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

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 Irreversible technical procedure error 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

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?

Faculty had to do it for the learner (hands-on intervention)
Faculty had to talk the learner through it (consistent verbal guidance)
Faculty had to prompt the learner from time to time (intermittent verbal guidance)
Faculty did not have to direct or intervene (procedure completed independently)

2. Prospective O-SCORE:

How much supervision should the learner have on a future encounter that is similar?

Faculty would have to do it for the learner (hands-on intervention)
Faculty would have to talk the learner through it (consistent verbal guidance)
Faculty would have to prompt the learner from time to time (intermittent verbal guidance)
Faculty would not have to direct or intervene (procedure completed independently)
Faculty would not need to be there (independence)

Context

Visit Difficulty, Patient Age, Patient Circumstances, Types of Procedures

Criteria	Definition
Visit Difficulty	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

ARICH

This framework reflects key behaviors for patient safety and quality care, including agency, reliability, integrity, capability and humility described earlier in this document.

Encounter Management Criteria Installation