee and their participation in the administrative decision-making process is stated in the School of Dental Medicine General Bylaws (Appendix 1.E). All students appointed have full participation and are voting members in each of these committees. Student participation at the campus and university system levels is governed by the UPR General Student Bylaws, and the MSC Student Bylaws, both amended in 2011 (Both available on site). There is a School of Dental Medicine student representative in the Academic Senate and there is a campus student representative in the Administrative Board. There are also several student and professional organizations at the MSC in which students can participate, among them: General Student Council, FIESTA XIV, religious organizations, Students for Community Services, and the Campus Choir. The school also encourages student participation in professional student organizations. Some of these organizations are: American Student Dental Association (ASDA), American Dental Education Association (ADEA), Hispanic Dental Association (HAD), and American Association of Women Dentists (AAWD). Availability of Financial Aid and Health Services

The MSC Financial Aid Office oversees financial assistance programs for dental students in compliance with US Department of Education policies and criteria. Financial aid funds are provided by the Legislature of the Commonwealth of Puerto Rico, the federal government, institutional funds, and private donations. These resources are distributed through scholarships, student loans, and work-study programs. The MSC also offers teaching and research assistantships to post-graduate students, which are funded by institutional budget allocations and distributed based primarily on academic merit rather than financial need. Decisions regarding teaching and research assistantships are made by a standing committee chaired by the MSC Associate Dean for Academic Affairs. The committee establishes priorities for students of the six campus schools following an approved regulations manual. An MSC Student Perception Survey conducted by the Financial Aid Office in 2005-06, revealed that 84% of students considered the diversity of aids and their availability as very important for the attainment of their academic goals.


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The school has an emergency fund for students in need of additional financial aid due to extraordinary circumstances. Students may apply for an emergency loan of $500.00 at the Office for Student Affairs and receive the funds by the next day. This emergency fund is maintained by fundraising activities conducted by the school for such purposes.

Once students are admitted they receive financial aid orientation by an officer who

interviews them personally and clarifies doubts regarding their application. Over 80% of dental students receive some type of financial aid during their dental school years. The Financial Aid Office provides guidance on debt management. Prior to graduation, students must attend an exit interview.

All full-time students are required to carry the UPR health plan, or provide evidence

of coverage by an equivalent health insurance plan. The university plan provides basic, dental, and pharmacy coverage, with major medical available for an additional fee. Coverage for dependents began in 2008-09, also for a fee. The Student Health Services Clinic provides ambulatory health services to all students free of charge. A family physician provides primary care in collaboration with a registered nurse. Services include first aid, medications, short term rest and observation, orders for laboratory tests, X - rays, and other diagnostic studies. Emergency care is provided by the Emergency Room at the Medical Center or at private hospitals. As reported in the Student Health Services Clinic 2009-2010 Annual Report, 90% of students rated the services as excellent. Health maintenance and preventive services are strongly emphasized through the immunization and universal precautions protocols. The clinic also promotes the surveillance of blood pathogens and occupational exposure protocols, including HIV prophylaxis. The Hepatitis B and Influenza vaccines are available at an affordable cost.

Due Process and Protection of Student Rights The UPRSDM recognizes the academic rights of students and has established procedures to fairly address student complaints and grievances. This due process is described in the Rules and Regulations for Administrative Appeal Processes of the University of Puerto Rico, Certification No. 138 1981-1982 of the Council on Higher Education (Available on site). These procedures are intended to achieve equitable solutions with due regard for the rights of all parties involved

The specific disciplinary process followed in the School of Dental Medicine is stated in the Academic Progress and Performance Rules and Regulations (Appendix 2.K). There is also an Honor Code (Available on site) written by the students and approved by the faculty in 2005, which addresses acceptable behaviors and specific mechanisms for the handling and reporting of complaints and allegations of improper conduct or violation. Since its creation, there has been only one complaint.

The MSC has established the necessary policies to foster an active learning

environment, supported by the appropriate student services. Policies and procedures that govern student life are widely distributed during recruitment and admission activities and are readily available at the campus’ academic offices and website (Orientation Documents Package available on site). The campus’ numerous administrative services to students are


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regulated by these policies and procedures designed to facilitate the students’ academic life and protect their rights. Most of the institutional regulations that govern student life are stated in the UPR General Student Bylaws, recently revised in January 2011 (Available on site), and the MSC Student Bylaws (2011), to assure congruence with all system policies (Available on site). These regulations address the following aspects of student affairs: rights and responsibilities; non-discrimination policy, including the right to reasonable accommodation (ADA); rules of conduct and ethics, including disciplinary procedures and due process; participation in student and institutional governance, and in academic processes; access to university/campus services; security of student records; and rules governing student organizations, publications, and extracurricular activities. Full versions of these documents, in hard copy or CD format, are distributed to admitted students by the schools’ Office for Student Affairs. Copies are also available at the Office of the Dean of Students and posted on the deanship’s website http://www.rcm.upr.edu/estudiantes/Documentos.htm.

Other institutional policies relevant to MSC students include those that address: rights

of persons with disabilities; acceptable use of information technology resources; intellectual property; guidelines for scientific research; sexual harassment and other uncivil behavior; personal safety and security; and the illicit use of drugs, controlled substances, and alcohol abuse. These are discussed in detail with new students during orientation activities and further clarified by the school’s academic administrators during meetings with first year students (attendance taken and on file). All policies are accessible via links found in the recently launched Student Services Portal at the MSC webpage (http://www.rcm.upr.edu/portalstu/Default.aspx), and are available at the school’s Office for Student Affairs upon request. The MSC Deanship for Student Affairs also publishes a bulletin updated annually that includes comprehensive and condensed data on student services, bylaws, policies, and important information on student life on campus. This bulletin, handed in CD format, is given to newly admitted students at the beginning of each academic year (Available on site). The MSC’s commitment to high standards of conduct is reflected in Certification 078, 2010-2011 of the Academic Senate (Appendix 2.H). This certification establishes the students and faculty’s duties and responsibilities and how they must relate in academic situations. The SDM educates students regarding this certification and other related matters of acceptable standards of conduct during the freshmen orientation activities, after which a signed copy of the participants’ attendance is kept on file as evidence of acknowledgement of receipt of the certification. This policy is also discussed at workshops sponsored by the Office of the Student Ombudsperson.

Student Advocacy The Assistant Dean for Student Affairs is the advocate for all students enrolled in the School of Dental Medicine. The Assistant Dean responds directly to the Dean in matters related to recruitment, admissions, and academic discipline. He/She fosters an environment conducive to good communication between students and faculty, and among students themselves. He/She also chairs the Student Liaison Committee, whose responsibilities are to provide feedback on student life at the school, plan enrichment activities, and identify problems and their possible solutions. As chairperson of this committee, the Assistant Dean


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for Student Affairs acts as liaison between the Dean, the faculty, the administration, and the students. This committee meets once a month. The Office for Student Affairs also plans two to three annual “town hall” meetings with the Dean and his/her staff. The purpose of these encounters is to bring to the attention of the staff those situations affecting student life, dynamics at the clinic, and academic performance issues that can be discussed and resolved in an informal setting. These sessions have proven to be very effective since all the individuals involved in the decision-making process are present.

In 1996, the MSC created the position of Student Ombudsperson. In 2005, the Board

of Trustees approved a system-wide policy regarding student ombudspersons (Board of Trustees Certification 32 2005-2006). The Student Ombudsperson offers intercession, mediation, negotiation, and conciliation services during student grievance procedures, and makes referrals to arbitration services, when needed. The office advocates for student rights in all areas of campus life. Students have confidential access to the Ombudsperson by telephone, facsimile, and an “Online Office” e-mail system at the MSC website. The office has also established a specific process for the management of those complaints directly related to noncompliance with reasonable accommodation pursuant to the American with Disabilities Act, and the Rehabilitation Act. According to the Office’s Student Satisfaction Questionnaire for AY 2006-2007, 85% of students expressed satisfaction with the services provided (Table 2, Section I: Outcome Assessment Plan, Required Tables Section). Supportive Documentation

1. School of Dental Medicine Bylaws (Appendix 1.E) 2. Academic Progress and Performance Rules and Regulations (Appendix 2.K) 3. UPR General Student Bylaws (Available on site) 4. MSC Student Bylaws (Available on site) 5. MSC Student Bulletin (Available on site) 6. Table 2 Section I – Outcome Assessment Plan (Required Tables Section) 7. Duties and Responsibilities of the Faculty and Students (Appendix 2.H)

4.3 Prior to admission, students must receive a statement of the total expected cost of dental education, including estimates of living expenses and educational fees, an analysis of financial need, and the availability of financial aid based on their need analysis. 4.4 During each year of enrollment, each student must receive a statement of accumulated debt, expected costs of remaining dental education, including living expenses and educational fees, an updated analysis of financial need and current information on the availability of financial aid based on the need analysis.


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4.5 Immediately prior to graduation, each student must receive a written statement identifying all sources of financial assistance received through the school for which repayment is required, as well as a review of promissory notes for each outstanding loan and the terms and conditions contained in each note including, but not limited to the following: (address separately)

a. repayment schedules and specific billing procedures b. grace periods and their impact on repayment schedules c. deferments and their implications d. cancellation provisions e. a description of available consolidation options and the time frame in which students would be eligible for them.

The University of Puerto Rico School of Dental Medicine complies with Standards 4-3, 4-4, and 4-5.

Information regarding estimated costs of expenses and financial aid at the SDM is

annually published on the MSC and SDM websites, and in official school brochures and catalogs. It is available to everyone applying to the school. Specifically, information related to available financial aid, total expected cost of educational expenses (tuition, fees, and equipment), estimates of living expenses (as estimated by the UPR Central Administration), and the process and deadline for seeking financial aid is available from the campus Deanship for Student Affairs, the Financial Aid Office of the UPR Central Administration, and the Assistant Dean for Student Affairs of the School of Dental Medicine. Some of the available documents are: Financial Aid Office Student Information Manual, Financial Aid Form Student Application (FAFSA), Estimated Cost of Expenses at the SDM, and other handouts (Appendix 4.B). Costs are revised and updated on a yearly basis by the school and university officials.

As soon as they are admitted, all dental students receive financial aid information from a financial aid officer who interviews them and clarifies doubts regarding the application for aid (attendance taken and on file). Those who do not qualify for financial aid can apply for payment deferment and divide their annual tuition in five installments distributed throughout the year. As stated above, financial aid application procedures are managed by the MSC Financial Aid Office in accordance with federal and state policies and criteria. Most dental students have expressed satisfaction regarding financial aid availability. In the MSC Student Perception Survey conducted by the office in 2005-06, 84% of students considered the diversity of aids and their availability as very important for the attainment of their academic goals. Prior to graduation, each student receives a statement of accumulated debt (Appendix 4.C), which details the total amount borrowed and the total amount in scholarships granted while enrolled in the SDM. Students with subsidized and unsubsidized guaranteed federal


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loans and legislative loans receive annul e-mail notifications from the agencies that granted the loan stating their accumulated debt. The campus Financial Aid Office provides yearly statements of accumulated debt and expected costs for the remaining years of dental education (see Appendix 4.C). Prior to graduation, the Financial Aid Office schedules at least two compulsory counseling sessions with students to discuss default prevention and loan consolidation (attendance taken and on file). The Collection and Claims Office sends a letter by certified mail to students who have received financial aid, including a statement of student loans processed while enrolled in the MSC. The letter urges students to visit the office for an exit interview. It includes a loan statement, financial aid received, total amount borrowed, approximate monthly installments for debt repayment, and the first installment due date. In the compulsory exit interview, students are counseled on repayment procedures of subsidized and unsubsidized guaranteed and legislative loans. Also, as part of the institutional clearance process, students who received financial aid through other loans granted from funds administered by the MSC (such as emergency loans) are required to visit the Collection and Claims Office for additional interviews and counseling sessions. All accounts are handled by the University Accounting Service, Inc., which is the service provider for the UPR. Repayment schedules and specific billing procedures: Since August 1998, repayment of the William D. Ford, Stafford GSL, and SLS loans is done through local commercial banks. The banking institution contacts the graduates to determine repayment and specific billing procedures. Repayment of Federal Perkins/National Direct Student Loans and Legislative Scholarships and/or Loans is administered by the University Accounting Service, Inc. Students receive a payment schedule for the loan or scholarship. Grace periods and their impact on repayment schedules: During the exit interview, students receive information related to grace periods and their impact on repayment schedules through the Exit Counseling Guide for Borrowers or directly at the interview. Deferments and their implications: Deferment documents and information are provided at the exit interview. This information is included in the Exit Counseling Guide for Borrowers. This document explains how to apply for deferment and the reasons for which students may apply, as well as its implications. Cancellation provisions: Students also receive written information related to cancellation provisions during their exit interviews. Consolidation options: Information handed to students at all exit interviews includes information on consolidation options and the time frame in which they will be eligible for them. Supportive Documentation

1. Student Financial Aid Documents (Appendix 4.B) 2. Samples of accumulated debt report (Appendix 4.C )


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4-6 The dental school must have pre-matriculation health standards that will ensure that prospective students are qualified to undertake dental studies.


