Appendix C - Glossary for Clinical Assessment

This section aims to provide criteria, definitions, and examples to calibrate learner evaluation using the UNC Adams School of Dentistry Assessment for Clinical Encounter (ACE). The clinical assessment process is based on the Entrustable Professional Activity (EPA) framework and the ADEA Compendium of Clinical Competency Assessment.

Clinical Assessment diagram

Quality and Safety

Ratings to assess quality as defined by the Adams School of Dentistry:

  • Meets expectations of the graduate: Has met standards for practice readiness.
  • Progressing: Developing skills appropriate for learners’ level (DDS2/DDS3/DDS4).
  • Below expectations: Performing at a substandard level that may or may not include a critical error

Critical Errors

Definition: An event or unprofessional behavior that disrupts safe, legal, and ethical person-centered care. A critical error includes events or behaviors — whether evident or harmful to the patient — that could lead to, but not limited to, disciplinary action by an employer or Board of Dentistry. In an academic setting, repeat critical errors may prompt discussions for dismissal from the program.

Domain Critical Errors
Advocate
  • Fails to act for the benefit of the patient
  • Reports or documents false or intentional inaccurate information
  • Practices under the influence of drugs/alcohol
  • Exhibits inappropriate conduct with patients, faculty, staff, and/or peers
  • HIPAA violations or breaches of confidentiality
  • Submits documentation more than 48 hours after clinical appointment
Clinician
  • Inaccurate patient assessment and/or diagnosis that could cause harm
  • Improper technical procedure
  • Excessive and/or irreversible damage during a procedure
  • Incorrect procedure, tissue, location, or patient for any clinic activity
  • Inappropriate medication dosing, administration, and/or prescription
  • Infection control breach
  • Radiology procedure breach
Thinker
  • Unable to solve a problem that could cause patient harm
  • Unprepared to the extent that could cause harm
  • Disregards faculty instruction or fails to obtain faculty consent

Independence Supervision Ratings

Independence ratings are based on the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE), designed to assess a learner’s level of independence using behavioral anchors.

1. Retrospective O-SCORE:

How much supervision did the learner need during the entire encounter? A diagram showing the escalating steps enumerated below

  1. Faculty had to do it for the learner (hands-on intervention)
  2. Faculty had to talk the learner through it (consistent guidance)
  3. Faculty had to prompt the learner from time to time (intermittent guidance)
  4. Faculty did not have to guide or intervene (supervision only)

2. Prospective O-SCORE:

How much supervision should the learner have on a future encounter that is similar? A diagram showing the escalating steps enumerated below

  1. Faculty would have to do it for the learner (hands-on intervention)
  2. Faculty would have to talk the learner through it (consistent guidance)
  3. Faculty would have to prompt the learner from time to time (intermittent guidance)
  4. Faculty would not have to guide or intervene (supervision only)
  5. Faculty would not need to be there (independence)

Context

Case Complexity, Patient Age, Patient Circumstances, Types of Procedures

Criteria Definition
Case Complexity
  • Average: well controlled systemic disease, no significant management challenges, access in care delivery
  • High: Poorly controlled systemic disease; management challenge (e.g., behavioral); difficulty in care delivery; advanced clinical presentation of dental disease
Patient Age
  • < 5 years (Pediatric)
  • 6–12 years (Pediatric)
  • 13–17 years (Pediatric)
  • 18–64 years (Adult)
  • > 65 years (Geriatric)
Patient Circumstances (Follows CODA Standard 2-25)
  • Complex medical history (ASA > 2)
  • Cognitive impairment
  • Developmental disability
  • Significant physical limitation
  • Visual, speech, or hearing impairment
  • Vulnerable elderly
  • Psychological diagnosis
  • Social barriers
  • Interpretations services (in person or via phone)
  • None of the above

Behavioral Determinants for Trust: ARICH

This framework reflects key behaviors for patient safety and quality care, including agency, reliability, integrity, capability and humility.

ARICH Framework

Definitions
  • Agency: proactive toward work, team, safety, personal development
  • Reliability: conscientious, predictable, accountable, responsible
  • Integrity: truthful, benevolent, patient-centered
  • Capability: specific knowledge, skills, experience, situational awareness
  • Humility: recognizes limits, asks for help, receptive to feedback

Elements of Entrustment

Encounter Management Criteria Installation