Unit 2 - Standards

This is your first site visit. You have the responsibility of assessing a program's compliance with accreditation standards. It is your initial meeting with the postdoctoral program head, Dr. Director, and the following dialogue ensues.

Objective Site Visitor - "Dr. Director, my name is Objective Site Visitor. I serve as a representative of the Commission on Dental Accreditation, and my role as a member of the team that is here, is to assess your program's compliance with the accreditation standards. We appreciate the gracious hospitality you have extended to us."

Dr. Director - "Oh, Site Visitor, it is our pleasure to have you. We are pleased to welcome you to our institution and to our program. We are very proud of what we are doing and what we have accomplished."

Objective Site Visitor - "As you are no doubt aware, my task is one of a fact-finder. During our time together I will be assessing the extent to which your program complies with the accreditation standards. My report will be submitted to the Commission on Dental Accreditation, who will use it to determine an accreditation status. I want to emphasize that this is an objective process. I will formulate judgments based only on your compliance with the standards and not on my personal views. I have read your self-study and look forward to validating it during my visit."

Dr. Director - "You bring up a matter about which I have very strong opinions. I am very concerned about the standards you are using, actually on two counts. First, who is this Commission that tells me as a university professor how to conduct my program, and where do they come up with these standards anyway? And secondly, Site Visitor, don't you agree with me that using standards like these only forces all of the programs in the country to look alike? Don't these standards inhibit our ability to use diverse approaches to educating our students? After all, the needs of advanced dental education students in our part of the country are not necessarily the same as those from elsewhere, and my approach to teaching may be different than my colleagues' from other parts of the country. Furthermore, I think the standards inhibit our ability to develop creative and innovative approaches to education and program development!"

How do you respond to Dr. Director?

Objectives

After reading the materials in this unit the site visitor will be able to:

1. Define educational standard and give examples of how standards might be used
2. Explain the difference between standards and standardization
3. Outline and explain the process used to develop the standards used by the Commission on Dental Accreditation (CODA)
4. Differentiate between the following as used in CODA standards:*
   • Approval with reporting requirements
   • Approval without reporting requirements
   • Basic Clinical Education
   • Clinical Competence
   • Clinical Instruction
   • Competence
   • Competencies
   • Competent
   • Didactic Instruction
   • Distance Site
   • Documentation
   • Enriching Clinical Experiences
   • Examples of evidence to demonstrate compliance
   • Exposure
   • Familiarity
   • In-depth
   • Initial Accreditation
   • Instruction
   • Intent
   • Interdisciplinary
   • Laboratory/Preclinical Competence
   • Laboratory/Preclinical Instruction
   • May/could
   • Multidisciplinary
   • Must
   • Outcomes Assessment
   • Patients with special needs
   • Practical Experience
   • Predoctoral
   • Should
   • Sponsor
   • Standard
   • Understanding

Learning Resources

Accreditation Standards for Predoctoral, Allied and Advanced Dental Education Programs

• Accreditation standards are developed through a consensus process. The Commission on Dental Accreditation has authority to formulate and adopt educational requirements and guidelines, i.e., standards for accrediting predoctoral programs, as well as advanced and allied dental education programs. Appropriate communities of interest are substantially involved during all stages of developing and revising accreditation standards.
• The process culminates in adoption of standards that become the property of the Commission. Anyone who assists in developing or revising a standards document must sign a release giving the Commission the right to copyright such documents.
• During the initial stage of the process, representatives from the communities of interest are invited to participate in the development of a preliminary document. These representatives are selected in cooperation with the national organization(s) or communities of interest whose membership reflects the disciplines.
• The communities of interest may include, but are not limited to the: American Dental Education Association, American Association of Dental Boards, American Dental Assistants' Association, American Dental Hygienists’ Association, National Association of Dental Laboratories, Special Care Dentistry Association , certifying boards and sponsoring organizations of recognized dental specialties, certifying boards for dental assistants and dental laboratory technicians, program directors, dental school deans, administrators of non-dental school institutions offering dental programs, and constituent societies of the American Dental Association.
• The steps taken by the Commission in developing accreditation standards are shown in the following diagram. Any of the steps may be repeated as needed.

Review and Practice 2.2: After reviewing the diagram, outline the process used to develop CODA standards.

Accreditation standards documents are individualized for the predoctoral, advanced and allied dental educational programs; however, there are characteristics common to all of them. Each set of standards begins with the Commission’s Mission Statement and a Preface or the Commission’s Statement of General Policy, followed by a section on the Definitions of Terms Used in Accreditation Standards. The Standards also include a document revision history and the accreditation status definitions.