Admission to the University of Puerto Rico School of Dental Medicine is open to all qualified individuals and complies with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act. Moreover, the school is committed to providing equal opportunities for all students. It endeavors to select applicants who have the ability to become highly competent general dentists, who are well prepared to enter private practice, or to enter graduate or residency training programs. Admission and retention decisions are based not only on prior satisfactory academic achievement, but also on non-academic factors that serve to insure that the candidates can complete the essential functions of the academic program required for graduation and perform adequately in their professional life. A candidate for the DMD degree must possess abilities and skills which include those that are observational, communicational, sensory/motor, intellectual/conceptual (integrative and quantitative), and behavioral/social. The use of trained intermediaries may not be acceptable in some clinical situations if it implies that a candidate’s judgment must be mediated by someone else’s power of selection and observation. Reasonable accommodations for qualified persons with disabilities can be made so long as such accommodations do not require a change in fundamental program requirements for the curriculum, create a direct threat to the health and safety of others, including patients, or create an undue burden to the state’s property. Candidates must be able to consistently, quickly, and accurately integrate all information received by whatever sense(s) employed, and they must have the intellectual ability to learn, integrate, analyze, and synthesize data. These principles are summarized in the Policy on Technical Standards for Dental Students document (Appendix 4.D), endorsed by the faculty in 2009. The standards state the minimum abilities and competence needed to withstand the curricular demands, pressures, and changing circumstances that characterize the practice of dentistry in accordance with professional accreditation standards. The document is available in the school’s website for the general community and potential candidates. During the interview process, candidates are handed the document and sign an acknowledgement letter stating their full understanding of this pre-matriculation health standard. Prior to registration, students are required to submit the Student Medical History Form signed by a licensed physician (Appendix 4.E). The form contains personal and demographic information, medical history, and evidence of a physical examination and immunization record, as required by law. The form also contains a sworn statement authorizing medical or hospital care for students under 21 and for older and married students. Student health information is recorded in a completely confidential medical record, following


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HIPAA and FERPA protocols. The documentation is requested by and must be submitted to the Office of Student Health, which maintains the records.

Once the student is registered, he/she can identify himself as a student with a handicap in the MSC Self-Identification of Disability Form (Appendix 4.F) for early management of these students by the Deanship for Student Affairs and/or faculty. Supportive Documentation

1. UPRSDM Policy on Technical Standards for Dental Students (Appendix 4.D) 2. Student Medical History Form (“Formulario médico de admisión para estudiantes de

nuevo ingreso al Recinto de Ciencias Médicas”) (Appendix 4.E) 3. MSC Self-Identification of Disability Form (Appendix 4.F)

4-7 There must be a mechanism for ready access to health care for students while they are enrolled in dental school.


All students enrolled in the School of Dental Medicine are required to have a health insurance plan throughout their years of study. During registration, students may apply for the health insurance plan offered by the University of Puerto Rico through a local insurance company, or submit evidence of comparable coverage by another plan (See UPR Medical Plan Benefits – Appendix 4.G) The campus provides health care services to all students free of charge at the Student Health Services Clinic located on the third floor of the main building. These are offered by a family physician with the assistance of a registered nurse, emphasizing health maintenance and prevention. The student health clinic routinely offers the Hepatitis B and Influenza vaccines, as well as antiviral medication and follow-up laboratory tests for cases of HIV occupational exposure, as established in the CDC Guidelines for such cases. Students may also receive evaluation and treatment for primary health conditions, first aid medication, and diagnostic tests at the clinic, and referral for x-rays and laboratory tests, specialized tests, emergency room visits, specialists’ visits, and hospitalizations. These services are all covered by the health insurance plan at local hospitals and health care facilities. The clinic is open Mondays through Fridays from 8:00 am to 5:00 pm. After regular hours, students may seek care at private health care facilities or at the Medical Center Emergency Room. All students receive information about health services during orientation week (Student Health Brochure – Appendix 4.H). The Counseling and Psychology Office of the SDM promotes the social, emotional and psychological well-being of students. Services are directed to assist students in coping


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with the demands of dental studies, support them while establishing personal and professional goals, and promote self-knowledge and healthy lifestyles. Should a medical condition develop, students are referred to the Student Health Services Clinic or a physician of her/his choice. In the event of a major medical or psychological emergency, students are instructed to contact the Assistant Dean for Student Affairs Office for proper management of the event.


1. UPR Medical Plan Benefits (Appendix 4.G) 2. Student Health Brochure (“Boletín Informativo de Servicios Médicos”)

(Appendix 4.H)

4-8 Students must be encouraged to be immunized against infectious diseases, such as mumps, measles, rubella and hepatitis B, prior to contact with patients and/or infectious objects or materials, in an effort to minimize the risk of infection to patients and dental personnel.


In compliance with local laws, the MSC requires that all students be immunized prior to the beginning of classes against Hepatitis B, tetanus, diphtheria, measles, mumps, varicella, and rubella (Student Medical History Form, Appendix 4.E) , Immunization Against Hepatitis B Policy, Appendix 4.I , Immunization Policies for: Tuberculin, Hepatitis B, Rubella, and Varicella , Appendix 4.J). All students are informed of this requirement at the time of admission and are instructed to present evidence of immunization at registration. The Student Health Services Clinic will prepare an annual schedule of immunizations and will also provide these services to those students who request them. The clinic issues a certificate of compliance when students fulfill this requirement. The certificate must be presented at the time of registration and enrollment. Students refusing immunization must sign an exoneration document (Appendix 4.K) stating the reasons for refusing immunization (those with a medical reason must present evidence with a medical certificate). This information is recorded in the student’s medical record and kept confidential under strict HIPAA and FERPA protocols. Supportive Documentation

1. Immunization Against Hepatitis B Policy (Appendix 4.I) 2. Immunization Policies for: Tuberculin, Hepatitis B, Rubella, and Varicella (Appendix

4.J) 3. Exoneration Document (Appendix 4.K)


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STANDARD 5 – PATIENT CARE SERVICES

5. 1 The dental school must conduct a formal system of quality assurance for

the patient care program that demonstrates evidence of: a. standards of care that are patient-centered, focused on comprehensive care and written in a format that facilitates assessment with measurable criteria; b. an ongoing review of a representative sample of patients and patient records to assess the appropriateness, necessity and quality of the care provided; c. mechanisms to determine the cause(s) of treatment deficiencies; and d. patient review policies, procedures, outcomes and corrective measures.

The University of Puerto Rico School of Dental Medicine complies with Standard

5.1. Description of the Quality Assurance Plan

The School of Dental Medicine has a Quality Assurance Plan for Patient Care since 1992 that assesses the quality of patient care by means of chart audits, patient satisfaction questionnaires, assessments of infection control and biohazard risk management, and the evaluation of patients in active and completed patient recall visits to assess quality of care. Mechanisms are in place to correct deficiencies and these, in turn, are evaluated. The plan is described in the Quality Assurance Program Manual included in Appendix5.A.

The school has a standing Quality Assurance Committee that oversees the program’s effectiveness and the implementation of corrective actions. The school is committed to high quality of care in all patient services. The Quality Assurance Manual describes the components of the program (including examples of forms/paperwork to be filled), the committee’s role, and the standards (parameters) of care. The Quality Assurance Program provides the necessary information for modifying and/or updating the curriculum in areas where deficiencies have been identified and provides reassurance in terms of the quality of the existing curriculum and delivery of patient care when the outcomes were expected (see Exhibit 5.1).

The Quality Assurance Plan assesses indicators in different areas or categories of patient services:

a) periodic evaluation of the active patient (Active Patient Recall System) b) post-treatment evaluation (Completed Patient Quality Form and Patient Satisfaction

Questionnaires) c) Completed Patient Recall System


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d) random sampling of Patient Satisfaction Questionnaires conducted at the main waiting room

e) record audits in each of the areas mentioned f) Restorative Sciences Department Quality Control Program g) Infection Control and Biohazard Risk Management, which is monitored on a daily

basis by the Infection Control Committee and by clinic team coordinators.

The Quality Assurance Program is based on quality assessment and improvement. It involves all members of the academic community Feedback from the stakeholders is of utmost importance. Administration, faculty, students, and staff are involved in different aspects of the program. The administration and faculty make sure patients receive quality care that is assessed by the Quality Assurance Committee. This committee has representation from the departments with clinical faculty and clinic administration. It collects data on all aspects identified in the Quality Assurance Program and analyzes results prior to reporting them to the department chairs and faculty in an annual meeting.

The Quality Assurance Committee is composed of faculty members who are in charge of the different areas of the program, the Infection Control Compliance Officer, a faculty representative from each department, and the school’s statistician. The Assistant Dean for Clinical Affairs and the three department directors are ex-officio members. Among the committee responsibilities are:

conduct the quality assessment of patient care develop and revise the standards of patient care conduct record audits to assess appropriateness, necessity, and quality of the care

provided develop and conduct patient review policies to determine causes of treatment

deficiencies submit recommendations for modifications to the approved program based on

outcomes

The quality assurance structure for the School of Dental Medicine is presented in the following diagram:


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Standard 5.1

INFECTION CONTROL & DAILY

CLINICAL EVALUATION

ACTIVE PATIENT RECALL

COMPLETED PATIENT RECALL & PATIENT

SATISFACTIONQUESTIONNAIRE

RESTORATIVE DEPARTMENT QUALITY

CONTROL PROGRAM

PATIENT CARE

QUALITY ASSESSMENT(STANDARDS OF CARE)

RECORDAUDITING

RECORDAUDITING

Exhibit 5.1QUALITY ASSURANCE PROGRAM

(UNDERGRADUATE PROGRAM)

DISSEMINATION OFINFORMATION

ANDRECOMMENDATIONS

- FACULTY MEETINGS- CURRICULUM COMMITTEE - DEPARTMENT DIRECTORS- ASSISTANT DEAN FOR CLINICAL AFFAIRS

CONSULTANTS:(FACULTY, STUDENTS AND

ADMINISTRATORS)

QUALITY ASSURANCE COMMITTEE

ACTION PLAN FOR CHANGEWHEN NECESSARY

PATIENT SATISFACTION

QUESTIONNAIRE AT CLINIC WAITING

AREAS AND THIRD YEAR REMOVABLE PROSTHODONTICS

DATA ANALYSIS

INSTITUTIONAL OUTCOMES ASSESSMENT

COMMITTEE


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Periodic evaluations and changes have been implemented in the Quality Assurance Program as a result of recommendations from faculty, staff, students, and administration. Examples of these are: changes in the way the forms and the data are collected and the dissemination of results at formal faculty meetings. As petitioned, the committee or any of its members presents the results in detail to sections and departments in meetings where specific changes and recommendations are further implemented. All recommendations and results are further discussed and presented to the SDM Institutional Outcomes Assessment Standing Committee.

A. Standards of care that are patient-centered, focused on comprehensive care and written in a format that facilitates assessment with measurable criteria

Comprehensive Care- The SDM follows the philosophy of patient-centered comprehensive care. This is done through a thorough medical and dental history and treatment plan that adjusts to the patient’s needs. All treatment plans are evaluated by general dentists in consultation with specialists, when needed. The treatment plan is sequenced with the emergency care first followed by the needed care. Patients with emergency care are treated at the clinic teams/modules. Although sporadic and specific care is not encouraged, limited care is referred to graduate clinics or faculty practice. Supervision of Care- All third and fourth year students’ clinical activity is divided into clinical teams supervised by faculty that act as team coordinators. Third year students clinical activity is supervised by clinical discipline faculty with the help of the coordinators that act as support and evaluators of patients’ comprehensive care. Clinic team coordinators and assigned faculty members are responsible for fourth year students’ clinical supervision. All students are required to obtain faculty approval at the start of each patient encounter. This assures approval of the planned treatment and instrument sterility. Daily faculty evaluation is done for every patient encounter. Students are evaluated at different levels of patient treatment, depending on the disciplines. Faculty evaluation is required upon treatment completion. Faculty signature is also required at the end of every patient encounter. Chart audits confirm compliance with clinic protocols, including the required signatures in patient records.

