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VII. The Portfolio Evaluation System

THE PORTFOLIO EVALUATION SYSTEM FOR COMPLETION OF UNIVERSITY OF MARYLAND, DENTAL SCHOOL'S ADVANCED EDUCATION IN GENERAL DENTISTRY PROGRAM

The Portfolio

A portfolio is a collection of authentic evaluation evidence of a resident's ability to perform tasks in realistic, unaided situations representative of what will be performed after completion of the program. The portfolio refers literally to a loosely bound document in which residents assemble and organize for presentation various pieces of evidence that they have satisfied program competencies and proficiencies. The evidence may consist of checklists, case documentations, write-up of interviews, papers, letters and other documentation. It is the resident’s responsibility to assemble two copies of the portfolio. An important tenant in competency-based education and portfolio evaluation is the shift of responsibility from teachers to students. One copy of the portfolio will be kept by the program as a part of the program's outcomes assessment documentation. The other copy is kept by the resident and may be used in applications for employment or for other programs or for documentation for hospital privileges, etc.

Competencies and Proficiencies

The Program Director will provide the program's competency and proficiency list for the residents and faculty and train them in the evaluation methodology and technique of developing a portfolio.

Evidence

The statements in the competency and proficiency list can be divided into several categories for the purpose of determining appropriate evaluation methodologies.

1. Statements related to technical procedures: Statements 5-9, 26-28, 33-57.
   1. These all represent procedures that are performed on or with patients and can be directly observed by faculty members.
   2. At the beginning of the program, faculty members are designated as responsible for evaluation of each technical competency and must certify the resident as competent in that area based on observation of the resident's work in that area.
   3. The resident will work with the designated faculty member from start to completion on a particular patient or procedure, but the performance must be independent. If faculty intervention is necessary, that procedure cannot be counted as evidence toward competency.
   4. Observation can be documented by:
      1. a signed case write-up including case history, procedures performed, and outcomes, supplemented with appropriate photographs or x-rays.
      2. faculty signature on the "certification" sheet, with evidence listed as "direct observation”.
   5. Where observation forms or case write-ups are used, more than one competency may be observed at a time. The observations can, and will in many instances, span several appointments or the entire treatment of a patient. A single evaluation form or case write-up may contain evidence related to several competency or proficiency statements.
   6. Where observation forms or case treatment plan write-ups are used, residents will accumulate at least one signed observation form or prepare one case write-ups that contain evidence related to each technical competency. Since each form or case write-up may contain evidence related to several statements, there should be less total forms or case write-ups than technical competency and proficiency statements.
   7. Faculty will certify the resident in that competency or proficiency prior to the end of the program by considering the procedures formally documented and also other examples of procedures observed that are related to that competency or proficiency statement.
2. Statements related to oral disease detection, diagnosis, prevention: Statements 23-25, 29, 30.
   1. These statements, as with technical competencies are performed with individual patients, and can be directly observed by faculty members.
   2. The process of evaluating and documenting these procedures is the same as that listed above for technical competencies and can use the same evaluation form, case write-up technique, or direct observation.
   3. Different faculty members may be designated to be responsible for certifying the resident in these competencies than were assigned to certify the resident on various technical competencies.
3. Statement related to developing treatment plans: Statement 3.
   1. This statement requires evidence of the formation of a treatment plan for a patient with complex needs.
   2. The resident shall prepare one formal treatment plan for presentation at a group treatment planning seminar.
   3. The treatment plan presentation shall include formal documentation of:
      1. a complete patient history
      2. dental examination
      3. mounted study models and photographs of the patient's pre-treatment condition
      4. diagnosis of the patient's conditions
      5. alternate treatment plans that could be accomplished for this patient
4. The portfolio evidence for the formal treatment plan shall include the write-up of the above treatment plan presentation, and mounted print photographs of the xrays and clinical slides.
   1. Pink treatment plan forms.
5. Statements related to comprehensive care: Statements 1, 2, 4, 31, 32.
   1. These statements require evidence of complete care of patients. (IO case complete reviews signs by AEGD faculty)
   2. The resident shall document and have signed by the program faculty one multi-disciplinary, comprehensive care. The documentation shall be assembled in a form suitable for inclusion in a portfolio binder. The documentation shall include:
      1. A complete write-up of the patient's history, examination, and treatment plan and effect of patient's psychological, medical, or oral conditions on the treatment plan.
      2. Mounted prints of photographs of the patient's pre-operative condition and post-operative condition.
      3. A write-up summarizing the treatment performed, special considerations, problems, or modifications encountered and prognosis and plans for further care.
   3. The resident shall make one formal case presentation in front of the faculty and other residents documenting complex, multi-disciplinary, comprehensive care. The case presentation shall include the items listed above with slides substituted for mounted prints.
6. Statements related to providing dental care in a dental practice setting and community and interprofessional teams: Statements 10-15.
   1. These statements refer to activities that take place in conjunction with practice in the program clinic with program staff over a period of time. They can be evaluated by interviews, written evaluations, or questionnaires solicited from staff, faculty, and patients.
   2. The resident is expected to design and carry-out a measure of each of these statements. A single measure can be used for more than one statement. Possible measures are:
      1. a patient questionnaire to be given to the resident's own patients
      2. participation in a community program (health care for homeless, work opportunity, and PLUS program)
      3. other measure approved by the program director or assistant program director.
   3. The results of these evaluation efforts will be summarized in writing and presented to the program director or assistant program director for approval.
7. Statements related to organized dentistry and professional ethics: Statements 16, 17.
   1. Statements related to participation in organized dentistry can be evaluated by evidence of participation in professional dental meetings.
   2. The ability to engage in an ethical analysis of dental practice situations or case studies and interact with colleagues in an ethical and professional manner can be documented by participation in an ethics discussion seminar series, which can be certified by the program ethicist or faculty.
8. Statements related to gathering and using information about dental practice: Statements 18-22.
   1. These statements refer to the ability to maintain continuous professional growth by gathering and using information relevant to various aspects of the practice of dentistry.
   2. Evidence of this ability must be by activities where residents gather and evaluate information.
   3. The residents will design and carry out three information projects in which they will gather and use data in each of the following areas:
      1. Documentation of dental materials or procedure evaluation. This project will involve gathering and evaluating information about a new dental material or procedure. It will take the form of a short oral presentation. This write-up will be a maximum of one page plus literature search and references, use at least 3 referenced sources, and include a summary of the referenced literature and conclusions about the use of the material or procedure in dental practice.
      2. Dental records evaluation. This project will involve analyzing outcomes from the resident’s own records. It will take the form of a structured record review with written documentation, analysis, and conclusions.
   4. The resident will propose a specific topic and format for each of the projects described above and present them to the program director or assistant program director for approval. The program director or assistant program director will also sign off on the completed projects.
9. Other evidence:
   1. Some of the evaluation methods described may be applicable to statements not listed with that method. In addition, there may be other forms of evidence not listed that may be acceptable.
   2. Examples of other forms of evidence that may be used include:
      1. A certificate of completion of an CPR course for the competency related to medical emergencies.
      2. Copy of prescription write ups.
      3. Medical consults and pathology reports.
   3. The resident may propose alternative forms of evidence to the program director or assistant program director and use them after approval.

