....................
......................................*......a
William D. Grant, EdD, Richard Mayne, DMD
An educational “treatment plan” model for the general practice residency The need to match residency program experiences with the interests, skills, and personal goals of residents is Influenced by many factors. A structured system, the lndivldualized Educational Plan, is described which provldes a hrmalized means of addresslng each of these needs. The development of an educational plan, slmilar in concept to the development of a formal treatment plan for patients, provides the basis for the system. The system provides both the program director and the resident with the means to evaluate in detail the resident’s progress and the program’s performance in helping the resident achieve competency.
esidency training is an exceptionally complex educational experience that occurs in a time-limited and increasingly regulated enviroment.l4 In this environment, the program itself must meet external standards of content and structure, residents are expected to attain high levels of competency in many dental areas in a relatively short period of time, residents must accumulate and integrate many diverse educational experiences involving many teachers, and, in addition, the program must address educational goals and objectives that reflect the individual resident’s own skills and interests, his or her own strengths and weaknesses, and his or her own future career plans. We have designed and implemented an educational “treatment” program, which, like the comprehensive treatment plan the dentist prepares for a complex patient, details the desired educational outcomes of the resident’s experience, includes consideration of the resident’s own goals, and considers alternatives available for the desired outcomes to be achieved. The plan provides the basis for documenting the resident’s educational experience, planning of programs to meet the needs of individual residents, and evaluating the resident’s progress toward achieving specific goals. The program also provides the basis for conducting effectiveness evaluations of the residency. As residents progress through their training program, just as patients proceed through their treatment plan, there are opportunities to modify their goals on rate of progression and on new information. Thus,
198 Speclal Care in Dentistry, Vol12 No S 1992
the educational experience can be tailored to the residents’ own particular needs.
The IEP The educational treatment program we have developed is designated as the Individualized Education Plan (IEP). The primary consideration in the initial development of the IEP program was to ensure flexibility without loss of accountability. Other considerationswere: first, to provide a process of identification of specific goals in relation to the resident’s own curricular goals and objectives; second, to provide a system for ongoing assessment of the resident’s skills; third, to identify and document the effects of implementation of various instructional components; and finally, to ensure that overall program evaluation is conducted in an ongoing and an effective manner. While the general structure of the IEP emphasizes information gathering, the use of such a system is wellgrounded in educational theory. In the transition from dental student to resident, the individual moves from an environment in which most educational activities are directed to a situation in which he or she is a largely self-directed adult learner. If this transition is not made successfully, the resident’s later performance may be less than optimal.5r6 The IEP process incorporates specific self-directed adult learning principle^.^ Compared with the more directed college or dental school student, the adult learner would rather study broad concepts which have wide applicability rather than concentrate on isolated facts. Also,
adults prefer to apply what they have learned as soon as possible after learning it. Third, adults prefer to assist in establishing their own learning objectives. Finally, adults want open, constructive, and instructive feedback on their performance. Specific attention to flexibility, accountability, and meeting the needs of the adult learner has guided the development and successful implementation of the IEP Program.
Resident Quarterly Revlew Summary
Resident: Faculty Advisor(s): Review:
1
2
4
3
Date: Please use this format when dictating the progress note for the Quarterly Review Consultation. This will assist in standardizing the notes for auditing purposes. If there is an area that you did not address during the Quarterly Review, please indicate by dictating, "not addressed.
Program implementation At the core of the IEP program is a simple "chart" which accumulates specific information to be documented: each resident's experiences; individual resident's program design and planning; and evaluation data on .the resident's progress in the program. By designing the "chart" (actuallya specifically designed and organized loose-leaf notebook) to resemble the familiar dental record format, we found that both the faculty and residents could easily apply process skiIls learned to prepare patient care treatment plans to the documentation requirements in this educational program. This was possible even if the faculty or the resident was unfamiliar with the underlying formal educational concepts upon which the IEP is based. One attending dentist is assigned to each resident in the program to serve as a faculty advisor. The faculty advisor is responsible for ensuring that the resident is on track toward successfully completing the program. Residents are introduced to the IEP process during an orientation period prior to the start of the program. At that time, the resident and faculty advisor review information on the resident's prior educational experiences in light of the residency program goals and in relation to the resident's own perceptions of his or her strengths, limitations, values, and areas of particular interest. The advisor works with the resident to articulate written educational and personal goals. Specific plans for achieving those goals are also discussed and documented. Thereafter, quarterly review meetings are held in which evaluation reports and progress
I.