Development and implementation of the school’s standards of care

The School of Dental Medicine standards of care are based on recommendations and evaluation criteria established by the clinical disciplines, with the American Dental Association Parameters of Care as reference. The standards of care, which are patient-centered and focused on comprehensive care, serve as benchmarks for the evaluation criteria for each discipline. These standards are stated in the Quality Assurance Program Manual, (See Appendix 5.A). Conformance to the standards of care is measured by conventional quality assessment techniques, i.e., evaluating structure, processes, and outcomes. Efforts to improve measurement techniques are continuous. Examples of these are changes in data collection and forms to expedite patient evaluations.


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General Standards of Care

Every prospective patient is evaluated by faculty from the predoctoral program at the Oral Diagnosis Clinic in order to determine if the patient is appropriate for the predoctoral teaching clinics. During this initial visit, the staff makes an assessment of the patient’s general treatment needs, along with a determination of whether the patient understands and accepts that the treatment may take longer than in a private practice setting due to the educational nature of the institution. Once they acknowledge this, the necessary radiographs are recommended. Patient assignment is based on patient needs, making sure the students have diverse clinical experiences.

After evaluation by the faculty member, if the patient cannot be treated by the undergraduate students, the faculty member will make a referral to a more appropriate setting for clinical care. These settings may be a postgraduate clinic, faculty practice, or outside private practice.

The SDM is in compliance with local and federal applicable laws and regulations for non discrimination on the basis of race, color, national origin, gender, disability, sexual orientation, or age. No patient will be denied treatment because of these characteristics.

Once patients are accepted as patients of the predoctoral clinics, they are categorized depending on their treatment needs as regular or emergency patients. A regular patient is one with a completed comprehensive oral exam and accepted treatment plan who has been examined by a predoctoral clinical faculty member, in most instances an Oral Diagnosis faculty. A patient with an oral or dental emergency is one with a specific need for care, who is evaluated with a problem-focused oral examination and is admitted to the clinics in order to treat that specific need and receive follow-up. Patients with urgent oral or dental conditions are also evaluated and referred for appropriate treatment.

Predoctoral clinics emphasize patient-centered comprehensive care. Students serve as primary care providers and are responsible for the coordination of all their patients’ treatments. This is supervised and approved by their clinical team coordinators. Students may co-treat their patients with other students or postgraduate residents according to the patient’s needs.

Informed Consent- Patients are informed of their treatment needs, treatment options, treatment benefits and risks, as well as the risk of no treatment. These are presented along with the costs for their treatment. If patients approve, they sign the treatment form and receive a copy.

The predoctoral clinics are divided into third and fourth year clinical teams, with a coordinator for each. The team coordinator is a faculty member in charge of the students and patients assigned to that module. He/she acts as a mentor and evaluator and is responsible for the students’ clinical progress and the patients’ comprehensive care. At the end of the appointment, a faculty signature is required in the patient’s record. Please refer to the Clinic Manual (Appendix 2.I) for a detailed description of the clinical team coordinator responsibilities.

All patient records and information are protected and managed according to local and federal HIPAA laws. Access to patient records and information is restricted. Students


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only have access to the records of patients who are assigned to them for care. Patients have a right to access the information contained in their records with the approval of the Assistant Dean for Clinical Affairs.

Regular patients should have a periodic oral examination every 6-12 months, which should include an oral exam, medical history update, necessary radiographs, and prophylaxis.

At the end of the third year, all team coordinators perform an evaluation and audit of the patient records under the students’ care. All treatment plans are evaluated before the students are promoted to their fourth year. At the beginning of the fourth clinical year, the students present the patients under their care to the new team coordinator who revises treatment plans and assesses continuity of care. Upon completion of the process, the patient becomes part of the fourth year team/module patients.

Oral Diagnosis

Diagnosis consists of the determination of the cause of the patient’s dental problem and its classification into a category of disease or dysfunction. It is based upon the findings of the medical history, systems review, and clinical examination, including the type of pain, if any, stimuli that induce or relieve the pain, and the duration of pain. Diagnostic aids include radiographs as well as study models, electrical and/or thermal pulp tests, percussion, palpation, transillumination and laboratory screening tests, and/or cytology, when recommended. Pediatric Dentistry

Children and adolescents receive patient-centered comprehensive care. This includes initial comprehensive oral exam, medical updates and periodic oral exams, radiographs, and eruption pattern evaluations. Students identify problems and present treatment plans to pediatric dentistry faculty members. Once the faculty member evaluates the proposed and alternative treatment plan, the students present it to the patients and parents. They inform the parents and patients of identified problems and recommend treatment alternatives, including their cost. Once informed and if they approve, parents or legal guardians must sign the treatment plan, which states the clinical procedures included and costs.

Pediatric and adolescent treatment may include dental prophylaxis, scaling, oral hygiene education, fluoride treatment, sealants, restorative care, pulpotomies, stainless steel crowns, oral surgery, and space maintainers. Children and adolescents with special care needs or complex treatment are referred to the graduate program. Orthodontics

Predoctoral orthodontics treatment includes simple space maintenance, interceptive procedures (such as serial extractions), and limited tooth movement or guidance. More than one phase of active treatment may be necessary and removable and/or fixed appliances may be utilized. Students evaluate patients using all the necessary diagnostic aids such as, but not limited to diagnostic casts, panoramic and cephalometric radiographs, and occlusal


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evaluations. They then develop treatment, biomechanics, and retention plans. Age, skeletal growth pattern, remaining facial growth, and severity of malocclusion treatable by predoctoral students, as well as the patient’s needs and desires are all considered when formulating the orthodontic diagnosis and treatment plan. As determined by the orthodontics faculty, patients with treatment complexities not suitable for treatment by undergraduate students are referred to the graduate program clinic or to private practitioners. Preventive, Health Promotion, and Periodontics

Every regular patient, unless edentulous, is evaluated with a periodontal examination as part of the comprehensive and periodic oral exams. By means of the periodontal exam, students evaluate the patient’s periodontium for evidence of periodontal disease. Treatment can range from an oral prophylaxis to scaling and root planning with the use of antimicrobials. Periodontics faculty co-treats periodontal surgery cases or refer them to the faculty clinic. All patients are placed on a recall or maintenance schedule. The faculty evaluates students on their ability to diagnose periodontal conditions, accurately record probing depths, furcations, loss of attachment, mobility, bleeding upon probing, presence of calculus, management of periodontal disease, and establishment of appropriate recall visits. Endodontics

The students, under the supervision of the Endodontics faculty, evaluate teeth for pulpal and periapical health and for the possibility of endodontic treatment. Once the students and faculty evaluate the pulpal, periapical condition and tooth restorability, they determine the possible treatments. Students inform the patients of the diagnosis, prognosis, and treatment options. Depending on the complexity of the root canal (root curvature, presence of pulp stones, calcified canals, internal or external resorption, among others), the Endodontics faculty may refer the case to the graduate endodontics clinic. Students are expected and responsible for managing endodontic emergencies. Operative

The SDM emphasizes a minimally invasive approach to restorative dentistry. Students are taught that minimal lesions can be remineralized. If lesions have penetrated dentin and remineralization is not an option, a conventional restorative procedure is recommended. Faculty evaluates students on restorations based on established criteria and parameters of care. Refer to Standard 2- Clinical Evaluation Criteria Manual (Appendix 2.J). Fixed Prosthodontics

Patients are evaluated for the possible need for fixed prosthodontics. This may include crowns, fixed bridges, temporary crowns and bridges, or dental implants. The prosthodontics faculty evaluates the students’ diagnosis, treatment plan, and presentations. When multiple units are considered as treatment options, students are required to have their study models articulated for evaluation and treatment planning. Students also evaluate patients for periodontal health and all necessary periodontal treatment must be completed


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prior to beginning the fixed restorations. Third year dental students must be present and assist on the surgical phase of at least one implant case as part of the core implant course. The student performs the restoration on that patient during the fourth clinical year. Removable Prosthodontics

Partial Dentures – When partial dentures are a treatment option, oral tissues and periodontal treatment must be completed. Prior to treatment, students must evaluate and survey the study models in order to have a design approved by the faculty for a case presentation. After insertion, the patient will be scheduled for follow-up visits as needed to ensure the partial denture is functional and the patient is comfortable. This is evaluated at each periodic patient visit. Denture adjustments are performed as needed. Acrylic temporary partial dentures can be used immediately after extractions to replace missing teeth during healing and to preserve space, esthetics, and function.

Complete Dentures – Prior to fabrication, students evaluate the patient’s oral health by means of clinical exams, radiographs, and study models to assess the need for pre-prosthetic surgery. The complete dentures should extend to the mucobuccal fold, exhibit good peripheral seal, and cover the areas that are used for maximum support (hard palate, maxillary tuberosity, retromolar pad). The complete dentures should be comfortable, provide lip and cheek support, and allow the patient to occlude without soft tissue damage. Undergraduate students perform dentures adjustments as necessary to ensure patient comfort. They also perform immediate dentures, relining of dentures, and tissue conditioning as needed by the patient. Edentulous patients with severely absorbed ridges may need implants.

Oral Surgery

Oral surgery treatments include dentoalveolar surgery, (extractions, tori reductions, alveoloplasties), the management of dental trauma, orofacial infections, biopsies, and the diagnosis and management of hard and soft tissue pathology. Oral surgery faculty evaluates students in all aspects of patient treatment, from case selection to post-operative evaluation. Upon completion of treatment, patients receive verbal and written postoperative instructions along with any needed prescriptions for medications. Patients evaluated by the oral surgery faculty that cannot be treated in the undergraduate clinic are referred to the graduate program. Implant placement on patients is performed by oral surgery faculty and graduate program residents assisted by third or fourth year students.

B. Ongoing review of a representative sample of patients and patient records to assess the appropriateness, necessity and quality of the care provided

Description of the school’s patient records review process. How often are records audited, who performs the audits, examples of deficiencies found and corrective actions the school has taken.


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Another area evaluated in the Quality Assurance Program is that of Chart Audit/Dental Records Auditing System. This is an important component of the quality assurance assessment. Record room staff assigns a record number to every new patient and attaches all the necessary documents to be filled, as well as a list of the document sequence. Included in the documents to be filled are all the necessary HIPAA consent forms. Faculty members in charge of evaluating case presentations monitor that all documents are completed and signed by the patient or the legal guardian. The adequate recording and gathering of information is part of the students’ daily evaluation. The quality assurance chart auditing assessment exercises are conducted with the Active and Completed Patient Recall groups and at the third year removable prosthesis rotation as part of the complete denture cases done by the students. In the third year exercise, patients receive a Satisfaction Questionnaire and a Completed Patient Quality Checklist upon completion of the visit. The faculty member in charge of the chart/record auditing part of the Quality Assurance Program evaluates all the data collected and makes recommendations to the Quality Assurance Committee. The record audit includes: radiographic assessment to determine quality of the radiographic images, medical and comprehensive oral history, dental and periodontal charting, treatment plan, progress notes, and the evaluation of proper sequence of treatment. Auditing results have revealed the need to further emphasize the importance of better documentation in progress notes by identifying tooth number and dental materials in the left hand corner of the progress notes, specifically under the date of the patient visit whenever it applies. Another recommendation recently approved by the faculty during the 2011-2012 academic year was the elimination of the special patient record format used when the patient needed dental care in two or less clinical disciplines (i.e., operative and preventive). Other areas of non-compliance were the improper order of documents, absence of periodontal charting, and improper documentation of events. The school took corrective actions after these were presented in faculty meetings (See Record Audit Protocols Forms in the Quality Assurance Program Manual, Appendix 5.A and results in Appendix 5.B).

C. Mechanisms to determine the cause of treatment deficiencies

The standards of care are used as a guide for the development of the evaluation criteria for each of the clinical disciplines. Students are evaluated daily for each dental treatment performed in order to guarantee quality of patient care. Each academic discipline is responsible for faculty calibration and how to evaluate student quality of care. Procedures that do not meet the expectations are redone at no charge to the patient with the approval of the Assistant Dean for Clinical Affairs. If a student repeatedly fails to meet what is expected of his/her clinical work, the faculty along with the course director and dental module coordinator will plan remedial actions.

Quality of patient care is also reviewed and evaluated in the Active and Completed Patient Recall Programs.