The Preface or Statement of General Policy provides introductory information about the accreditation process. It usually includes a statement of the role of the Commission and the purpose of accreditation. It may also provide a brief historical perspective, a description of the genesis of standards, and an overview of the steps in the accreditation process. Standards may contain customized materials to orient each site visitor to their specific area of focus.

The Definition of Terms section follows the introductory pages. It is important that site visitors have a thorough understanding of the terms used in the standards. (Although there is slight variation from discipline to discipline, the following is a comprehensive list of all of the terms.) Additional terms may also be found at the end of each standards document. They include the status classifications that are granted to institutions by the Commission after an evaluation has occurred.

Basic Clinical Education

The patient care experiences required for all students in order to attain clinical competence and complete the program. This education is provided in the program's clinical facilities (primary site on campus or off campus facilities) as defined in the Accreditation Standards and is supervised and evaluated by program faculty according to predetermined criteria.

Competence

The achievement of a predetermined level of special knowledge and skill derived from education, experience and task completion.

Competencies

Written statements describing the levels of knowledge, skills and values required of graduates.

Competent

The level of knowledge, skills, and values required by students/residents to perform independently an aspect of dental practice after completing the program.

Distance Education

Education that uses one or more technologies to deliver instruction to student who are separated from the instructor and to support regular and substantive interaction between the student and the instructor, either synchronously or asynchronously.

Documentation

Evidence of compliance with the standard. All evidence described is to be maintained by the program and is to be available for review by Commission representatives.

Enriching Clinical Experiences (Enrichment/Observational)

Clinical experiences that exceed the basic clinical education requirements of the program and that are provided to enhance the basic clinical education but are not used for achieving program or accreditation requirements. Enriching experiences may be provided on campus and/or in extramural clinical facilities and may be supervised by non-program personnel.

Evidence-Based Dentistry

Evidence-based dentistry is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences.

Examples of Evidence to Demonstrate Compliance

Desirable condition, practice or documentation indicating the freedom or liberty to follow a suggested alternative.

Graduate Program

A planned sequence of advanced courses leading to a masters or doctoral degree granted by a recognized and accredited educational institution.

Instruction

Describes any teaching, lesson, rule, or precept; details of procedure; directives.

Intent Statements

Intent statements are presented to provide clarification to the programs in the application of and in connection with compliance with the Accreditation Standards. The statements of intent set forth some of the reasons and purposes for the particular Standards. As such, these statements are not exclusive or exhaustive. Other purposes may apply.

Interdisciplinary

Including dentistry and other health care professions.

International Dental School

A dental school located outside the United States and Canada.

Manage

Coordinate the delivery of care using a patient-focused approach within the scope of their training. Patient-focused care should include concepts related to the patient’s social, cultural, behavioral, economic, medical and physical status.

May/Could

Indicates freedom or liberty to follow a suggested alternative.

Multidisciplinary

Including multiple disciplines within the profession of dentistry.

Must

Indicates an imperative or duty; an essential or indispensable item; mandatory; required.

Patients with Special Needs

Those patients whose medical, physical, psychological, or social situations make it necessary to modify normal dental routines in order to provide dental treatment for that individual. These individuals include, but are not limited to, people with developmental disabilities, complex medical problems, and significant physical limitations.

Post Graduate Program

A planned sequence of advanced courses that leads to a certificate of completion in an area of advanced dental education.

Practical Experience

Indicates instruction in which students receive supervised experience in performing techniques and procedure in the laboratory setting by fabricating prostheses for patients currently under treatment, or from actual casts or impressions, and occlusal records from previously fabricated prostheses. Performance of the procedures is evaluated by faculty or laboratory supervisors according to predetermined criteria that emphasize quality, productivity and the ability to complete a clinically acceptable appliance in a reasonable amount of time.

Predoctoral

Denotes training leading to the DDS or DMD degree.

Should

Indicates a method to achieve the standard; highly desirable, but not mandatory.

Sponsor

The institution which has the overall administrative control and responsibility for the conduct of the program.

Standard

Offers a rule or basis of comparison established in measuring or judging capacity, quantity, quality, content and value; criterion used as a model or pattern.

Accreditation Status Classifications

Approval without reporting requirements

An accreditation classification granted to an educational program indicating that the program achieves or exceeds the basic requirements for accreditation.

Approval with reporting requirements

An accreditation classification granted to an educational program indicating that specific deficiencies or weaknesses exist in one or more areas of the program. Evidence of compliance with the cited standards must be demonstrated within 18 months if the program is between one and two years in length or two years if the program is at least two years in length. If the deficiencies are not corrected within the specified time period, accreditation will be withdrawn, unless the Commission extends the period for achieving compliance for good cause.