CLINICAL SKILLS (cognitive, psychomotor, and interpersonal) A. Rotation Evaluations (rotations taken; summary of performance)
Outpatient Clinic (informationin IEP progress notes; peer and staff input) II. PARTICIPATION IN DEPARTMENT ACTIVITIES A. Conferences, Grand Rounds (attendancefor didactic activities; conferencesor special lectures prepared/delivered) B. Other department activities (videotaping;observation/feedback,etc.) III. RESIDENT'S ASSESSMENT OF PROGRESS A. Mastery Skills Checklist B. Assessment of training (resident's perceptions of his/her performanceand quality of his/her training during the last three months) IV. GOALS A. Professional (specificallyby each goal addressed, including new input data, such as exam scores, evaluations, or other inventories) 1. Progress with previous plans 2. New implementation plans B. Personal (specificallyby each goal addressed) 1. Progress with previous plans 2. New implementation plans B.
Encourage residents to review your summary and remind them that they have an opportunity to respond if they want. flgure 1. Standardbed reportlng outline for resident quarterly reviews.
notes on the resident's performance are discussed. The resident's progress toward realization of program and personal goals is reviewed, and additional goals may be set. For the most part, the IEP notebook is the property of the resident. The notebooks are kept confidential and may be "signed out" only by authorized faculty or by the resident. Sections of the notebook which are not needed by the program to document the resident's experience and performance are turned over to the resident at the time of graduation. Goal lists,
progress notes, and mastery skills checklists, for instance, are the property of the resident, and copies are not kept in the Department after the resident's graduation.
IEP components The IEP notebook is arranged in a standardized format, making it, over time, familiar and comfortable to use. Sections are designed to allow the program faculty to accumulate information in a logical manner. Section I contains biographical information and a summary of
Special Care In Dentist@,Vol12
No S 1992 199
RESTORATIVE
A.
Amalgam Restoration
B.
PinBuild-up
C. Acid-etch Build-up D. Crowns 1. Porcelain-fused-to-Metal 2.
E.
Full-cast Metal
Other Restorative Services 1. Sedative Filling
2.
Cast Post and Core
3.
Pre-fabricated Post and Core Labial Veneer (Optional)
4.
Figure 2. Illustrative segment of the comprehensive Mastery Skills Checklist.
previous educational experiences. Residents are encouraged to include in this Section important information about themselves that they think would be helpful to their advisors or other faculty members. Section I1 includes written statements of professional and personal goals (similar to a patient’s problem list). These lists are prepared in conjunction with a resident‘s advisor and are reviewed and updated quarterly. Section I11 contains documentation of the resident’s educational progress (Progress Notes) and copies of Quarterly Review Notes. All faculty are encouraged to dictate an educational progress note on any resident when they have information that would be helpful to the resident or to the advisors. For instance, faculty members responsible for particular teaching conferences are asked to make comments about the presentations made by residents at those conferences. Quarterly Review Notes are dictated summaries of mandatory meetings between the resident and the resident’s advisor. These notes are written based on a specific outline which allows for standardization of reporting of residents’ progress (Fig. 1). A Mastery Skills Checklist was developed to assist the resident and program faculty in assessing the resident’s progress toward achieving competence in the core content areas of dentistry. The ”Mastery Skills Checklist” contains approximately 100
procedures, common diagnoses, interpersonal skills, and clinical decision-making skills that are believed to represent those basic skills that all residents should have mastered by the end of their program. Lists of optional skills for residents with specific interests in other areas are also provided. An illustrative segment of the items included in the Mastery Skills Checklist is shown in Fig. 2. A complete listing is available from the authors. Each item on the list indicates the minimum number of times the individual resident must satisfactorily perform the activity under the direct supervision of a faculty member or before the resident will be considered to have ”mastered” that item. The Mastery Skills Checklist is formally reviewed and updated by the resident and his/her advisor at least every three months. Once a resident has satisfactorily completed a particular skill a minimum number of times, the resident may be ”credentialed” by the Residency Program Director in that specific skill. Under New York State regulations, the ”credentialed resident may then perform that skill under limited supervision (this does not require an attending physician to be physically present at ”chairside”). The Performance Evaluation Section contains formal evaluations completed by the faculty, attending dentists, or physicians encountered on medical rotations. Twice a year, each resident completes an evaluation sheet on each attending physician with whom he or she has had contact. The use of a structured “chart” such as the IEP notebook serves two purposes: First, audits of a resident’s progress may be completed by any of the faculty or the program director, and second, it becomes easy to determine the progress of any resident at any point of the year.
