General Practice Residency (GPR) Program In Dentistry

Overview

• Introduction
• Program Goals & Objectives
• Curriculum
• Program Evaluation & Assessment
• Further Information

Introduction

The University of Michigan Health System's program for "General Practice Residency" (GPR) was founded in 1985. Since that time, the program's goal has been to train dental residents to provide comprehensive general dental and oral medicine care to patients of all ages in a hospital setting.

Clinicians enrolled in this one-year certificate program gain considerable experience in all aspects of general dentistry. The medical center environment provides extensive resources for both clinical and didactic experiences, and the management of medically compromised patients is a significant component of residents' clinical activities.

Residents spend the majority of their training experience at the University of Michigan Medical Center, built in 1986. The dental clinic has five operatories equipped for the practice of general dentistry; three operatories equipped for oral and maxillofacial surgery, and one operatory equipped for general anesthesia cases and oral and maxillofacial surgery; intraoral and extraoral radiographic equipment; sterilization room, dental laboratory and residents' room with a library.

A significant portion of each resident's dental outpatient population includes patients waiting or having received bone marrow or organ transplants or radiation therapy for head and neck cancer, patients with physical and mental handicaps, dentofacial congenital anomalies, AIDS/HIV, hematologic disorders, patients receiving renal dialysis, and geriatric patients.

The inpatient consultation service has expanded to include all patients undergoing organ transplantation, screening of patients prior to cardiac surgery, evaluation and treatment of trauma patients, and evaluation of patients with fevers of unknown origin, in addition to inpatient emergency dental care.

The program currently includes rotations in geriatric and general dentistry, with off-service rotations to: anesthesia, internal medicine, pediatric dentistry and oral and maxillofacial surgery. Residents participate in head and neck cancer rounds as appropriate, depending on patient need.

All resident activities are supervised by a member of the General Practice Residency program teaching staff. These individuals will be selected based on their desire for teaching, professional credentials, and clinical experience.

Program Goals & Objectives

A General Practice Residency in Dentistry provides advanced training beyond the level of predoctoral education in clinical dentistry and applied basic and behavioral sciences, as well as refines those skills necessary for the generalist to provide comprehensive patient care for all population groups. It is a planned, sequential postdoctoral training program of one year in length, that is specifically designed to meet the needs of graduates desirous of enhancing their skills as general practitioners. The program is a supplement to the predoctoral curriculum, but is not a required component of that educational sequence.

Specific objectives of the program include:

1. Enhance competence and confidence in the various clinical disciplines that are integral components of general dentistry.
   • Broaden the perspectives of the recent dental school graduate by affording the opportunity to observe, treat, practice, and experience techniques not common to the undergraduate curriculum.
2. Enhance the knowledge of the various physical systems in relation to diseased and traumatic conditions of the oral tissues.
   • Enhance the graduate's ability to make judgments (i.e., in arriving at a diagnosis, in planning treatment and in decision-making during the course of treatment).
   • Provide formal instruction and clinical experience in medical risk assessment to insure the provision of high quality dental care.
3. Enhance the graduate's ability to interact with all health practitioners treating the patient.
   • Familiarize the residents with hospital protocol and procedures and to permit interaction with other medical disciplines.
4. Become proficient in evaluation and treating the majority of dental emergencies

It is expected that individuals completing this program will be prepared to:

1. Serve as the dentist of first contact with the patient and provide a means of entry into the oral health care system.
2. Evaluate the patient's total oral health needs, provide professional general dental care, and refer the patient, when indicated, to appropriate specialists while preserving the continuity of care.
3. Develop responsibility for the patient's comprehensive and continuous oral health care, and when needed, act as the coordinator of the patient's total oral health care.
4. Offer a broad range of dental services, which can meet the needs of a diverse spectrum of patients, including the very young, elderly, handicapped, and medically compromised.
5. Meet the dental needs of underserved areas, which suffer from limited access to specialty services.

Continuity of care for both the patient and resident will be emphasized. Referral both to and from specialty services will be utilized as necessary, with the generalist maintaining responsibility for overall patient care.

While the program is designed primarily as an advanced, multi-disciplinary clinical experience, there is also a strong educational component, emphasizing the application and integration of the basic sciences as a part of a "problem-solving" approach to clinical care.

Residents will be expected to execute independent judgments beyond those permitted in a predoctoral curriculum. However, General Practice Residency program faculty members will be present to aid each resident in resolving difficult patient management, or treatment situations.

