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Commission on Dental Accreditation

Self-Study Guide forThe Evaluation of aPeriodonticsEducation Program


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Self-Study Guide forThe Evaluation of an

Periodontics Education Program

Commission on Dental AccreditationAmerican Dental Association

211 East Chicago AvenueChicago, Illinois 60611

312/440-4653www.ada.org

Document Revision History

Date Item Action

July 31, 2008 Accreditation Standards for Advanced SpecialtyEducation Programs in Periodontics

Adopted

January 1, 2009 Accreditation Standards for Advanced SpecialtyEducation Programs in Periodontics

Implemented

January 30, 2009 Revisions to Language Common to AllSpecialties (Standards 1, 4 and 5)

Adopted

July 1, 2009 Revisions to Language Common to AllSpecialties (Standards 1, 4 and 5)

Implemented

July 31, 2009 Revised Policy on Major Change Adopted andImplemented

August 6, 2010 Policy Revisions (Major Change, Off-CampusSites, Authorized Enrollment Increases) Adopted

January 1, 2011 Policy Revisions (Major Change, Off-Site,Authorized Enrollment Increases)

Implemented

August 5, 2011 Revised Policy on Program Changes Adopted andImplemented

February 3, 2012 The Joint Commission Equivalency Statement AdoptedAugust 4, 2012

January 31, 2013January 31, 2013

The Joint Commission Equivalency StatementAddition of BioSketch Exhibit 3.3Revised Compliance with Commission Policiessection (Complaints)

ImplementedImplementedImplemented

Copyright 2013

Commission on Dental AccreditationAmerican Dental Association

All rights reserved. Reproduction is strictly prohibited without prior written permission.

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TABLE OF CONTENTS

Contents

Contents...........................................................................................................................................3INTRODUCTION TO THE SELF-STUDY GUIDE.....................................................................4POLICIES AND PROCEDURES RELATED TO THE EVALUATION OF ADVANCEDSPECIALTY EDUCATION PROGRAMS.....................................................................................6ORGANIZING FOR THE SELF-STUDY......................................................................................9INSTRUCTIONS FOR COMPLETING THE SELF-STUDY.....................................................11TITLE PAGE.................................................................................................................................13......................................................................................................................................................15GENERAL INFORMATION........................................................................................................15PREVIOUS SITE VISIT RECOMMENDATIONS.....................................................................17COMPLIANCE WITH COMMISSION POLICIES.....................................................................17PROGRAM EFFECTIVENESS....................................................................................................18STANDARD 1 INSTITUTIONAL COMMITMENT/PROGRAM EFFECTIVENESS...........19STANDARD 2 - PROGRAM DIRECTOR AND TEACHING STAFF.......................................23STANDARD 3 FACILITIES AND RESOURCES....................................................................27STANDARD 4 - CURRICULUM AND PROGRAM DURATION.............................................31STANDARD 5 - ADVANCED EDUCATION STUDENTS/RESIDENTS................................43STANDARD 6 RESEARCH......................................................................................................47SUMMARY OF SELF-STUDY REPORT....................................................................................48REQUIRED APPENDIX INFORMATION..................................................................................50SELECTED EXHIBITS................................................................................................................55

TEACHING APPOINTMENTS (Begin with current)..................................................................60HOSPITAL APPOINTMENTS (Begin with current)...................................................................61

PRACTICE EXPERIENCE.......................................................................................................61PROTOCOL FOR CONDUCTING A SITE VISIT......................................................................71

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INTRODUCTION TO THE SELF-STUDY GUIDE

The Self-Study Guide is designed to help an institution succinctly present information about its advancedspecialty education program in preparation for an evaluation visit by the Commission on Dental AccreditaIt is suggested that the institution initiate the self-study process approximately 12 months prior to complet

of the Self-Study Report. The primary focus of the self-study process should be to assess the effectivenesthe educational program in meeting (1) the programs stated goals and objectives and (2) the CommissionAccreditation Standards for Advanced Specialty Education Programs in Periodontics.

The Self-Study Report should be a concise, yet thorough, summary of the findings of the self-study proceThe Commission hopes that the self-study will be a catalyst for program improvement that continues longthe accreditation process has been completed. In its opinion, this is a more likely outcome if there is thoroplanning, as well as involvement of students/residents and administrators in the self-study process. Mostprograms will concentrate upon questions germane to the Commissions Accreditation Standards.Nevertheless, the benefits of self-study are directly related to the extent to which programs evaluate theirefforts, not simply in light of minimal standards for accreditation, but also in reference to the programs stgoals and objectives as well as standards for educational excellence. Conclusions of the self-study may in

qualitative evaluation of any aspect of the program whether it is covered in the Self-Study Guide or not.Programs must respond to all questions included in the Self-Study Guide. The responses should be succinbut must in every case provide or cite evidence demonstrating achievement of objectives in compliance weach of the Accreditation Standards.

For the educational program, the self-study provides an opportunity to:

1. Clarify its objectives as they relate to:

a. Preparation of periodontists;b. Expectations of the dental profession and the public in relation to the education of

periodontists; andc. The programs general educational objectives.

2. Candidly and realistically assess its own strengths and weaknesses in light of its own stated objecti

3. Internalize the process and engage in the kind of self-analysis essential to effective planning and ch

4. Provide the basis for a more informed and helpful site visit related to the real issues including thestrengths and weaknesses of the program.*

*Adapted and summarized from Role and Importance of the Self-Study Process in Accreditation, Richa

Millard, President, Council of Postsecondary Accreditation (July 25-26, 1984)

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For the Commission and visiting committee, the self-study process should:

1. Ensure that the program has seriously and analytically reviewed its objectives, strengths andweaknesses.

2. Provide the site visitors the basic information about the program and the programs best judgmentown adequacy and performance, thus providing a frame of reference to make the visit effective andhelpful to the program and the Commission.

3. Ensure that the accrediting process is perceived not simply as an external review but as an essentiacomponent of program improvement.

4. Ensure that the Commission, in reaching its accreditation decisions, can benefit from the insights oboth the program and the visiting committee.

The Self-Study process and report are not the following :

A self-study is not just a compilation of quantitative data. Such data may be a prerequisite for developingeffective self-study, but such data in themselves are not evaluative and must not be confused with a self-st

A self-study is not or should not be answers to a questionnaire or a check-off sheet. While a questionnairbe probing, it is essentially an external form and does not relieve the responder of the critical review essenself-study. A check-off list based on the Commissions Accreditation Standards can be helpful in developthe self-study but does not reveal the conditions or rationale leading to the answers -- again both the organactivity and the critical analysis are missing.

A self-study is not or should not be a simple narrative description of the program. While such a descriptionecessary, the self-study should go beyond such description to an analysis of strengths and weaknesses in

of the programs objectives, as well as develop a plan for achieving those objectives that have not been fulrealized. It should be emphasized that, while the self-study is essential to the accrediting process, the majvalue of an effective self-study should be to the program itself. The report is a document, which summarithe methods and findings of the self-study process. Thus, a self-study report written exclusively by aconsultant or an assigned administrator or faculty member is not a self-study.



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POLICIES AND PROCEDURES RELATED TO THE EVALUATION OFADVANCED SPECIALTY EDUCATION PROGRAMS

The Commission has established a seven-year site visit cycle for accreditation review for all disciplines exc

oral and maxillofacial surgery, which has a five-year cycle. Every effort is made to review all existing denand dental-related programs in an institution at the same time. However, adherence to this policy ofinstitutional review may be influenced by a number of factors, e.g., graduation date established for newprograms, recommendations in previous Commission reports, and/or current accreditation status.

The purpose of the site evaluation is to obtain in-depth information concerning all administrative andeducational aspects of the program. The site visit verifies and supplements the information contained in thcomprehensive self-study document completed by the institution prior to the site evaluation.

