GHANA COLLEGE OF PHYSICIANS AND SURGEONS

FACULTY OF DENTAL SURGERY

CURRICULUM FOR FELLOWSHIP TRAINING

IN

PAEDIATRIC DENTISTRY

APRIL 2018

OUTLINE

Preamble

Philosophy

Aims/Objectives

Admission requirements

Course Duration

Programme outline

Training site(s)/ requirements

Core competencies

Fellow Activities

Research

Specialty Conferences (Local, Abroad)

Recommended textbooks and Journals

Assessment/ Evaluation Methods

Final Assessment

Time table

Criteria for certification (General Fellowship criteria)

Logbook/Portfolio

PREAMBLE: Pediatric dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

PHILOSOPHY When compared to the other specialities in Dentistry, there is a complete lack of specialists and consultants in the field of Paediatric Dentistry in Ghana. The pedodontic treatment in the country is carried out by General Dentists with very little experience and knowledge in this specialty leading to compromised outcomes. It is thus imperative that more dentists are trained in this field of dentistry to fill this vacuum and provide quality care for patients needing treatment.

AIMS OF THE PROGRAM

1. To train the senior residents to acquire higher level of competency in the

management of oral health conditions in children and adolescents and

to undertake greater responsibility in clinical decision making.

2. Offer comprehensive, contemporary and advanced knowledge in

paediatric dentistry to a consultant level, and instil the need for

continuing professional development and lifelong learning.

COURSE DURATION The course is expected to last for a minimum of 2 years full time. PROGRAMME OUTLINE The guidelines of the American Academy of Paediatric Dentistry for the

training of Pedodontic specialists and consultants will be used throughout the programme. This programme is for those who have passed the three-year Membership examination in Paediatric Dentistry and would like to seek further consultant level training. These additional clinical years of education and training would consolidate the candidate with valuable experience to the highest level endorsed by the association. In addition to academics, the senior Residents will gain high level training on multi-disciplinary management in children and adolescents who require preventive, restorative and interceptive treatments.

During the course of training, the senior resident is expected to participate in - Tutorials, seminars, journal club presentations - Presentation of clinical cases - Patient management carried out independently or under supervision as

required

- Development of school based oral health programs

Apart from the above mentioned, the following requirements will have to be fulfilled by the candidate: - Rotation in pediatrics (2 months ) - candidate is expected to rotate

through child emergency unit and sickle cell clinic - At the end of the senior residency training programme candidate must

have attended six (6) workshops and two (2) conferences (international or national level)

- The candidate should have published at least two articles along with other members of the unit from a departmental research during the period of senior residency programme

- Completion of dissertation on a topic relevant to the specialty

- Residents are also required to do supervision work in the clinic and also deliver some lecture topics and mentor junior residents

At the end of the training the senior resident should have acquired knowledge and skills in the following areas:

1) Growth and development

2) Behavior management 3) Preventive strategies for caries

4) Prenatal counseling in primary health care 5) Dental caries management

6) Aesthetic dentistry 7) Management of dental and orofacial trauma 8) Management of soft tissue lesions and infections 9) Management of physically, mentally and medically compromised

patients including children with other orofacial defects 10) Paediatric oral surgery 11) Preventive and Interceptive orthodontics

12) Treatment under sedation

13) Laboratory procedures - fabrication of space maintainers, habit breaking

appliances

TRAINING SITE/REQUIREMENTS: The site of training shall be at the University of Ghana School of Medicine and Dentistry(UGSMD) Dental clinic and the Kwame Nkrumah University of Science and technology (KNUST) Dental School or any other institution accredited by the college of Physicians and Surgeons. The Resident is required to have passed the membership examination in Paedodontics and per the requirements of the Ghana Health Service should have served at least 1 year in the district. Residents must be enrolled full-time and are required to attend an adequate amount of faculty-supervised clinical sessions to establish proficiency in clinical Paedodontics. Twenty-four (24) hours per week of supervised patient management is recommended. The trainee may spend more time in preparatory work in the form of individual studies, research or other specific assignments. However, all clinical training and taught courses must fit within an 8-hour daily work schedule. Ten to twelve hours per week, 25% to 30% of the programme should be dedicated for research and administration (treatment planning, preparation of tutorials, assignments and case presentations). The number of new patients assigned to each resident should not be fewer than 60 (20 per year) and equal or more transferred patients will be assigned during the course of the study. Clinical responsibilities of the residents should also include supervision of retention patients and recall for observation of former patients with special clinical interest. A minimum of 2 hours per week should be devoted to case presentation and another 1 hour for review of the current literature in the form of a journal clubs.