Curriculum

The overall goal of the General Practice Residency program is to prepare qualified advanced general dentists to provide care to a wide variety of patients. In the context of providing such comprehensive care, specific areas of focus are listed below, followed by discipline-specific goals and objectives:

Restorative Dentistry

Goals include increasing experience in the use of new restorative materials, gaining knowledge in the biological aspects of dental materials and increasing confidence and competence in the planning and execution of advanced operative dentistry.

Resident proficiency is examined informally during clinical treatment, and formally during each resident's quarterly performance review.

Fixed Prosthodontics

Goals include providing an increased proficiency in diagnosis, treatment planning and provision of fixed prosthodontic care. Refining skills in dental preparations and understanding the usage of newer material and devices used in this discipline are considered as well.

Resident proficiency is examined informally during clinical treatment, and formally during each resident's quarterly performance review.

Removable Prosthodontics

Goals include increasing proficiency in diagnosis and treatment planning, in order to refine skills in the fabrication and completion of partial dentures; utilizing new impression techniques, improving working relationships with a technical laboratory and becoming involved in more complicated cases involving preprosthetic surgery, ridge augmentation, obturators, etc.

Resident proficiency is examined informally during clinical treatment, and formally during each resident's quarterly performance review.

Implants

Goals include training in at least one implant system (e.g. Brnemark, Calcitek, etc.), increasing experience in the use of dental implants, including treatment planning, surgery, restoration, and maintenance of the prosthesis.

Resident proficiency is examined informally during clinical treatment and during each resident's quarterly performance review. In addition, residents are formally assessed by means of an outcomes exam, sections of which pertain to topics of Implantology.

Periodontics

Goals include development of expertise in nonsurgical periodontics (e.g. scaling, root planing, etc.); understanding the indications for periodontal surgery and gaining skills in the more routine of these techniques, including an understanding of flap techniques, osseous recontouring, gingivoplasty, etc. Resident proficiency is examined informally during clinical treatment, and formally during each resident's quarterly performance review. In addition, residents participate in a formal periodontal surgery course sponsored by the dental school.

Endodontics

Goals include increasing resident proficiency in conventional root canal therapy (especially for multirooted teeth), introducing of surgical endodontics (including apicoectomy, hemisection, etc.), introduction of new materials and techniques, and refinement of skill involving the management of traumatized teeth.

Resident proficiency is examined informally during clinical treatment, and formally during each resident's quarterly performance review.

Oral & Maxillofacial Surgery

Goals include increasing competence in routine and surgical exodontia, giving the resident exposure to complicated maxillofacial surgery (including trauma, and head and neck oncological surgery), allowing the trainee to gain experience in operating room procedures, and the ability to diagnose and treat preprosthetic surgical cases. An emphasis will be placed on the management of the medically compromised patient.

Resident proficiency is examined informally during clinical treatment, and formally during each resident's quarterly performance review.

Pediatric Dentistry

Goals include the development of skills in the management of children and the prevention of dental disease. An understanding of orthodontics, craniofacial growth and development and nutrition will also be gained from each resident's pediatric dental experience, including a two-week rotation in pediatric dentistry at an external site.

Resident proficiency is examined informally during clinical treatment, and formally during each resident's quarterly performance review.

Oral Pathology and Oral Medicine

Goals include increasing resident ability to recognize and differentiate pathologic structures, and to become familiar with biopsy procedures, techniques, and evaluation. Residents will be exposed to a wide variety of oral manifestations of systemic diseases, oral dermatological conditions, and acute and chronic infections and their proper treatments.

Residents are formally assessed by means of an outcomes exam, sections of which pertain to topics of Oral Pathology covered in this seminar series. In addition, attendance records at meetings are reviewed with each resident during his or her quarterly resident evaluation.

Oral Diagnosis and Treatment Planning

Goals include improving the ability of each resident to recognize, diagnose and manage pathology present in the oral cavity and surrounding structures, and to adequately manage patients' dental conditions. Residents will then be able to formulate, organize, and prioritize an appropriate treatment plan, manage treatment and treatment issues, and provide comprehensive oral health care for each patient.

Residents are formally assessed by means of an outcomes exam, sections of which pertain to principles of Oral Diagnosis and Treatment Planning covered in this seminar series. In addition, attendance records at weekly treatment planning meetings are reviewed with each resident during his or her quarterly resident evaluation.

Special Care

Goals include increasing experience in knowledge of techniques and modalities of care as well as alternative strategies for the provision of care. Integration of basic sciences, behavioral modification techniques is stressed during the treatment planning of these individuals. Emphasis is placed on active patient follow-up and recall, with the dentist functioning as a part of each patient's "health care team". Each resident will provide dental care for patients with acute and chronic systemic disorders, including special patients with physical and behavioral problems.