As stated in Instructions for Completing the Self-Study Report, one copy of the completed Self-StudyReport should be sent directly to each member of the visiting committee at least 60 days prior to the date ovisit. Names and addresses of the members of the team will be provided to the institution approximately tthree months ahead of the visit. In addition, one copy of all self-study materials is to be submitted to theCommission office 60 days in advance of the visit. NOTE: If a Commission staff member is serving on thvisiting committee, the Commission should receive one copy of the self-study report for this individual andsecond copy for the programs files.

Third Party Comment Policy: The program is responsible for soliciting third party comments fromstudents/residents and patients that pertain to the Standards or policies and procedures used in theCommissions accreditation process. An announcement for soliciting third party comments is to be publisat least ninety (90) days prior to the site visit. The notice should indicate that third party comments are duthe Commissions office no later than sixty (60) days prior to the site visit. Please review the entire policyThird Party Comments in the Commissions EOPP: Evaluation and Operational Policies and Procedures

manual.

Complaints Policy: The program is responsible for developing and implementing a procedure demonstratithat students/residents are notified, at least annually, of the opportunity and the procedures to file complaiwith the Commission. Additionally, the program must maintain a record of student/resident complaintsreceived since the Commissions last comprehensive review of the program. Please review the entire poliComplaints in the Commissions EOPP: Evaluation and Operational Policies and Procedures manual.

Student Identity Verification Requirement For Programs That Have Distance Education Sites : Programs toffer distance education must have processes in place through which the program establishes that the studwho registers in a distance education course or program is the same student who participates in and comp

the course or program and receives the academic credit. Programs must verify the identity of a student wparticipates in class or coursework by using, at the option of the program, methods such as a secure loginpass code; proctored examinations; and/or new or other technologies and practices that are effective inverifying student identity. The program must make clear in writing that processes are used that protectstudent privacy and programs must notify students of any projected additional student charges associated the verification of student identity at the time of registration or enrollment.

Site Visitor Requests for Additional Information: Visiting committee members are expected to carefullyreview the completed self-study reports and note any questions or concerns they may have about thePeriodontic Self-Study Guide

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information provided. These questions are forwarded to Commission staff (or staff representatives), compand submitted to the program director prior to the visit. The requested information is provided to the teammembers either prior to the visit or upon their arrival to the program. Site visitors will have a copy of theinstitutions most recent Annual Survey.

Site Visit Committee Composition: The Commission on Dental Accreditations accreditation program isaccomplished through mechanisms of annual surveys, site evaluations and Commission reviews. The visitcommittees are assigned to review allied dental education programs by the Commission Chairman. The viscommittees are composed, as appropriate, of Commission staff representatives who are responsible forcoordinating the visit and preparing the site visit report and Commission-appointed site visitors in advancespecialty education who have expertise in their respective areas.

For advanced education site visits, the Commission urges the program to invite a representative from the examining board of the state in which the program is located to participate with the committee as the StatBoard representative. This representation; however, must be at the request of the institution/program beievaluated. State Board representatives participate fully in site visit committee activities as non-voting meof the committee. State Board representatives are required to sign the Commissions Agreement of

Confidentiality.

After the Site Visit: The written site visit report embodies a review of the quality of the program. It servethe basis for accreditation decisions. It also guides officials and administrators of educational institutions determining the degree of their compliance with the accreditation standards. The report clearly delineatesobserved deficiencies in compliance with standards on which the Commission will take action.

The Commission is sensitive to the problems confronting institutions of higher learning. In the report, theCommission evaluates educational programs based on accreditation standards and provides constructiverecommendations, which relate to the Accreditation Standards and suggestions, which relate to programenhancement.

Preliminary drafts of site visit reports are prepared by the site visitors, consolidated by staff into a singledocument and approved by the visiting committee. The approved draft report is then transmitted to theinstitutional administrator for factual review and comment prior to its review by the Commission. Theinstitution has a maximum of 30 days in which to respond. Both the visiting committees approved draft rand the institutions response to it are considered by the Commission in taking the accreditation action.

The site visit report reflects the program as it exists at the time of the site visit. Any improvements or chamade subsequent to a site visit may be described and documented in the programs response to the prelimidraft report, which becomes part of the Commissions formal record of the programs evaluation. Suchimprovements or changes represent progress made by the institution and are considered by the Commissiodetermining accreditation status, although the site visit report is not revised to reflect these changes. Follassignment of accreditation status, the final site visit report is prepared and transmitted to the institution. Commission expects the chief administrators of educational institutions to make copies of the Commissionvisit reports available to program directors, faculty members and others directly concerned with programquality so that they may work toward meeting the recommendations contained in the report.



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Commission members and visiting committee members are not authorized, under any circumstances, to diany information obtained during site visits or Commission meetings. The extent to which publicity is givesite visit reports is determined by the chief administrator of the educational institution. Decisions to publireports, in part or in full, are at the discretion of the educational institution officials, rather than theCommission. However, if the institution elects to release sections of the report to the public, the Commisreserves the right to make the entire site visit report public.

Commission Review of Site Visit Reports: The Commission and its review committees meet twice each yto consider site visit reports, progress reports, applications for accreditation and policies related toaccreditation. These meetings are usually in winter and summer. Reports from site visits conducted less tninety (90) days prior to a Commission meeting are usually deferred and considered at the next Commissimeeting.

Notification of Accreditation Action: An institution will receive the formal site visit report, including theaccreditation status, within thirty (30) days following the official meeting of the Commission. TheCommissions definitions of accreditation classifications are published in its Accreditation Standards

documents.

Additional Information: Additional information regarding the procedures followed during the site visit iscontained in the Commissions publication, Evaluation and Operational Policies and Procedures. TheCommission uses the Accreditation Standards for Advanced Specialty Education Programs as the basis foevaluation of advanced specialty education programs; therefore, it is essential that institutions be thoroughfamiliar with this document.



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ORGANIZING FOR THE SELF-STUDY

The self-study should be comprehensive and should involve appropriate faculty and staff throughout theinstitution.

When feasible, it is suggested that a committee, with appropriate faculty representation, be selected to assthe program director with the self-study process. This committee should be responsible for developing animplementing the process of self-study and coordinating the sections into a coherent self-study report. It be desirable to establish early in the process some form or pattern to be used in preparing the sections in treport in order to provide consistency.

The committee should have assistance with preparing and editing the final self-study report. Appropriatefaculty and other institutional representatives (e.g., learning resources staff, financial/budget officers,counselors, admissions officers, instructional design staff) should be involved in the process to ensure thatSelf-Study Report reflects the input of all individuals who have responsibility for the program.

Suggested Timetable for Self-Study:

Months Prior to Visit

12 Appoint committee and resource persons; Assign sections of self-study to appropriate facuresource persons; Develop action plan and report format

10 Sections of report are analyzed and developed by assigned individuals

7 Faculty and program director review tentative reports

6 Committee prepares rough draft of self-study document

5 Draft document is reviewed institution-wide

4 Self-study document finalized and duplicated

3 Solicit comments in accordance with the Policy on Third Party Comments found in theCommissions Evaluation and Operational Policies and Procedures manual.

2 Final self-study document forwarded to Commission and members of the visiting committedays prior to date of the scheduled visit.

Staff Assistance/Consultation: The Commission on Dental Accreditation provides staff consultation to aleducational programs within its accreditation purview. Programs may obtain staff counsel and guidance atime.

Policies and Procedures for Site Visits: These policies and procedures are included at the end of this SelfStudy Guide.