CORE COMPETENCIES • Demonstrate the possession of in-depth and extensive current knowledge in

Paedodontics to a consultant level. • Undertake independent, proficient and advanced clinical practice in Paedodontics to the highest level in either primary or secondary care settings. • Utilise problem-solving and decision-making skills to assess, diagnose and treatment plan advanced, multi-disciplinary and complex cases.

• Accept secondary referrals for advice and treatment in Paedodontics.

• Understand and analyze the literature and research bases for evidence-

based clinical care and plan and perform research including clinical audits. • Communicate effectively and interact with patients and colleagues in other dental and medical specialties. • Be eligible for entry to sit the fellowship examination of the Ghana College of Physicians and Surgeons • Efficiently organize, present, and publish research findings, as well as present clinical cases in a comprehensive manner.

FELLOW ACTIVITIES PATIENT CARE • For every patient, Residents must have full documentation of records and

this Includes a full detailed history, study models, X-rays, pictures and these must be available at all times during patient treatment. • During the period of residency training, every patient being treated will be strictly under the supervision of the consultant in charge.

CLINIC ETIQUETTE • Residents must be at post at least 10mins before the start of clinic. Reprieve

is given for the Resident attending lectures and seminars etc. • At every quarter, each Resident will be required to submit an update and summary of cases done and of patients undergoing treatment. • The patients of the Consultant must be attended to before the patients of the Resident. In case you need to see your patient earlier, you must arrange to do so before the official start of the clinic. • The periods for your lab work and research work are not off days and thus you are to be present at all times. Laboratory and research days for each Resident are mandatory and start at 8.30am and ends at 12pm. If for any reason you cannot make it, this has to be communicated to the HOD either verbally or in writing. Absenteeism will not be condoned. Any missed day without any tangible reason will be deducted from your leave period.

LEAVE PERIOD Your leave period should be planned at the beginning of the year and submitted to the HOD. Each Resident shall take full responsibility for his or her

patient. Resident must plan their annual leave in advance so as not to coincide with the visits of their patients. Patients will only be attended to in your absence only in cases of emergency.

RESEARCH Six months into the residency programme each Resident is required to submit for Consideration, an outline of research topic to be undertaken for the fellowship programme. Each Resident is also required to identify two smaller topics to research on. Each Senior Resident should undertake a research project for which its methodology as well as the results should be presented in the form of a dissertation. The Senior Resident should produce a bound dissertation of research work before submission date and be able to discuss and defend the research in an oral examination.

Senior Residents are expected to publicize the findings of their research in a variety of ways, including

(a) Presentation at research seminars,

(b) Presentation at national/international meetings and

(c) Publication in a refereed journal.

SPECIALTY CONFERENCES Within the 2 years of the fellowship programme, each Resident is encouraged to attend at least one International Paedodontic conference and submit at least two article and abstract for presentation or publication in any peer reviewed journal. The orthodontic / Paedodontic courses attended will form part of the Resident’s final assessment before being required to take the examinations.

SPECIALITY RELATED JOURNALS The following journals are recommended for use by the fellowship resident.

Journal of Pediatric Dentistry

Journal of Dentistry for Children

International Journal of Paediatric Dentistry

European Journal of Paediatric Dentistry

International Journal of Pedodontic Rehabilitation

Indian society of Pedodontics and Preventive Dentistry

British Paedodontic Society journal

RECOMMENDED TEXT BOOKS

1) Pediatric Dentistry: Total Patient Care by Stephen H.Y. Wei

2) McDonald and Avery's Dentistry for the Child and Adolescent

3) Clinical Pedodontics by Finn

4) Fundamentals of Pediatric Dentistry by Richard J.Mathewson and Robert E. Primosch

5) Textbook of Pediatric Dentistry by Raymond L. Braham, Merle E. Morris.