Outcomes of the system Since the initial implementation of the IEP program, we have seen direct benefits to the ten participating residents who have completed their residencies, to the attending staff, and to the program itself. For example: (1) We have been able to improve
200 Special Can, In Dentistry, Vol12 No I 1992
the public lecturing skills of the dental residents by providing practice and preparation support from the hospital’s audiovisual and medical education departments. (2) We have re-defined, re-ordered, and re-structured the entire lecture schedule for the program based on feedback from the residents. The lecture series now better supports the program goals and objectives of the residency. (3) We have been able directly to document the need for changes and additions in the curriculum, specifically, a segment on practice management theory, and sessions on the uses of computers in practice. In addition, changes in the orthodontic program have led to an increased emphasis on minor tooth movement. These changes are currently being incorporated. (4)We were able to provide documentation of the educational need for the upgrade of equipment, clinic space, and teaching space. Based upon this documentation, the hospital has provided a new panoramic radiographic unit and will be moving the program into larger and more adequately equipped clinical and teaching space. (5) Several attending physicians, through their own initiative, are working with members of the hospital’s department of medical education to improve their teaching and presentation skills. ( 6 ) Attending physicians report that they feel more confident as teachers, in that the goals and objectives for each resident are clearly stated, and they know that they, the attendings, will receive evaluative feedback on their performance for the residency. (7) We have been able to identify residents‘ educational needs early in the program and have been able to take definitive corrective actions as needed. For the program director, the IEP program offers an ongoing organized record of all the residents’ activities during the year. It affords the means to assess each resident’s progress and identify areas where the program needs to be improved. Since these
assessments are made and documented on a continuous basis, corrective action can be taken and the effect of the action re-assessed. In the initial implementation efforts, the response of residents and attendings was skeptical rather than negative. Residents were uncertain that they could, indeed, take an active and collaborative role in their own educational experiences. Attendings were concerned that documentation would require an inordinate amount of time. Our experience with this program shows that residents rapidly adjust to their new roles and become deeply involved in their educational pro. gram. Their direct inputs have immeasurably improved the program and have led to the improvement of the quality of teaching by the attendings. Ongoing documentation by attendings has evolved into a quick response system which balances ease of reporting with the need to provide performance data on the progress of the resident. A combined checklist/ narrative form is used by each attending for each teaching session. Forms are designed for completion in about five minutes. Thus, an attending who has contact with three residents on a given day is required to spend 15 minutes or less on documentation. Service as a faculty advisor requires about one hour per month per resident in providing assistance to an individual resident. Advisors review
evaluations of attendings as received in the previous week and discuss with the residents any significant (positive or negative) reports. This usually requires about 15minutes per week. Once every three months, advisors and residents meet for about one hour to discuss the residents’ progress in detail and to prepare the Resident Quarterly Reyiew (Fig. 1).
target the educational strategies required to implement the changes successfully, and document the effectiveness of the changes directly. The program director can analyze the general practice residency with the assurance of being able to demonstrate the need for new programs, evaluate their impact, and maintain a viable and dynamic program.