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Self-Study Format: As noted in the instructions with this Self-Study Guide, this is a suggested approach tcompleting a self-study report. All institutions should be aware that the Commission respects their right torganize their data differently and will allow programs to develop their own formats for the exhibits requein the appendix sections of the Guide. However, if the programs proposed format differs from that suggein the Self-Study Guide, the program should contact Commission staff for review and approval prior toinitiating the self-study process. This procedure will provide assurance to the program that its proposed fwill include the elements considered essential by the Commission and its visiting committees.



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INSTRUCTIONS FOR COMPLETING THE SELF-STUDY

Background: The Self-Study for advanced specialty education programs was designed to mirror the SitVisitor Evaluation Report Form and provide a listing of documentary evidence that supports the program

answers to each question. All questions are based on a specific must statement of the AccreditationStandards for Advanced Specialty Education Programs in Periodontics. The number of the standard uponwhich the question is based is noted in parenthesis after each question.

Before answering each question, the program should read the corresponding standard in order to determinintentof the standard. Then, after answering the question, the program is required to identify thedocumentary evidence on which it supports its answer. In this manner, the self-study process becomesevidence-based in demonstrating compliance with each accreditation standard. Intent statements are preseto provide clarification to the advanced specialty education programs in periodontics in the application of in connection with compliance with the Accreditation Standards for Advanced Specialty Education Prograin Periodontics. The statements of intent set forth some of the reasons and purposes for the particular

Standards. As such, these statements are not exclusive or exhaustive. Other purposes may apply.

Additionally, the program is required to attach appendix information. This appendix information is identifafter the questions. Exhibits containing charts are provided to assist the program in presenting importantprogram information data. It should be noted that documentary evidence may include required appendiinformation where appropriate. The exhibits included are intended as samples, and some may not be applto the program.

With this new self-study process, the interviews and on-site observations during the site visit take on a moimportant role in that this is the place within the process that the program provides additional descriptioncompliance with accreditation standards, that is not evident from the answers to the Self-Study questions required appendix information.

Instructions: The following general instructions apply to the development of the advanced specialty eduprograms self-study report:

1. It is expected that information collected during the self-study will be presented in the order that thsections and questions occur in the Guide. The sections of the report should culminate in a qualitaanalysis of the programs strengths and weaknesses. Keep in mind that the programs written respmust provide the Commission and its visiting committee with enough information to understand thoperation of the programs.

2. The suggested format for preparing the report is to state the question and then provide the narrativresponse. A copy of the Self-Study Guide is available on a word processing program (IBM compMicrosoft Word) from the Commission office.



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3. All questions posed in the Guide should be addressed. In the event that a program has chosen to ma particular standard in a manner other than that suggested by the questions, please so indicate andexplain how the program complies with the Standards. There is no need to repeat at length informthat can be found elsewhere in the documentation. Simply refer the reader to that section of the reor appended documentation, which contains the pertinent information.

4. The completed self-study document should include appropriately tabbed sections; pages should benumbered. (The page numbers in the completed document are not expected to correspond to the numbers in this Guide).

5. The completed document should include:

a. Title Page: The title page should include the name of program and sponsoring institution; address, city and state, telephone number and area code; and date of accreditation visit.

b. Verification Page: The Commission requests that the institutions chief executive officer,

administrator of the academic unit that sponsors the advanced specialty education programprogram director and other appropriate administrators of the institution verify that the contof the completed self-study document are factually correct. The verification page shouldinclude the names, titles, and signatures of individuals who have reviewed the self-study re

c. Table of Contents: The table of contents should include the verification page, the generalinformation sheets, previous site visit recommendations, compliance with Commission polisections on each of the 6 Standards, the conclusions and summary of the Self-Study Reporany necessary appendices; page numbers for each section should be identified.

d. Self-Study Report: The Commission encourages programs to develop a self-study report

reflects a balance between outcomes and process and that produces an appropriately brief cost-effective Self-Study Report. The supportive documentation substantiating the narratishould not exceed what is required to demonstrate compliance with the Standards. Exhibishould be numbered sequentially. The Exhibit numbers in the completed document are notexpected to correspond with the example exhibits provided in the Self-Study Guide.

e. Conclusion and Summary: At the completion of the report, a standard by standard qualitaanalysis of the programs strengths and weaknesses is required. Actions planned to correcidentified weaknesses should be described. It is suggested that the summary be completedthe program director with assistance from other faculty and appropriate administrators.



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6. The programs documentation for CODA (self-study, application, or reports to CODA, for exampmust NOT contain any patient protected health information. If an institution nevertheless providesCommission and/or Commission site visitors with materials containing patient protected healthinformation (PHI), such materials must be in electronic form and encrypted as outlined by the mosrecent breach notification regulations related to the Health Insurance Portability and Accountabilityof 1996 (HIPAA).

In addition, most states have enacted laws to protect sensitive personally identifiable information(PII) such as social security numbers, drivers license numbers, credit card numbers, accountnumbers, etc. Before sending documents such as faculty BioSketches to CODA, institutions mustredact the following PII: social security numbers, credit or debit card numbers, drivers license numor government-issued ID numbers, account numbers, health information, taxpayer ID, and date of

7. In addition to the number of paper copies requested, please be advised that the Commission requirthat all accreditation correspondence/documents/reports and related materials submitted to theCommission for a programs permanent file be done so electronically. The Electronic Submission

Guidelines will assist you in preparing your report. If the program is unable to provide acomprehensive electronic copy of the self-study document, the Commission will accept a paper coand assess a fee to the program for converting the document to an electronic version.

Please be advised that the Commission requires that all accreditation correspondence/documents/reports arelated materials submitted to the Commission for a programs permanent file be done so electronically. Tattached Electronic Submission Guidelines will assist you in preparing your report. If the program is unabprovide a comprehensive electronic document, the Commission will accept a paper copy and assess a fee discipline self-study document to the program for converting the document to an electronic version.

A summary of the self-study documentation that must be provided to the visiting committee prior

visit and additional information which must be available on-site is listed under Resources/MateriaAvailable On-Site of the Protocol For Conducting a Site Visit section of the Self-Study Guide.

TITLE PAGESELF-STUDY GUIDE FOR ADVANCEDSPECIALTY EDUCATION PROGRAMS



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Sponsoring Organization:

(Dental School/Hospital, Other, e.g., Consortium)Street Address:

City, State & Zip Code:

Chief Executive Officer

(University President/Chancellor)

or Hospital Administrator:

Telephone Number: ( )

Fax Number: ( )

E-Mail Address:

Signature________________________________________________________________Date________________________________________________________________Dental School Dean or

Chief of Dental Service:

_


Fax Number: ( )E-Mail Address:

Signature ______________________________________________________________Date _____________________________________________________________Program Director:

_


Fax Number: ( )

E-Mail Address:

Signature ______________________________________________________________Date _____________________________________________________________I have seen and reviewed the completed Self-Study Guide (and required appendix information) tha

will be used in an upcoming site visit to this institution.



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GENERAL INFORMATION

a. What is the length of the program? month

b. How many full-time students/residents are currently enrolled in the program peryear?

c. How many part-time students/residents are currently enrolled in the program peryear?

d. What is the programs CODA-authorized base number enrollment?

e. The program offers a certificate degree or both

f. What other programs does the organization sponsor? Indicate whether each programis accredited. Indicate which programs are accredited by the Commission on DentalAccreditation.

g. If the program is affiliated with other institutions, provide the full names and addresseof the institutions, the purposes of the affiliation and the amount of time eachstudent/resident is assigned to the affiliated institutions.

h. What is the percentage of the students/residents total program time devoted to eachsegment of the program?