The Active Patient Recall Program is responsible for the evaluation of quality of

patient care in active patients at the undergraduate program and an essential part of the Quality Assurance Program. The process consists of peer evaluations of active


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patients by fourth year dental students supervised by the faculty member in charge of the program with the assistance of other faculty members as consultants. Six students are assigned on a weekly basis to evaluate the quality of care in the work done by their peers. The evaluations run on Mondays, Tuesdays, and Thursdays, in morning and afternoon sessions of two patients per session. All fourth year students must rotate through the program, collect data, complete the evaluation forms and discuss their findings through a comprehensive case presentation in order to receive credit for their participation. The student, under supervision of a faculty member, evaluates the patient to assess the comprehensive treatment received and the appropriateness, timeliness, and acceptability of care. Students also provide preventive services at the rotation. Consultations with specialists are done as needed. The evaluation also includes patient satisfaction and chart audit evaluations, which are required. Results are tabulated and presented at the Quality Assurance meetings and to faculty at faculty meetings each academic year. The faculty member in charge of the program is part of the Quality Assurance Committee and is responsible for presenting the assessment results, which are discussed and evaluated by department directors and their faculty. The school implements corrective measures when deficiencies are found. For example, a deficiency in fixed temporary restorations was presented to the Quality Assurance Committee and the Restorative Sciences Department Director. The faculty addressed the problem and increased the number of temporary fixed crown and bridges pre-clinical lab projects. This led to an improvement in the performance of students at the clinic.

The Completed Patient Recall Program is responsible for the evaluation of quality of care in completed patients at the undergraduate program and an essential part of the Quality Assurance Program. Patients are evaluated in the same clinical disciplines as in the Active Patient Recall System. Fourth year students must rotate through this program twice in the academic year in order to receive an evaluation. The purpose of the rotation is to assess appropriateness, acceptability of the treatment provided after a period of time, and patient satisfaction. The rotation runs Tuesdays and Thursdays in morning and afternoon sessions, with two students per session. The staff member appointed to the program selects patients from a group of completed patients. Students evaluate patients for quality of treatment (peer review), following the established criteria in an encounter form. They administer the Patient Satisfaction Survey, conduct a complete record audit, an oral health status evaluation, and an oral prophylaxis as part of the rotation. A new treatment plan may be recommended as a result of the clinical appraisal. After consultations, the student may continue with the patient care or the case is referred to another student. Evaluations for both recall programs are part of the preventive care competency evaluation in the fourth year Comprehensive Care Clinic course.

In order to collect uniform data and conduct comparable assessments, both systems

have used the same evaluation forms since 2006, with periodic revisions. The Active and Completed Patient Recall systems facilitate the flow of information to the clinical disciplines and facilitate improvements in the quality of services rendered. Examples of actions taken are: preparing temporary bridges before patient visits in order to enhance time management


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when treating patients, increasing supervision time of prosthodontics faculty in removable prosthesis procedures, and reviewing and following-up of signatures in the Quality Control Evaluation Form of the Restorative Sciences Department Quality Control Program. The school has made an effort to address the importance of all patients receiving oral health education through either the plaque control program or periodontal education. The Oral Diagnosis Section and the Restorative Sciences Department have conducted follow-up meetings in order to assure the inclusion of the preventive and recall visits in all patient records. Please refer to Quality Assurance Outcomes Results and Actions Taken Report, Appendix 5.C.

Data collected from both the active and completed patient recall groups indicates that the percentage of acceptability of treatment in fixed and removable prosthetic treatments for both groups has ranged yearly since 2006 between 90%-96%, meeting or exceeding the 90% benchmark. One hundred percent (100%) acceptability was observed in the completed endodontics patients recall group for root canal treatments in all years evaluated. The only exception was an 87.5% in the 2009-2010 academic year due to contaminated canals as a result of the lack of a final restoration, but not directly related to the endodontic treatment. For the oral surgery treatments evaluated in the active patient recall group, the percentage of acceptability was 99%, exceeding the benchmark. In operative dentistry there was a 95% rate of acceptability. In the completed patient recall group, the school is close to the 90% benchmark for both clinics. Although the percentage of acceptability is above the 90% benchmark, the faculty will improve calibration in operative dentistry in order to correct the identified deficiencies. An 82% of acceptability was found in oral diagnosis in the active patient recall group. The Quality Assurance Committee identified specific deficiencies which were discussed with the Oral Diagnosis Section Chief. The committee requested specific corrective actions, evidence of which will be available on site.

The Record audits and patient satisfaction surveys are used to review the non-clinical standards of care and are an essential part of the Quality Assurance Program. The Quality Assurance Committee continuously reviews the data reports and makes recommendations when it identifies deficiencies. As an example, it identified the absence of the periodontal charting from some of the records audited. The finding was discussed by the committee, which took immediate action and informed the Oral Diagnosis Section and the faculty involved in case presentations. The quality indicator of acceptability improved as a result.

Patient satisfaction is of utmost importance to the SDM. The Quality Assurance Committee designed a Patient Satisfaction Survey instrument to obtain this information. This survey serves as another assessment tool to gauge the appropriateness and acceptability of care, to place patients in the completed patient recall group for visits, and to assess patient satisfaction with the service rendered. The Completed Patient Satisfaction Surveys are conducted at the completion of the dental treatment in the third year Removable Prosthesis Rotation and in the fourth year Comprehensive Care Clinic. Students fill an updated clinical evaluation form for the completed patient, Patient Quality Checklist, which is reviewed by a faculty member. A completed patient satisfaction survey is administered to the patient at this appointment. Other patient satisfaction surveys are conducted once a year at a random date, selecting all active and willing patients in the waiting room area of the main clinic. This


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survey is conducted by the Academic Affairs Office. All surveys are analyzed and compared. The results are presented in faculty meetings. For the years 2009 to 2011, 65% of the patients surveyed were women. The main reasons for the first visit were that the clinic was recommended by family or friends and also due to a personal interest in receiving the services. For 98% of those surveyed, the most influential factor for the decision to receive treatment was the trust in the quality of service, the treatment cost, and the prompt attention. Ninety-two (92%) of the patients reported that the dental student or dentist explained the treatment and 95% reported they approved the treatment plan. In general, 95% of the patients were satisfied with the quality of the service rendered and 98% would recommend the SDM clinics to other patients (Sample Patient Satisfaction Report, Appendix 5-D).

The Assistant Dean of Clinical Affairs created a log for treatment remakes. Faculty

refers these cases to the Assistant Dean with the reasons for the remake and the necessary consults are done. The log serves as another method to measure the quality of care provided. Please refer to the Quality Assurance Program Manual Appendix 5.A.

D. Patient review policies, procedures, outcomes, and corrective measures Description of how the school determines patient treatment deficiencies, outcomes of the reviews, and how the deficiencies are corrected The SDM utilizes several ways to assess outcomes of care and determine patient

treatment deficiencies. These include faculty daily clinical evaluations and direct supervision of care, active and completed patients recall evaluations, chart audits (as presented in 5.1 b), peer reviews, patient satisfaction surveys, clinic team coordinators’ patient evaluations and clearance at the end of both third and fourth years, and quality assurance reports and periodic reviews of infection control and risk management. Faculty Evaluation- Faculty members are required to evaluate the treatment rendered during each clinical session. Faculty signatures in patient records verify that supervision of the clinical work has occurred. Daily evaluations are also evidence of patient evaluation and approval of treatment outcomes. If the treatment is not acceptable, the student must redo it either immediately or in the next clinic encounter. The type of remediation is determined by the supervising faculty taking into consideration the patient’s well-being. When students present continuous difficulty with any given treatment, the supervising faculty recommends a remediation plan in coordination and with the recommendations of the course director and the clinic team coordinator.

As described before, the Active and Completed Patient Recall Programs assess the outcomes of care at different stages in patient care. Students rotate under the supervision of the faculty that coordinate the programs and do peer evaluations, patient satisfaction surveys, chart audits, and clinical evaluations with the aid of radiographs. Students present their cases to the supervising faculty who evaluate treatment outcomes and consult with specialties as needed. In some cases the faculty recommends a new treatment plan and students correct the deficiencies. Oral prophylaxis is part of the recall visit for all patients who need it. The Quality Assurance Committee collects and analyzes data and makes recommendations to


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department directors and faculty as needed (See Quality Assurance Outcomes Results and Actions Taken Report, Appendix5.C).

Patient Satisfaction Surveys are another ways of assessing patient opinions of the quality of services rendered. Surveys are conducted at the completed patient recall visits and once the third year removable prosthesis rotation is completed and dentures are inserted. These are also conducted at the main clinic patient waiting area at least once a year. Patient satisfaction has been above the 90% benchmark in most of the areas assessed (Patient Satisfaction Surveys are included in Quality Assurance Manual, Appendix 5-A, Sample of Results, Appendix 5-D).

The Restorative Sciences Department Quality Control Program for all prosthetic appliances inserted at the undergraduate clinics has been in place since 1992. Its purpose is to evaluate all steps in the fabrication of the appliances prior to insertion. The faculty members in charge make sure the appliances comply with each critical step in prosthesis construction, as required by the department and included in a form designed for the evaluation. Please refer to the Quality Assurance Manual, Appendix 5.A. Examples of steps are: periodontal condition, diagnostic wax-up for fixed dentures, final impression, dies, and articulating working cast, metal casting, and final porcelain. Each step is evaluated and approved by a clinical faculty member and a Restorative Sciences Department Quality Assurance member prior to allowing the student to continue until final insertion. Modifications done to the program have had an impact on faculty calibration, students’ clinical experience with commercial laboratories, interdepartmental integration, and controlling risk factors for treatment failure.

Students’ compliance with infection control and clinic protocols is measured in the daily evaluations. These assure the use of proper techniques, compliance with standards of care, and quality of care. This is done by immediate feedback from supervising faculty in order to offer the best treatment alternatives by all the disciplines involved in patient care. Non-compliance with infection control protocols is monitored by all faculty members and staff. Infection Control Committee members and the Infection Control Compliance Officer conduct unannounced inspections. The SDM also has an Infection Control and Risk Management consultant who is the committee president and is responsible for the annual evaluation of the protocols. This consultant makes recommendations regarding proper actions to address non-compliance and gives orientations to the academic community regarding changes in rules and regulations. The results of the inspections are presented and discussed in the Infection Control Committee and recommendations are presented to the Quality Assurance Committee and the Assistant Dean for Clinical Affairs for immediate actions. An immediate removal of the student from the clinic may be authorized by any faculty member or supporting staff if major breaches of non-compliance are detected. The care of the patient is of utmost importance and the faculty member evaluating the treatment is responsible for the culmination of care. Supportive Documentation

1. Quality Assurance Program Manual (Appendix 5.A)


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2. Patient Record Audit Results (Appendix 5.B) 3. Quality Assurance Outcomes and Actions Taken Report 2007-2011 (Appendix 5.C) 4. Sample Patient Satisfaction Results (Appendix 5.D)

5.2 The use of quantitative criteria for student’s advancement and graduation must not compromise the delivery of comprehensive patient care.

The University of Puerto Rico School of Dental Medicine complies with Standard 5.2. Description

Clinical Teaching Philosophy Predoctoral students at the UPRSDM are required to adopt a comprehensive patient care approach with all assigned patients, except emergency cases. The concept of comprehensive care is introduced during the preclinical courses and is further explained by the Assistant Dean for Clinical Affairs during the introduction to clinic orientation week, a requirement for third year students before beginning their clinical experience. All third and fourth year students receive a copy of the Clinic Manual (Appendix 2.I) which states the school’s philosophy on comprehensive patient care:

Comprehensive Patient Care is defined as the ability to create a system of clinical procedures which permits students to provide patient care in a manner closely related to the way in which they will conduct their practice after graduation. It may include the following: 1. The examination and evaluation of patients, including the patient’s medical and

systemic condition. 2. Identification and recording of dental problems presented by the patients. 3. Prescribing an individualized treatment plan and being able to perform the care

required by the patients, including care related to the several disciplines of dentistry.

4. Recognizing and accepting the need to refer patients to a dental specialist if the scope of the required treatment is beyond the capability of the general practitioner.

5. Retaining the responsibility for care while authorizing others to provide specific services delegated by students with the authorization of a faculty member.

6. Maintaining a proper recall evaluation system for all assigned patients while under the student’s care.

The comprehensive treatment philosophy is explained to patients during their initial screening visit at the Oral Diagnosis and Pediatric Dentistry Clinics. Patients are encouraged to ask questions or express their concerns regarding their treatment at anytime. They are


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instructed to ask their assigned student first. If they still have questions or doubts, they can ask the faculty assigned to the area, the Clinical Team Leader, or seek help at the office of the Assistant Dean for Clinical Affairs.

The brochure Salud Oral: Parte Esencial De Su Salud General (Appendix 5-E) given

to patients interested in dental treatment, describes comprehensive (complete) dental and emergency treatments. The brochure also informs patients on how to apply for each service. Patients requesting emergency dental treatment are required to sign a waiver form (Waiver Form for Dental Emergency Clinic - available on site) releasing the School of Dental Medicine from the responsibility of providing any treatment other than that specified for the emergency.

