This is provided for use by Health Centers and other safety-net clinics in creating materials to be used as part of an orientation process for students who are beginning a clinical affiliation. Please modify the content as you wish. Throughout the slideset, some text appears in [red typeface]. These are prompts for entry of information specific to your organization or clinic. Be sure to type your own text in those areas, change the color to “automatic,” and remove the brackets. We recommend that you insert your own JPEG images into the placeholders provided, but the placeholders are easily deleted.

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You can also create new slides within this template. When you click “New Slide” on the “Home” ribbon, you’ll see a number of slide layouts. Each of them shares the colors and graphics of the existing slides. You can change the color scheme of all slides at once by editing the graphics in the “Slide Master” view for each slide type.

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This template was developed by the National Network for Oral Health Access and Dr. Rob Berg of the University of Colorado School of Dental Medicine. If you have any questions, please contact us at info@nnoha.org.

Note for oral health programs using this template

ORIENTATION TO YOUR AFFILIATION WITH [XYZ] HEALTH CENTER’S CLINIC IN�[ _____________ ]

Student beginning FIRST community-based clinical affiliation

[XYZ] HEALTH CENTER

• Our mission at [XYZ] Health Center
• [Your organization’s mission statement]
• Last year, we provided services to [number] people
• Medical: [number] patients, [number] visits
• Mental health: ________ patients, [number] visits
• Dental: [number] patients, [number] visits
• Pharmacy: [number] patients, [number] visits
• Our programs aimed at specific populations include
• [Diabetes/Health Education Team]
• [Maternal Child Health Program]
• [Adolescent Services]
• [Healthy Start Program]
• [AmeriCorps Program]

GET TO KNOW US

Section 1 –

WORKING AT OUR CLINIC

• Here are the times you’ll be at work in our clinic
• Please arrive by [time] am, Monday through Friday
• We usually break for lunch between [time] and [time]
• Last appointment at [time] pm, staff leaves by [time] pm
• You need to stay until your preceptor says you can leave!
• Make yourself comfortable
• Do park in [parking info] / Don’t park in [no-parking info]
• Put coat & backpack in [Name’s] office
• No patient? Talk, study, or eat in [Name’s] office
• Delays & absences are major problems for us
• We understand traffic/weather delays and we understand illness
• But keep us informed by calling [Name] at [cell phone number]

MEET THE FACULTY

• Primary clinical supervisor
• Dr. [Name]
• [Specialty or clinical interests]
• [Hometown or personal interest]
• Other staff clinicians
• Dr. [Name]
• [Specialty or clinical interests]
• [Hometown or personal interest]
• Dr. [Name]
• [Specialty or clinical interests]
• [Hometown or personal interest]
• Dr. [Name]
• [Specialty or clinical interests]
• [Hometown or personal interest]

MEET THE STAFF

• Dental Hygienists
• [Name]
• [Name]
• Clinic operations manager
• [Name]
• Lead dental assistant
• [Name]
• Dental assisting staff members
• [Name]
• [Name]
• [Name]
• [Name]

WHO WE TREAT

• Our catchment area or geographic focus [describe boundaries]
• [Policy for people outside catchment area]
• [Focus on specific primary or secondary schools]
• Pediatric patients: [number]% of patient visits
• [Describe, e.g. policy for patients with behavior issues]
• Services available for specific medical conditions or age groups
• [Pregnant women]
• [Older adults]
• [Referrals from medical division]
• Levels of care
• Urgent care, [number]%
• Limited care, [number]%
• Examples such as Phase 1 or Phase 2 care
• Comprehensive care, [number]%
• Examples of exclusions such as second molar endodontics)

TEACHING PHILOSOPHY

• Why are we teaching?
• Help the next generation get started
• Broaden network of those who understand this community
• Encourage you to keep asking why you do things
• Teaching you to make the best clinical decisions
• Combine scientific evidence with clinical experience
• Balance clinical assessment with your patient’s physical and social resources
• Decide efficiently, but learn when to “wait and see”
• Explore your strengths, but learn when to ask for help

PRACTICING IN OUR CLINIC

Section 2 –

CHARTING POLICIES

• Your assistant will chart for you
• But you will always write progress note yourself
• Without an assistant, you’ll need to learn to do the following in our EDR (electronic dental record) system
• History updates
• Perio charting
• Documents such as consent forms, limited exams
• Tooth charting
• Treatment plans, context notes and general notes
• You will need to learn how to effectively use our EDR
• Ask [Name] for our EDR training materials and study them.

