1. NAVIGATING THE CDHM CONTINUING COMPETENCY PROGRAM
Joanna Asadoorian AAS(DH), BScD(DH), MSc
Associate Professor
School of Dental Hygiene, Faculty of Dentistry
University of Manitoba
Asadoorian, J., CDHM Presentations Spring 2010 ©

2. Navigating the CDHM Continuing Competency Program
The CDHM mandate is to protect the public by ensuring safe, quality oral health care
What is quality…where does competence fit?
“degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”
Blumenthal, 1996
Knowledge, skill and appropriateness of health care
Structure and process to ensure best outcomes
Competence and daily performance
Measurement and improvement of the entire profession
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

3. Diffusion of Innovations: Problems & Recommendations
A considerable lag time exists between new research findings and general application into practice settings
Research shows almost a twenty year lapse between dissemination and implementation
Significant time delays reflect a failure to implement newer, more effective procedures and the discontinuation of ineffective or harmful ones
Implies a delay of best practices available to patients
Known as the theory practice gap
“Education allowance systems” as in those based on CE time requirements have been described as failures to the
profession…” (Grant, 2002)
“Conducting a needs assessment is essential in directing the educational process.” (Cantillon and Jones, 1999)
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

4. Self-Assessment (SA): Panacea or Part of the Problem
Rationale for Conducting Self-Assessments
Problems with Self- Assessment
Provide direction to one’s learning
Promotes increased efficiency in learning
Generates motivation to one’s learning and for implementing change
(Asadoorian & Batty, 2005)
Incapability of self-assessing accurately
SA used to protect one’s self concept
Need to preserve confidence and positive attitudes
Learning activities chosen based on areas we excel
SA is an over and misused term
Not intended to be an individualistic activity
Multiple sources of external feedback recommended
(Eva & Regehr, 2007)
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

5. Self-directed Assessment Seeking
What is Self-directed Assessment Seeking?
Collecting data about one’s professional performance through:
honest reflective introspection (internal)
requesting unbiased feedback from others (external)
Creating an awareness of deficiencies, opportunities for improvement and continuing competency needs
specific knowledge topics, skills, client problems and practice issues
Indicating the continuing competency goals
that one should ideally address
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

6. Self-directed Assessment Seeking (SDAS)
How to accomplish a meaningful SDAS:
Internal
External
Internal evaluation should be conducted in a meaningful and structured way
Use of tools for thinking about one’s own practice performance
1. Reflection-on-practice
2. Competencies & Practice Standards
3. Evidence-based Practice
4. Self-assessment tests
External evaluation should be intentional, ongoing activity and increasingly relied upon
Use multiple sources:
Include appraisal by peers, experts, clients and others to help expose areas in need of improvement
Tools available to carry out
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

7. Self-directed Assessment Seeking
Internal: 1. Reflection on Practice
Defined: “an important human activity in which people recapture their experience, think about it, mull it over and evaluate it” (Boud)
Reflect on and learn from:
Day-to-day practice problems
client care including complex medical conditions, communication challenges, procedural difficulties and poor treatment outcomes– surprises!
Ongoing challenges from one’s practice environment
Antiquated office policies, conflicting treatment philosophies and structural inadequacies
Practice problems often generate emotional responses:
Emotional cues help identify competency challenges
Maintaining a practice log aids in recalling challenges for later reflection
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

8. Self-directed Assessment Seeking: Reflection on Practice
5 Good Reasons:
1. Links theory & practice
2. Uses our own (clinical) experiences
3. Helps make sense of real practice problems
“messy swamplands”
4. Encourages a different kind of learning
- deep rather than superficial
5. Generates a different kind of knowing
“transformative” knowing that motivates change
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

9. Keys to Using Reflection in Practice:
1. Self-directed Assessment
Self-directed Assessment Seeking:
Reflection on Practice
Keys to Using Reflection in Practice:
Foundation is concrete experience; start with meaningful experiences
Structure may help; use a model for a framework
Many available: Kolb, Mezirow, Boud…
Use your feelings; trigger the need to reflect
Reflect regularly
Start with a Journal or practice log
Note your feelings and/or practice problems
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

