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Dental General Practice Residency Program

The Baltimore VA Medical Center, a part of the VA Maryland Health Care System, is an acute care medical and surgical hospital which offers a one-year Dental General Practice Residency Program following the Accreditation Standards established by the Commission on Dental Accreditation of the American Dental Association. There are a total of five dental residents each year and the program is accredited by the ADA.

Purpose of the Program

The purpose of this program is to provide the graduate dentist with the opportunity to advance his or her dental education and clinical experience to a level beyond that accomplished in pre-doctoral training. The program also provides the opportunity to experience the practice of general dentistry within the hospital environment, employing a greater level of physician-dentist interaction. Emphasis is upon dental treatment of the medically complex patient.

The major portion of the program is devoted to providing comprehensive dental care with emphasis on diagnostic techniques and therapeutic skill. Emergency dental treatment is also provided. The balance of the program is subdivided into scheduled assignments in other areas of the hospital such as Anesthesia and Medicine. Lectures, seminars and clinic supervision are regularly provided by the medical center's attending staff. The program is under the direct supervision of the Director of the General Practice Residency Program.


Period of Training

The training period is twelve months in duration, commencing on July 1st of each year and paying an educational stipend of approximately $60,000 for the year. The resident will receive a total of 20 paid days of annual and sick leave per year. Health insurance for self and family is provided. Upon successful completion the resident will receive a certificate which is registered with the ADA.


Program Training List

Didactic and/or Clinical Training 

General Dentistry Consultation and Referral
Community Service Patient Focused Care
Resident Education Interdisciplinary Health Care
Emergency Dental Care Implant Placement and Restoration
Comprehensive Dental Care Endodontic Therapy
Operative Dentistry Oral Surgery
Fixed Prosthodontic Replacement of Teeth Pain and Anxiety Control
Removable Prosthodontic Replacement of Teeth Temporomandibular Disorder
Periodontal Therapy Orofacial Pain
Medical Emergencies Informed Consent
Oral Mucosal disease Management of Same Day Surgery Patients
Physical Evaluation and Medical Assessment

Instruction List

  • Hospital Credentialing Process
  • Principles of Practice Management
  • Ethics and Professionalism
  • Hospital Organization and Function
  • Confidentiality of Information

The program will include:

  • Assignments in critical review of scientific literature
  • Involvement in quality improvement
  • BLS certification

There are two rotations outside of the dental clinic

  • Anesthesia (70 hours)
  • Primary Care Medicine (70 hours)

Goals and Objectives for off service rotations

Anesthesia

The resident will receive supervised practical experience in the following:

  • Preoperative evaluation
  • Assessment of the effects of behavioral and pharmacologic techniques
  • Venipuncture technique
  • Patient monitoring
  • Airway management
  • Understanding the use of pharmacologic agents
  • Recognition and treatment of anesthetic emergencies
  • Assessment of patient recovery from anesthesia

Primary Care Medicine

The resident will receive supervised practical experience in the following:

  • Obtaining and interpreting the patient's chief complaint, medical and social history, and review of systems.
  • Obtaining and interpreting clinical and other diagnostic data from other health care providers.
  • Using the services of clinical, medical, and pathology laboratories.
  • Performing a history and physical evaluation and collecting other data in order to establish a medical assessment.

Overall Program Goals and Objectives

There are Overall Program Goals and Objectives as well as Specific Goals and Objectives for the program. These goals and objectives closely follow the Accreditation Standards for Advanced Education Programs in General Practice.

The training program will include a period of orientation and basic instructions in duties, responsibilities and privileges of the dental residents. The resident will receive training in medical center procedures related to the dental and medical care of the patient.

Overall Program Goals and Objectives

  1. Residents completing the program will be able to provide general dentistry in a comprehensive care setting.
  2. Residents completing the program will understand that education is a continuing and career long process.
  3. Residents completing the program will be able to treat patients in both the emergent and comprehensive care setting.
  4. Residents completing the program will be able to provide multidisciplinary health care.
  5. Residents will participate in a community service project while in the program.
  6. Residents completing the program will be able to provide oral health care within the hospital setting.

Upon completion of the program the resident will be able to act as a primary oral health care provider for:

  1. Providing emergency and multidisciplinary comprehensive oral health care.
  2. Obtaining informed consent.
  3. Functioning effectively within interdisciplinary health care teams, including consultation and referral.
  4. Providing patient-focused care that is coordinated by the general practitioner.
  5. Directing health promotion and disease prevention activities.

Upon completion of the program the resident will be able to assess, diagnose and plan for the provision of multidisciplinary oral health care for a wide variety of patients with special needs. (Those patients whose medical, physical, psychological, or social situations make it necessary to modify normal dental routines in order to provide dental treatment for that individual). These individuals include, but are not limited to, people with developmental disabilities, complex medical problems and significant physical limitations.