6) Pediatric Dentistry: scientific foundations and clinical practice by Ray E. Stewart

7) Pediatric Dentistry: Infancy through adolescence by Pinkham

ASSESSMENT There will be a system of ongoing evaluation and advancement. The evaluation will include: a. Cognitive skills; b. Clinical skills; c. Interpersonal skills; d. Patient management skills; and e. Ethical standards. f. Research activity Twice a year, the institution shall conduct constant evaluation of the performances of the Resident to assess the progress forward (formative assessment). Procedures that are required are assessed and graded by trainers. Residents must have completed all the necessary procedures and should have a record of it in their log books.

FINAL ASSESSMENT Part II Fellowship Examinations Candidates must have received instruction in the application of the principle of ethical reasoning, ethical decision-making and professional responsibility as they pertain to the academic environment, research, patient care and practice management before the Final Fellowship Examinations.

There should be assessment of the achievement of the competencies for the specialty in all the three domains (cognitive, psychomotor and affective) using formal evaluation methods;

a. Presentations

b. Assessment of log books c. Assessment of interest in publication writing d. Bi-annual reports of performance from their trainers

The Format of the Examination The Final Fellowship examination will consist of three parts: 1) Dissertation defense: 15 minutes of power point presentation followed by 45 minutes of questioning by examiners.

2) Clinical case presentation: 15 minutes Power Point presentation by

candidate and 45 minutes of questioning by the Examiners. NB: five (5) Clinical Case Presentations covering different areas of the specialty including one interdisciplinary case should be submitted for the examination for assessment. However, ONLY ONE will be presented by the candidate, but all five (5) will be scored. Full clinical records of the 5 cases must include: i. Clinical photographs (Extra-oral views) – frontal and lateral views (Intra-oral views) - lower arch, upper arch, right and left lateral and frontal views in occlusion. ii. Study models iii. Radiographs Log book should be accepted at the time of application for the Final Fellowship Examination. The logbook and Dissertation should be submitted and sent to the examiners 2-3 months prior to the examination. An Internal Assessor shall be present at the examination. NOTE: Candidates must pass ALL SECTIONS of the Final Fellowship Examinations to merit a PASS in the examination

3) Specialty vivo voce and Log book assessment:

- Log-Book which must show clear evidence of the treatments done. - One hour of questioning will be conducted covering a wide range of topics in Paedodontics.

- There will be at least two internal examiners and one external examiner

present at the final exam.

TIME TABLE At the beginning of each academic year a time table will be drawn up. This will include clinical and laboratory training schedules with the junior residents, weekly seminars and case presentations, lectures debates, assessments and research work.

CRITERIA FOR CERTIFICATION The minimum of two years senior residency training programme encompasses the full scope of Paedodontic fellowship training leading to: Fellowship of Ghana College of Surgeons in Paedodontics

The certification gives recognition to the effect that the holder has acquired the competences expected.

NOTE: Candidates must pass ALL SECTIONS of the Final Fellowship Examinations to merit a PASS in the examination.

LOGBOOK/PORTFOLIO E-Logbooks will be provided by the College and procedures done by trainees that are approved by Trainers will be accepted at the time of application for the Final Fellowship Examination. The E-logbook and Dissertation would be submitted to the College to be sent to the examiners 3 months before the proposed examination date for assessment by internal and external Assessors. Senior Residents who commenced their training before the introduction of the e-logbooks will record all procedures done in the hard copy log book. The logbook will be assessed before the candidate is allowed to take the final examination.