Indicate the approximate number of periodontitis patients each student/resident will treat prto completion of the program:

Moderatedisease

Severe disease

The approximate number of dental implants each student/resident willplace prior to completion of the program:



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For the clinical phases of the program, indicate the number of faculty members specificallyassigned to the advanced education program in each of the following categories and theireducational qualifications:

TotalNumber

# Board Certified # EducationallyQualified*

Other**

Full-time

Half-time

Less thanhalf-time

* Individual is eligible but has not applied to the relevant Board forcertification.**Individual is neither a Diplomate nor Candidate for board certification by the relevantcertifying Board.

Verify the cumulative full-time equivalent (F.T.E.) for all facultyspecifically assigned to this advanced education program. For example:a program with the following staffing pattern one full-time (1.00) +one half-time (0.50) + one two days per week (0.40) + one half-day perweek (0.10) would have an F.T.E. of 2.00.

Cumulative F.T.



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PREVIOUS SITE VISIT RECOMMENDATIONS

Using the programs previous site visit report, please demonstrate that the recommendationsincluded in the report have been remedied.

The suggested format for demonstrating compliance is to state the recommendation and then provide anarrative response and/or reference documentation within the remainder of this self-study document.

* Please note if the last site visit was conducted prior to the implementation of the revised AccreditationStandards for Advanced Specialty Education Programs (January 1, 2000), some recommendations may nolonger apply. Should further guidance be required, please contact Commission on Dental Accreditationstaff.

COMPLIANCE WITH COMMISSION POLICIES

Identify all changes which have occurred within the program since the programs previous site visi

in accordance with the Commissions policy on Reporting Program Changes in AccreditedPrograms.

Changes have a direct and significant impact on the programs potential ability to comply with the accredistandards. These changes tend to occur in the areas of finances, program administration, enrollment,curriculum and clinical/laboratory facilities, but may also occur in other areas. Failure to report in advancincrease in enrollment or other change, using the Guidelines for Reporting Program Change, may result inreview by the Commission, a special site visit, and may jeopardize the programs accreditation status. Thprogram must report changes to the Commission in writing at least thirty (30) days prior to a regularlyscheduled semi-annual Review Committee meeting. The Commission recognizes that unexpected, changemay occur. If an unexpected change occurs, it must be reported no more than 30 days following the

occurrence. Unexpected changes may be the result of sudden changes in institutional commitment, affiliateagreements between institutions, faculty support, or facility compromise resulting from natural disaster. Fto proactively plan for change will not be considered unexpected change. Depending upon the timing andnature of the change, appropriate investigative procedures including a site visit may be warranted. Forenrollment increases in advanced specialty programs the program must submit a request to the Commissio(1) month prior a regularly scheduled semiannual Review Committee/Commission meeting. For the additoff-campus sites, the program must report in writing to the Commission at least thirty (30) days prior to aregularly scheduled semi-annual Review Committee meeting. See the Policy on Enrollment Increases InAdvanced Specialty Programs and the Policy on Accreditation Of Off-campus Sites for specific informatiothese types of changes.

Provide documentation and/or indicate what evidence will be available during the site visit todemonstrate compliance with the Commissions policy on Third Party Comments.

The program is responsible for soliciting third party comments from students/residents and patients that pto the Standards or policies and procedures used in the Commissions accreditation process. An announcfor soliciting third party comments is to be published at least ninety (90) days prior to the site visit. The nshould indicate that third party comments are due in the Commissions office no later than sixty (60) daysto the site visit. Please review the entire policy on Third Party Comments in the Commissions EOPPEvaluation and Operational Policies and Procedures manual.



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Provide documentation and/or indicate what evidence will be available during the site visit todemonstrate compliance with the Commissions policy on Complaints.

The program is responsible for developing and implementing a procedure demonstrating that students/resiare notified, at least annually, of the opportunity and the procedures to file complaints with the CommissioAdditionally, the program must maintain a record of student/resident complaints received since theCommissions last comprehensive review of the program. Please review the entire policy on Complaintsthe Commissions EOPP: Evaluation and Operational Policies and Procedures manual.

Provide documentation and/or indicate what evidence will be available during the site visit todemonstrate compliance with the Commissions policy on Distance Education.

Programs that offer distance education must have processes in place through which the program establishethat the student who registers in a distance education course or program is the same student who participand completes the course or program and receives the academic credit. In addition, programs must notifystudents of any projected additional student charges associated with the verification of student identity at time of registration or enrollment. Please read the entire policy on Distance Education in the Commissi

EOPP: Evaluation and Operational Policies and Procedures manual.

PROGRAM EFFECTIVENESS

Program Performance with Respect to Student Achievement:Provide a detailed analysis explaining how the program uses student achievement measures, such a

national assessment scores, results of licensure or certification examinations and/or employment raassess the programs overall performance. In your analysis, provide examples of program changesmade based on student achievement data collected and analyzed.



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STANDARD 1 INSTITUTIONAL COMMITMENT/PROGRAM EFFECTIVENE

(Complete each question by inserting an x in the appropriate box and identifying documentation in suppyour answer. Appendices A-F are also required for this section. Note: required appendix information mserve as documentary evidence where appropriate.)

1. Has the program developed clearly stated goals and objectives appropriate toadvanced specialty education, addressing education, patient care, research andservice? (1)

YES NO

Documentary Evidence:

2. Are planning for, evaluation of and improvement of educational quality for theprogram broad-based, systematic, continuous and designed to promoteachievement of program goals related to education, patient care, research andservice? (1)

YES NO


3. Does the program document its effectiveness using a formal and ongoingoutcomes assessment process to include measures of advanced educationstudent/resident achievement? (1)

YES NO

Intent: The Commission on Dental Accreditation expects each program to define its own goals andobjectives for preparing individuals for the practice of periodontics and that one of the program goals iscomprehensively prepare competent individuals to initially practice periodontics. The outcomes processincludes steps to: (a) develop clear, measurable goals and objectives consistent with the programspurpose/mission; (b) develop procedures for evaluating the extent to which the goals and objectives are (c) collect and maintain data in an ongoing and systematic manner; (d) analyze the data collected and shthe results with appropriate audiences; (e) identify and implement corrective actions to strengthen theprogram; and (f )review the assessment plan, revise as appropriate, and continue the cyclical process.


4. Are the financial resources sufficient to support the programs stated goals andobjectives? (1)

YES NO



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Intent: The institution should have the financial resources required to develop and sustain the programcontinuing basis. The program should have the ability to employ an adequate number of full-time facultpurchase and maintain equipment, procure supplies, reference material and teaching aids as reflected inannual budget appropriations. Financial allocations should ensure that the program will be in a compeposition to recruit and retain qualified faculty. Annual appropriations should provide for innovations anchanges necessary to reflect current concepts of education in the advanced specialty discipline. TheCommission will assess the adequacy of financial support on the basis of current appropriations and thestability of sources of funding for the program.


5. Does the sponsoring institution ensure that support from entities outside of theinstitution does not compromise the teaching, clinical and research components

of the program? (1)

YES NO


6. Is the advanced specialty education program sponsored by an institution, whichis properly chartered, and licensed to operate and offers instruction leading todegrees, diplomas or certificates with recognized education validity? (1)

YES NO


7. If a hospital is the sponsor, is the hospital accredited by an accreditationorganization recognized by the Centers for Medicare and Medicaid (CMS)? (1)

YES NO N


8..

If an educational institution is the sponsor, is the educational institution accreditedby an agency recognized by the United States Department of Education? (1)

YES NO




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9. If applicable, do the bylaws, rules and regulations of the hospital that sponsors orprovides a substantial portion of the advanced specialty education programensure that dentists are eligible for medical staff membership and privilegesincluding the right to vote, hold office, serve on medical staff committees andadmit, manage and discharge patients? (1)

YES NO N


10..