Anesthesia, Pain Control & Pharmacology

Goals include increasing resident familiarity with modern pain management techniques during an anesthesia rotation at the University of Michigan Hospital. Residents will be expected to develop skills in preoperative evaluation, assessment of the effects of pharmacologic agents, especially those agents commonly used in treating oral and systemic diseases, venipuncture technique and administration of intravenous agents, patient monitoring, airway management, anesthetic induction and intubation, administration of anesthetic agents, prevention and treatment of anesthetic emergencies, and assessment of patient recovery from anesthesia.

Residents also gain experience in prescribing medications for patient under their care, and receive advanced instruction and clinical experience in the control of pain and anxiety in the conscious patient, through the use of behavioral management, local anesthesia, and conscious sedation techniques, and are knowledgeable of the indication, contraindications and potential adverse reactions of medications used.

Emergency Medicine and Dental Care

Goals include increasing resident familiarity with emergency medicine and dental emergency procedures which enable them to anticipate, diagnose and treat emergencies that may occur concurrently with dental procedures. Residents will be able to review a medical history to recognize factors which may predispose a patient to a systemic emergency during dental treatment, anticipate systemic emergencies by preoperative evaluation and management, diagnose the primary systemic abnormalities in a patient with a medical emergency, support a patient's respiration and/or circulation when required because of systemic collapse, evaluate and manage seizure and sudden loss of consciousness in patients, and treat allergic reactions encountered in the course of dental treatment.

Residents are provided formal training in emergency procedures by becoming certified in Basic Life Support (BLS) as well as Advanced Cardiac Life Support (ACLS). Residents also rotate through the hospital's emergency department to gain experience in managing medical emergencies.

In addition, each resident shares "on-call" responsibilities for all after-hours dental emergencies for both the hospital's dental patients, as well as the dental patients of record of the University of Michigan School of Dentistry. Here, residents gain experience in the diagnosis, patient assessment, and treatment of emergency problems related to the oral cavity. This includes the diagnosis and provision of primary care of acute infections of oral origin, acute disorders of the oral mucosa, hemorrhage of the oral cavity, and traumatic injuries to the dental and maxillofacial structures, (wound debridement, treatment of dental and alveolar fractures, and early or initial management of fractures of facial bones).

Physical Evaluation and Medical Risk Assessment

Goals include development of the ability to evaluate a patient's general health status, and to interpret physical signs and symptoms of systemic disease. Utilization of laboratory data to assess the presence of abnormal systemic diseases and to recognize those medical conditions which might prejudice the provision of routine dental care is stressed. Residents will increase their ability to obtain a patient's medical history, perform a physical evaluation, read and understand medical charts, understand basic physiology, order and interpret basic and advanced laboratory tests, radiographic data, and commonly prescribed medications.

Residents participate in a formal physical evaluation course, including integrated didactic and clinical components, designed specifically to enhance the resident's ability to recognize significant deviations from normal health status which may affect dental management, make informed judgments on the risk of dental procedures to both hospitalized and ambulatory patients, and identify the need for medical consultation. This course contains lectures, seminars and demonstrations covering medical history taking, including major organ systems, physical examination and interpretation of clinical laboratory studies and data.

Upon completion of this course residents are able to take, record and interpret a complete medical history, understand the indications for and interpretations of laboratory studies and other techniques used in the diagnosis of oral and systemic diseases, interpret the physical evaluation performed by a physician with an understanding of the process, terms and techniques employed, use the techniques of physical examination (i.e. inspection, palpation, percussion and auscultation), conduct a physical examination of a patient's general appearance, skin, head and neck, thorax and lungs, abdomen, lymph nodes, heart, blood pressure and pulse, and neurologic and mental status.

Residents are formally assessed by means of an outcomes exam, sections of which pertain to topics of physical evaluation covered in this seminar series, as well as review of each resident's assessment of patient "History and Physical" (H&P) examinations, performed as a precursor to patient admission for inpatient or same-day surgery general anesthesia cases.

Management of Inpatients and Same-Day Surgery Patients

Goals include providing the resident with experience and training in the comprehensive management of individual inpatients or same-day surgery patients from admission to discharge. This includes training in the admission and discharge of patients, obtaining medical histories and conducting appropriate physical examinations, prescribing treatment and medications, providing dental care in the operating room, preparing the patient record, including notation of pre- and postoperative orders, progress notes, description of surgical procedures and discharge summaries.

