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NAVIGATING THE CDHM CONTINUING COMPETENCY PROGRAM
Joanna Asadoorian AAS(DH), BScD(DH), MSc
Associate Professor
School of Dental Hygiene, Faculty of Dentistry
University of Manitoba
Navigating the CDHM Continuing Competency
Program The CDHM mandate is to protect the
public by ensuring safe, quality oral health care
What is quality…where does competence fit? “degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”
Blumenthal, 1996
Knowledge, skill and appropriateness of health care Structure and process to ensure best outcomes Competence and daily performance Measurement and improvement of the entire profession
Asadoorian, J., CDHM Presentations Spring 2010 © 7/30/10
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Diffusion of Innovations: Problems & Recommendations
A considerable lag time exists between new research findings and general application into practice settings
Research shows almost a twenty year lapse between dissemination and implementation
Significant time delays reflect a failure to implement newer, more effective procedures and the discontinuation of ineffective or harmful ones
Implies a delay of best practices available to patients
Known as the theory practice gap “Education allowance systems” as in those based
on CE time requirements have been described as failures to the
profession…” (Grant, 2002)
“Conducting a needs assessment is essential in directing the educational process.” (Cantillon and Jones, 1999)
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Self-Assessment (SA): Panacea or Part of the
Problem
Incapability of self-assessing accurately
SA used to protect one’s self concept Need to preserve
confidence and positive attitudes
Learning activities chosen based on areas we excel
SA is an over and misused term Not intended to be an
individualistic activity Multiple sources of
external feedback recommended
(Eva & Regehr, 2007)
Provide direction to one’s learning
Promotes increased efficiency in learning
Generates motivation to one’s learning and for implementing change
(Asadoorian & Batty, 2005)
Rationale for Conducting Self-Assessments
Problems with Self-Assessment
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Self-directed Assessment Seeking
What is Self-directed Assessment Seeking? Collecting data about one’s professional
performance through: honest reflective introspection (internal) requesting unbiased feedback from others (external)
Creating an awareness of deficiencies, opportunities for improvement and continuing competency needs specific knowledge topics, skills, client problems and
practice issues Indicating the continuing competency goals that one should ideally address
1. Self-directed
Assessment
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Self-directed Assessment Seeking (SDAS)
Internal evaluation should be conducted in a meaningful and structured way
Use of tools for thinking about one’s own practice performance 1. Reflection-on-
practice 2. Competencies &
Practice Standards 3. Evidence-based
Practice 4. Self-assessment tests
External evaluation should be intentional, ongoing activity and increasingly relied upon
Use multiple sources: Include appraisal by
peers, experts, clients and others to help expose areas in need of improvement
Tools available to carry out
Internal External
1. Self-directed
Assessment
How to accomplish a meaningful SDAS:
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Self-directed Assessment Seeking
Internal: 1. Reflection on Practice Defined: “an important human activity in which
people recapture their experience, think about it, mull it over and evaluate it” (Boud)
Reflect on and learn from: Day-to-day practice problems
client care including complex medical conditions, communication challenges, procedural difficulties and poor treatment outcomes– surprises!