Does the authority and final responsibility for curriculum development and approval,student/resident selection, faculty selection and administrative matters rest within thesponsoring institution? (1)

YES NO


11. Is the position of the program in the administrative structure consistent with thatof other parallel programs within the institution? (1)

YES NO


12. Does the program director have the authority, responsibility and privilegesnecessary to manage the program? (1)

YES NO


AFFILIATIONS

(If the program is not affiliated with other institutions, please skip to Standard 2).

13. Does the primary sponsor of the educational program accept full responsibilityfor the quality of education provided in all affiliated institutions? (1)

YES NO




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14. Is documentary evidence of agreements, approved by the sponsoring andrelevant affiliated institutions, available? (1)

YES NO


15. Are the following items covered in such inter-institutional agreements:

a.

Designation of a single program director? YES NO

b. The teaching staff? YES NOc

.The educational objectives of the program? YES NO

d. The period of assignment of students/residents? and YES NO

e.

Each institution's financial commitment? (1) YES NO

Intent: The items that are covered in inter-institutional agreements do not have to be contained in a sindocument. They may be included in multiple agreements, both formal and informal (e.g., addenda and lof mutual understanding).




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STANDARD 2 - PROGRAM DIRECTOR AND TEACHING STAFF

(Complete each question by inserting an x in the appropriate box and identifying documentation in suppyour answer. Appendices G-Kare also required for this section. Note: required appendix information mserve as documentary evidence where appropriate.)

16. Is the program administered by a director who is board certified in the respectivespecialty of the program, or if appointed after January 1, 1997, has previouslyserved as program director? (2)

YES NO

Intent: The director of an advanced specialty education program is to be certified by an ADA-recognizecertifying board in the specialty. Board certification is to be active. The board certification requiremenStandard 2 is also applicable to an interim/acting program director. A program with a director who is nboard certified but who has previous experience as an interim/acting program director in a Commissionaccredited program prior to 1997 is not considered in compliance with Standard 2.


17. Is the program director appointed to the sponsoring institution and havesufficient authority and time to achieve the educational goals of the program andassess the programs effectiveness in meeting its goals? (2)

YES NO


18. Does the program director have primary responsibility for the organization andexecution of the educational and administrative components of the program?(2-2)

YES NO


19. Does the director devote sufficient time to the program:

a. Utilize a faculty that can offer a diverse educational experience inbiomedical, behavioral and clinical sciences?

YES NO

b. Promote cooperation between periodontics, general dentistry, relateddental specialties and other health sciences?

YES NO



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c. Select students/residents qualified to undertake specialty training inperiodontics unless the program is sponsored by a federal serviceutilizing a centralized student/resident selection process?

YES NO

d. Develop and implement the curriculum plan? YES NO

e. Evaluate and document student/resident and faculty performance? YES NO

f. Document educational and patient care records as well as records ofstudent/resident attendance and participation in didactic and clinicalprograms?

YES NO

And

g. Have responsibility for the quality and continuity of patient care?

(2-2)

YES NO


20. Does the program director prepare graduates to seek certification by theAmerican Board of Periodontology? (2-3)

YES NO


21. Does the program director track Board Certification of program graduates?(2-3.a)

YES NO




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22. Are the number and time commitment of faculty sufficient to provide didacticand administrative continuity? (2-4)

YES NO


23. Are faculty assigned for all clinical sessions and immediately available forconsultation with students/residents and patients? (2-5)

YES NO


24. Is there direct faculty supervision of students/residents who are performingsurgical procedures? (2-5)

YES NO


25. Do faculty take responsibility for patient care and actively participate in thedevelopment of treatment plans and evaluation of all phases of treatment

provided by students/residents? (2-6)

YES NO


26. Are faculty formally evaluated at least annually by the program director todetermine their effectiveness in the educational program? (2-7)

YES NO




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27. In addition to their regular responsibilities in the program, do full-time facultyhave adequate time to develop and foster advances in their own education andcapabilities in order to ensure their constant improvement as clinicalperiodontists, teachers and/or researchers? (2-8)

YES NO


28. Do the program director and faculty actively participate in the assessment of theoutcomes of the educational program? (2-10)

YES NO




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STANDARD 3 FACILITIES AND RESOURCES

(Complete each question by inserting an x in the appropriate box and identifying documentation in suppyour answer. Appendices L-M are also required for this section. Note: required appendix information mserve as documentary evidence where appropriate.)

29. Are institutional facilities and resources adequate to provide the educationalexperiences and opportunities required to fulfill the needs of the educationalprogram as specified in the Accreditation Standards for Advanced SpecialtyEducation Programs? (3)

YES NO


30. Are equipment and supplies for use in managing medical emergencies readily

accessible and functional? (3)

YES NO

Intent:The facilities and resources (e.g.; support/secretarial staff, allied personnel and/or technical stafshould permit the attainment of program goals and objectives. To ensure health and safety for patients,students/residents, faculty and staff, the physical facilities and equipment should effectively accommodatclinic and/or laboratory schedule.


31. Does the program document its compliance with the institutions policy andapplicable regulations of local, state and federal agencies, including but notlimited to, radiation hygiene and protection, ionizing radiation, hazardousmaterials, and bloodborne and infectious diseases? (3)

YES NO


32. Are the above policies provided to all students/residents, faculty and appropriatesupport staff and continuously monitored for compliance? (3)

YES NO




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33. Are policies on bloodborne and infectious diseases made available to applicantsfor admission and patients? (3)

YES NO

Intent: The program may document compliance by including the applicable program policies. The prodemonstrates how the policies are provided to the students/residents, faculty and appropriate support staand who is responsible for monitoring compliance. Applicable policy states how it is made available toapplicants for admission and patients should a request to review the policy be made.


34. Are students/residents, faculty and appropriate support staff encouraged to beimmunized against and/or tested for infectious diseases, such as mumps,measles, rubella and hepatitis B, prior to contact with patients and/or infectious

objects or materials, in an effort to minimize the risk to patients and dentalpersonnel? (3)

YES NO

Intent: The program should have written policy that encourages (e.g., delineates the advantages of)immunization for students/residents, faculty and appropriate support staff.


35. Are all students/residents, faculty and support staff involved in the directProvision patient care continuously recognized/certified in basic life supportprocedures, including cardiopulmonary resuscitation? (3)

YES NO

Intent: Continuously recognized/certified in basic life support procedures means the appropriate indiviare currently recognized/certified.


36. Are private office facilities used as a means of providing clinical experiences?In advanced specialty education? (3)*Answer YES if statement is true; answer NO if statement is false.

YES NO


37. Are adequate clinical and radiographic facilities readily available in order to meet YES NOPeriodontic Self-Study Guide

28


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the objectives of the program? (3-1)


38. Is there a sufficient number of operatories to efficiently accommodate thenumber of students/residents enrolled? (3-1)

YES NO


39. Do students/residents have clinical photographic equipment available? (3-4) YES NO


40. Does the institution provide audiovisual capabilities for student/residentseminars? (3-5)

YES NO


41. Are resources available to accurately reproduce slides, radiographs and otherpatient records? (3-5)

YES NO


42. Do students/residents have ready access to dental and biomedical librariescontaining equipment for retrieval and duplication of information? (3-6)

YES NONO


43. Is adequate support personnel assigned to the program to ensure chairside andtechnical assistance? (3-7)

YES NO



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STANDARD 4 - CURRICULUM AND PROGRAM DURATION

(Complete each question by inserting an x in the appropriate box and identifying documentation in suppyour answer. Appendices N-T are also required for this section. Note: required appendix information mserve as documentary evidence where appropriate.)

44. Is the advanced specialty education program designed to provide specialknowledge and skills beyond the D.D.S. or D.M.D. training and oriented to theaccepted standards of specialty practice as set forth in specific standardscontained in the Accredited Standards for Advanced Specialty EducationPrograms? (4)

YES NO

Intent: The intent is to ensure that the didactic rigor and extent of clinical experience exceeds pre-doctoentry level dental training or continuing education requirements and the material and experience satisfiestandards for the specialty.