Dental Clinical Curriculum The curriculum at the UPRSDM is competency based, following a clinical program based on comprehensive care to patients. The Clinical Evaluation Criteria Manual (Appendix 2.J) establishes and outlines the students’ clinical performance criteria for achieving clinical competency in each discipline. Students are required to meet specific minimum quantitative and qualitative criteria regarding dental procedures in order to request and be considered for promotion tests. These include third year examinations offered by some clinical disciplines and competency examinations in the fourth year. The clinical evaluation policy is based mainly on the quality of performance and, as stated in the Clinic Manual, “completing the minimum experiences established by each discipline does not in itself imply the attainment of an acceptable standard of performance” (Appendix 2.I). Both third and fourth year students are evaluated in accordance to this same method and philosophy. The patient’s individualized comprehensive treatment plan is determined in the oral diagnosis case presentation. Students must meet the oral diagnosis clinic criteria for case presentations (included in the Oral Diagnosis Clinical Rotation, PRET 7396, course description). During the case presentation visit, they review the patient’s dental record, including medical and dental histories, determine the patient’s oral condition, assess the oral and dental diagnosis, and discuss the complete treatment plan prior to its approval. Faculty and students discuss the treatment plan and explain it to the patient. The treatment plan must reflect the patient’s needs, taking into consideration his/her complete or comprehensive oral health and other pertinent information. During the discussion of the detailed treatment plan, students inform the patient of the various options available, the expected outcomes of each treatment, and the potential risks of deviation from the plan. They also explain the option and risks of no treatment. The faculty approves a treatment plan designed according to the patient’s needs and priorities. Once the treatment plan is approved, it is signed in the patient’s record by the student, patient, and faculty member who approved the plan. The student also enters the patient’s information and treatment plan in a sequential order into the clinic computerized program, which must also be approved digitally by the same faculty who approved the case presentation, or by the student’s Clinical Team Coordinator, after reviewing the findings and the approval form signed by the evaluating faculty.


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Patients sign a copy of the complete treatment plan approved during the case presentation visit, as evidence that they received an explanation of the recommended treatment plan. Patients receive a copy of the treatment plan (in the recommended sequence) and the cost of all procedures. When the oral diagnosis case presentation is completed and the treatment plan approved, the student schedules appointments for the patient to complete the treatment plan and meet the established dental care needs. All dental services are provided to patients under the supervision of the faculty members assigned to the clinical teams to which the students are assigned. Faculty members and clinical team leaders ensure that the patient’s treatment plan is followed in the specified sequential order. The faculty member working with the student must review the treatment plan and all previous completed treatment in the patient’s record and the computerized system. This ensures that the treatment is carried out in the appropriate order and that the students’ needs do not take priority over the patient’s wellness. Clinical Course Coordinators receive a student evaluation report for all dental procedures performed by the student (Student Evaluation Report). At all times, faculty oversee that patients receive the complete approved treatment. Every three (3) months, an audit of all patients assigned to students is conducted by the Clinical Team Leader and the office of the Assistant Dean for Clinical Affairs, using the Report for Clinical Faculty (see below) and records, in order to make certain that all patients are being treated in a timely manner. The report is available through the clinic computerized program for those with password privileges assigned by the Assistant Dean for Clinical Affairs. Patient abandonment is strictly prohibited and penalized with suspension from the clinic until the patient is contacted and his/her treatment brought up-to-date. Patient re-assignment, transfer, or referral is only permitted with the approval of the faculty (clinical instructor), and must not compromise the order of the comprehensive treatment plan. It may only be authorized by the Clinical Team Coordinator, with the patient’s consent and taking into consideration the well-being of the patient as a priority. Patients may be transferred to another predoctoral student, referred to any of the postdoctoral programs, the intramural faculty practice, or to a private practice if the comprehensive treatment needs of the patient exceed the school’s ability to deliver care.

Clinic Reports The computerized program for the administration of clinical activities provides forms and reports on student performance, among them:

Patient Encounter Form: Students print this form on the day of a given appointment. It includes the patient, student, and faculty identification, date and time, clinic discipline, procedure, and cost. The procedure indicates the sequential order of the treatment steps according to the established plan. This form can be used to verify that the student has followed the recommended sequence for the patient’s treatment. It is signed by the patient at the beginning of the appointment and by the cashier, as evidence of payment for the procedure. The same form can be used for daily student activity


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evaluations upon completion of the procedures. The appointment and student daily evaluation forms (Patient Encounter Form) include professional development as the first area to be evaluated.

Patient Treatment Plan Form: This form is used upon completion of a case

presentation. It includes student, patient, faculty identification, date of the case presentation (approval of the treatment plan), and all dental treatments, in the recommended sequence. Faculty members and Clinical Module Coordinators who approve the treatment plan ensure that all information is included accurately and in the recommended order. The form includes all procedures, intermediate procedures, and the fees for each detailed treatment. Once approved, the patient, student, and faculty member sign the form. . The treatment plan is entered into the computerized system in the same order that it was approved, a printout is filed in the patient’s clinical record, and a copy is given to the patient for his/her personal file.

Student Evaluation Report: This report provides the daily evaluation/grade a

student receives for any given procedure. It can be searched by Clinical Course Directors and provides information by clinical discipline and specific evaluation criteria.

Report for Clinical Faculty: This report provides information by student and

patient name. The names of all patients assigned to a particular student can be searched to monitor the progress of the approved treatment plans. The report displays those procedures which have not been completed, those completed with the date of completion, those that have been evaluated (by student and faculty), and whether payments have been received. This is used along with patient record audits, to assess the progress of the treatment provided to the patient, as well as the frequency with which the patient has been receiving treatment, and the status of each appointment.

Clinic Activity-Progress Report: Every trimester, the Assistant Dean for

Clinical Affairs evaluates the students’ computerized reports for clinical activities and monitors patient status. After the initial patient screening visit, all patients can be monitored and their status assessed whether they are currently assigned to a student or on the waiting list. This report also shows the date of the patient’s last visit. In the event that treatment for a patient has been delayed for more than one month, the Assistant Dean for Clinical Affairs informs the Clinical Team Coordinators (for third and fourth year students), and the Associate Dean in order to implement immediate corrective measures. The Report for Clinical Faculty can provide more specific details of a patient’s treatment, if needed.


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Patient Management by Third Year Students

Third year students are organized in clinical teams, with a coordinator that supervises the student’s administrative and clinical performance. During the first semester of their third year, students are assigned to a clinical rotation in Oral Diagnosis. Intentionally, this rotation is given priority during the first semester in order for the students to adequately diagnose and produce treatment plans for their patients. Students are allowed to make appointments with the other clinical disciplines to treat patients according to their treatment plans.

After patients have been evaluated in the first screening visit to the Oral Diagnosis

Clinic, they are assigned to a student. Students provide treatment to the assigned patients during the scheduled clinical time, starting with the rotation in Oral Diagnosis, once the faculty of the Oral Diagnosis Clinic has approved the comprehensive treatment plan during the case presentation, and the Clinical Team Coordinator approves the treatment plan in the computerized system. The faculty and Team Coordinator ensure that the treatment is performed in accordance with the order of the treatment plan and assuring the comprehensive treatment of the patient during the year.

The last activity a student performs at the end of the third year is to review all treated

patients/records with his/her assigned Clinic Team Coordinator. Every patient record is assessed (audited) and verified for appropriate delivery of dental treatment at the clinic and for information on the clinical status of each assigned patient. Patients whose treatment is completed during the students’ third year are assigned to the completed patient recall system. Any patient whose treatment has not been completed, due to the complexity of the case or because the patient was assigned at the end of the year is identified for adequate follow-up. This auditing is another way of verifying the adequacy, timeliness, and sequence of the treatment provided. It also provides the Clinic Team Coordinator with information on the patient pool that each student has had available during the third year, how the student managed his/her time and the progress of the patients’ treatment. According to their needs, patients may either remain assigned to the student for the incoming fourth year (i.e., third year student continuing treatment), reassigned to another student, or referred to a postdoctoral program or to the Faculty Clinic. Students are responsible for the dental treatment and dental emergencies of all assigned patients.

Patient Management by Fourth Year Students

Consistent with the comprehensive care model, students are expected to continue treating their patients without delay, after completing the minimal experiences of their third year curriculum. To guarantee continuity of care, all extra experiences performed by the student during their third year are credited towards the minimal experiences outlined in their fourth year curriculum. Besides continuing treatment of third year patients, fourth year students are assigned a group of new patients for comprehensive care. The fourth year Clinic Team Coordinator uses the patient auditing information obtained at the end of the third year as an aid to determine which experiences the students need to perform, as well as those needing to be reinforced. The final objective is to demonstrate competency in the clinical disciplines while providing comprehensive treatment to patients. All additional patients


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assigned to students are incorporated into the student’s patient family that may have resulted from the third year.

The fourth year clinic has been designed in a manner that enables students to provide

treatment to patients in a setting resembling a private practice. The fourth year class is divided into five teams, each supervised by a Clinic Team Coordinator. Other faculty members, in addition to the Coordinator, are assigned to clinical supervision duties in each team.

The Team Coordinator or faculty member in charge may evaluate the delivery of

treatment to patients anytime. Clinical faculty or the Clinic Team Coordinator, along with the student, may determine if the patient’s treatment should be completed by someone other than the assigned student. Students must provide complete patient treatment in a continuous manner, which includes: 1) examining and evaluating a patient, 2) diagnosing correctly and recommending a treatment plan, including preventive measures 3) providing direct dental care treatment to all assigned patients, following an agreed treatment sequence, until treatment completion, and 4) referring patients to a dental specialist or other health professional, if needed.

At the end of the fourth year, students must again discuss all treated patients with the Clinic Team Coordinator. This activity verifies the completion of the patient’s dental treatment, and identifies any patient whose treatment has not been completed. Completed patients are referred to the Completed Patient Recall system. Patients whose treatment has not been completed are evaluated. The patient will either continue as a patient in the same Clinical Team with the entering fourth year students, or referred elsewhere for treatment completion (faculty practice, postdoctoral programs, or private practice), thus assuring comprehensive treatment. Supportive Documentation 1. Clinic Manual (Appendix 2.I) 2. “Salud Oral: Parte Esencial De Su Salud General” (Appendix 5.E) 3. Clinical Evaluation Criteria Manual (Appendix 2.J) 4. Waiver Form for Dental Emergency Clinic (Available on site)


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5.3 The dental school must have developed and distributed to all appropriate students, faculty, staff, and to each patient a written statement of patients’ rights.

The University of Puerto Rico School of Dental Medicine complies with Standard 5.3.

The school has a written patient rights statement in Spanish and English. During the patients’ first visit they receive the statement along with the HIPAA disclosure/consent form. These are in the Request for Treatment form, which is handed out to all patients requesting services at the clinic (General Information for Patients of the Dental Clinic, Appendix 5.F, Patient’s Rights and Responsibilities, Appendix 5.G). Patient’s rights and responsibilities statement posters from the local government Patient Ombudsperson Office are also posted on the walls of all patient waiting areas. All clinical faculty, third and fourth year students, as well as clinical support staff are informed of patients’ rights in the Clinic Manual (Appendix 2-I), which is distributed to all students when they begin their third year and to any new clinical faculty and support staff when they begin clinical duties. If rights are revised, these are given out to all personnel and students. Additional copies of the Clinic Manual are available at the Office of the Assistant Dean for Clinical Affairs, and given to clinical personnel upon request. Additionally, the patient rights and responsibilities document is distributed to all faculty, students, and staff by email on a yearly basis. Supportive Documentation

1. General Information for Patients of the Dental Clinic, English and Spanish Versions (Appendix 5.F) 2. Patient’s Rights and Responsibilities Statement (Appendix 5.G) 3. Clinic Manual (Appendix 2.I)


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5.4 The dental school must ensure that active patients have access to professional

services at all times for the diagnosis and management of dental emergencies.

The University of Puerto Rico School of Dental Medicine complies with Standard 5.4. Description All patients are provided professional services for the diagnosis and management of dental, oral, or orofacial emergencies at all times. Patients with dental emergencies, regardless of whether they are non-registered or registered patients, are accepted during the week between 7:30am – 11:00am and 12:00pm – 2:00pm, on a walk-in basis, at the Oral Diagnosis Clinic. Dental emergency patients are screened by clinic faculty and referred to the D4 Clinical Team, assigned to dental emergencies for the corresponding day. Cases beyond the expertise of predoctoral students are referred to other pertinent clinical areas (i.e., Oral and Maxillofacial Clinic, post-graduate programs or Faculty Clinic).