Conclusion The implementation of the Individualized Education Program has brought a method of comprehensive documentation of the resident’s general practice residency experience. The assessment and systematic evaluation of a resident’s progress are enhanced by the Progress Notes and Evaluations of the attending staff. The Mastery Skills Checklist, in conjunction with the quarterly advisor/ resident reviews, provides information for gauging whether or not the goals set by the residents are being achieved. If not, then reference to the checklist and to the goal statements can be of value in identdying the areas that need to be addressed for those goals to be achieved. As the notebooks are evaluated over several years, patterns of residency program strengths and weaknesses can be established. The use of a structured documentation system has proven to be an invaluable part of our educational program. Through this system, it is possible to document the needs for program improvement,
Dr. Grant is Research Associate Professor, Department of Family Medicine, State University of New York-Health Science Center, 475 Irving Avenue, Suite 200, Syracuse, NY 13210. Dr. Mayne is Director, General Practice Residency, St. Joseph‘s Hospital Health Center, Syracuse, NY. Address correspondence and requests for reprints to Dr.Grant. 1. Garrison RS Jr. General practice residency
2.
3.
4.
5.
6.
7.
programs: Benefits to residents and patients. J Dent Educ 55:534-6,1991. Formicola AJ, Myers R. A postgraduate year for the practice of dentistry: Rationale and progress. J Dent Educ 55526-30,1991. Brody HA. University of California at San Francisco: A conducted GPR/AEGD model. J Dent Educ 55:508-9,1991. Barnes DM, Blank LW. The advanced education in general dentistry program and the University of Maryland at Baltimore. J Dent Educ 55:505-7,1991. Tedesco LA, Feagans DW. Meaningful instruction and life-long learning: Curriculum 2000. NY State Dent J 57(3):313,1991. Patterson SK, Thompson GW. Priorities for continuingeducation courses. J Can Dent Assoc 561077-80,1990. Schwenk TC, Whitman N. The physician as teacher. Baltimore (MD): Williams and Willcins, 1987.
Special Care In Dentistry, Vol12 No 5 1992 201
......................................*......a
William D. Grant, EdD, Richard Mayne, DMD
An educational “treatment plan” model for the general practice residency The need to match residency program experiences with the interests, skills, and personal goals of residents is Influenced by many factors. A structured system, the lndivldualized Educational Plan, is described which provldes a hrmalized means of addresslng each of these needs. The development of an educational plan, slmilar in concept to the development of a formal treatment plan for patients, provides the basis for the system. The system provides both the program director and the resident with the means to evaluate in detail the resident’s progress and the program’s performance in helping the resident achieve competency.
esidency training is an exceptionally complex educational experience that occurs in a time-limited and increasingly regulated enviroment.l4 In this environment, the program itself must meet external standards of content and structure, residents are expected to attain high levels of competency in many dental areas in a relatively short period of time, residents must accumulate and integrate many diverse educational experiences involving many teachers, and, in addition, the program must address educational goals and objectives that reflect the individual resident’s own skills and interests, his or her own strengths and weaknesses, and his or her own future career plans. We have designed and implemented an educational “treatment” program, which, like the comprehensive treatment plan the dentist prepares for a complex patient, details the desired educational outcomes of the resident’s experience, includes consideration of the resident’s own goals, and considers alternatives available for the desired outcomes to be achieved. The plan provides the basis for documenting the resident’s educational experience, planning of programs to meet the needs of individual residents, and evaluating the resident’s progress toward achieving specific goals. The program also provides the basis for conducting effectiveness evaluations of the residency. As residents progress through their training program, just as patients proceed through their treatment plan, there are opportunities to modify their goals on rate of progression and on new information. Thus,
198 Speclal Care in Dentistry, Vol12 No S 1992
the educational experience can be tailored to the residents’ own particular needs.