45. Is the level of specialty area instruction in the certificate and degree-grantingprograms comparable? (4)

YES NO

Intent: The intent is to ensure that the students/residents of these programs receive the same educationarequirements as set forth in these Standards.


46. Is documentation of all program activities ensured by the program director andavailable for review? (4)

YES NO


47. If the institution/program enrolls part-time students/residents, does the institutionhave guidelines regarding enrollment of part-time students/residents? (4)

YES N N


48. If the institution/program enrolls part-time students/residents, do they start andcomplete the program within a single institution, except when the program is

YES NO N



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discontinued? (4)


49. If the institution/program enrolls students/residents on a part-time basis, doesthe director of the program ensure that:

a) The educational experiences, including the clinical experiences andresponsibilities, are the same as required by full-timestudents/residents? and

YES NON/A

b) There are an equivalent number of months spent in the program? (4) YES NON/A


50. Is the program duration three consecutive academic years with a minimum of30 months of instruction? (4-1)

YES NO


51. Do at least two consecutive years of clinical education take place in a singleeducational setting? (4-1)

YES NO




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BIOMEDICAL SCIENCES

52. Although students/residents entering postdoctoral programs will have takenbiomedical science courses in their predoctoral dental curriculum, is thismaterial updated and reviewed in the program at an advanced level? (4-2)

YES NO


53. Does education in the biomedical sciences provide the scientific basis needed tounderstand and carry out the diagnostic and therapeutic skills gained duringtraining in clinical periodontics and oral medicine? (4-2)

YES NO


54. Does formal instruction in the biomedical sciences enable students/residents to:

a) Identify patients at risk for periodontal diseases and employ suitablepreventive and/or interceptive treatment?

YES NO

b) Diagnose and treat patients with periodontal diseases according to

scientific principles and knowledge of current concepts of etiology,pathogenesis, and patient management? and

YES NO

c) Evaluate critically the scientific literature, update their knowledge base,and evaluate pertinent scientific and technological issues as they arise?(4-3)

YES NO




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55. Is formal instruction provided in (4-4):

a) Developmental, gross, surgical, microscopic and ultrastructural anatomyand physiology of tissues of the oral cavity and related structures withspecial emphasis on the periodontium?

YES NO

b) The microbial ecology of the oral flora and the microbiologic aspects ofperiodontal diseases, caries and other oral diseases?

YES NO

c) The role of infectious processes in oral diseases? YES NO

d) The role of immunologic processes in oral health and oral diseases? YES NO

e) The histopathology, pathogenesis and natural history of periodontaldiseases?

YES NO

f) The epidemiology of periodontal diseases? YES NO

g) The mechanisms of inflammation andwound healing, especially as these areas relate to the biochemistry andmolecular biology of epithelium, and hard and soft connectivetissue?

YES NO

h) The concepts of molecular biology and the molecular basis of genetics? YES NO

i) The etiology and pathogenesis of caries? YES NO

j) Principles of nutrition, especially as theyrelate to patient evaluation, disease processes and wound healing?

YES NO

k) Principles of biostatistics, research design and research methods? YES NO

l) Scientific writing? YES NO

m) Critical evaluation of the research literature? YES NO

n) Dental implants, including relevantinformation in biomaterials, bone physiology and histology?

YES NO

And

o) Behavioral science, to include communication skills with patients andhealth professionals, and positive modification of behavior, attitudes andhabits?

YES NO



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56. Is the content of biomedical sciences instruction documented? (4-6) YES NO


57. Is that documentation readily available for review? (4-6) YES NO


CLINICAL SCIENCES

58. Does the educational program provide training to the level of proficiency for thestudent/resident to: (4-7)

a) Collect, organize, analyze and interpretdata?

YES NO

b) Interpret radiographic images as theyrelate to the diagnosis of periodontal diseases and dental implants

YES NO

c) Formulate a diagnosis and a prognosis? YES NO

d) Develop a comprehensive treatment plan? YES NO

e) Understand and discuss a rationale for theindicated therapy?

YES NO

f) Evaluate critically the results of therapy? YES NO

g) Communicate effectively to patients the nature of their periodontal healthstatus and treatment needs?

YES NO

h) Communicate effectively with dental andother health care professionals, interpret their advice and integrate thisinformation into the treatment of the patient?

YES NO



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i) Integrate the current concepts disciplines into periodontics? YES NO

j) Organize, develop, implement andevaluate periodontal disease control programs for patients?

YES NO

k) Organize, develop, implement and evaluate a patient recall program andprovide supportive periodontal maintenance therapy?

YES NO

l) Utilize allied dental personnel effectively? and YES NO

m) Organize, develop and implement an infection control program for adental practice setting? (4-7)

YES NO


59. Does each student/resident complete an adequate number and variety ofacceptable fully documented and treated cases to a level that:

a) Periodontal health is achieved? YES NO

b) Initiating and contributory factors in theetiology of periodontal disease are controlled? and

YES NO

c) A schedule for periodontal maintenance therapy is organized for the

patients? (4-8)

YES NO


60. Do students/residents treat a variety of patients with different periodontaldiseases and conditions as defined by The American Academy ofPeriodontology? (4-8)

YES NO


61. Do periodontitis cases reflect a majority of moderate to severe disease? (4-8) YES NO



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62. Is an ongoing record of the number and variety of clinical experiencesaccomplished by each student/resident maintained? (4-9)

YES NO


63. Does this ongoing record include periodontal diagnosis, disease severity,periodontal treatment, as well as patient's age, sex and health status? (4-9)

YES NO


64. Does the educational program provide clinical training for the student/residentto the level of proficiency? (4-10)

YES NO


65. Does the clinical training include, but not limited to, the following treatmentmethods? (4-10)

a) Scaling and root planing? YES NO

b) Adjunctive use of local and systemic chemotherapeutic agents? YES NO

c) Gingivectomy/gingivoplasty? YES NO

d) Periodontal flap procedures to include: replaced, apically positioned andcoronally positioned techniques?

YES NO

e) Periodontal resective surgery (osteoplasty, ostectomy, and root resection)? YES NO

f) Tooth extraction in the course of periodontal and implant therapy? YES NO

g) Periodontal soft and hard tissue regenerative therapies for health, comfort,function and esthetics?

YES NO

h) Occlusal treatment to include occlusal adjustment/selective grinding;stabilization/splinting, including bite-guard therapy?

YES NO



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And

i) Management of endodontic-periodontal lesions; treatment should beprovided in consultation with the individuals who will assume theresponsibility for the completion or supervision of endodontic therapy?

(4-10)

YES NO


66. Does the educational program provide didactic instruction and clinical training inoral medicine, including periodontal medicine (i.e. periodontal systemic

interrelationships),as defined in each of the following areas: as defined in eachof the following areas: (4-11)

4-11.1 In-depth didactic instruction in oral medicine includes thefollowing?:

a) Those aspects of medicine and pathology related to the etiology,pathogenesis, diagnosis and management of periodontal diseasesand other conditions in the oral cavity?

YES NO

b) Mechanisms, interactions and effects of drugs used in the

prevention, diagnosis and treatment of periodontal and other oraldiseases?

YES NO

c) Mechanisms, interactions and effects of therapeutic agents used inthe management of systemic diseases that may influence theprogression of periodontal diseases or the management of patientswith periodontal diseases?

YES NO

d) Clinical and laboratory assessment of patients with specificinstruction in:

YES NO

1) Physical diagnosis? YES NO

2) Laboratory diagnosis of metabolic and infectious diseases? YES NO

3) Oral pathology? YES NO

And

e) Principles of periodontal medicine to include theinterrelationships of periodontal status and overall health?