Patients Presenting with Dental Emergencies during Working Hours In the case of non-registered patients, they must register and provide their demographic data. Dental emergencies are screened by the Oral Diagnosis Clinic faculty to determine if they are true dental emergencies. Patients are informed about their rights and responsibilities during their screening. D4 students assigned to the emergency rotation or any other pertinent clinical area are notified by the oral diagnosis clinic staff that a patient has arrived. Once informed, the assigned student or resident requests the patient’s documents from the Oral Diagnosis Clinic and requests a record number for the patient at the Record Room Office, where the patient’s dental records are released to the student. All management and treatment provided to dental emergency patients by the students is supervised and evaluated by a faculty a member. If the patient is under active treatment and has been previously assigned to a student for comprehensive patient care, the student must manage the emergency of his/her patient. If the student is unavailable to provide the treatment, or the patient has not been assigned to a specific student for comprehensive care, the patient’s case is handled following the same procedure described above for a non-registered patient.

Patients Presenting with Dental Emergencies after Working Hours

Patients presenting dental emergencies after working hours and/or on week-ends are treated by the General Practice Residency (GPR), Pediatric Dentistry Residency (PDR), or the Oral and Maxillofacial Surgery (OMS) postdoctoral students at the Medical Center. Registered patients are instructed by their assigned students regarding the appropriate measures to be taken in case they require emergency dental treatment. Patients are instructed


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to request treatment at the emergency room of the Puerto Rico Medical Center. Upon arriving at the emergency room, the patient must inform the staff that he/she has a dental emergency. The staff of the Emergency Room will call the resident on duty of one of the school’s programs depending on the patient’s age and condition. Instructions to patients regarding this procedure are also displayed on the school website and recorded on the school telephone answering system. The dental emergency patient management protocol is specified in the Clinic Manual (Appendix 2.I). Patients also receive information regarding how and where to request dental emergency treatment in the Dental Clinic brochure “Salud Oral: Parte Esencial de su Salud General” (Appendix 5.E). Information is also printed on the back of the patient’s appointment card (Appendix 5.H), and posted on the walls of the waiting room. Supportive Documentation

1. Clinic Manual (Appendix 2.I) 2. “Salud Oral: Parte Esencial de su Salud Total” (Appendix 5.E) 3. Patient Appointment Card (Appendix 5.H)

5-5 All students, faculty and support staff involved in the direct provision of patient

care must be continuously recognized in basic life support (B.L.S.), including cardiopulmonary resuscitation, and must be able to manage common medical emergencies.

The University of Puerto Rico School of Dental Medicine is in compliance with Standard 5.5.

Description

The School of Dental Medicine has a formal Policy on Basic Life Support

Recognition (available on site). All students are required to take courses on basic life support and management of common medical emergencies and be certified in cardiopulmonary resuscitation (CPR) at all times during their four year program. In the curriculum, students are first introduced during the freshman year to basic life support skills in the course EVDI 7105 Assessment and Diagnosis I, in which they are certified in cardiopulmonary resuscitation (CPR) by an official instructor from the American Heart Association. This is mandatory in order to prepare students for their early clinical experiences. After the two initial years (D1 and D2), and prior to their junior year (D3), they are again re-certified in basic life support before entering their clinical years. Students admitted to the advanced international student placement program are also required to take the course before beginning their training.


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The School of Dental Medicine, through the Office of Continuing Education offers all clinical personnel, staff and faculty, the continuous opportunity to take B.L.S. courses. Once a year, a course on the management of medical emergencies is also offered to everyone. The Assistant Dean for Clinical Affairs maintains a record of all faculty and support staff’s B.L.S. certificates (Summary Log of Basic Life Support Certification – Appendix 5.I). In terms of emergency equipment, the school has several complete emergency kits, automatic external defibrillators, and oxygen units. All equipment is inspected regularly according to local laws by a company under contract.

The School of Dental Medicine has formal written policies regarding the management of medical emergencies which are included in two documents: Protocol for the Management of Acute Medical Emergencies in the Dental Clinic (Appendix 2.U), and Manual for Practical Management of Common Medical Emergencies in the Dental Office (available on site). The protocol establishes roles, responsibilities, emergency exits and other relevant procedures. Announced and unannounced emergency drills are performed in the clinic at least twice a year. Emergencies are simulated at random in the Oral Surgery Clinic to test the students’ readiness to handle emergencies. Three emergency teams are assigned to assist in case of real emergencies. Each team is composed of a faculty member, a student, and two dental assistants. Supportive Documentation

1. Policy on Basic Life Support Recognition (Available on site) 2. Summary Log of Basic Life Support Certification (Appendix 5.I). 3. Clinic Manual (Appendix 2.I) 4. Salud Oral: Parte Esencial de su Salud General (Appendix 5.E) 5. Protocol for the Management of Acute Medical Emergencies in the Dental Clinic

(Appendix 2.U) 6. Manual for Practical Management of Common Medical Emergencies in the

Dental Office (Available on site) 5-6 Written policies and procedures must be in place for the safe use of ionizing

radiation.


Description

The School of Dental Medicine has written policies regarding ionizing radiation and radiograph prescription. These policies comply with the 2004 revision of the document The Selection of Patients for Dental Examinations, published by the American Dental


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Association and the U.S. Department of Health and Human Services. The University of Puerto Rico School of Dental Medicine Institutional Policies for the Safe Use of Ionizing Radiation provides the criteria for patient selection and frequency of exposing and retaking radiographs on patients. These policies are included in the school’s Clinic Manual (Appendix 2.I). The radiographic equipment at the school is inspected annually by local authorities and is either updated or replaced periodically if needed. All the radiographic equipment available at the clinics and laboratories complies with Title 21, Code of Federal Regulations, Sections 1020.30-33, on the Performance Standard for Diagnostic X-ray Systems and their Major Components.

The school has acquired digital intraoral x-ray sensor units for all x-ray areas, digital

panoramic/cephalometric units, and a Cone Beam CT unit. The benefits of digital imaging include: reduced radiation exposure, the advantage of sensitivity that may enhance image analysis, and the implementation of electronic health records. Faculty, staff and students are currently in training on the use and management of the equipment and software used to obtain digital images. The school expects to be fully operational in digital radiology sometime during academic year 2012-2013. It will maintain traditional radiography as back-up.

All documents pertaining to the safe use of ionizing radiation are kept in the Office of the Assistant Dean for Clinical Affairs. Among these are reports on radiographic equipment inspections, radiation control, and radiation dosimeters of faculty and staff working near radiographic equipment (Available on site). The films from the badge dosimeters are sent at the end of each month to an external laboratory that analyzes the data and submits a monthly report to the school. Supportive Documentation

1. X-Ray units’ inspection logs (Available on site). 2. Radiographic Equipment Report (Available on site). 3. Radiation Control Reports from the Puerto Rico Health Department Commission

on Radiation Control (Available on site). 4. Radiation Dosimeter Reports (Available on site).

5-7 The dental school must establish and enforce a mechanism to ensure adequate

preclinical/clinical/laboratory asepsis, infection and biohazard control and disposal of hazardous waste.



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Description The School of Dental Medicine has the Infection Control and Risk Management Protocols (Appendix 5.J) in place to ensure adequate preclinical, clinical, and laboratory asepsis, infection and biohazard control, and the adequate disposal of hazardous waste. The protocols are revised yearly to adapt new techniques and to comply with local, federal, and university regulations. The protocols follow CDC, ADA, OSHA, and OSAP guidelines and are based on federal and local laws. Compliance with the protocols is mandatory for the academic community of the SDM. The SDM Infection Control Consultant provides annual trainings to faculty, staff, and students in all infection control and waste management protocols and policies. Students are introduced to the protocols during their first year in the Professional Development I (DESP 7117) course in an introductory conference and in the Professional Development II (DESP 7127) course which covers core infection control, ergonomics, and risk management course. Students review what has been presented in the previous courses during the third year Clinic Orientation Seminar where all clinical protocols are discussed and in the Review for the National Boards Dental Examination II (PRET 7326) course at the end of their third year. Graduate students discuss the SDM protocols during their orientation seminars and in annual trainings scheduled by each program. Students in the Advanced Placement Program for International Students are introduced to the protocols during their summer course Preparatory Clinical and Academic Integration for International Students. (Available on site). The faculty and staff enforce compliance with all protocols. Clinical faculty is responsible for monitoring adequate infection control procedures in all dental treatments. Daily evaluation of infection control and follow-up on compliance with the school’s regulations is performed for every treatment rendered. Written reminders of specific aspects of infection control and risk management are placed in all clinical and laboratory areas. The Infection Control Committee and the Infection Control Compliance Officer (ICCO) (Results of Infection Control Monitoring Program, Appendix 5-K) conduct unannounced inspections in clinics and laboratories. These are done throughout the academic year at the undergraduate and graduate programs. Infractions must be corrected immediately. Course directors, faculty, and staff conducting educational programs at affiliated sites are responsible for compliance with the protocols. Depending on the severity of the non-compliance, students receive a written report of the findings as a first warning or they are suspended from the clinic until actions are taken to correct their deficiency. Students may receive up to three warnings before being suspended from the clinic. The SDM Infection Control and Risk Management Consultant (Infection Control Committee President) or the Assistant Dean for Clinical Affairs receive a copy of the citations or warnings. If non-compliance occurs in a laboratory or graduate programs, a written report is sent to the Infection Control Consultant for immediate actions to enforce compliance. Failure to comply with the established protocols by employees may result in


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disciplinary actions. Non-compliance by students will affect the daily clinical evaluations, which in turn affect their clinical performance and result in loss of clinical privileges. As stated before, depending on the severity of the infraction, students may be suspended from the clinics until they present evidence they understand the importance of infection control policies and give assurance that they will comply with them. Students, faculty, and clinical personnel are immunized against Hepatitis B with seroconversion status verified. Tuberculin tests are performed annually by the campus Occupational Health Office nurse. All clinic personnel are encouraged to get immunized against seasonal influenza. The Protocol for the Management of Injuries in which possible exposure to bloodborne pathogens may occur is part of the Infection Control and Risk Management Protocols. It is enforced by the Infection Control Consultant and followed by the faculty, students, and staff. All accident reports are kept by the consultant and will be available on site. The SDM has a central sterilization area along with a separate room for the ultrasonic cleaning and packaging of instruments prior to sterilization. The graduate clinics also have an ultrasonic cleaning and packaging area, except the Oral and Maxillofacial Surgery and Orthodontics clinics that have their own sterilization areas. All sterilizers are biologically monitored at least once a week. Logs of the results will be available on site. If positive growth of bacterial spores occurs in any of the sterilizers, another test is done to confirm the finding. If positive, the sterilizer is immediately removed until the problem is corrected. In order to ensure compliance with the proper sterilization of instruments, the Infection Control Committee now monitors three specific steps to assure sterility. These are: 1) a written log for instrument cleaning prior to sterilization, 2) a record of date and evidence of sterility once the instruments are sterilized, and 3) log signed by the faculty evaluating the treatment or by the clinical staff assuring sterility at the clinic teams/modules prior to patient treatment. Waste at the SDM is divided in three types: regular, biomedical (infectious), and hazardous waste. Regular non-contaminated waste from all the laboratories and clinics is placed in regular waste covered trash containers identified for that purpose with a clear plastic bag. This non-contaminated waste is disposed of in the normal waste stream by the MSC maintenance personnel. Biomedical (infectious) waste is discarded in red, impervious plastic bags with the biohazard sign in designated red biohazard labeled containers. Students have small red biohazard bags in their work areas where they deposit the contaminated waste. These are disposed at the end of the clinical session in the big red plastic bag containers located at all clinics and laboratories. Sharps containers labeled with the biohazard sign are also available in all the clinics and laboratories where sharps are handled. Both biomedical waste and sharps containers are collected and disposed of by a private company according to federal and local laws.


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The SDM has specific protocols for the handling and disposing of hazardous waste. There are “satellite areas” where the hazardous waste is located for the private company to dispose of. The “satellite areas” are identified in all the clinics and laboratories where hazardous waste is produced. A dental assistant or staff member is responsible for the cleanliness, proper recording of the information and disposal forms in each of the areas. The Infection Control Compliance Officer (ICCO) is responsible for the inspection of the “satellite areas” and for the generation of the forms needed for the hazardous waste final disposal. If non-compliance is observed with the proper handling of hazardous waste, immediate action is taken by the ICCO to address the issue (Sample Monitoring Report Form, Appendix 5-L). Hazardous waste is collected as soon as the SDM generates the order to the MSC Office of Radiological and Hazardous Waste Management. The hazardous waste is then disposed in compliance with federal and local laws. Material Safety Data Sheets are available at all clinics and laboratories where the handling of hazardous waste is anticipated. The academic community is informed and educated on how to use them and where they are located. The logs containing the information regarding the collection of biomedical and hazardous waste are maintained by the Office of the Assistant Dean for Clinical Affairs and will be available on site. Assessment measures in the area of infection control and safety include: infection control inspection reports, safety evaluations, annual infection control and risk management trainings, accident reports, sterility assurance logs, and biological monitoring for sterility and quality assurance. (see Quality Assurance Outcomes Results and Actions Taken Report, Appendix 5.C) Supportive Documentation

1. Infection Control and Risk Management Protocols (Appendix 5.J) 2. Hazardous Waste Control Policy (part of the Infection Control and Risk Management

Protocols in Appendix 5.I) 3. Autoclave Testing Results (available on site) 4. Results of Infection Control Monitoring Program (Appendix 5.K) 5. Post-Exposure Control Plan (included in the Infection Control and Risk Management

Protocols in Appendix 5.J) 6. Sample Monitoring Report Form (Appendix 5.L) 7. Quality Assurance Outcomes Results and Actions Taken Report (Appendix 5.C)


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5-8 The school’s policies must ensure that the confidentiality of information

pertaining to the health status of each patient is strictly maintained.