Ongoing challenges from one’s practice environment Antiquated office policies, conflicting treatment
philosophies and structural inadequacies Practice problems often generate emotional
responses: Emotional cues help identify competency challenges Maintaining a practice log aids in recalling challenges for
later reflection
1. Self-directed
Assessment
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Self-directed Assessment Seeking: Reflection on
Practice
1. Self-directed
Assessment
5 Good Reasons: 1. Links theory & practice
2. Uses our own (clinical) experiences
3. Helps make sense of real practice problems“messy swamplands”
4. Encourages a different kind of learning- deep rather than superficial
5. Generates a different kind of knowing“transformative” knowing that motivates
change
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Keys to Using Reflection in Practice: Foundation is concrete experience; start
with meaningful experiences Structure may help; use a model for a
framework Many available: Kolb, Mezirow, Boud…
Use your feelings; trigger the need to reflect Reflect regularly Start with a Journal or practice log
Note your feelings and/or practice problems
1. Self-directed
Assessment
Self-directed Assessment Seeking:
Reflection on Practice
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A Suggested Model of Reflection An integration of the literature…
TriggerDescribe theExperience
Develop an Awareness
Analyse theSituation
Relate the Experience
Develop a newPerspective
Validate newPerspective
Non-reflectors
Reflectors
Critical Reflectors
Asadoorian, 2005
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A Suggested Model of Reflection An integration of the literature…
TriggerDescribe theExperience
Develop an Awareness
Analyse theSituation
Relate the Experience
Develop a newPerspective
Validate newPerspective
Non-reflectors
Reflectors
Critical Reflectors
Asadoorian, 2005
What was your emotional response
Give a descriptive account of
what happened
What was occurring before and after; what
other things were influencing you
Take the experience apart and examine it
What knowledge do you have that relates to this;
what knowledge is
missing
Transformed thinking results and
compels change
Trying out new
thinking and seeing
how it works in practice
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What, why, how? Helpful for determining professional strengths and
weaknesses and directing one’s continuing competency goals
Using these documents involves comparing one’s own practice performance to the competency/standard outlined in the document Look for new National Competencies document on
CDHA website (September) To determine if one has competency in the specific
item or if additional development is required— often due to insufficient knowledge, skill and/or experience
The dental hygienist is cued in to develop a corresponding continuing competency goal
1. Self-directed
Assessment
Self-directed Assessment Seeking:
Internal: 2. Competencies & Standards
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1. Self-directed
Assessment
Self-directed Assessment Seeking:
Internal: Competencies & Standards
ASSESSMENT (67 Competencies) √
29 Assesses health status of dental implants
30 Assesses hard and soft deposits
31 Assesses intraoral hard tissues
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Self-directed Assessment Seeking
Internal: Evidence-Based Practice3. EBP: The rationale
“the most cost-effective opportunity to improve patient outcomes over the next quarter century will likely come not from discovering new therapies but from discovering how to deliver therapies that are known to be effective” (Berenholz & Pronovost, 2003)
Even the most robust evidence supporting optimal clinical care typically fails to be implemented
Failures in knowledge application results in gaps between best practice and actual performance
In health care practice, practitioners may be unaware of what they do not know
Dental hygienists may not realize that current research does not support a specific routine procedure
1. Self-directed
Assessment
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Self-directed Assessment Seeking
Internal: Evidence Based Practice Reading professional journals and articles, attending professional conferences and lectures, searching databases, conducting research and participating in journal clubs provide valuable opportunities for exposure to new research
Databases: “PubMed” (Medline) Cochrane Collaboration- Reviews
Search, by topic Oral health
1. Self-directed
Assessment
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Self-directed Assessment Seeking
Internal: 4. Self-Assessment Tests Read article and then take SA test
immediately Take SA test first to determine if reading
article is necessary Take SA test later for retention and
application
1. Self-directed
Assessment
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Self-directed Assessment Seeking
External: Questions, Discussion and Feedback
Increasingly rely on external sources for feedback about performance
Highlights topics or issues that one has limited knowledge about or contradicts one’s current beliefs It is human nature to dismiss or rationalize negative feedback
or conflicting philosophies Opportunities may occur spontaneously (i.e. client
questions, employer/colleague comment and discussions), but more often individuals must solicit others for feedback Questions, discussions, and feedback from peers,
employers and clients provide excellent resources for identifying deficiencies and opportunities for improvement: Continuing competency goals
1. Self-directed
Assessment
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Self-directed Assessment Seeking
External: Questions, Discussion and Feedback
1. Self-directed
Assessment
DENTAL HYGIENIST SELF-DIRECTED FEEDBACK FORMName:Date:Please return feedback by:Thank you for agreeing to provide your valuable feedback to me
regarding my dental hygiene practice. Your feedback will assist me in addressing my learning needs.
On the following sheet(s) please make written comments about the area(s) indicated below.
When you are providing the feedback please be specific, clear and descriptive. Please include examples where possible.
I would also appreciate meeting briefly with you to discuss your feedback. Perhaps we can schedule some time to meet after you have returned the written feedback.
1.__________________________________________________________________ 2.__________________________________________________________________ 3.__________________________________________________________________
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It is important to ask for others to be specific and limit feedback:
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1.