Circumstances under which an extension for good cause would be granted include, but are not limited to:

• sudden changes in institutional commitment;
• natural disaster which affects affiliated agreements between institutions; faculty support; or facilities;
• changes in institutional accreditation;
• interruption of an educational program due to unforeseen circumstances that take faculty, administrators or students away from the program.

Initial Accreditation

Initial Accreditation is the accreditation classification granted to any dental, advanced dental or allied dental education program which is not yet fully operational. This accreditation classification provides evidence to educational institutions, licensing bodies, government or other granting agencies that, at the time of initial evaluation(s), the developing education program has the potential for meeting the standards set forth in the requirements for an accredited educational program for the specific occupational area. The classification “initial accreditation” is granted based upon one or more site evaluation visit(s).

Levels of Knowledge

Familiarity

A simplified knowledge for the purposes of orientation and recognition of general principles.

In-depth

A thorough knowledge of concepts and theories for the purpose of critical analysis and the synthesis of more complete understanding (highest level of knowledge).

Understanding

Adequate knowledge with the ability to apply.

Levels of Skill

Clinical Competence

The achievement of a predetermined level of special skill derived from education and experience in the clinical setting.

Competent

The level of knowledge, skills and values required by a new graduate to begin practice.

Exposure

The level of skill attained by observation of or participation in a particular activity.

Laboratory/Preclinical

The achievement of a predetermined level of special skill derived from education and experience in the preclinical setting.

Competence

Derived from laboratory/preclinical instruction.

Types of Instruction

Clinical Instruction

Indicates instruction in which students receive supervised experience in performing functions in the clinical setting on patients. This clinical performance of functions is evaluated by faculty according to predetermined criteria.

Didactic Instruction

Refers to lectures, demonstrations or other instruction without active participation by students.

Laboratory/Preclinical

Indicates instruction in which students receive supervised experience performing functions using study models, manikins or other simulation methods; students' performance is evaluated by faculty according to predetermined criteria.

Instruction

Experience performing functions using study models, manikins or other simulation methods; students’ performance is evaluated by faculty according to predetermined criteria.

Review and Practice 2.3: Look at the set of accreditation standards that is most applicable to your area of expertise. Find and highlight examples where each of the above terms are used. Substitute terms and identify how the insertion of different terms would change the meaning of the standard. For example, a dental program must/should/could be established in an institution of higher education that is accredited by a recognized accrediting agency.

If the terms were changed, dental programs could be in any setting, not just accredited institutions.

The Commission’s policy for assessment is based on the following formula:

The validity and reliability of accreditation standards will be assessed after they have been in effect for a period of time equal to the minimum academic length of the accredited program plus three years.

The Commission believes that a minimum time should elapse between adoption of new standards or implementation of standards that have been comprehensively revised and the assessment of the validity and reliability of those standards. This time is directly related to the academic length of the accredited programs in each discipline. The Commission believes this minimum period is essential to allow time for programs to implement the new standards and to gain experience with their use in each year of the curriculum.

Thus, the validity and reliability of new standards for a one year program will be assessed after four years while standards that apply to programs four years in length will be assessed seven years after implementation. In conducting a validity study, the Commission considers the variation of program types across institutions and obtains data from each type in accordance with good statistical practices.

The Commission’s ongoing review results in standards that evolve in response to changes in the educational and professional communities. Requests to consider specific revisions are received from a variety of sources.

Action on such revision is based on:

• broad input and participation of the affected communities and/or
• a comprehensive revision of the entire standards document.

Specific issues or concerns can result in development of new standards or modification of existing standards. Comprehensive revisions of the standards are considered subsequent to significant:

• changes in disease or practice patterns,
• scientific or technological advances, and
• responses to changing professional needs for which the Commission has evidence.

If none of the above circumstances prompts a revision, in approximately the fifth year after the validity and reliability of the standards have been assessed, the Commission conducts a study of whether the accreditation standards remain appropriate to the discipline. This study includes input from the broad communities of interest. The communities are surveyed or invited to participate in a national forum, such as an invitational conference, to help the Commission determine whether the standards are still relevant and appropriate or whether a comprehensive revision should be initiated.

The following alternatives might result from assessment of the adequacy or appropriateness of the standards:

• Authorization of a comprehensive revision of the standards.
• Revision of specific sections of the standards.
• Refinement/clarification of portions of the standards.
• No changes in the standards but use of the result of this assessment during the next revision.

When a comprehensive revision of an accreditation standards document is required, the new document is developed with input from the communities of interest in accordance with Commission policies. An implementation date is specified and copyright privileges are sought when the document is adopted.

Assessment of the validity and reliability of these new standards will be scheduled in accord with the policy specified above. Exceptions to the prescribed schedule may be approved to ensure a consistent timetable for similar disciplines (e.g. advanced dental education programs and/or allied dental education programs).