EPA 4C: Dentoalveolar Surgery - Hard And Soft Tissue

Dentoalveolar Surgery - Hard And Soft Tissue	Meets Expectations of the Graduate	Progressing	Below Expectations	Critical Error

Case Presentation	Extremely well organized, logical format, accurate, explicit, well aware of indicated treatment modifications and treatment of potential complications	Thoughtful, signs of organization, unclear at times, mostly accurate grasp of medical concerns and required treatment modifications	Can list medications and medical concerns but does not know how they can adversely affect dental care Aware of possible surgical complications but does not know how to avoid them or, if they occur, how to treat them	Choppy, confused, inaccurate, unaware of how to manage treatment modifications or potential complications
Sterile Field	No breaks in sterility during surgery after patient is draped and surgeon is gloved/gowned	Few breaks in sterility	Several breaks in sterility. Unable to properly drape the patient with sterile towels that keep hair out of the surgical field Forgets eye protection	Many breaks in sterility
Patient Positioning	Patient positioned for optimum safety and comfort of patient and operator		Learner unaware that putting patient in the supine position during administration of local anesthetic can minimize occurrence of medical emergencies such as Syncope	Patient sitting up (unless it is medically indicated); patient uncomfortable; operator uncomfortable
Throat Screen	Throat screen present and ideally positioned for maximum effectiveness	Throat screen present but not positioned to be completely effective	Gauze in mouth but completely ineffective	No throat screen
Proper Use and Handling of Instrumentation	Instruments held with fingers not fist Good finger rest used to avoid injury if instrument slips No trauma to tissues outside the immediate extraction site	Some unnecessary trauma to adjacent gingiva but not requiring repair	Learner uses instruments in an ineffective manner	Instruments used with excessive force causing damage to adjacent tissues, teeth, and restorations
Incision*	Incision properly placed without damage to adjacent structures Incision allows proper site visualization Scalpel/blade handled safely	Incision allows minimally adequate visualization of site Incision inappropriately damages tissue mildly (reversible)	Incision not adequate to allow proper site exposure Incision not completely through the periosteal tissue Incision inappropriately and damages tissue impacting function and esthetics (reversible) Unsafe handling of sharps	Incision in the incorrect location. Incision damages adjacent structures creating irreversible harm (nerve, teeth, gingiva) Patient and/or learner injured during incision
Recognize Complications	Recognizes existing complications, knows how to treat the complication, and can treat most complications properly	Recognizes existing complications and knows what should be done but does not have the skills to treat the patient	Recognizes existing complications but doesn’t know how to address them	Unaware of existing complications
Control Bleeding	Minimal oozing of blood	Mild oozing of blood	Does not remove all granulation tissue from surgical site, difficult to control bleeding Unaware of options available to control bleeding Patient leaves clinic with gauze sticking out of the mouth	Uncontrolled bleeding
Suturing*	Proper choice of suture material Tissues anatomically correct. Knots away from tongue. Knots tight without blanching of tissues	Sutures properly positioned but somewhat loose	Learner uses wrong suture material to repair an intraoral wound, causing irritation to adjacent tissues. Learner wastes suture material by having very long “tails”	Soft tissue flaps not repositioned anatomically correctly Gingival margins not aligned. Knots positioned toward tongue
Post-Op Instructions	Verbal and written instructions given Well organized, definitely understood by patient	Verbal and written instructions given but delivery somewhat confusing to patient	Learner gives wrong information during post-op instruction	No verbal instructions given, only written

^* Soft tissue surgery

Removable Denture Manage Medical Emergencies