Description The School of Dental Medicine has written policies regarding patients' health status information and its confidentiality following HIPAA regulations. These are included in the Clinic Manual, in the patient’s Consent for Use and Disclosure of Health Information, Note of Privacy Practices, and the Acknowledgement of Receipt of Notice of Privacy Practices forms given to each patient at the first patient encounter/visit. This policy is also available in the Patient’s Rights and Responsibilities Statement (Appendix 5.G). The patient’s consent form is provided and attached to the patient’s record. The academic community, including students and staff, receives training regarding HIPAA compliance. Students, faculty, and staff are instructed on all the privacy forms (Appendix 5.M), voice and noise control, and the proper use of confidential information. New faculty, researchers, and students are instructed to comply with the regulations by means of training in IRB meetings and seminars, new faculty orientations, and clinic orientation week for students and residents. Evidence of attendance and presentations is available upon request. Students are instructed to turn in patient records at the end of the day and to make sure all progress notes and information regarding patient treatment is completed. Students and staff are also instructed to corroborate the patient’s identity whenever possible with a photo ID and to obtain a photo ID or affidavit from parents or legal guardians of underage patients. Data entry personnel is instructed not to enter any information on the patient’s identity and new clinical records information unless the HIPAA consent forms are signed by the patient or his/her legal guardian. Patient records used in the billing process and in the record room are secured during and after business hours so that only authorized persons can access them. Any health history alert is placed inside the patient record to maintain confidentiality. Students are instructed to turn in all procedural tickets after completion of treatment to the Office of Tickets and Procedures Auditing, where they are processed and securely stored or destroyed, accordingly. No unauthorized copies of any part of a patient record or form are permitted. Patients or legal guardians requiring copies of their records must go in person to the Office of the Assistant Dean for Clinical Affairs to fill out the appropriate request form.


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All researchers at the School of Dental Medicine are instructed by the IRB Office of the Medical Sciences Campus on HIPAA regulations regarding research and patients’ confidentiality. All patient requests, such as the authorization for disclosure and/or the copying of dental records are processed by the Office of the Assistant Dean for Clinical Affairs. Each department is responsible for the identification of new employees and their training. HIPAA training is offered by the HIPAA Compliance Officer or the IRB Office of the Medical Sciences Campus. Assessment measures include chart audits and record room chart audits. Supportive Documentation

1. Patient’s Rights and Responsibilities Statement (Appendix 5.G) 2. HIPAA Forms (Appendix 5.M) 3. HIPAA training records (Available on site)


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STANDARD 6- RESEARCH PROGRAM

6-1 Research, the process of scientific inquiry involved in the development and

dissemination of new knowledge is an integral component of the purpose/mission, goals and objectives of the dental school.

The University of Puerto Rico School of Dental Medicine complies with standards 6-1 and 6-2.

Description

As stated in Standard 1, the mission of the Medical Sciences Campus of the University of Puerto Rico is to train the interdisciplinary team of health professionals that will meet the health care needs of the people of Puerto Rico. The School of Dental Medicine’s specific mission within that context is to train the dental professionals who will join the interdisciplinary team.

The campus and the school have established three complementary areas of endeavor in order to comply with their missions, i.e., teaching, research, and service. The School of Dental Medicine conducts research on the prevailing oral health conditions that affect residents of the island in its pursuit of excellence in oral health care. The SDM organizes research activities through the Office of the Assistant Dean for Research (OADR) and the Center for Clinical Research and Health Promotion (CCRHP). The mission of the OADR and the CCRHP is to promote collaborative and scientifically meritorious research and scholarly activities that advance the search for scientific information that impact oral and systemic health. In addition, they provide research opportunities for faculty and students at the SDM. The OADR´s vision is to be leaders in dental research to impact government health policies in Puerto Rico in the area of improvement of oral and systemic health. The OADR was established in 2002 to foster and promote a research culture within the SDM. It promotes administrative and fiscal self-sufficiency and supervises research efforts undertaken by faculty and students. The Assistant Dean for Research is the director of the OADR. Exhibit 6.1 shows the organization of research activity within the school. To support research activities at the SDM the Office of the Assistant Dean for Research has established four core elements: Administrative Core, Research and Academic Programs and Pipeline Core; Biostatistics and Epidemiology Core, and the Supporting Programs Core (Please see Exhibit 6-1).


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Exhibit 6-1: Organization of research within the School of Dental Medicine.

DEAN

ASSISTANT DEAN(ADMINISTRATIVE cORE)

RESEARCHPROGRAMS

EPIDEMIOLOGY AND

BIOSTATISTICSINSTITUTIONAL AND EXTERNAL

SUPPORTPROGRAMS

CCRHP

RESEARCH COMMITTEE

EM

Center For Clinical Research And Health Promotion

The OADR has established four major goals:

Goal 1 - Develop research programs and projects directed to oral and systemic health with an emphasis on oral health disparities.

Goal 2 - Promote research and scholarly activities among students and faculty to augment their academic, clinical, and research skills.

Goal 3 - Establish a pipeline to prepare future researchers and faculty members for the School of Dental Medicine. This goal was part of the OADR’s activities until May 2012. The graduate programs component of the pipeline has been transferred under the Assistant Dean for Graduate Programs.

Goal 4 - Secure funds to promote and enhance research and scholarly activities.

Research Facilities and Environment

The main offices of the OADR and the CCRHP are located on the main floor of the Medical Sciences Campus building (141AE and A142). The 3,000 sq. ft. facility includes a dental clinic with two dental chairs, seven administrative and research faculty offices, a reception area and ample storage space. In addition, four research faculty offices are located in the basement of the Medical Sciences building (BB32 and BB34). The OADR and the


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CCRHP offices are equipped with computer terminals connected to the Medical Sciences Campus’ mainframe and statistical software. There are four portable dental chairs and state- of-the-art technology for dental caries detection, including Quantitative Light Induced Fluorescence (QLF) and Fiber Optic Trans Illumination (FOTI). A 750 sq. ft. oral biology laboratory under the supervision of Dr. Evangelia Morou (DDS, PhD) is located on the first floor, adjacent to the clinical area (B136C). It is equipped with a Beckman Spectrophotometer, an incubator, and a minus twenty degree freezer, among other resources. The OADR has allocated funds to remodel its facilities to accommodate new researchers and staff for a recently approved multi-center study “Pregnancy and Early Lifestyle Improvement Study (PEARLS)”. Additional research space (2000 sq. ft.) for this study has been assigned at the School of Nursing.

6-2 The dental school faculty, as appropriate to meet the school’s purpose/mission,

goals and objectives engage in research or other forms of scholarly activity and provide opportunities for students to participate.

The OADR has a standing research committee to evaluate its goals and objectives in order to achieve its mission and vision. Annual modifications are implemented to address the recommendations of the committee, which evaluates the strengths, weaknesses, external and internal threats, and opportunities to involve the faculty in research projects, continuing education training in research, and opportunities to complement the students’ educational activities.

Faculty Research

Twenty-seven (27) school faculty members assigned to OADR have between 10 to 80 percent protected released time for research related activities (Table 16-A, Faculty Research Information). During the past five years there has been a significant increase (150 %) in the number of submitted grants for funding, faculty publications in peer reviewed journals (317%), and 500% in funds received for research (See Exhibits 6-2 to 6-4, Table 15 – Research Grants, and Table 16-B – Faculty Publications, Required Tables Section).


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$3,399,367.00 $2,876,343.00 $2,632,231.00

$3,942,573

$5,051,211.00

$-

$1,000,000.00

$2,000,000.00

$3,000,000.00

$4,000,000.00

$5,000,000.00

$6,000,000.00

2007-2008 2008-2009 2009-2010 2010-2011 2011-2012

Amou

nt

Fiscal Years

Exhibit 6-2. UPR-SDM Grant Income from Research Fiscal Years 2007-2012

$3.01

$17.95

$0.00

$3.00

$6.00

$9.00

$12.00

$15.00

$18.00

2002-2007 2007-2012

Millions

Fiscal Years

Exhibit 6-3. Total Amount of Grants Received: Fiscal years 2002-2007 and 2007-2012


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The OADR had nine faculty members with protected time released for research during the years 2002-2007. At present, there are 27 faculty members assigned to the OADR with protected time for research. Four SDM clinical faculty members were released from clinic duties with protected time for research. Nine new faculty members/researchers were recruited during this period, including one magnet investigator and five young faculty members with protected time released for research and scholarly activities (See Exhibit 6-5). Exhibit: 6-5. Newly recruited research faculty by degree, expertise, and protected time release. Faculty Degree Expertise Protected

time release Carmen J. Buxó MPH, DrPH, MSc Public Health 75%

Oelisoa Mireille Andriankaja DMD, MS, PhD Perio/Clinical Research

70%

Sona Rivas-Tumanyan DMD, MPH, DrPH Epidemiology 80%

Francisco Muñoz MPH Statistics 80%

María Angélica Trak MPH, PhD Nutrition 80%

1. Faculty Research Opportunities:

SDM faculty interested in research has been offered opportunities to do so and has participated in the following:

a. Six SDM faculty members have participated in the NIDCR University of Washington Summer Research Program. Nine SDM faculty members/residents have completed the UPR’s Medical Sciences Campus Master’s in Clinical Research (R-25)

24

100

0

20

40

60

80

100

120

2002-2007 2007-2012

Exhibit 6-4. Number of Faculty Peer Reviewed Publications: Fiscal years 2002-2007 and 2007-2012


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since its creation in 2001, and five are currently enrolled in other courses in oral cancer control, detection of early dental caries (ICDAS), systematic literature review, biostatistics, and epidemiology and oral cancer, as well as specialty courses offered to SDM faculty during the academic year by OADR faculty and the Office of Academic Affairs at the Medical Sciences Campus.

b. Fourteen faculty members serve as manuscript reviewers in their respective fields of expertise for the Puerto Rico Health Sciences Journal. During the last two years, over 15 SDM faculty members were requested to served as reviewers. In addition, two members of the faculty serve as referees for Revista Científica Odontológica del Colegio de Cirujanos Dentistas de Costa Rica. There are also faculty members who serve as reviewers for Acta Odontológica Universidad Central de Venezuela, Acta Odontológica Universidad de Zulia, Venezuela, and Archivos Latinoamericanos de Nutrición (ALAN). These activities are coordinated by the Associate Editor of this journal, who is a faculty member at the school.

c. Participate as referees for abstract acceptance, as judges of poster and oral presentations for the Medical Sciences Campus Research Forum, and the local American Student Dental Association (ASDA) competition. In 2011, ten and in 2012, twelve SDM faculty members volunteered to serve as judges and referees at the Medical Sciences Campus (MSC) Research and Education Forum.

d. Collaborate with research intensive universities in the United States, Latin America and Europe, including the University of Rochester, New York University, Boston University, the University of Washington, Indiana University, University of San Francisco, University of Kentucky, MD Anderson University of Texas, University of Costa Rica, Central University of Venezuela, University of Seville, and the University of Alcalá de Henares in Spain.

e. Collaborate with other UPR-MSC researchers from the University of Puerto Rico Graduate School of Public Health (SOALS-RO1, CAiRI-S21, PEARLS-U01), the UPR School of Medicine (Puerto Rico Comprehensive Center for HIV Disparities and Partnership for Cancer Research MDAnderson-UPR U54), and a recently approved infrastructure grant with the School of Nursing (UPR Research and Development Office).

2. Research Incentives:

a. Faculty members who are granted external funds can receive compensations up to an amount equivalent to 100% of their salary in addition to their regular salary.

b. Since its approval in June 27, 2008, Law 101 permits tax exemption on income paid to researchers working on competitive grants that fall within its specifications.


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c. Faculty may request up to six hours weekly for research related activities with the

authorization of the department head.