CLINICAL PRACTICE RULES

• Review chart before entering treatment area
• Assess recent progress notes, medical status, etc.
• Brief preceptor on patient data, planned tx, consent & any concerns you have
• Introduce yourself to patient as a student dentist
• General consent lists student providers, but status must be evident
• Prescribing policies
• Protocol for issuing any prescription
• Protocol for analgesics and narcotics
• Remember you’re practicing under preceptor’s license
• Never change treatment plan without preceptor permission
• Preceptor must approve 3^rd radiograph attempt, 3^rd carpule
• Endo access prep must be directly observed by preceptor
• Never start treatment without preceptor approval
• Never dismiss a patient without preceptor approval

SURGICAL SAFETY CHECKLIST

• Sign in – prior to administering anesthetic
• Assess patient’s vital signs and confirm identity
• Review planned procedure and site with supervising dentist
• Review planned procedure and site with patient
• Ensure verbal and written consent is reviewed, signed, & witnessed
• Confirm if medical prophylaxis is needed and has been done
• Time out – prior to cutting tissue
• Verbally confirm procedure and site
• Review available radiographs and treatment plan
• Confirm availability of needed instruments
• Sign out – prior to dismissing patient
• Assess patient’s vital signs
• Provide post-operative instructions
• Review with supervising dentist, obtain permission to dismiss patient

PROGRESS NOTES

• Progress note is a vital part of the patient chart
• Progress notes must be reviewed and counter-signed by preceptor who supervised treatment
• Notes must be completed by [time] and [time] daily
• Complete and accurate; No unnecessary abbreviations
• Hx update, diagnostic codes, anesthetic, CDT codes, pain level
• Check tooth numbers, other data and spelling carefully
• Follow our clinic’s standard note structure
• [Description of your clinic’s note structure here]
• [Description of your clinic’s note structure here]
• [Description of your clinic’s note structure here]
• [Description of your clinic’s note structure here]

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APPOINTMENT CONTROL

• Patients invest time and effort to get appointments
• Our schedule is set about [number] weeks in advance
• People wait about [number] weeks for an appointment
• We try very hard not to cancel appointments
• Manage personal schedule to give patients priority they deserve
• Patients will be assigned to you for care
• Student column, shared column or assigned case-by-case
• Appointments scheduled in [number] minute increments
• When you’re ready to see another patient, let [Name] know
• Expect to treat about [number] patients per average day
• Concerns about procedure mix, being too busy,�not being busy enough? Discuss with Dr. [Name]

YOUR EDUCATIONAL EXPERIENCE

Section 3 –

OUR TEACHING RELATIONSHIP

• Collegial relationship
• Let’s talk regularly, as professional colleagues
• Puzzled by something our clinic does? Ask about it
• Our relationship in context of patient care
• Demonstrate strengths and we’ll offer you more discretion
• If we don’t have a familiar instrument or material and that makes you uncomfortable, ask Dr. [Name] about it
• It’s safe to say you don’t know something – �Ask for help too early, before you’re in over your head
• Please care about patients – they’re yours and ours
• Disagreement? Talk about it, but keep in�mind, you’re using your preceptor’s license

PACE AND FLOW OF SCHEDULES

• Potential imbalance among clinician schedules
• Some patients specifically request a specific dentist
• longstanding patient relationship
• anxious patient
• In a slow period, you may treat patients while we do not
• You came here to gain experience, so given a choice we’ll usually maximize experience for you instead of us
• We’ll always be available for consultation or help
• Pace of work is quite variable
• Like the airlines, we overbook our schedule to stay busy
• If everyone keeps their appointment, it can get extremely busy
• With more failed appointments that usual, it can get very slow
• One thing we don’t see very often is an “average” day

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SHARPS INJURY RESPONSE

• Rule #1: Be careful and prevent sharps injuries
• [Your rules for safe handling of sharps]
• [Your rules for safe injection technique]
• What to do if you have a sharps injury
• Stop treatment immediately, discuss with preceptor
• Procedure temporized/completed by other dentist
• Resolve uncertainty with PEPLine, 1-888-448-4911
• Two blood draws needed
• From health care worker (you, the student): Baseline to show you’re currently not seropositive
• From source patient (only assent needed): Assess for HIV, HBV, and HCV

SHARPS INJURY TESTING PROTOCOL

• Samples must be tested as soon as possible
• Kept cool in “gold-top” SSTs for rapid testing lab
• Rapid testing no more than 2 hours after draw
• Response to testing
• Risk of worker seroconversion is extremely small
• No prophylaxis available for HBV or HCV
• Pharmaceutical prophylaxis is possible for HIV
• Indicated if source patient is HIV+ or if status unknown
• Should be initiated as quickly as possible
• If rapid test unavailable, prophylax until status determined