Upon completion of the program the resident will be able to manage the delivery of patient-focused oral health care relating to the patient's social, cultural, behavioral, economic, medical and physical status.


Upon completion of the program the resident will be able to provide the following at an advanced level of skill and complexity beyond that accomplished in pre-doctoral training.

A. Operative Dentistry

  1. Diagnose and treatment plan the need for restorations via oral exam, radiographic interpretation and other diagnostic data.
  2. Determine the appropriate restorative material and technique.
  3. Perform comprehensive operative dentistry.
  4. Diagnose and treat operative emergencies.
  5. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

B. Restoration of the edentulous space

  1. Diagnose and treatment plan the need for fixed and/or removable appliances.
  2. Make and assess preparations for fixed and removable appliances.
  3. Make and assess impressions for fixed and removable appliances.
  4. Construct provisional/interim restorations.
  5. Design, request and evaluate the fabrication of prosthetic work performed by lab technicians.
  6. Evaluate and deliver the final prosthesis.
  7. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

C. Periodontal Therapy

  1. Diagnose, chart, classify, treatment plan, assess and manage the treatment of periodontal disease.
  2. Provide comprehensive periodontal care using chemical and non-surgical technique.
  3. Provide basic periodontal therapy and recognize the need for referral of complicated and advanced cases.
  4. Manage surgical periodontics and advanced or complicated cases.
  5. Assess and evaluate the prognosis and effectiveness of treatment.
  6. Diagnose and treat periodontal emergencies.
  7. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

D. Endodontic Therapy

  1. Diagnose pulpal and periapical pathology and determine/treatment plan the need for endodontic therapy
  2. Diagnose and provide initial treatment/referral of endodontic emergencies.
  3. Recognize the need for consultation/referral of complicated or advanced cases.
  4. Perform uncomplicated traditional or rotary endodontics.
  5. Manage complicated or advanced endodontic cases.
  6. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

E. Oral Surgery

  1. Diagnose, treatment plan and perform uncomplicated extractions and uncomplicated surgical extractions to include alveoloplasty.
  2. Diagnose and treat/manage (based on complexity) the need for preprosthetic surgery.
  3. Diagnose and treat/manage (based on complexity) the need for I & D of abscess.
  4. Diagnose and treat/manage (based on complexity) the need for biopsy
  5. Diagnose, treatment plan and manage the treatment of complicated or advanced surgical extractions
  6. Provide initial treatment and appropriate referral for oral surgery emergencies.
  7. Recognize the need for consultation or referral.
  8. Diagnose and treat/manage postoperative complications.
  9. Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

F. Evaluation and treatment of dental emergencies

  1. Diagnose and provide treatment for uncomplicated dental emergencies.
  2. Diagnose and provide initial treatment of complicated/advanced dental emergencies, and then manage these emergencies through appropriate consultation and referral.
  3. Recognize the need for consultation and/or referral of dental emergencies.
  4. Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

G. Pain and anxiety control utilizing behavioral and pharmacological techniques.

  1. Diagnose and evaluate the patient's level of pain and/or anxiety.
  2. Treatment plan and provide control of pain and anxiety through local, behavioral and pharmacological techniques.
  3. Determine when to refer the patient for management of the appropriate level of pain and anxiety control.
  4. Determine the ability of the patient to safely undergo the appropriate type of pain/anxiety control through appropriate medical risk assessment and/or consultation.
  5. Anticipate, prevent, diagnose and treat/manage complications and medical emergencies arising from pain and anxiety control.
  6. Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Upon completion of the program the resident will be able to manage (diagnose and treatment plan the need for care and coordinate the delivery of that care) the following:

A. Medical emergencies

  1. Anticipate, prevent, diagnose and manage potential medical emergencies through medical risk assessment.
  2. Anticipate the impact of systemic disease on dental treatment and the effect of dental treatment on medical health.
  3. Anticipate, diagnose and provide initial treatment for medical emergencies to include BLS.
  4. Manage medical emergencies after initial diagnose and treatment has been performed.
  5. Demonstrate proficiency as evidenced by staff appraisals and self appraisals

B. Implants

  1. Diagnose and treatment plan the need for implants including appropriate patient selection.
  2. Place and restore uncomplicated implant cases.
  3. Manage the placement and restoration of complicated or advanced implant cases to include directing ideal implant placement and evaluating of the quality of treatment provided by the referral.
  4. Diagnose and treat implant emergencies for initial care, then manage via referral.
  5. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

C. Oral mucosal diseases

  1. Diagnose and treatment plan the need for evaluation of abnormal mucosa lesions and abnormal radiographic appearance.
  2. Recognize the need for consultation/referral of lesions.
  3. Diagnose and treatment plan the need for biopsy. Perform uncomplicated/simple biopsies and manage, complicated/difficult biopsies.
  4. Diagnose and treat complications of oral mucosal disease treatment and biopsy.
  5. Recognize the oral manifestation of systemic disease.
  6. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