Strengths I have noticed:A
B
C
Enhancements that could be made:A
B
C
Date Written: Date Reviewed:
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Self-directed Assessment Self-directed Assessment
Self Directed Assessment: CCR
How did you determine that you had a professional need or deficiency? (See pages 10 & 11 in Section 2 of the CCP Package)
Practice problems & reflection
Using the CDHM Competencies/Standards/Code of Ethics
Questions, discussions or external feedback
Evidence-based practice
Other: (Specify) ________________________________________
FILLING OUT THE FORM! Step One:
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Navigating the CDHM Continuing Competency
Program Professional Development Component:
CCR
1. Self-directed
Assessment
2. Goals Development
& Activity Planning
3. Activity Implementati
on & Evaluation
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Goal Development &
Planning Activity Self-directed assessment seeking strategies assist in
detecting deficiencies and opportunities for improvement Step two involves developing continuing competency goals
and associated plans to address identified deficiencies Two typical types of goals:
knowledge attainment goals action oriented goals
action oriented goals often require change to practice and may require activities to support the behavior change from the clinician or other practice members
Practice deficiencies must be prioritized to determine if which require immediate attention and those that should be deferred
Planned activities should address some aspect of achieving one’s goal and chosen based on resources and preference one to several activities will be needed to support achievement of goals use traditional methods and new online and digital resources
2. Goal Development
& Planning Activity
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Goal Development
Once “cued in”, describe in detail the perceived practice deficiency/opportunity for improvement May be just a hunch at this
point Include:
What led to this observation?
What do you already know? Is it possible this
knowledge could be updated?
Is it possible that practice is not currently based on evidence?
In one sentence, define a goal that captures the need you have identified Include a subject,
action, timeline and measurable outcome
Example: “Within 6 months, I will
ensure that the dental implant care I provide/recommend is based on the most current evidence available”
Developing the goal Defining the goal
2. Goal Development
& Planning Activity
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Goal Development
I have been out of school for several years and have not really ever incorporated ultrasonic scaling into my clinical practice; I practice with a new graduate dental hygienist and she uses the ultrasonic scaler along with hand scaling with virtually every client. She explains to her clients that ultrasonics is the latest technology and that it has several therapeutic benefits over and above hand scaling. This makes me feel uncomfortable for several reasons. First, I am not sure how accurate the information she is sharing is, but I feel a little out of date on my knowledge surrounding power scalers and therefore not well-equipped to have a discussion about it. Second, I would prefer that we practice in a more standardized way based on the most recent evidence. Lastly, I am wondering if my clients feel short-changed that they are not receiving ultrasonic debridement because they may over hear what she is telling her clients.
Developing the goal
2. Goal Development
& Planning Activity
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Goal Development
I will use the ultrasonics/power scalers in my dental hygiene practice in accordance with the most recent research/evidence within 6 months.
Be specific Be realistic Include only one goal Will you be able to measure your
success?
Defining the goal
2. Goal Development
& Planning Activity
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Planning Activity
Once the goal is developed and defined, determine some objectives (mini-goals) to meet the goal
Think about the learning component AND what will be needed to ensure implementation of the goal into practice: be realistic and detailed
Consider what resources will be available and what you prefer to use for achieving goals This may require some research Try to incorporate new methods
(i.e. internet searches, online learning programs)
This is a plan, and may require some modifications later
Asadoorian, J., CDHM Presentations Spring 2010 ©
2. Goal Development
& Planning Activity
Objectives/mini-goals: What do I need to achieve and
learn? i.e. latest ultrasonics
information/research How am I going to do it?
(potential ideas) Do PubMed/Cochrane search
Download relevant articles See if any courses/workships
coming up on topic MDHA, CDHA, industry
Call an expert Educator, researcher, colleagues
Then what? Implement!! Read, attend, consult, buy…Make
Changes To Practice!