PATIENT FINANCIAL CONSIDERATIONS

• Wonder how we pay our bills here?
• Many children we treat are covered by Medicaid or CHP+
• Adults & non-covered children charged on “sliding fee scale”
• For example, household with one adult, two children and income of $[number] is charged [number]% of our standard fees
• As in any practice, payment is made when services are provided
• Our budget is supplemented by earnings, grants and gifts
• Treatment must proceed at pace the patient can afford
• If you’re ahead of schedule and want to do more for your patient, talk with preceptor before talking with patient
• Don’t offer non-scheduled procedures without permission
• Manage expectations & avoid causing patients unexpected costs

PATIENT PRIVACY

Section 4 –

REVIEW OF HIPAA RULES

• You must read our HIPAA training materials
• Talk with [Name] about our PHI rules and find out how to access our training materials.
• Rules for use of Protected Health Information (PHI)
• All information created or used by health care providers that also identifies a person or could be used to identify that person
• Two major components of HIPAA regulations
• Privacy rule – standards for who can have access to PHI and what use they are allowed to make of it. This rule describes rights the patient has to PHI control and access
• Security rule – standards providers must meet to make sure that only people who the privacy rule allows to use PHI have access to it. It protects the confidentiality, integrity and security of PHI.

PRIVACY & SECURITY OF PHI

• PHI privacy
• Includes printed, spoken and electronic forms of information
• Can only be accessed with patient permission, to do your job
• PHI security
• Confirm identities, phone numbers before providing PHI
• Emails containing PHI must be encrypted
• PHI may never be placed on a social networking site
• Never leave a computer with access to PHI unattended
• Computer with access to PHI may not access peer-to-peer sites
• Sticky notes & loose papers entered into chart, then shredded
• No PHI on flash drives, personal laptops, tablets or smartphones
• Conversations about PHI must be limited to non-public areas

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HIPAA PROGRAM: PATIENT RIGHTS

• Patients have a right to
• receive copy of our privacy policy
• restrict access to PHI
• see and have copies of records
• request corrections of records
• request accounting of our disclosure of their PHI
• file a complaint about perceived violation

GETTING THE MOST OUT OF YOUR AFFILIATION

Section 5 –

WHAT WE EXPECT OF YOU

• Write down goals you want to achieve in this affiliation
• Talk with Dr. [Name] about them today
• Discussion progress in weekly meetings, [day] at [time] am
• Remain engaged with us in a learning experience
• Take responsibility as a staff provider on our team
• Help promote open communication and mutual respect
• Work with us to make each clinic day a success
• Make sure you meet with Dr. [Name] at the end
• Bring your written goals to the end-of-affiliation meeting
• Expect open and direct feedback
• Tell [her/him] what went well, what could make it better

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COMMUNITY-ORIENTED CARE

• Changing the world, one patient at a time
• Educate a patient about health
• Friends and family are influenced too
• Improve a parent’s health
• Improve their children’s health
• Treat disease in children
• Keep them in school, help them in ways we can’t predict
• Shared resources, complex decisions
• Not enough money to do everything for everyone
• Resource given to one person isn’t available for anyone else
• Balance individual needs with needs of community
• Fairness and equity become part of clinical decision making

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WELCOME!

We hope you’ll have a great clinical affiliation –

MEET OUR TEAM

• Preceptor/Clinical supervisor
• Dr. [Name]
• Specialty or clinical interest
• Hometown or personal interest
• Other staff members
• [Name]
• Job role at clinic
• Personal interest
• [Name]
• Job role at clinic
• Personal interest

If you have a smaller staff, use this instead of the “Meet the Faculty” and “Meet the Staff” slides

CQMS: CLINICAL QUALITY MEASURES

• To qualify for “meaningful use” reimbursement of EDR costs, our dentists must track six CQMs
• There are three Core Set measures
• Hypertension: blood pressure measurement
• Tobacco use: assessment and counseling
• Periodontal disease assessment*
• The alternate Core Set measures we’ve chosen
• Topical fluoride or fluoride varnish treatment*
• Provision of dental sealant*
• Oral cancer risk assessment and counseling*

*Alternative CQMs under review by CMS

Enter your oral health CQMs here if you’re tracking CQMs

QUALITY IMPROVEMENT (CQI)

• Step 1: Plan
• We’ve chosen CQMs that will help improve the health of our patients
• Step 2: Do
• In your practice here, carry out these CQMs and document that you’ve done so
• Step 3: Study
• We review our effectiveness at carrying out the CQMs, as well as their outcomes for our patients
• Step 4: Act
• Based on conclusions we draw from this process, we continue to refine both the CQM goals and what we do to pursue those goals

Use slide if you’re tracking CQMs