EPA 2A: Form Diagnosis and Risk Assess

SCOPE OF WORK: This activity includes developing a diagnosis list that contains: (a) all general health issues, (b) oral health issues, (c) patient’s chief concerns, (d) behavioral/psychosocial issues that may impact patients and the delivery of their oral health care, (e) clinical examination and tests (radiographic images, head and neck skeletal and occlusal abnormalities, periodontal and pulpal pathoses, carious and non-carious abnormalities of teeth, esthetic concerns, defects with restorations, prostheses, or implants). Graduates must be able to identify risk factors and risk indicators for common oral health problems. At a minimum, for a comprehensive care patient, including but not limited to, identification and categorization of risk for: oral cancer, periodontal disease, caries, occlusal abnormalities, and tooth fracture.

Domains of Competence

Professionalism and Ethics
Critical Thinking and Decision Making
Biomedical Science Application

Knowledge

Etiology (biopsychosocial), pathogenesis, and epidemiology of oral health problems
Components of a comprehensive or problem focused diagnosis
Differential diagnosis, working diagnosis, comprehensive diagnosis
Risks and categorization for oral and maxillofacial diseases and conditions (e.g., oral cancer, periodontal disease, dental caries, occlusal problems [bruxism/tooth fracture], etc)
Required documentation of patient diagnoses and risk assessment in electronic patient record (EPIC Wisdom)

Skills

Evaluate and integrate patient data
Distinguish relevant information and identify when to investigate further (e.g., other diagnostic tests, consultation/referral)
Compile an accurate and complete diagnosis, including risk assessments
Properly document elements/components of patient diagnoses and risks in electronic patient record (Epic Wisdom)

Form Diagnosis and Risk Assess	Meets Expectations of the Graduate	Progressing	Below Expectations	Critical Error

Develop Comprehensive Diagnosis	Integrates all gathered information and significant findings to arrive at a working diagnosis, differential diagnosis and/or definitive diagnosis needed to frame treatment options for the patient	Proposes reasonable diagnoses/ differential diagnoses; organizes knowledge to generate and support the diagnoses but may omit diagnostic information of lesser importance; able to support the inclusion of each diagnosis listed	Struggles to filter and make connections between sources of information to comprise an accurate diagnosis; poses a differential diagnosis that is too narrow/too broad or contains inaccuracies	Misdiagnosis or unsupported differential diagnosis; lacks basic medical knowledge to reason effectively; cannot synthesize information to form an acceptable diagnosis
Assess and Categorize Risk	Accurately assesses and categorizes degree of risk for key oral health conditions (e.g., oral cancer, periodontal disease, caries, occlusion/trauma)	Accurately assesses and identifies risks but fails to categorize the degree of risk for key oral health conditions	Fails to identify a risk or accurately categorize “obviously” indicated risks	Fails to assess risk information or miscategorized risk that results in gross overtreatment or undertreatment of the patient

Risk Assessment	Meets Expectations of the Graduate	Progressing	Below Expectations	Critical Error

Dental Caries	Accurately assesses key oral health conditions associated with dental caries (completed diet diary, performed biofilm evaluation and, when necessary, other risk factors, as saliva tests, drugs usage, microbiologic tests) AND correctly categorizes degree of risk	Accurately assesses and identifies risk factors for dental caries BUT fails to categorize the degree of risk	Fails to identify a risk or accurately categorize "obviously" indicated risks for dental caries	Inaccurate patient assessment and/or diagnosis that could cause harm (fails to assess risk information or miscategorized risk that results in gross overtreatment or undertreatment of the patient)
Periodontal Disease	Accurately assesses key oral health conditions associated with periodontal disease (PI, BoP, Tobacco Use, Diabetes status, Alveolar an Attachment Loos, Hx of Periodontitis) AND correctly categorizes degree of risk	Accurately assesses and identifies risk factors for periodontal disease BUT fails to categorize the degree of risk	Fails to identify a risk or accurately categorize “obviously” indicated risks for periodontal disease	Inaccurate patient assessment and/or diagnosis that could cause harm (fails to assess risk information or miscategorized risk that results in gross overtreatment or undertreatment of the patient)
Occlusion/Trauma	Accurately assesses key oral health conditions associated with occlusion disorders and/or trauma (Hx of bruxism, tooth fractures; presence of wear facets, fremitus, mobility, craze lines, compromised cusp integrity) AND correctly categorizes degree of risk	Accurately assesses and identifies risk factors for occlusion disorders and/or trauma BUT fails to categorize the degree of risk	Fails to identify a risk or accurately categorize "obviously" indicated risks for occlusion disorders and/or trauma	Inaccurate patient assessment and/or diagnosis that could cause harm (fails to assess risk information or miscategorized risk that results in gross overtreatment or undertreatment of the patient)
Oral and Maxillofacial Pathology	Accurately assesses key oral health conditions associated with oral and maxillofacial pathologies (evaluated all soft and hard tissues by visual, palpation, and radiographic methods; and asked about risk factors for oral cancer - tobacco, alcohol, HPV) AND correctly categorizes degree of risk	Accurately assesses and identifies risk factors for oral and maxillofacial pathologies BUT fails to categorize the degree of risk	Fails to identify a risk or accurately categorize “obviously” indicated risks for oral and maxillofacial pathologies	Inaccurate patient assessment and/or diagnosis that could cause harm (fails to assess risk information or miscategorized risk that results in gross overtreatment or undertreatment of the patient)

Rating on "Documentation" for this encounter will be included for the assessment of this task.

Pathology Biopsy Interpretation (Oral Mucosal/Osseous Disorders) Develop Comprehensive Treatment Plan