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Goal Development &
Activity Planning
Goal Development &
Activity Planning
Goal Development & Activity Planning: CCR
Please describe the professional need or deficiency perceived: (see pages 10 & 11 in Section 2 of the CCP Package)
__________________________________________________________________________________________________________________________________________________________________________________ ...CONTINUING COMPETENCY GOAL # 1: (see pages 12 & 13 in Section
2 of the CCP Package)
I will use the ultrasonics/power scalers in my dental hygiene practice in accordance with the most recent research/evidence within 6 months.
FILLING OUT THE FORM! Step Two:
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Navigating the CDHM Continuing Competency
Program Professional Development Component:
CCR
1. Self-directed
Assessment
2. Goals Development
& Activity Planning
3. Activity Implementati
on & Evaluation
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Changing Practice: Activity Implementation & Evaluation
3. Activity Implementati
on & Evaluation
Knowledge Awareness ≠ Knowledge Application People, including dental hygienists, resist change
Dental hygienists have been shown to embrace traditional behaviours and maintain the status quo ~ even in the face of strong evidence
Barriers exist that contribute to making change difficult– but enhancers exist too!
Facilitating the change process: Recognize the relevance of a change Possess transformed thinking (from reflection on practice) Use more active strategies for learning
Problems carrying out change: Change is not automatic; humans do not behave completely
rationally Human change process is complex
based on individual and structural influences
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Changing Practice: Activity Implementation & Evaluation
Activity Implementation: Matching activities to practice
deficiencies ensures the most efficient use of one’s time— rather than spending numerous hours on
activities that are irrelevant to one’s practice Using a detailed and realistic activity
plan, it is relatively straightforward to carry out
Activities can be conducted over a period of time to achieve continuing competency goals
Despite the most carefully developed activity plans, some obstacles may be encountered In these cases it will be necessary to
implement a contingency plan and adjust one’s timeline accordingly
Asadoorian, J., CDHM Presentations Spring 2010 ©
3. Activity Implementati
on & Evaluation
Evaluation: One of the most important continuing
competency tasks is the evaluation of goals Without evaluation it is impossible to know
how to proceed Three possible outcomes to the
evaluation are possible: goal is met goal is unmet goal is in process
Based on the outcome, think about what will need to occur next Goals are fully met: focus on new continuing
competency activity or goal Unmet or in process goals: more learning or
supplementary activities may be necessary; a need to revise the goal may also become apparent
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Activity Implementation
& Evaluation
Activity Implementation
& Evaluation
Activity Implementation &
Evaluation: CCR
CONTINUING COMPETENCY ACTIVITIES: What type of activities did you participate in to support the achievement of this goal? Check all that apply (see pages 14 & 15 in Section 2 of the CCP Package)
Educational Courses/Seminars Date of Course: _______ Name of Course/Presenter: __________
Online Courses Date of Course: _______ Name of Course/Presenter: __________
Advanced Formal Education Institution: ___________ Name of Course/Program of Study: ___
Professional Journals/ Articles Date Read: __________ Journal/Article Reviewed: (may attach)
Journal Clubs Date(s) Met: _________ Journal and/ or Topic Reviewed: _____
Videos or DVDs Date Viewed: _______ Title of Video/DVD/Producer: ________
Other: (Specify) _______ Please describe: ______________________________________
What was the approximate time spent participating in the activities? __________
FILLING OUT THE FORM! Step Three:
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Did these activities assist you in meeting your Continuing Competency Goal? Met Not Met Partially Met
Please Explain: ________________________________________________...
Please describe the information/skills gained from these activities:_____________________________________________________________...
What changes do you intend to make in your area of dental hygiene practice as a result of these activities?
(please include the timeframe you hope to accomplish this in - i.e. immediately,
within 1 year): __________________________________________________...
FILLING OUT THE FORM! Step Three (cont...):
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Did you implement these changes into your dental hygiene practice? Yes No In-Process
Briefly Describe: ___________________________________________________________ …
If a change was made, did it help to improve your dental hygiene practice? Yes No In-Process
Briefly Describe: __________________________________________________________ …
Were there any constraints you encountered in implementing this change? Yes No
Briefly Describe: __________________________________________________________ …
FILLING OUT THE FORM! Step Three (cont...):
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Navigating the CDHM CCP:In Summary
Self directed
assessment
Goals development & activity planning
Activity implement
ation & evaluation
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