Guidelines for Supervision of Dental Students
UTDB Clinics

 These Guidelines are intended for undergraduate dental students, dental hygiene students and postgraduate students/residents.¹  The guidelines are not meant to serve as standards of care, but are intended for use by the students, disciplines and departments of the UTDB. Students must not schedule, examine, attend, diagnose, treat, or otherwise see patients in UTDB clinics without faculty supervision.²

Each department or discipline is responsible for determining the level of supervision required of students. Each is also responsible for determining and ensuring that the key steps in the clinical procedures being performed under their supervision are evaluated at the appropriate time to ensure optimum quality of patient care. For example, minimally at the beginning of the clinic period the patient’s health status, oral hygiene status, diagnosis, proposed treatment in proper sequence and informed consent to the proposed treatment must be reviewed prior to allowing the student to proceed with treatment.

Achieving the balance between student supervision and autonomous experience is a constant challenge in training clinicians. Supervision adequate to enhance the quality of patient care requires that: 1) the degree of autonomous student functioning is appropriately assessed; 2) supervisory faculty are readily available to evaluate and support student care decisions and performance; and, 3) students can recognize when assistance is needed and feel comfortable seeking this help.

Assessment of Students' Ability to Perform Planned Clinical Procedures and to Function Independently

1. The student must be ready and prepared to perform the clinical procedures that meet a particular patient’s treatment needs. The assessment of a student's clinical preparedness and abilities shall serve as the basis for determining the minimum level of supervision required for different activities. This should include knowledge of or evaluation of technical, patient management, and communication skills.

1. Minimum levels of supervision must be established for students with unknown or unproven clinical preparedness and abilities. All clinical faculty are responsible for maintaining the minimum level of clinical supervision of students until satisfied that the student is ready to progress to more independence in the specific procedures in which the faculty member has observed student performance, knowledge, and management. There should be articulable and documentable evidence to support the decision. Students performing procedures for the first time generally always warrant the established minimum levels regardless of prior experience performing other procedures.

2. Students must not perform treatment, even under faculty supervision, that exceeds their clinical readiness and abilities. In those instances students should assist and/or serve as an observer. Reassignment or referral of the patient may be appropriate where the assigned patient is too difficult for the student’s level of preparedness. This determination may be made at any time by faculty during the course of supervising treatment of patients.

2. Objective criteria to evaluate a student's progressive level of ability to perform and function independently in clinical skill areas must be developed and consistently applied. Such measures may include:

• assessments of other faculty with knowledge of the student’s clinical experiences, and technical, patient management and communication skills.
  
• assessments of other faculty with knowledge of the student’s preclinical technical skills, if appropriate.
  
• assessments of the student’s performance, knowledge and management with a particular patient by the supervising faculty member.
  
• assessment of the student’s overall performance, knowledge and management with the assigned faculty member.
  
• residency program director assessments and evaluations, when appropriate.
  
• number and distribution of clinical experiences (both operative and non-operative)
  
• patient comments, when available
  
• quality improvement data, when available

3. Information about a student's abilities must be provided to all supervisory faculty to which the student is assigned or who may be supervising the student in clinical areas so that the student receives appropriate assignments and levels of responsibility. Improved communications faculty, departments, disciplines, clinical department chairs and clinical deans is a must so that those responsible for patient assignments to students and those responsible for the quality of patient care in the clinics have the same information and are in agreement upon the levels of supervision required by each student. Those making patient assignments to students must have performed a clinical examination of the patient prior to assigning the patient to a particular student. They may rely upon information from faculty who have knowledge of the patient’s care needs and the student’s level of clinical preparedness.

4. Students should be informed of the criteria used to evaluate their clinical performance, which should be found in course syllabi. Supervisory faculty should give ongoing, specific feedback to students about their clinical progress. It is recommended that students complete a self-assessment for the purposes of discussion. This presents an opportunity to identify and address any discrepancies between a student's perceived abilities and those observed by supervisory faculty.

Supervisory Faculty Interaction

1. Faculty with responsibility for supervising students are ultimately responsible for the quality of patient care and ensuring that the standard of care is met. Faculty must be familiar with the patient, the patient’s medical history, diagnosis, treatment plan, and treatment to be performed at every session. Faculty and student should know the goal of each clinic session and faculty must be prepared to assist or otherwise intercede on behalf of the patient to ensure achievement of the goal as appropriate. When time allows, faculty should create an environment in which students must discuss patient care issues prior to, during and after treatment, e. g. health status, oral hygiene status, diagnosis, proposed treatment, and possible or likely complications. Students should be encouraged to discuss patient management issues and to seek advice and assistance when appropriate. The extent to which faculty act as role models in discussing patient care and management issues will influence the success of such an effort.

2. A supervisory clinical faculty member shall be readily available to provide sufficient support to students in all aspects of patient care. In addition to the usual areas of care, this support may extend to talking with patients/families during difficult or complex situations such as: when the patient has experienced an untoward event, or when the patient/family is difficult.

¹  Both undergraduate and postgraduate students, including residents, are hereinafter referred to as "students."

²  See the UTDB Clinic Manual, Section 3.13. 

Debbie Noel
4/20/01