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NAVIGATING THE CDHM CONTINUING COMPETENCY PROGRAM Joanna Asadoorian AAS(DH), BScD(DH), MSc Associate Professor School of Dental Hygiene, Faculty of Dentistry.

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Presentation on theme: "NAVIGATING THE CDHM CONTINUING COMPETENCY PROGRAM Joanna Asadoorian AAS(DH), BScD(DH), MSc Associate Professor School of Dental Hygiene, Faculty of Dentistry."— Presentation transcript:

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

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 ©7/30/10 2

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 3

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

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 1. Self-directed Assessment Asadoorian, J., CDHM Presentations Spring 2010 ©7/30/10 5

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

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 1. Self-directed Assessment Asadoorian, J., CDHM Presentations Spring 2010 © 7/30/10 7

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

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

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

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

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

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

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 1. Self-directed Assessment Asadoorian, J., CDHM Presentations Spring 2010 ©7/30/10 14

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 1. Self-directed Assessment Asadoorian, J., CDHM Presentations Spring 2010 © 7/30/10 15

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 1. Self-directed Assessment Asadoorian, J., CDHM Presentations Spring 2010 ©7/30/10 16

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

18 Self-directed Assessment Seeking External: Questions, Discussion and Feedback 1. Self-directed Assessment 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 © It is important to ask for others to be specific and limit feedback: 7/30/10 18

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

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

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

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 2. Goal Development & Planning Activity Asadoorian, J., CDHM Presentations Spring 2010 © 7/30/10 22

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

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

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

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

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

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

29 Changing Practice: Activity Implementation & Evaluation 3. 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 29

30 Changing Practice: Activity Implementation & Evaluation Activity Implementation:  Matching activities to practice deficiencies ensures the most efficient use of one’s time—  rather than spending numerous hours on activities that are irrelevant to one’s practice  Using a detailed and realistic activity plan, it is relatively straightforward to carry out  Activities can be conducted over a period of time to achieve continuing competency goals  Despite the most carefully developed activity plans, some obstacles may be encountered  In these cases it will be necessary to implement a contingency plan and adjust one’s timeline accordingly Asadoorian, J., CDHM Presentations Spring 2010 © 3. Activity Implementation & Evaluation Evaluation:  One of the most important continuing competency tasks is the evaluation of goals  Without evaluation it is impossible to know how to proceed  Three possible outcomes to the evaluation are possible:  goal is met  goal is unmet  goal is in process  Based on the outcome, think about what will need to occur next  Goals are fully met: focus on new continuing competency activity or goal  Unmet or in process goals: more learning or supplementary activities may be necessary; a need to revise the goal may also become apparent 7/30/10 30

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

32 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 © 7/30/10 32

33 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 © 7/30/10 33

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 34


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