Portfolio Description

The completed portfolio shall be submitted in duplicate and consist of the following parts:

1. A title page and table of contents. (place for program director’s signature)
2. A completed summary sheet with the competency and proficiency statements listed and the signature of the responsible faculty member. Any procedure observation forms that were used can be included in this section.
3. Documentation of one formal treatment planning seminar presentations as described in Evidence, #3.
4. Ten case complete reviews (Quality Assessment Audits)
5. Documentation of one case involving multi-disciplinary comprehensive care as described in Evidence, #5.
6. Documentation of measures of the provision of dental care in practice, community, and interprofessional settings as described in Evidence, #6.
7. Write up of literature-based treatment considerations for treatment of two patients as described in Evidence, #5.
8. Write up of literature-based considerations for use of a dental material or procedure as described in Evidence, #8, c. i.
9. Write up of a dental records evaluation project as described in Evidence, #8, c. ii.
10. A section for other evidence (i.e. operative reports, certificates of completion of specific training sessions, etc.)
11. Other sections dictated by inclusion of other evidence approved by the program director.

Standards

1. The portfolio must be completed, turned in, and approved by the program director in order to receive a certificate of completion from the program.
2. In case of a dispute the resident may ask to meet with the administrator at the level above the program director for review of the program director's decision.

Logistics

1. Residents will get approval for methodology and projects and gather evidence throughout the program as described above.
2. At the resident’s second review, the residents will submit the data that they have collected for review.
3. One month before the end of the program, residents will turn in the completed portfolio to mentor for evaluation. The program mentor and/or director may accept it as complete, or request additional evidence, or other changes in the portfolio.
4. Two weeks prior to the end of the program the program director will make the final decision about granting a certificate of completion from the program.
5. In case of a dispute, the resident may ask to meet with the administrator at the level above the program director for review of the program director's decision.
6. In addition, the program director must follow the Dental School’s Due Process Policy for Advanced Dental Education for an academic dismissal from the program.