10. A Suggested Model of Reflection An integration of the literature…
Asadoorian, 2005
Develop a new
Perspective
Validate new
Perspective
Develop an
Awareness
Analyse the
Situation
Relate the
Experience
Trigger
Describe the
Experience
Critical Reflectors
Reflectors
Non-reflectors
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

11. A Suggested Model of Reflection An integration of the literature…
Transformed thinking results and compels change
Asadoorian, 2005
Take the experience apart and examine it
What was your emotional response
Develop a new
Perspective
Validate new
Perspective
Develop an
Awareness
Analyse the
Situation
Relate the
Experience
Trigger
Describe the
Experience
Critical Reflectors
Trying out new thinking and seeing how it works in practice
What was occurring before and after; what other things were influencing you
What knowledge do you have that relates to this; what knowledge is missing
Reflectors
Give a descriptive account of what happened
Non-reflectors
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

12. 1. Self-directed Assessment
Self-directed Assessment Seeking: Internal: 2. Competencies & Standards
What, why, how?
Helpful for determining professional strengths and weaknesses and directing one’s continuing competency goals
Using these documents involves comparing one’s own practice performance to the competency/standard outlined in the document
Look for new National Competencies document on CDHA website (September)
To determine if one has competency in the specific item or if additional development is required—
often due to insufficient knowledge, skill and/or experience
The dental hygienist is cued in to develop a corresponding continuing competency goal
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

13. Self-directed Assessment Seeking: Internal: Competencies & Standards
ASSESSMENT (67 Competencies) √ 29
Assesses health status of dental implants 30
Assesses hard and soft deposits 31
Assesses intraoral hard tissues
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

14. Self-directed Assessment Seeking Internal: Evidence-Based Practice
3. EBP: The rationale
“the most cost-effective opportunity to improve patient outcomes over the next quarter century will likely come not from discovering new therapies but from discovering how to deliver therapies that are known to be effective” (Berenholz & Pronovost, 2003)
Even the most robust evidence supporting optimal clinical care typically fails to be implemented
Failures in knowledge application results in gaps between best practice and actual performance
In health care practice, practitioners may be unaware of what they do not know
Dental hygienists may not realize that current research does not support a specific routine procedure
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

15. Self-directed Assessment Seeking Internal: Evidence Based Practice
Reading professional journals and articles, attending professional conferences and lectures, searching databases, conducting research and participating in journal clubs provide valuable opportunities for exposure to new research
Databases:
“PubMed” (Medline)
Cochrane Collaboration- Reviews
Search, by topic
Oral health
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

16. Self-directed Assessment Seeking Internal: 4. Self-Assessment Tests
Read article and then take SA test immediately
Take SA test first to determine if reading article is necessary
Take SA test later for retention and application
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

17. 1. Self-directed Assessment
Self-directed Assessment Seeking External: Questions, Discussion and Feedback
Increasingly rely on external sources for feedback about performance
Highlights topics or issues that one has limited knowledge about or contradicts one’s current beliefs
It is human nature to dismiss or rationalize negative feedback or conflicting philosophies
Opportunities may occur spontaneously (i.e. client questions, employer/colleague comment and discussions), but more often individuals must solicit others for feedback
Questions, discussions, and feedback from peers, employers and clients provide excellent resources for identifying deficiencies and opportunities for improvement: Continuing competency goals
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

18. 1. Self-directed Assessment
Self-directed Assessment Seeking External: Questions, Discussion and Feedback
It is important to ask for others to be specific and limit feedback:
DENTAL HYGIENIST SELF-DIRECTED FEEDBACK FORM Name: Date: Please return feedback by: Thank you for agreeing to provide your valuable feedback to me regarding my dental hygiene practice. Your feedback will assist me in addressing my learning needs. On the following sheet(s) please make written comments about the area(s) indicated below. When you are providing the feedback please be specific, clear and descriptive. Please include examples where possible. I would also appreciate meeting briefly with you to discuss your feedback. Perhaps we can schedule some time to meet after you have returned the written feedback. 1.__________________________________________________________________ 2.__________________________________________________________________ 3.__________________________________________________________________
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