Residents also make rounds on dental inpatients or same-day surgery patients, and are responsible for requesting and reviewing consultations for patients, and gain experience in responding to requests for consultation from other services.

Assessment is measured by resident OR outcomes analyses, as well as by an outcomes exam, sections of which pertain to topics of inpatient and same-day surgery patients.

In addition to the curriculum described above, continuing education courses and various post-graduate electives are available through the University of Michigan.

Program Evaluation & Assessment

In order to maintain a high degree of quality control, many aspects of the General Practice Residency program will be subject to periodic review by the Program Director and Program Faculty. Samples of individual evaluation forms are available upon request.

Resident Evaluation

General Practice Residency program residents will undergo the following evaluation procedures:

Daily: Evaluation of previous day's treatment, as well as planned treatment for the day. Areas of concern can be identified and corrected before impacting on patient care.

Quarterly: Areas to be addressed include:

• Chart Review
• Infection Control
• Clinical Skills Evaluation
• Attitude & Motivation
• Communication Skills (written and oral)
• Didactic Evaluation

Annual: Residents receive an exit interview, summarizing total annual productivity and performance. This also provides an opportunity for resident feedback in order to monitor the program's performance from a provider perspective.

Faculty Evaluation

Faculty are evaluated on a triannual basis, and receive a summary evaluation on an annual basis, near the end of the program's academic year. Overall impressions of resident performance and program operation will be discussed, as well as providing feedback to each faculty member regarding his or her individual performance. Identification of potential problems in the coming year receive priority during these evaluations.

Tuition & Stipend

There is no tuition required for residents participating in this program. The annual stipend is approximately $38,300, consistent with the salary of a first-year house officer at the University of Michigan Medical Center.

Vacation and Sick Time Policies

Each General Practice Residency program resident accrues vacation and sick leave according to protocols established by the University of Michigan. All sick days are considered unexcused absences, and are subtracted from accrued sick leave. Approximately 3 weeks (15 days) of vacation are given.

Practice Privileges and Other Activities Outside the Educational Program

Residents are not allowed to practice dentistry outside the scope of the residency program.

Professional Liability Coverage

Residents receive professional liability coverage at no cost through the sponsoring institution, the University of Michigan, for all patient care services related directly or indirectly to their residency program. This coverage does not extend to any resident practicing outside the scope of the residency program, including but not limited to practicing as an associate in an independent dental practice, or other "moonlighting" activities.

Due Process

Residents are governed by institutional policies which provide for due process for all individuals who may be potentially involved when actions are contemplated or initiate which could result in dismissal of a resident. When there are grievances against a program or an institution, review of these grievances are initiated at the local level prior to the involvement of outside organizations or agencies.

Current Accreditation Status

The University of Michigan Hospital General Practice Residency is fully accredited by the American Dental Association.

Admission Procedure

Residents are selected from students who have completed a course of study in a recognized U.S. or Canadian dental school and who have graduated with a DDS or D.M.D. degree. Applicants must have a Michigan State License, or be eligible for a Michigan State Limited Permit to Practice Dentistry. Interested applicants must apply through the Postdoctoral Application Support Service (PASS). Information about PASS and registration material is available by visiting the American Dental Education Association (ADEA) website at http://www.adea.org/PASS . Three letters of recommendation, a dean's letter, personal statement, curriculum vitae, National Board scores and transcripts are submitted through PASS. The letters from faculty and the dean must be on letterhead stationary. No additonal materials are required unless later requested. The University of Michigan General Practice Residency Program participates in the Postdoctoral Dental Matching Program and candidate selection will initially be from those individual applicants also participating in the Match. Our Program Code with the Postdoctoral Dental Matching Program is 561. To register for the match, visit their website at http://www.natmatch.com/dentres/. Any unmatched positions will be filled following review and selection of remaining and/or non-matched applicants. Deadline for receipt of all completed applications is October 15.

Applicants will be evaluated on the basis of their past academic record, their demonstrated interest in pursuing general, hospital and special care dentistry as a career, and following personal interview. Applicant integrity, motivation, professionalism, resourcefulness, and knowledge and experience will be subjects of discussion during the interview.

Visit the website of the Office of Graduate Medical Education to learn more about UMHS policies.

Further Information

Samuel Zwetchkenbaum, DDS
Program Director - General Practice Residency
The University of Michigan Medical Center
1500 East Medical Center Drive, Rm. B1-208
Ann Arbor, MI 48109-0018
Telephone: 734-936-5955
Email: szwetch@umich.edu