Design and Outcomes of a Comprehensive Care Experience Level System to Evaluate and Monitor Dental Students’ Clinical Progress

Abstract

A Comprehensive Care Experience Level (CCEL) system that is aligned with Commission on Dental Accreditation (CODA) standards, promotes comprehensive care and prevention, and addresses flaws observed in previous Relative Value Units (RVU)-based programs has been implemented at the School of Dental Medicine, Case Western Reserve University since 2011. The purpose of this article is to report on the design, implementation, and preliminary outcomes of this novel clinical evaluation system. With the development of the CCEL concept, it was decided not to award points for procedures performed on competency exams. The reason behind this decision was that exams are not learning opportunities and are evaluated with summative tools.To determine reasonable alternative requirements, production data from previous classes were gathered and translated into CCEL points. These RVU points had been granted selectively only for restorative procedures completed after the initial preparation stage of the treatment plan, and achievement of the required levels was checked at multiple points during the clinical curriculum. Results of the CCEL system showed that low performing students increased their productivity, overall production at graduation increased significantly, and fluoride utilization to prevent caries rose by an order of magnitude over the RVU system. The CCEL program also allowed early identification and remediation of students having difficulty in the clinic. This successful implementation suggests that the CCEL concept has the potential for widespread adoption by dental schools. This method also can be used as a behavior modification tool to achieve specific patient care or clinical educational goals as illustrated by the way caries prevention was promoted through the program.

Dental Students’ Clinical Experience Across Three Successive Curricula at One U.S. Dental School

“…For example, a procedure with an RVU of 4 on average would take twice the combined level of skill, knowledge, and effort of a procedure with an RVU of 2. This use of RVUs at UCSF is consistent with research on student experience reported by other dental schools 23 – 26 …”

Development of a novel integrated educational relative‐unit value system to assess dental students' clinical performance

“…The development processes of identified systems were evaluated in light of Kane's views of validity 21 . Of these, 3 studies used insurance‐based RUVs to measure students’ performance, 1,16,17 and 5 described systems that were specifically developed for the educational setting 5–7,18,19 . Alignment between the purpose of developing the RUV system and the purpose it was used for, was noted in 2 of the 8 systems 6,7 .…”

“…In fact, some schools have used RUVs to set targets for desired checkpoints, including graduation. These are becoming popular with students and faculty, because of the flexibility they offer in helping students meeting requirements and, hence, reducing their anxiety 6,7 …”

“…Some of these practice‐based RUVs have been used by dental educators to assess dental students’ clinical productivity in the educational settings 1,16,17 . Since these systems were not originally developed for use in education, several educational RUVs were developed 5–7,18,19 . A timeline of the usage of RUVs in dentistry is summarized in Figure 1.…”

Components of responsibility in estimating relative value units: How do dentists value their work?

“…Relative value units (RVU) are considered an important measure of the work effort provided by clinicians . RVU systems in dentistry were initially developed in Canada and the United States as a fee setting guide that accounted for factors such as knowledge, skill, effort and responsibility . RVUs have since been incorporated into analyses of dental productivity in Veteran Dental Service clinics, productivity monitoring of students in community‐based dental education programmes, and used to compare outputs from school‐ and community‐based dental clinics .…”