19. Strengths I have noticed:1.
Strengths I have noticed: A B C
Enhancements that could be made:
Date Written: Date Reviewed:
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

20. Self Directed Assessment: CCR
FILLING OUT THE FORM! Step One:
How did you determine that you had a professional need or deficiency? (See pages 10 & 11 in Section 2 of the CCP Package)
Practice problems & reflection
Using the CDHM Competencies/Standards/Code of Ethics
Questions, discussions or external feedback
Evidence-based practice
Other: (Specify) ________________________________________
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

21. Navigating the CDHM Continuing Competency Program
Professional Development Component: CCR
3. Activity Implementation & Evaluation
2. Goals Development & Activity Planning
1. Self-directed Assessment
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

22. Goal Development & Planning Activity
Self-directed assessment seeking strategies assist in detecting deficiencies and opportunities for improvement
Step two involves developing continuing competency goals and associated plans to address identified deficiencies 
Two typical types of goals:
knowledge attainment goals
action oriented goals
action oriented goals often require change to practice and may require activities to support the behavior change from the clinician or other practice members
Practice deficiencies must be prioritized to determine if which require immediate attention and those that should be deferred
Planned activities should address some aspect of achieving one’s goal and chosen based on resources and preference
one to several activities will be needed to support achievement of goals
use traditional methods and new online and digital resources
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

23. 2. Goal Development & Planning Activity
Developing the goal
Defining the goal
Once “cued in”, describe in detail the perceived practice deficiency/opportunity for improvement
May be just a hunch at this point
Include:
What led to this observation?
What do you already know?
Is it possible this knowledge could be updated?
Is it possible that practice is not currently based on evidence?
In one sentence, define a goal that captures the need you have identified
Include a subject, action, timeline and measurable outcome
Example:
“Within 6 months, I will ensure that the dental implant care I provide/recommend is based on the most current evidence available”
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

24. 2. Goal Development & Planning Activity
Developing the goal
I have been out of school for several years and have not really ever incorporated ultrasonic scaling into my clinical practice; I practice with a new graduate dental hygienist and she uses the ultrasonic scaler along with hand scaling with virtually every client. She explains to her clients that ultrasonics is the latest technology and that it has several therapeutic benefits over and above hand scaling. This makes me feel uncomfortable for several reasons. First, I am not sure how accurate the information she is sharing is, but I feel a little out of date on my knowledge surrounding power scalers and therefore not well-equipped to have a discussion about it. Second, I would prefer that we practice in a more standardized way based on the most recent evidence. Lastly, I am wondering if my clients feel short- changed that they are not receiving ultrasonic debridement because they may over hear what she is telling her clients.
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

25. 2. Goal Development & Planning Activity
Defining the goal
I will use the ultrasonics/power scalers in my dental hygiene practice in accordance with the most recent research/evidence within 6 months.
Be specific
Be realistic
Include only one goal
Will you be able to measure your success?
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

26. 2. Goal Development & Planning Activity
Once the goal is developed and defined, determine some objectives (mini-goals) to meet the goal
Think about the learning component AND what will be needed to ensure implementation of the goal into practice: be realistic and detailed
Consider what resources will be available and what you prefer to use for achieving goals
This may require some research
Try to incorporate new methods (i.e. internet searches, online learning programs)
This is a plan, and may require some modifications later
Objectives/mini-goals:
What do I need to achieve and learn?
i.e. latest ultrasonics information/research
How am I going to do it? (potential ideas)
Do PubMed/Cochrane search
Download relevant articles
See if any courses/workships coming up on topic
MDHA, CDHA, industry
Call an expert
Educator, researcher, colleagues
Then what?
Implement!!
Read, attend, consult, buy…Make Changes To Practice!
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

27. Goal Development & Activity Planning: CCR
FILLING OUT THE FORM! Step Two:
Please describe the professional need or deficiency perceived: (see pages 10 & 11 in Section 2 of the CCP Package)
________________________________________________________________ _____________________________________________________________ _____________________________________________________ ...
CONTINUING COMPETENCY GOAL # 1: (see pages 12 & 13 in Section 2 of the CCP Package)
I will use the ultrasonics/power scalers in my dental hygiene practice in accordance with the most recent research/evidence within 6 months.
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