Student Research/Scholarly Activities The OADR faculty coordinates and offers courses and mentorship to doctoral and post-doctoral students. The coordination of post-doctoral students’ research activities has been transferred to the Office of the Assistant Dean of Graduate Programs as of May 2012. 1. Predoctoral Level (DMD) Students:

Dental students are exposed throughout the four years of dental school to the following research courses and scholarly activities, coordinated by the Office of the Assistant Dean for Research:

a. Summer Research Programs:

The summer research program is an experience for first and third year dental students, conducted in Puerto Rico and abroad for a period of six to 10 weeks. Students receive elective credit towards graduation. Participating institutions include the University of Rochester, MD Anderson University of Texas, and the University of Minnesota. These institutions have partnered to offer this valuable research intensive program, which is mentored by National Institute of Health (NIH) funded scientists. Participating students receive a stipend and funds to cover travel and lodging expenses. Upon completion of this summer research experience, students are required to prepare an abstract for a poster or oral presentation at the UPR-MSC Research and Education Forum, local ASDA meeting, and the Puerto Rico Dental Society Annual Meeting. The student who receives first prize at the local ASDA competition is co-sponsored by the OADR to attend a National ADA Convention. Students from this program have also attended the First Poster Session of the Annual Meeting of the American Student Dental Association and the Scientific Session of the American Dental Association’s Annual Meeting.

Upon completion of their dental degrees, Summer Program participants have pursued the Master in Clinical Research degree at New York University and the UPR MSC Master in Clinical Research, as well as PhD level training.

b. Research Courses Offered at Predoctoral-level (DMD):

DESP 7237 - Evaluation of Scientific Literature and Epidemiology. This course is offered during the third trimester of the second year. Its purpose is to help dental students develop the basic skills necessary to interpret scientific literature. The course topics are presented in three units: Research Design, Biostatistics, and Epidemiology. Students are grouped according to a research question they formulate for which they review the literature and


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prepare a PowerPoint presentation for SDM researchers and other students attending the course. DESP 7411 - Research Experience in Dentistry. Senior and junior students can enroll in this elective course designed to develop knowledge and skills in research methods through active participation in ongoing research activities under the supervision of a mentor. Students are required to present their work as an oral and/or poster presentation in a research forum in Puerto Rico or abroad. Students enrolled in DESP 7411 may receive additional credit if they participate in four additional two-hour sessions of a systematic literature review course offered every semester, and evaluate three articles using the CONSORT 2010 Checklist. Eight students presented their projects at several research meetings in 2011, while 13 students presented theirs in 2012. Presently, 20 students are enrolled for the 2012-2013 academic year (See List of Predoctoral Student Research Projects, Appendix 6.A). This increase in student interest in a research experience may be attributed to the growing number of researchers available to serve as mentors at the school.

c. DMD PhD Training Program:

The DMD/PhD Training Program, jointly offered by UPRSDM and the University of Rochester, is coordinated by Dr. Evangelia Morou from the OADR. Candidates for this program are UPR students participating in the summer research programs and/or other qualified students as identified by the Admissions Committee. The first PhD candidate has already completed the clinical requirements for the DMD and the qualifying examination for the PhD degree. Two additional first-year dental students and three second-year dental students conducted research at the University of Rochester in the summer of 2011.

d. Publications From 2007 to the present, doctoral students have published 49 abstracts in the Puerto Rico Health Sciences Journal special issues and ASDA programs (See List of Predoctoral Student Publications, Appendix 6.B) 2.Post-doctoral students

SDM Post-doctoral programs: Certificate, Masters of Sciences Dentistry (MSD), and Fellowships

a. Certificate and Masters of Sciences Dentistry (MSD)

Post-doctoral programs in Pediatric Dentistry, Prosthodontics, Orthodontics, and Oral and Maxillofacial Surgery offer residents a Post-doctoral Certificate or a Master of Science in Dentistry (MSD). The Orthodontics Program requires the completion of the master’s degree; for all other residency programs, the master’s degree is optional but encouraged. Pediatric and Oral and Maxillofacial Surgery residents often choose to pursue the master’s program upon completion of the appropriate post-doctoral certificate. All post-doctoral


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students are required to complete a research project and are encouraged to prepare a manuscript for submission to a peer reviewed journal. Those enrolled in the MSD program are required to complete a research project and submit an article to a peer reviewed journal. The courses offered for post-doctoral students include epidemiology, statistics, systematic literature review, research planning and design, methods, statistics applied to their project, and thesis. Since June 30, 2012, the Assistant Dean for Graduate Programs has been in charge of the graduate students’ research program. However, second and third year post-doctoral students will complete their research courses and projects under the OADR. During the 2007-2012 period, a total of 24 post-doctoral students completed a master’s degree. In addition, 21 manuscripts have been published in peer review journals, 5 theses were approved, 11 abstracts were produced, and there are 6 ongoing projects (See Appendixes 6-C, 6-D and 6-E). The reasons given by post-doctoral students in Prosthodontics and Oral and Maxillofacial Surgery for not enrolling in the master’s degree program are: the amount of time required to complete their clinical work, difficulty understanding statistics, and the limited number of content mentors available in the students’ fields of interest. In order to address these difficulties, since 2009, two faculty members with expertise in epidemiology and biostatistics (Dr. C. Buxó and S. Tumanyan) assist post-doctoral students in the clinical tract in their epidemiology and statistics courses, as well as with their research projects. In addition, the OADR coordinated faculty training in biostatistics and epidemiology.

b. Fellowships OADR and CCRHP offer a one-year or two-year post-doctoral residency in Clinical Research. Residents participate in protocol preparation and as research assistants of funded researchers. They also participate in postdoctoral research courses. During 2010-2011 two residents served as examiner and project director of an island-wide study to assess the oral health status of 12 year olds in Puerto Rico. Both residents presented posters on the prevalence of dental caries and fluorosis findings at the 2012 AADR meeting in Tampa. The First Annual Research Forum for post-doctoral dental students was held in June 2012. Nine graduate students presented their completed research project. This activity was coordinated by the OADR and the Assistant Dean for Graduate Studies.

c. Research Incentives

Funds:

Student research activities are supported by funds allocated from the Capacity Advancement in Research Infrastructure Endowment Fund and indirect funds assigned to the Office of the Assistant Dean for Research. The following funds are available:


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o A total of $5,000 is available yearly to support student research projects, distributed among participating students

o Funds to support poster presentations, accepted at research meetings o Funds to support summer research in PR and the US; $1,500 to $2,000 are

available for four students yearly

o Funds to support trips to present research projects in the USA (AADR, ADA and ASDA)

Awards:

Each year, the Medical Sciences Campus Research and Education Forum holds a campus-wide research competition for students from the Schools of Medicine, Dental Medicine, Nursing, Health Professions, Pharmacy, and the Graduate School of Public Health. Over the past 10 years, SDM students have excelled in the oral and poster competitions of this event. Students from the summer research program and the DESP 7411 course have received first ($500), second ($200) and third ($100) place awards in Basic Sciences, Epidemiology, and Clinical Research.

Researchers’ pipeline development The SDM offers and supports diverse research activities at different educational levels, from high school through post-doctoral training. These programs constitute the SDM’s pipeline for the development of future researchers and faculty (See Exhibit 6-6).


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Exhibit 6-6: UPR-SDM Research Pipeline.

Pipeline

High School CollegeDentalDMD

Post-Doctoral UPR-Rochester DMD/PHD

FacultyDevelopment

Certificate

MSD

Fellowship

Exhibit 6-6.UPR-SDM:Research Pipeline

Pre-doctoral Research Program

a. High school and college students- The SDM research office coordinates a mentoring program for high school and college students interested in participating in oral health-related research projects. OADR researchers serve as mentors to these students. Faculty mentors are: Lydia López, DMD, MPH in collaboration with Evangelia Morou, DDS, PhD; Elba Díaz, DMD, MSD, MPH; Augusto R. Elías-Boneta, DMD, MSD; Enrique Santiago, DMD, MBA; Sona Tumanyan, DMD, MPH, DrPH; Carmen Buxó, MPH, DrPH, MSc; and Kaumudi Joshipura, DDS, MS, DSc. b. Junior and senior college students from the UPR Río Piedras campus can enroll in a 3-5 credit elective course (BIOL 4990) to participate in an ongoing research project mentored by investigators at the UPRSDM. Generally, participating students have an interest in pursuing a career in dentistry or medicine. Each year, eight to 10 students enroll in this course, work on pilot projects with UPRSDM mentors, prepare oral presentations, and assist post-doctoral students in literature reviews. c. High School students interested in participating in science fair competitions can seek advice from SDM faculty for the design of their projects. In March 2012, Kevin Rodríguez, a high school senior from a local San Juan public school, won the island-wide


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research competition with a project titled: Comparison of Three Sterilization Methods in the Dental Office.

Four Core Elements: The Office of the Assistant Dean for Research has established four core elements in order to support research activities at UPRSDM: Administrative Core; Research Programs, Academic and Pipeline Core; Biostatistics and Epidemiology Core; and the Institutional and External Support Programs Core. 1) The Assistant Dean-Administrative Core: The overall administrative and programmatic activities of the OADR and CCRHP, such as recruitment, travel arrangements, and purchasing equipment and materials are coordinated by the administrator, a secretary, a clinical research coordinator, and a research assistant. 2) The Research Programs, Academic and Pipeline Core:

Research Programs with a focus on Oral Health Disparities:

The biology and prevention of dental caries Oral cancer control with an emphasis on studying the factors that affect the delayed

detection in Puerto Rico, especially among men Oral systemic links that study the association between periodontal and cardiovascular

disease, diabetes, modifiable risk factors, nutrition, and exercise.

Other research programs include:

A corporate program for the conduct of clinical trials in studying therapeutics for the prevention of dental caries, gingivitis, and dental sensitivity. In addition, funds have been provided for epidemiological studies and calibration exercises.

A standardization and calibration program in dental caries (NIDCR, ICDAS), plaque, gingivitis and dentinal hypersensitivity.

Academic activities:

See: Faculty Research Opportunities Students Research/Scholarly Activities 3) The Biostatistics and Epidemiology Core: Personnel serving in this core consist of three master’s level statisticians, one PhD in Epidemiology, one PhD biostatistician, an editor, and a research assistant. These professionals advise and train faculty and students in study design and methods to conduct scientifically meritorious research.


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4) Supporting Programs Core: This core enhances and expands the physical and fiscal support to SDM students and faculty in the process of conducting research. The physical facilities available include the Oral Biology Laboratory, Dental Materials Laboratory, clinical space at the Office of the Assistant Dean for Research, and the Medical Sciences Campus Clinical Research Center. The external fiscal support for pilot studies, equipment and faculty and student development is derived from corporate and NIH sources, as well as funds from the S21-Capacity Advancement in Research Infrastructure program. Funds are also allocated to scholars from the Medical Sciences Campus Master in Clinical Research Program (R-25). Additional research support is provided by the School of Dental Medicine, the Medical Sciences Campus and through collaborative programs with the University of Rochester, University of Texas at Houston (MD Anderson), University of Minnesota, the Research Centers in Minority Institutions (RCMI), and the Clinical Research Center (CRC) of the Medical Sciences Campus.

Future Directions

1. Faculty

a. Recruitment

Recruit an RO1 level cariologist to strengthen this research area Oral systemic link: Periodontist-PhD to complete the oral systemic research area Increase the research component for faculty development

b. Research Culture

Establish a sub-committee to promote research culture at the department level. A group of researchers are in the process of organizing the Puerto Rico section of

the AADR, with Dr. Lydia López as leader of this initiative. During the last AADR annual meeting, we initiated a dialogue with Dr. Chris Fox, Executive Director, to consider the possibility of holding an AADR meeting in Puerto Rico (proposed date, 2018). At present, there are 13 UPRSDM faculty members who are AADR members.

2. Students

a. Research Culture

Periodic Review of Dental School Research Curriculum A group of second and third-year students is organizing a UPR SDM Chapter

of the National Student Research Group. Joel Arana dental student III, who


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has attended the most recent AADR Tampa meeting, was selected to serve as the group’s first president during a meeting held in August 15, 2012. Students are planning to meet in October 2012, to elect other group officials. This group is sponsored and supported by the OADR, which will cover the initiation fee for the president, secretary, treasurer, and one member of each class for the next three years.


1. UPR-SDM Mission and Goals Statement (See Standard 1) 2. Research grants (Table 15 Required Tables Section)) 3. Faculty Research information (Table 16-A Required Tables Section) 4. List of Faculty Publications (Table16-B Required Tables Section) 5. Predoctoral Students Research Projects (Appendix 6.A) 6. Predoctoral Students Publications (Appendix 6.B) 7. Post-doctoral Students Publications (Appendix 6.C) 8. Post-doctoral Students Abstracts (Appendix 6.D) 9. Post-doctoral Students Ongoing Projects (Appendix 6.E)