The IEP The educational treatment program we have developed is designated as the Individualized Education Plan (IEP). The primary consideration in the initial development of the IEP program was to ensure flexibility without loss of accountability. Other considerationswere: first, to provide a process of identification of specific goals in relation to the resident’s own curricular goals and objectives; second, to provide a system for ongoing assessment of the resident’s skills; third, to identify and document the effects of implementation of various instructional components; and finally, to ensure that overall program evaluation is conducted in an ongoing and an effective manner. While the general structure of the IEP emphasizes information gathering, the use of such a system is wellgrounded in educational theory. In the transition from dental student to resident, the individual moves from an environment in which most educational activities are directed to a situation in which he or she is a largely self-directed adult learner. If this transition is not made successfully, the resident’s later performance may be less than optimal.5r6 The IEP process incorporates specific self-directed adult learning principle^.^ Compared with the more directed college or dental school student, the adult learner would rather study broad concepts which have wide applicability rather than concentrate on isolated facts. Also,
adults prefer to apply what they have learned as soon as possible after learning it. Third, adults prefer to assist in establishing their own learning objectives. Finally, adults want open, constructive, and instructive feedback on their performance. Specific attention to flexibility, accountability, and meeting the needs of the adult learner has guided the development and successful implementation of the IEP Program.
Resident Quarterly Revlew Summary
Resident: Faculty Advisor(s): Review:
1
2
4
3
Date: Please use this format when dictating the progress note for the Quarterly Review Consultation. This will assist in standardizing the notes for auditing purposes. If there is an area that you did not address during the Quarterly Review, please indicate by dictating, "not addressed.
Program implementation At the core of the IEP program is a simple "chart" which accumulates specific information to be documented: each resident's experiences; individual resident's program design and planning; and evaluation data on .the resident's progress in the program. By designing the "chart" (actuallya specifically designed and organized loose-leaf notebook) to resemble the familiar dental record format, we found that both the faculty and residents could easily apply process skiIls learned to prepare patient care treatment plans to the documentation requirements in this educational program. This was possible even if the faculty or the resident was unfamiliar with the underlying formal educational concepts upon which the IEP is based. One attending dentist is assigned to each resident in the program to serve as a faculty advisor. The faculty advisor is responsible for ensuring that the resident is on track toward successfully completing the program. Residents are introduced to the IEP process during an orientation period prior to the start of the program. At that time, the resident and faculty advisor review information on the resident's prior educational experiences in light of the residency program goals and in relation to the resident's own perceptions of his or her strengths, limitations, values, and areas of particular interest. The advisor works with the resident to articulate written educational and personal goals. Specific plans for achieving those goals are also discussed and documented. Thereafter, quarterly review meetings are held in which evaluation reports and progress
I.
CLINICAL SKILLS (cognitive, psychomotor, and interpersonal) A. Rotation Evaluations (rotations taken; summary of performance)
Outpatient Clinic (informationin IEP progress notes; peer and staff input) II. PARTICIPATION IN DEPARTMENT ACTIVITIES A. Conferences, Grand Rounds (attendancefor didactic activities; conferencesor special lectures prepared/delivered) B. Other department activities (videotaping;observation/feedback,etc.) III. RESIDENT'S ASSESSMENT OF PROGRESS A. Mastery Skills Checklist B. Assessment of training (resident's perceptions of his/her performanceand quality of his/her training during the last three months) IV. GOALS A. Professional (specificallyby each goal addressed, including new input data, such as exam scores, evaluations, or other inventories) 1. Progress with previous plans 2. New implementation plans B. Personal (specificallyby each goal addressed) 1. Progress with previous plans 2. New implementation plans B.
Encourage residents to review your summary and remind them that they have an opportunity to respond if they want. flgure 1. Standardbed reportlng outline for resident quarterly reviews.
notes on the resident's performance are discussed. The resident's progress toward realization of program and personal goals is reviewed, and additional goals may be set. For the most part, the IEP notebook is the property of the resident. The notebooks are kept confidential and may be "signed out" only by authorized faculty or by the resident. Sections of the notebook which are not needed by the program to document the resident's experience and performance are turned over to the resident at the time of graduation. Goal lists,
progress notes, and mastery skills checklists, for instance, are the property of the resident, and copies are not kept in the Department after the resident's graduation.