28. Navigating the CDHM Continuing Competency Program
Professional Development Component: CCR
3. Activity Implementation & Evaluation
2. Goals Development & Activity Planning
1. Self-directed Assessment
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

29. Changing Practice: Activity Implementation & Evaluation
Knowledge Awareness ≠ Knowledge Application
People, including dental hygienists, resist change
Dental hygienists have been shown to embrace traditional behaviours and maintain the status quo ~ even in the face of strong evidence
Barriers exist that contribute to making change difficult– but enhancers exist too!
Facilitating the change process:
Recognize the relevance of a change
Possess transformed thinking (from reflection on practice)
Use more active strategies for learning
Problems carrying out change:
Change is not automatic; humans do not behave completely rationally
Human change process is complex
based on individual and structural influences
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

30. Changing Practice: Activity Implementation & Evaluation
Matching activities to practice deficiencies ensures the most efficient use of one’s time—
rather than spending numerous hours on activities that are irrelevant to one’s practice
Using a detailed and realistic activity plan, it is relatively straightforward to carry out
Activities can be conducted over a period of time to achieve continuing competency goals
Despite the most carefully developed activity plans, some obstacles may be encountered
In these cases it will be necessary to implement a contingency plan and adjust one’s timeline accordingly
Evaluation:
One of the most important continuing competency tasks is the evaluation of goals
Without evaluation it is impossible to know how to proceed
Three possible outcomes to the evaluation are possible:
goal is met
goal is unmet
goal is in process
Based on the outcome, think about what will need to occur next
Goals are fully met: focus on new continuing competency activity or goal
Unmet or in process goals: more learning or supplementary activities may be necessary; a need to revise the goal may also become apparent
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

31. Activity Implementation & Evaluation: CCR
FILLING OUT THE FORM! Step Three:
CONTINUING COMPETENCY ACTIVITIES: What type of activities did you participate in to support the achievement of this goal? Check all that apply (see pages 14 & 15 in Section 2 of the CCP Package)
 Educational Courses/Seminars Date of Course: _______ Name of Course/Presenter: __________
 Online Courses Date of Course: _______ Name of Course/Presenter: __________
 Advanced Formal Education Institution: ___________ Name of Course/Program of Study: ___
 Professional Journals/ Articles Date Read: __________ Journal/Article Reviewed: (may attach)
 Journal Clubs Date(s) Met: _________ Journal and/ or Topic Reviewed: _____
 Videos or DVDs Date Viewed: _______ Title of Video/DVD/Producer: ________
 Other: (Specify) _______ Please describe: ______________________________________
What was the approximate time spent participating in the activities? __________
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©

32. FILLING OUT THE FORM! Step Three (cont...):
Did these activities assist you in meeting your Continuing Competency Goal?
 Met  Not Met  Partially Met
Please Explain: ________________________________________________...
Please describe the information/skills gained from these activities:
_____________________________________________________________...
What changes do you intend to make in your area of dental hygiene practice
as a result of these activities?
(please include the timeframe you hope to accomplish this in - i.e. immediately,
within 1 year): __________________________________________________...
FILLING OUT THE FORM! Step Three (cont...):
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

33. FILLING OUT THE FORM! Step Three (cont...):
Did you implement these changes into your dental hygiene practice?
 Yes  No  In-Process
Briefly Describe: ___________________________________________________________ …
If a change was made, did it help to improve your dental hygiene practice?
 Yes  No  In-Process
Briefly Describe: __________________________________________________________ …
Were there any constraints you encountered in implementing this change?
 Yes  No
Briefly Describe: __________________________________________________________ …
FILLING OUT THE FORM! Step Three (cont...):
Asadoorian, J., CDHM Presentations Spring 2010 ©
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10

34. Navigating the CDHM CCP: In Summary
Self directed assessment
Goals development & activity planning
Activity implementation & evaluation
Asadoorian, J., CDHM Presentations Spring 2010 ©
7/30/10
Asadoorian, J., CDHM Presentations Spring 2010 ©