COURSE WORK: Topics to be covered

CLINICAL SCIENCES BEHAVIOR GUIDANCE 1) Didactic Instruction: Didactic instruction in behavior guidance must be at the in-depth level and include: a. Physical, psychological and social development. This includes the basic principles and theories of child development and the age-appropriate behavior responses in the dental setting; b. Child behavior guidance in the dental setting and the objectives of various guidance methods; c. Principles of communication, including listening techniques, including the descriptions of and recommendations for the use of specific techniques, and communication with parents and caregivers; d. Principles of informed consent relative to behavior guidance and treatment options; e. Principles and objectives of sedation and general anesthesia as behavior guidance techniques, including indications and contraindications for their use in accordance with the AAPD guidelines and f. Recognition, treatment and management of pharmacologic-related emergencies. 2) Clinical Experiences: Clinical experiences in behavior guidance must enable students/residents to achieve competency in patient management using behavior guidance: a. Experiences must include infants, children and adolescents including patients with special health care needs, using: 1. Non-pharmacological techniques; 2. Sedation; and 3. Inhalation analgesia. All sedation cases must be completed in accordance with the recommendations and guidelines of AAPD/AAP, the ADA’s Teaching of Pain Control and Sedation to Dentists and Dental Students, and relevant institutional policies.

GROWTH & DEVELOPMENT 1) Didactic Instruction: Didactic instruction in craniofacial growth and development must be at the in-depth level with content to enable the resident to understand and manage the diagnosis and appropriate treatment modalities for malocclusion problems affecting orofacial form, function, and esthetics in

infants, children, and adolescents. This includes but is not limited to an understanding of: a. Theories of normative dentofacial growth mechanisms; b. Principles of diagnosis and treatment planning to identify normal and abnormal dentofacial growth and development; c. Differential classification of skeletal and dental malocclusion in children and adolescents; d. The indications, contraindications, and fundamental treatment modalities in guidance of eruption and space supervision procedures during the developing dentition that can be utilized to obtain an optimally functional, esthetic, and stable occlusion; e. Basic biomechanical principles and the biology of tooth movement. Growth modification and dental compensation for skeletal problems including limitations; and f. Appropriate consultation with and/or timely referral to other specialists when indicated to achieve optimal outcomes in the developing occlusion. 2) Clinical Experiences: Clinical experiences must enable residents to achieve competency in: a. Diagnosis of dental, skeletal, and functional abnormalities in the primary, mixed, and young permanent dentition stages of the developing occlusion; and b. Treatment of those conditions that can be corrected or significantly improved by evidence-based early interventions which might require guidance of eruption, space supervision, and interceptive orthodontic treatments. These transitional malocclusion mechanisms conditions include the recognition, diagnosis, appropriate referral and/or focused management of: 1. Space maintenance and arch perimeter control associated with the early loss of primary and young permanent teeth; 2. Transverse arch dimensional problems involving simple posterior crossbites; 3. Anterior crossbite discrepancies associated with localized dentoalveolar crossbite displacement and functional anterior shifts (e.g. pseudo-Class III); 4. Anterior spacing with or without dental protrusion; 5. Deleterious oral habits; 6. Preservation of leeway space for the resolution of moderate levels of crowding; 7. Ectopic eruption, ankylosis and tooth impaction problems; and 8. The effects of supernumerary (e.g. mesiodens) and/or missing teeth.

ORAL FACIAL INJURY AND EMERGENCY CARE Didactic Instruction: Didactic instruction in oral facial injury and emergency care must be at the in-depth level and include: Care of orofacial injuries in infants, children and adolescents as follows: a. Evaluation and treatment of trauma to the primary, mixed and permanent dentitions, such as repositioning, replantation, treatment of fractured teeth, and stabilization of intruded, extruded, luxated, and avulsed teeth; b. Evaluation, diagnosis, and management of the pulpal, periodontal and associated soft and hard tissues following traumatic injury; c. Recognition of injuries including fractures of the maxilla and mandible and referral for treatment by the appropriate specialist; and d. Recognition, management and reporting child abuse and neglect and non-accidental trauma. 2) Clinical Experiences: Clinical experiences in oral facial injury and emergency care must enable residents to achieve competency in: a. Diagnosis and management of traumatic injuries of the oral and perioral structures including primary and permanent dentition and in infants, children and adolescents; and b. Emergency services including assessment and management of dental pain and infections.