IEP components The IEP notebook is arranged in a standardized format, making it, over time, familiar and comfortable to use. Sections are designed to allow the program faculty to accumulate information in a logical manner. Section I contains biographical information and a summary of
Special Care In Dentist@,Vol12
No S 1992 199
RESTORATIVE
A.
Amalgam Restoration
B.
PinBuild-up
C. Acid-etch Build-up D. Crowns 1. Porcelain-fused-to-Metal 2.
E.
Full-cast Metal
Other Restorative Services 1. Sedative Filling
2.
Cast Post and Core
3.
Pre-fabricated Post and Core Labial Veneer (Optional)
4.
Figure 2. Illustrative segment of the comprehensive Mastery Skills Checklist.
previous educational experiences. Residents are encouraged to include in this Section important information about themselves that they think would be helpful to their advisors or other faculty members. Section I1 includes written statements of professional and personal goals (similar to a patient’s problem list). These lists are prepared in conjunction with a resident‘s advisor and are reviewed and updated quarterly. Section I11 contains documentation of the resident’s educational progress (Progress Notes) and copies of Quarterly Review Notes. All faculty are encouraged to dictate an educational progress note on any resident when they have information that would be helpful to the resident or to the advisors. For instance, faculty members responsible for particular teaching conferences are asked to make comments about the presentations made by residents at those conferences. Quarterly Review Notes are dictated summaries of mandatory meetings between the resident and the resident’s advisor. These notes are written based on a specific outline which allows for standardization of reporting of residents’ progress (Fig. 1). A Mastery Skills Checklist was developed to assist the resident and program faculty in assessing the resident’s progress toward achieving competence in the core content areas of dentistry. The ”Mastery Skills Checklist” contains approximately 100
procedures, common diagnoses, interpersonal skills, and clinical decision-making skills that are believed to represent those basic skills that all residents should have mastered by the end of their program. Lists of optional skills for residents with specific interests in other areas are also provided. An illustrative segment of the items included in the Mastery Skills Checklist is shown in Fig. 2. A complete listing is available from the authors. Each item on the list indicates the minimum number of times the individual resident must satisfactorily perform the activity under the direct supervision of a faculty member or before the resident will be considered to have ”mastered” that item. The Mastery Skills Checklist is formally reviewed and updated by the resident and his/her advisor at least every three months. Once a resident has satisfactorily completed a particular skill a minimum number of times, the resident may be ”credentialed” by the Residency Program Director in that specific skill. Under New York State regulations, the ”credentialed resident may then perform that skill under limited supervision (this does not require an attending physician to be physically present at ”chairside”). The Performance Evaluation Section contains formal evaluations completed by the faculty, attending dentists, or physicians encountered on medical rotations. Twice a year, each resident completes an evaluation sheet on each attending physician with whom he or she has had contact. The use of a structured “chart” such as the IEP notebook serves two purposes: First, audits of a resident’s progress may be completed by any of the faculty or the program director, and second, it becomes easy to determine the progress of any resident at any point of the year.