D. Temporomandibular disorder

  1. Diagnose and manage temporomandibular disorder.
  2. Diagnose and manage occlusal disorders
  3. Diagnose and provide minor occlusal adjustment
  4. Provide conservative therapy to include construction of an occlusal appliance.
  5. Recognize the need for consultation and referral for cases involving more than minor occlusal disorders to include full mouth equilibration, orthodontic and orthognathic disorders
  6. Evaluate and assess the quality of care given by the provider to whom the referral was made.
  7. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

E. Orofacial pain

  1. Diagnose and manage orofacial pain.
  2. Recognize the need for consultation and referral.
  3. Evaluate and assess the quality of care given by the provider to whom the referral was made.
  4. Demonstrate proficiency as evidenced by staff appraisals and self appraisals.

Goals and Objectives for off-service rotations

Anesthesia

  • The resident will receive supervised practical experience in the following;
  • Preoperative evaluation
  • Assessment of the effects of behavioral and pharmacologic techniques
  • Venipuncture technique
  • Patient monitoring
  • Airway management
  • Understanding the use of pharmacologic agents
  • Recognition and treatment of anesthetic emergencies
  • Assessment of patient recovery from anesthesia

Primary Care Medicine

  • The resident will receive supervised practical experience in the following;
  • Obtaining and interpreting the patient's chief complaint, medical and social history, and review of systems.
  • Obtaining and interpreting clinical and other diagnostic data from other health care providers.
  • Using the services of clinical, medical, and pathology laboratories.
  • Performing a history and physical evaluation and collecting other data in order to establish a medical assessment.

The program will provide the resident with formal instruction in physical evaluation and medical assessment to include:

  1. Taking, recording, and interpreting a complete medical history.
  2. Understanding the indications of and interpretations of laboratory studies and other techniques used in the diagnosis of oral and systemic diseases.
  3. Understanding the relationship between oral health and systemic disease.
  4. Interpreting the physical evaluation performed by a physician with an understanding of how it impacts on proposed dental treatment.
  5. Appropriately interacting with other health care providers.

The program will provide the resident with instruction in the principles of practice management.

The program will provide the resident with an understanding of hospital organization, function and the credentialing process.


The resident will receive training and experience in the management of inpatients or same-day surgery patients to include:

  1. Reviewing medical histories and physical examinations.
  2. Prescribing treatment and medications.
  3. Providing care in the operating room.
  4. Preparing the patient record, including notations of medical history, review of physical examination, pre- and post-operative orders and description of surgical procedures.

The program will ensure that students/residents are able to demonstrate the application of the principles of ethical reasoning, ethical decision making and professional responsibility as they pertain to the academic environment, research, patient care, and practice management.

 

Residents will provide after hours dental call services by long-range pager, which is provided. Call responsibility is shared among five dental residents.

Professional liability (under Tort Reform) is assumed by the Department of Veterans Affairs for treatment of veterans within the Hospital facilities only.


Requirements for Appointment

  1. The applicant must be a U.S. Citizen
  2. The applicant must be a graduate of a dental school approved by the American Dental Association
  3. The applicant must be recommended by the Dean of his or her dental school
  4. The applicant must be approved by the Dental Residency Review Board, VAMC, Baltimore, MD

Application Procedures

The applicant may apply through the PASS service. We do not participate in the MATCH. The program deadline is posted on the PASS website.

http://programpages.passweb.org/view/750

The applicant must provide through PASS:

  1. Recommendation from the dental school Dean, to include anticipated date of graduation, academic rank and GPA
  2. Dental School transcripts
  3. National Board scores
  4. Curriculum vitae
  5. Essay or Personal Statement
  6. Three Professional Evaluation Forms (PEF) from clinical instructors who have knowledge of your clinical skills in (1) operative (2) fixed and (3) oral surgery
  7. VA Form 10-2850d “Application for Health Professions Trainees”

The applicant must mail a recent photograph to the program director.

Contact Information:

K. Hashimoto, D.D.S.
Program Director, GPR

VA Medical Center
Dental 160
10 North Greene Street
Baltimore, MD 21201
410-605-7056
katherine.hashimoto@va.gov

W.H. Inge, Jr., D.D.S.
Director, Dental Care Clinical Center, VAMHCS

VA Medical Center
Dental 160
10 North Greene Street
Baltimore, MD 21201
walter.inge@va.gov

The program in general practice residency is accredited by the Commission on Dental Accreditation. The Commission is a specialized accrediting body recognized by the United States Department of Education. The Commission on Dental Accreditation can be contacted at 312-440-4653 or at 211 East Chicago Avenue, Chicago, IL 60611-2678. 

The Commission on Dental Accreditation has accredited the postdoctoral program in general practice residency. However, this education area is not one of the American Dental Association recognized dental specialty areas. Therefore, dentists graduating from this program cannot announce that they are specialists, as recognized by the American Dental Association.