YES NO



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(4-11.1)

4-11.2 Clinical training in oral medicine to the level of competency includesthe following?:

a) Periodontal treatment of older adult patients? YES NO

b) Periodontal treatment of medically compromised patients? YES NO

c) Management of patients with periodontal diseases (inflammation) andinterrelated systemic diseases or conditions? and

YES NO

d) Management of non-plaque related diseases and disorders of theperiodontium?

YES NO


67. Does the educational program provide didactic instruction and clinical training indental implants as defined in each of the following areas: (4-12)

4-12.1 In-depth didactic instruction in implants includes:

a) The historical development of dental implants? YES NO

b) The biological basis for dental implants and principles ofimplant biomaterials and bioengineering?

YES NO

c) The indications and contraindications for dental implants of variousdesigns and characteristics?

YES NO

d) The prosthetic requirements of dental implants? YES NO

e) The pre-surgical examination and treatment planning for the use ofdental implants?

YES NO

f) Implant site development? YES NO

g) Surgical placement of dental implants? YES NO

h) The evaluation and management of peri-implant tissues and themanagement of biologic implant complications?

YES NO

i) The maintenance of dental implants? and YES NO

j) The appropriate sterile or aseptic technique for the placement of YES NO



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dental implants? (4-12.1)

4-12.2 Does clinical training in dental implants to the level of proficiency include:

a) Implant site development to include hardand soft tissue preservation and reconstruction, including ridge andsinus floor augmentation?

YES NO

b) Surgical placement of implants in nativeand regenerated bone? and

YES NO

c) Management of peri-implant tissues inhealth and disease?

YES NO

4-12.3 Clinical training to the level of exposure in the prosthetic aspects of dentalimplant therapy?

YES NO


68. Does the educational program provide training for the student/resident in themethods of pain and anxiety control to achieve the following: (4-13)

a) In-depth knowledge in all areas of conscious sedation? and YES NO

b) Proficiency in more than one method of conscious sedation, whichincludes nitrous oxide/oxygen inhalation sedation, oral sedation orintravenous sedation?

YES NO


69. Does the educational program provide instruction in: (4-14)

a) The treatment in a hospital setting of patients with periodontal disease,to the level of familiarity?

YES NO

b) The management of temporomandibular disorders including: YES NO

1) Radiographic interpretation, differential diagnosis,treatment planning, symptomatic treatment, occlusal appliances,and referral when indicated to a level of familiarity? and

YES NO



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2) Concepts related to more advanced forms of therapy andcoordination of this therapy with other disciplines, to a level offamiliarity? and

YES NO

c) Orthodontic procedures in conjunction with periodontal therapy, to a levelof familiarity?

YES NO

d) Surgical exposure of teeth for orthodontic purposes, to a level ofunderstanding? (4-14)

YES NO


70. Does the educational program provide instruction to the level of understandingin the management of a periodontal practice? (4-15)

YES NO


71. Is the use of private office facilities not affiliated with a university as a means ofproviding clinical experiences in advanced specialty education approved?(4-15.1)

*Answer YES if statement is true; answer NO if statement is false.

YES NO




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STANDARD 5 - ADVANCED EDUCATION STUDENTS/RESIDENTSELIGIBILITY AND SELECTION

(Complete each question by inserting an x in the appropriate box and identifying documentation in suppyour answer. Appendices U-X are also required for this section. Note: required appendix information mserve as documentary evidence where appropriate.)

74. Are dentists with the following qualifications eligible to enter the advancedspecialty education program accredited by the Commission on DentalAccreditation:

a) Graduates from institutions in the U.S. accredited by the Commission onDental Accreditation?

YES NO

b) Graduates from institutions in Canada accredited by the Commission onDental Accreditation of Canada? and

YES NO

c) Graduates of international dental schools who possess equivalenteducational background and standing as determined by the institutionand program? (5)

YES NO


75. Are specific written criteria, policies and procedures followed when admittingstudents/residents? (5) YES NO

Intent:Written non-discriminatory policies are to be followed in selecting students/residents. These polishould make clear the methods and criteria used in recruiting and selecting students/residents and howapplicants are informed of their status throughout the selection process.


76. Is the admission of students/residents with advanced standing based on the samestandards of achievement required by students/residents regularly enrolled in theprogram? (5)

YES NO




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77. Do transfer students/residents with advanced standing receive an appropriatecurriculum that results in the same standards of competence required bystudents/residents regularly enrolled in the program? (5)

YES NO


EVALUATION

78. Does a system of ongoing evaluation and advancement ensure that, through thedirector and faculty, each program:

YES NO

a) Periodically, but at least semiannually, evaluates the knowledge, skills,

ethical conduct and professional growth of its students/residents, usingappropriate written criteria and procedures?

b) Provides to students/residents an assessment of their performance, atleast semiannually?

YES NO

c) Advances students/residents to positions of higher responsibility only onthe basis of an evaluation of their readiness for advancement? and

YES NO

d) Maintains a personal record of evaluation for each student/residentwhich is accessible to the student/resident and available for review during

site visits? (5)

YES NO

Intent: (b) Student/Resident evaluations should be recorded and available in written form.(c) Deficiencies should be identified in order to institute corrective measures.(d) Student/Resident evaluation is documented in writing and is shared with the student/resident.


79. Is written criteria for evaluating the quality of a students/residents performanceused? (5-1)

YES NO




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80. Is written criteria for evaluating the quality of a students/residents performanceshared with appropriate staff and students/residents? (5-1)

YES NO


81. Is a record of each students/residents clinical and didactic activities maintainedand reviewed as part of each students/residents evaluation? (5-1.1)

YES NO


82. Are evaluation results provided to students/residents in writing? (5-1.2) YES NO


83. Is documentation of evaluation meetings with students/residents, along withrecords of students/residents' activities, and formal evaluations ofstudents/residents kept in a permanent file?(5-1.3)

YES NO


DUE PROCESS

84. Are there specific written due process policies and procedures for adjudicationof academic and disciplinary complaints, which parallel those established by thesponsoring institution? (5)

YES NO

Intent:Adjudication procedures should include institutional policy which provides due process for allindividuals who may potentially be involved when actions are contemplated or initiated which could resudisciplinary actions, including dismissal of a student/resident (for academic or disciplinary reasons). Inaddition to information on the program, students/residents should also be provided with written informawhich affirms their obligations and responsibilities to the institution, the program, and the faculty. Theprogram information provided to the students/residents should include, but not necessarily be limited to,information about tuition, stipend or other compensation; vacation and sick leave; practice privileges another activity outside the educational program; professional liability coverage; and due process policy acurrent accreditation status of the program.



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RIGHTS AND RESPONSIBILITIES

85. At the time of enrollment, are the advanced specialty educationstudents/residents apprised in writing of the educational experience to beprovided, including the nature of assignments to other departments orinstitutions and teaching commitments? (5)

YES NO


86. Are all advanced specialty education students/residents provided with writteninformation which affirms their obligations and responsibilities to the institution,the program and program faculty? (5)

YES NO




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STANDARD 6 RESEARCH

(Complete each question by inserting an x in the appropriate box and identifying documentation in suppyour answer.)

87. Do advanced specialty education students/residents engage in scholarly activity? YES NO


88. Do graduates of periodontal training programs possess a general understandingof the theory and methods of performing research? (6-1)

YES NO


89. Are postdoctoral students/residents given the opportunity to participate inresearch? (6-1.1)

YES NO




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SUMMARY OF SELF-STUDY REPORT

Note: This summary culminates the self-study report in a qualitative appraisal and analysis of theprograms strengths and weakness.