Outcomes of the system Since the initial implementation of the IEP program, we have seen direct benefits to the ten participating residents who have completed their residencies, to the attending staff, and to the program itself. For example: (1) We have been able to improve
200 Special Can, In Dentistry, Vol12 No I 1992
the public lecturing skills of the dental residents by providing practice and preparation support from the hospital’s audiovisual and medical education departments. (2) We have re-defined, re-ordered, and re-structured the entire lecture schedule for the program based on feedback from the residents. The lecture series now better supports the program goals and objectives of the residency. (3) We have been able directly to document the need for changes and additions in the curriculum, specifically, a segment on practice management theory, and sessions on the uses of computers in practice. In addition, changes in the orthodontic program have led to an increased emphasis on minor tooth movement. These changes are currently being incorporated. (4)We were able to provide documentation of the educational need for the upgrade of equipment, clinic space, and teaching space. Based upon this documentation, the hospital has provided a new panoramic radiographic unit and will be moving the program into larger and more adequately equipped clinical and teaching space. (5) Several attending physicians, through their own initiative, are working with members of the hospital’s department of medical education to improve their teaching and presentation skills. ( 6 ) Attending physicians report that they feel more confident as teachers, in that the goals and objectives for each resident are clearly stated, and they know that they, the attendings, will receive evaluative feedback on their performance for the residency. (7) We have been able to identify residents‘ educational needs early in the program and have been able to take definitive corrective actions as needed. For the program director, the IEP program offers an ongoing organized record of all the residents’ activities during the year. It affords the means to assess each resident’s progress and identify areas where the program needs to be improved. Since these
assessments are made and documented on a continuous basis, corrective action can be taken and the effect of the action re-assessed. In the initial implementation efforts, the response of residents and attendings was skeptical rather than negative. Residents were uncertain that they could, indeed, take an active and collaborative role in their own educational experiences. Attendings were concerned that documentation would require an inordinate amount of time. Our experience with this program shows that residents rapidly adjust to their new roles and become deeply involved in their educational pro. gram. Their direct inputs have immeasurably improved the program and have led to the improvement of the quality of teaching by the attendings. Ongoing documentation by attendings has evolved into a quick response system which balances ease of reporting with the need to provide performance data on the progress of the resident. A combined checklist/ narrative form is used by each attending for each teaching session. Forms are designed for completion in about five minutes. Thus, an attending who has contact with three residents on a given day is required to spend 15 minutes or less on documentation. Service as a faculty advisor requires about one hour per month per resident in providing assistance to an individual resident. Advisors review
evaluations of attendings as received in the previous week and discuss with the residents any significant (positive or negative) reports. This usually requires about 15minutes per week. Once every three months, advisors and residents meet for about one hour to discuss the residents’ progress in detail and to prepare the Resident Quarterly Reyiew (Fig. 1).
target the educational strategies required to implement the changes successfully, and document the effectiveness of the changes directly. The program director can analyze the general practice residency with the assurance of being able to demonstrate the need for new programs, evaluate their impact, and maintain a viable and dynamic program.
Conclusion The implementation of the Individualized Education Program has brought a method of comprehensive documentation of the resident’s general practice residency experience. The assessment and systematic evaluation of a resident’s progress are enhanced by the Progress Notes and Evaluations of the attending staff. The Mastery Skills Checklist, in conjunction with the quarterly advisor/ resident reviews, provides information for gauging whether or not the goals set by the residents are being achieved. If not, then reference to the checklist and to the goal statements can be of value in identdying the areas that need to be addressed for those goals to be achieved. As the notebooks are evaluated over several years, patterns of residency program strengths and weaknesses can be established. The use of a structured documentation system has proven to be an invaluable part of our educational program. Through this system, it is possible to document the needs for program improvement,
Dr. Grant is Research Associate Professor, Department of Family Medicine, State University of New York-Health Science Center, 475 Irving Avenue, Suite 200, Syracuse, NY 13210. Dr. Mayne is Director, General Practice Residency, St. Joseph‘s Hospital Health Center, Syracuse, NY. Address correspondence and requests for reprints to Dr.Grant. 1. Garrison RS Jr. General practice residency
2.
3.
4.
5.
6.
7.
programs: Benefits to residents and patients. J Dent Educ 55:534-6,1991. Formicola AJ, Myers R. A postgraduate year for the practice of dentistry: Rationale and progress. J Dent Educ 55526-30,1991. Brody HA. University of California at San Francisco: A conducted GPR/AEGD model. J Dent Educ 55:508-9,1991. Barnes DM, Blank LW. The advanced education in general dentistry program and the University of Maryland at Baltimore. J Dent Educ 55:505-7,1991. Tedesco LA, Feagans DW. Meaningful instruction and life-long learning: Curriculum 2000. NY State Dent J 57(3):313,1991. Patterson SK, Thompson GW. Priorities for continuingeducation courses. J Can Dent Assoc 561077-80,1990. Schwenk TC, Whitman N. The physician as teacher. Baltimore (MD): Williams and Willcins, 1987.
Special Care In Dentistry, Vol12 No 5 1992 201