ORAL DIAGNOSIS, ORAL PATHOLOGY, AND ORAL MEDICINE 1) Didactic Instruction: Didactic instruction in oral diagnosis, oral pathology and oral medicine must be at the in-depth level and include: a. The epidemiology of oral diseases encountered in infants, children and adolescents including those with special health care needs including prevalence and severity; b. The oral diseases of hard and soft tissue encountered in infants, children and adolescents including those pediatric patients with special health care needs; c. The diagnosis of oral and perioral lesions and anomalies in infants, children, and adolescents; d. Gingival, periodontal and other mucosal disorders in infants, children and adolescents; and e. Treatment of common oral diseases in infants, children and adolescents. f. Referring persistent lesions and/or extensive surgical management cases to appropriate specialists.

2) Clinical Experiences: Clinical experiences in oral diagnosis, oral pathology, and oral medicine must enable students/residents to achieve competency in: a. Pediatric oral and maxillofacial radiology and appropriate procedures of radiation hygiene; and b. Treatment of common oral diseases in infants, children and adolescents.

PREVENTION AND HEALTH PROMOTION 1) Didactic Instruction: Didactic instruction in prevention must be at the in-depth level and include: a. The scientific basis for the etiology, prevention, and treatment of dental caries and periodontal and pulpal diseases, traumatic injuries, and developmental anomalies; b. The effects of proper diet nutrition, fluoride therapy and sealants in the prevention of oral disease; c. Perinatal oral health and infant oral health supervision; d. Scientific principles, techniques and treatment planning for the prevention of oral diseases, including diet management, chemotherapeutics, and other approaches; e. Dental health education programs, materials and personnel to assist in the delivery of preventive care; and f. Diagnosis of periodontal diseases of childhood and adolescence, treatment and/or refer cases of periodontal diseases to the appropriate specialist.

2) Clinical Experiences: Clinical experiences must be of sufficient scope, volume and variety to enable residents to achieve competency in application of prevention in clinical practice.

COMPREHENSIVE DENTAL CARE 1) Didactic Instruction: Didactic instruction must be at the in-depth level and include: a. Restorative and prosthetic techniques and dental materials for the primary, mixed and permanent dentitions; b. Management of comprehensive restorative care for pediatric patients; c. Treatment planning for infants, children, adolescents and those with special health care needs; and d. Characteristics of the dental home.

2) Clinical Experiences: Clinical experiences must enable residents to achieve competency in: a. Diagnosis and treatment planning for infants, children, adolescents and those with special health care needs; and b. Provision of comprehensive dental care to infants, children, adolescents and those with special health care needs in a manner consistent with the dental home.

MANAGEMENT OF A CONTEMPORARY DENTAL PRACTICE 1) Didactic Instruction: Didactic instruction must be at the understanding level and include: a. The design, implementation and management of a contemporary practice of pediatric dentistry, emphasizing business skills for proper and efficient practice; b. Jurisprudence and risk management specific to the practice of Pediatric Dentistry; c. Use of computers in didactic, clinical and research endeavors, as well as in practice management; d. Principles of ethical and biomedical ethical reasoning, ethical decision making and professional responsibility as they pertain to the academic environment, research, patient care and practice management; and e. Working cooperatively with consultants and clinicians in other dental specialties and health fields. f. The prevention and management of medical emergencies in the dental setting.

PATIENTS WITH SPECIAL HEALTH CARE NEEDS 1) Didactic Instruction: Didactic instruction must be at the in-depth level and include: a. Formulation of treatment plans for patients with special health care needs. b. Medical conditions and the alternatives in the delivery of dental care that those conditions might require. c. Management of the oral health of patients with special health care needs, i.e.: 1. Medically compromised; 2. Physically compromised or disabled; and diagnosed to have developmental disabilities, psychiatric disorders or psychological disorders. 3. Transition to adult practices

2) Clinical Experiences: Clinical experiences must enable advanced residents to achieve competency in: a. Examination, treatment and management of infants, children, adolescents and adults with special health care needs.

