1. Sang Park, DDS, MMSc

2. Objective : Development and implementation of CCC as a new clinical model for the predoctoral program. To achieve patient-based comprehensive care requiring case completion of assigned patient cases. Senior Tutors as group leaders responsible for patient assignment, tx.planning, monitoring student performance and verifying patient care.

3. Problems: 1. Loss of motivation once minimum numerical thresholds have been met 2. Clinic sessions in the 4 th yr. are underutilized (low productivity) 3. Lack of continuation of care: “pick and choose” treatments that will fit their requirements 4. Lack of commitment to providing comprehensive patient care 5. Random transfer of patients among students 6. “Sharing” removable prosthodontic cases for credit

4. Goals : 1. Encourage students to perform comprehensive care 2. Instill sense of commitment and responsibility of completing treatment plans 3. Less need for transfers and smoother transitions if necessary 4. Reduce the amount of patients who are in-between treatments due to neglect (and eventually reduce the number of remakes) 5. Students will learn the importance of patient management and will make efforts to maintain their patients

5. Proposal : Patient-based comprehensive care Case completion Numerical Threshold = GRADUATION

6. Things to consider… Number of required cases Measurement of complexity, units, and disciplines Combination with thresholds Incomplete cases axiUm (Exan Enterprise Inc., Las Vegas, NV), a new clinic information system led to Electronic Health Records Faculty development and student education

7. Methods: Perform Chart Reviews with Senior Tutors in the 3 rd year prior to 4 th year promotions Senior Tutors review and assess the cases that will require case completion Cases are determined by the complexity and duration of treatment required (It can vary depending on individual needs and progress) Cases that involve multidisciplinary learning are preferred

8. The Case Classification System Case TypeProcedures 1 Preventive therapies, simple operative procedures, prophylaxis and scaling and root planing 2 Interdisciplinary management (endodontics, periodontal surgery, oral surgery, etc) and complex restorative procedures, not including prosthodontic treatment 3 Interdisciplinary management and restorative procedures, including prosthodontic treatment (less than 3 fixed prosthodontic units) 4 Complex interdisciplinary management (4 or more disciplines) with restorative procedures including prosthodontic treatment (3 or more fixed prosthodontic units) 5 Removable partial dentures (metal and resin) 6 Complete dentures, immediate dentures, overdentures, and implant supported overdentures Park, Timothe, Nalliah et al. J Dent Educ 2011, accepted.

9. The Case Selection and Requirements Criteria (2010) Minimum Requirements Case Compositions (All cases from 3 rd & 4 th years) Pass: 15 casesMaximum of seven comprising of Type 1 & 2 cases Minimum of four Type 3 & 4 cases (one of which must be type 4) Minimum of four Type 5 & 6 cases (must consist of both types) Honors: 20 casesMaximum of nine cases comprised of Type 1 & 2 cases Minimum of six Type 3 & 4 cases (two of which must be Type 4) Minimum of five Type 5 & 6 cases Park, Timothe, Nalliah et al. J Dent Educ 2011, accepted.

10. CompleteIncomplete*Transfer 2010 (33 students) 22.86.64.6 2009 (30 students) 12.814.416.4 Case Completion Comparisons (Graduated Classes of 2009 and 2010) Park, Timothe, Nalliah et al. J Dent Educ 2011, accepted.

11. Case Distributions by Case Types Case Type Type 1Type 2Type 3Type 4Type 5Type 6 Average (range) 7.0 (3-11) 3.6 (1-10) 5.3 (3-11) 2.6 (1-7) 2.2 (1-3) 1.9 (1-4) *Results indicate the number of cases students completed defined by the Case Classification System for the graduated class of 2010. The range of case numbers completed for the class is also noted according to each case type. Park, Timothe, Nalliah et al. J Dent Educ 2011, accepted.

12. Student Clinical Productivity: To evaluate the effects of the clinical education change, from a numeric procedural curriculum to a Case Completion Curriculum (CCC), on student productivity, measured as number of procedures performed in the student teaching practice. The two study groups (Threshold group and Case completion group) consisted of students who graduated during the period 2009-2010. Clinical performance was assessed by clinical productivity across five major discipline areas: periodontics, operative, removable prosthodontics, fixed prosthodontics, and endodontics.

13. Challenges: Demands for additional mentoring and management of students and patients were significantly greater with this curriculum. Utilization and selection of group leaders or managers with strong backgrounds in teaching, mentoring, clinical skills, and administration skills have always posed great challenges. Concurrent with the implementation of this new educational model, a new computer information system, axiUm, was introduced that led to Electronic Health Records (EHR).

14. Conclusions: Shifting the focus from numerical procedural requirements to case completions of assigned cases has increased the number of completed cases and ensured continuity of care. Less need for transfers took place among students and allowed for smoother transitions when student providers graduated. This clinical education model could help students learn the importance of patient management and make further efforts to maintain their patients.