INSTITUTION-RELATED

1. Assess the adequacy of institutional support for the program.

2. Assess whether the program is achieving goals through training beyond pre-doctoral level.

3. Assess whether the program is achieving goals through stated competencies.

4. Assess whether the program is achieving goals through stated proficiencies.

5. Assess whether the program is achieving goals through outcomes.

6. Assess calibration among program directors and faculty in the student/resident evaluation process ensure consistency of the evaluation process.

7. Assess the faculty evaluation process to ensure consistency of the evaluation process.

8. Assess the institutions policies on advanced education students/residents.

9. Assess the institutions policies on eligibility and selection.

10. Assess the institutions policies on due process.

11. Assess the institutions policies on student/resident rights and responsibilities.

12. Assess the adequacy and accessibility, hours of operation and scope of holdings of the sponsoringinstitutions library resources.

13. Assess the institutional oversight of the quality of training at affiliated institutions.

PATIENT CARE

1. Assess the institutions/programs preparedness to manage medical emergencies.

2. Assess the adequacy of radiographic services and protection for patients, advanced educationstudents/residents and staff.

3. Assess the programs capacity for four-handed dentistry.



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4. Assess the institutions policies and procedures on hazardous materials, and bloodborne and infectdiseases for patients, advanced education students/residents and staff.

5. Assess how students/residents may be able to apply ethical, legal and regulatory concepts in theprovision, prevention and/or support of oral health care.

PROGRAM-RELATED

1. Assess the students/residents time distribution among each program activity (e.g., didactic, clinicteaching, research) and how well it is working

2. Assess the volume and variety of the programs patient pool.

3. Assess the programs student/resident/faculty ratio.

4. Assess the programs student/resident pool.

5. Assess rotations, electives and extramural experiences of the program.

6. Assess the programs record keeping and retention practices.

7. Assess the research activities of the program.



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REQUIRED APPENDIX INFORMATION

STANDARD 1 INSTITUTIONAL COMMITMENT/PROGRAMEFFECTIVENESS/AFFILIATIONS

Appendix A Attach as Appendix A the institutions educational mission andprograms goals and objectives.

Appendix B Attach as Appendix B the programs outcomes assessment plan, outcommeasurements, and outcomes assessment results.

Appendix C Attach as Appendix C the institutions administrative structure in anorganizational chart.

Appendix D - Attach as Appendix D the success rate of graduates on the boardexamination for the last 5 years.

Appendix E - Attach as Appendix E the affiliated institutions that participate in trainstudents/residents, indicate: (Use Exhibit 1 for each affiliated institution

by the program. Make copies of the form as needed. Number appropriatele.g., Appendix E1, Appendix E2, etc.)

Appendix F - Attach as Appendix F the names of other programs that rotate

students/residents through this sponsoring organization. Note the purposthe affiliation and the time duration.

Have a copy of the organizations by-laws available at the time of the site visit.



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STANDARD 2 PROGRAM DIRECTOR AND TEACHING STAFF

Appendix G - Attach as Appendix G information regarding the program directors ticommitment. (Use Exhibit 2.)

Appendix H - Attach as Appendix H information regarding the teaching staff. (Use thExhibits 3.1 and 3.2.)

Appendix I - Attach as Appendix I BioSketch of the program director and all FTEteaching faculty (Use Exhibit 3.3).

Appendix J - Attach as Appendix J monthly attending staff schedules.

Appendix K - Attach as Appendix K a blank faculty evaluation form.

STANDARD 3 FACILITIES AND RESOURCES



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STANDARD 4 CURRICULUM AND PROGRAM DURATION

Appendix N - Attach as Appendix N the percentages of the students/residents totalprogram time. (Use Exhibit 6.)

Appendix O Attach as Appendix O students/residents schedules for each year of thprogram. (Use Exhibit 7.)

Appendix P Attach as Appendix P information regarding Biomedical Sciencesinstruction. (Use Exhibit 8.)

Appendix Q Attach as Appendix Q a schedule of department seminars, conferencesand/or lectures. Indicate the title or topics and name and title of the

presenter(s) for each seminar, conference and/or lecture. Also includegoals, objectives and course outlines for each course identified.

Appendix R Attach as Appendix R a schedule of off-service assignments. (Use Exhi9.)

Appendix S Attach as Appendix S information regarding Admissions. (Use Exhibit

Appendix T Attach as Appendix T information regarding Clinical training. (UseExhibit 11.)



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STANDARD 5 ADVANCED EDUCATION STUDENTS/RESIDENTS

Appendix U Attach as Appendix U a brochure, school catalog or formal descriptionthe program.

Appendix V Attach as Appendix V a student/resident evaluation form.

Appendix W Attach as Appendix W the specific written due process policies andprocedures for adjudication of academic and disciplinary complaints,which parallel those established by the sponsoring institution.

Appendix X Attach as Appendix X a copy of the written material given to enteringstudents/residents, describing their rights and responsibilities to theinstitution, program and faculty.



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EXHIBIT 1a

OUTCOMES ASSESSMENT(Standard 1)

This table provides one example of a format, which may be utilized to present the programs outcomes asseprocess. A copy should be made for each of the programs overall goals and objectives. If an alternative foplease be sure it includes the information below.

Overall Goal or Objective #_________:

Overall Goal or Objective

Outcomes Assessment

Mechanism

How often conducted

Date to be conducted/

finished by

Results expected

Results achieved

Assessment of results

Program improvement as a

result of data analysis

Date of next assessment



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Exhibit 2

PROGRAM DIRECTOR

Please complete the following chart for all programs being reviewed at this time.

Name ofProgram

DirectorsFirst Init. &Last Name

BoardCertified orpreviouslyserved asProgramDirector andYearAppointed

Yr Appointedto Position

Number of Hrs/wk atSponsoring Institution Breakdown time intofollowing categories:

administration

teaching

research

other

Number ofHrs/wkDevoted toProgram



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Exhibit 3.1

TEACHING STAFF

On the table below, indicate the members of the teaching staff who are scheduled to devote ONE-HALF DOR MORE PER WEEK specifically to the program. Indicate whether each staff member listed is a generpractitioner or specialist, the number of hours per week, and the number of weeks per year devoted to theprogram. If the staff member is a specialist, indicate the specialty and board status. Be sure to include thprogram director.

Name Discipline/Specialty

Board Status(If Specialist)

Hoursper week

Weeksper year

Assignments*

*Use the following codes to indicate assignments:

SCSupervision of students/residents in clinicTTeaching Didactic Sessions (lectures, seminars, courses)

PAProgram Administration



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BioSketchDo not attach Curriculum Vitae.

Print or Type Only

Name:Current

Institution:

EDUCATIONAL BACKGROUND (Begin with college level)

Name of School, City and StateYr ofGrad.

Certificate or Degree Area of Study

LICENSURE

License (Do not include license number) From (Year) To (Year)

BOARD CERTIFICATION

Certifying Organization Specialty Date certified

CE COURSES TAKEN (last 5 years)

Course Title Course Content and Provider Month and Year

TEACHING APPOINTMENTS (Begin with current)

Name of Institution, City and State RankSubjects/Content AreasTaught/Administrative Responsibilities

From(Year)

To(Year)



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CURRENT TEACHING RESPONSIBILITIES

Name of Institution, City, State Course Title Discipline and Level ofStudents (Year) Total Contact Hours Per Year

Didactic Clinic/Laboratory

HOSPITAL APPOINTMENTS (Begin with current)

Name of Hospital City StateFrom(Year)

To(Year)

PRACTICE EXPERIENCE

Location (City and State) Type of Practice From(Year)

To(Year)

MEMBERSHIP, OFFICES OR APPOINTMENTS HELD IN LOCAL, STATE OR NATIONAL DENTAL OR ALLIED D

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