HOSPITAL DENTISTRY 1) Didactic Instruction: Didactic instruction must be at the understanding level and include: a. hospital policies and procedures; b. medical/dental staff organization; and c. medical/dental staff member responsibilities. 2) Clinical Experiences: Clinical experiences must enable residents to acquire knowledge and skills to function as health care providers within the hospital setting. The program must provide the following clinical experiences: A. Dental treatment in the Operating Room Setting: 1. Each resident participates in the treatment of pediatric patients under general anesthesia in the operating room and these are documented in the RCL (Resident Clinical Log). The resident provides the pre-operative workup and assessment, conducting medical risk assessment, admitting procedures, informed consent, and intra-operative management including completion of the dental procedures, post-operative care, discharge and follow up and completion of the medical records. Intent: Each resident participates in and directly provides dental treatment to pediatric patients under general anesthesia in the operating room. This might occur in an out-patient ambulatory care facility. B. Inpatient Care: 1. Each resident participates in the evaluation and medical management of pediatric patients admitted to the hospital; and 2. Each resident demonstrates understanding of admitting procedures, completing of consultation requests, obtaining and evaluating patient/family history, orofacial examination and diagnosis, ordering radiological and laboratory tests, writing patient management orders, pediatric patient monitoring, discharging and chart completion. c. Anaesthesiology Rotation:

1. Residents must complete a rotation under the supervision of an anaesthesiologist in a facility approved to provide general anesthesia; 2. The anaesthesiology rotation in pediatric dentistry must be structured to provide the advanced specialty education resident with knowledge and

experience in the management of infants, children and adolescents undergoing general anesthesia; and 3. The rotation must provide and document experiences in : (1) pre-operative evaluation, (2) risk assessment, (3) assessing the effects of pharmacologic agents, (4) venipuncture techniques, (5) airway management, (6) general anesthetic induction and intubation, (7) administration of anesthetic agents, (8) patient monitoring, (9) prevention and management of anesthetic emergencies, (10)recovery room management, and (11) postoperative appraisal and follow up.

PULP THERAPY 1) Didactic Instruction: Didactic instruction must be at the in-depth level and include: a. Pulp histology and pathology of primary and young permanent teeth, including indications and rationale for various types of indirect and direct pulp therapy; and b. Management of pulpal and periradicular tissues in the primary and developing permanent dentition. 2) Clinical Experiences: Clinical experiences must enable residents to achieve competency in: a. Diagnosis of pulpal disease in primary and permanent teeth; b. Treatment of pulpal disease in primary teeth; c. Treatment of pulpal disease in immature permanent teeth; and d. Management of pulpal disease in mature permanent teeth including emergency care, stabilization and referral to specialists.

PEDIATRIC MEDICINE 1) Didactic Instruction: Didactic instruction must be at the understanding level and include: a. Normal speech and language development and the recognition of speech and language delays/disorders; b. Fundamentals of pediatric medicine including those related to pediatric patients with special health care needs such as:

1. Developmental disabilities; 2. Genetic/metabolic disorders; 3. Infectious disease; 4. Sensory impairments; and 5. Chronic disease. 2) Clinical Experiences: Clinical experiences must expose residents to pediatric medicine: a. Advanced education students/residents in pediatric dentistry must participate in a pediatric medicine rotation of eight (8) weeks duration which is the resident’s principal activity during this scheduled period 1. This rotation may occur in a variety of settings i.e., Emergency Department, subspecialty clinics, multi-disciplinary team clinics and general paediatrics. 2. The rotation must include exposure to obtaining and evaluating complete medical histories, parental interviews, system-oriented physical examinations, clinical assessments of healthy and ill patients, selection of laboratory tests and evaluation of data, evaluation of physical, motor and sensory development, genetic implications of childhood diseases, the use of drug therapy in the management of diseases, and parental management through discussions and explanation.