Competency Statements for
Dental Public Health*
Preamble
Competency
statements for dental public health, and the performance indicators by which
they can be measured, were developed at a workshop in San Mateo, California,
on May 4-6, 1997. This was the third in a series of such workshops conducted
by the American Association of Public Health Dentistry and the American
Board of Dental Public Health which set up the knowledge and practice base
by which the specialty is recognized. The first such workshop was held at
Boone, NC, in 1974 (1), and the second at Bethesda, MD, in 1988 (2). Social
and technological change and the evolution of the specialty make periodic
revisions essential.
Dental
public health is defined by the American Board of Dental Public Health
as:
"...the
science and art of preventing and controlling dental diseases and promoting
dental health through organized community efforts. It is that form of
dental practice which serves the community as a patient rather than the
individual. It is concerned with the dental education of the public, with
applied dental research, and with the administration of group dental care
programs as well as the prevention and control of dental diseases on a
community basis.. "
This
population-based approach to professional practice is quite different from
the approach required for individual patient care in private practice, though
both forms of practice are integral parts of the dental profession. Accordingly,
dental public health practice demands an additional body of knowledge and
a set of skills beyond those obtained in an undergraduate dental education.
There
are some fundamental aspects of dental public health practice which are
not readily encompassed in a competency statement, and these can be considered
part of the framework in which the competency statements are set. These
fundamental attributes of the dental public health specialist include:
Being
a dentist. The scientific background and clinical skills to diagnose,
prevent, and manage oral diseases and conditions inherent in a dental
education provide the underlying foundation for advanced knowledge of
dental public health.
Demonstration
of public health values, which essentially means a view of health issues
as they affect a population rather than an individual with particular
emphasis on prevention, the environment in its broadest sense, and service
to the community. Public health dentists usually work collaboratively
as part of a multidisciplinary team of public health professionals and
community representatives.
Leadership
characteristics, such as influencing health policies and practice through
research, education, and advocacy; articulating a vision for the organization;
negotiating and resolving conflicts; etc.
Subscribing
to the code of ethics set down by the American Association of
Public Health Dentistry.
The
format for these competency statements is based on those developed by the
American College of Preventive Medicine for residents in Preventive Medicine
(3). As such, the competency statements are presented in general terms with
accompanying specific performance indicators to illustrate the range and
depth expected in the competency.
Competency
means being able to function in context, and the term is used most often
to describe the skills, understanding, and professional values of the beginning
practitioner (4). Competency is a level reached by the person who is initially
a novice, and who, after training and experience, reaches the level where
they can be certified as competent. It is a major landmark in professional
development, but it is not the final point in the journey. That comes with
proficiency, and the ultimate status of expert after many years of experience
and professional growth. Competency in dental public health is seen as the
point reached after students in advanced dental education programs complete
two years of postgraduate education in the specialty requirements of dental
public health. In that sense, these expectations comprise a "floor"
rather than a "ceiling", a basic collection of the minimum knowledge,
skills, and values needed for an entry level specialist to practice dental
public health. It is understood that new practitioners may not have performed
every competency at the level indicated while in training. However, it is
expected that the practitioner will progress beyond the status of competency
as his or her career continues, at least in certain areas.
The
previous set of competency objectives (2) for dental public health specialty
certification developed at the Bethesda workshop looks quite different from
this current set. The previous objectives are essentially areas of knowledge
that comprehensively cover just about everything that a public health dentist
needs to know but are not "competencies" per se. By no means are
they outdated, and they will continue to be used by advanced education directors
as a guide for curriculum development. Many of those areas of knowledge
have been incorporated into the current document.
There
are two principal changes between the new competency statements and the
previous set. First, the new competencies are stated in behavioral terms;
they are intended to define what dental public health practitioners can
do as opposed to what they know or understand. These competencies describe
skills or abilities that are measurable or observable. Second, performance
indicators have been added. Performance indicators are examples of the types
of outcomes or categories of evidence to be collected and are used as a
basis for judging competency attainment (3).
The
competencies are the result of an attempt to achieve a consensus on the
level of performance to be expected of all dental public health specialists.
They can help define the specialty to potential employers, to potential
applicants for specialty certification, and to colleagues in the health
professions. These competency statements form the basis by which standards
for specialty education can be developed and applied. Specialty education
programs in dental public health are accredited by the American Dental Association
in accordance with their degree of adherence to separately defined standards,
so these competency statements do not directly form a part of the accreditation
process. Instead, they are used by educational and residency program directors,
faculty and students to establish curricula, and by graduates of these programs
as they prepare to take their examinations which lead to specialty certification
accorded by the American Board of Dental Public Health.
References
1.
Hughes JT. Behavioral objectives for dental public health. J Public Health
Dent 1978;38:100-7.
2. Competency objectives for dental public health. J Public Health Dent
1990;50:338-44.
3. Lane DS, Ross V. Final report: Improving training of preventive medicine
residents through the development and
evaluation of competencies. November 1993. United States Department of Health
and Human Services, Public Health Service, Health Resources and Services
Administration, Bureau of Health Professions. HRSA Contract #92-468(P).
4. Chambers DW, Gerrow JD. Manual for developing and formatting competency
statements. J Dent Educ 1994;58:361-6
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Dental
Public Health
Competencies*
A
specialist in dental public health will:
I.
Plan oral health programs for populations.
Planning
reflects:
1. Establishing goals and setting priorities.
2. Assessing oral health status, needs and demands, and their determinants
in a community. (See Competencies VI, IX, X)
a.
understanding the natural history of oral diseases and conditions.
b. assembling, reviewing, analyzing and interpreting existing data,
including census, vital statistics, scientific literature, oral health
care/public health and relevant legal documents. (See IX)
c. assessing quality of data, noting strengths and limitations. (See
IX)
3.
Compiling all types of resource inventories (e.g., economic, personnel,
legal, political, social)
4. Developing program plans (such as for prevention and service delivery,
etc.)
a.
identifying problem or potential problem
b. setting goals, objectives and priorities
c. identifying target population
d. assessing current system (public and private components) including
organizational structure and its relevance to decision making process
e. determining demand for program
f. analyzing alternative interventions (See IX)
g. selecting best practices and interventions that take into account
cultural differences (See II, VII-6, IX)
h. determining procedures, policies and implementation plans
i. identifying and analyzing liability issues and developing risk
reduction strategies
j. developing budget and financing to ensure access for needed services
k. determining timeline
l. developing plans for monitoring and evaluation (See V, VI)
5.
Collaborating with community partners and constituency building (See
II-4, II-9, III-1, VII, VIII-4)
II.
Select interventions and strategies for the prevention and control of
oral diseases and promotion of oral health
This
competency reflects:
1. Using a comprehensive knowledge of the efficacy, effectiveness and
efficiency of the various interventions to select interventions and
strategies to prevent and control oral diseases. Balancing costs and
possible risks against benefits of potential interventions. (See V,
IX)
2. Understanding national, state and local health objectives.
3. Integrating knowledge of health determinants when selecting interventions.
4. Identifying the role of cultural, social, and behavioral factors,
practices, and issues in determining disease initiation and progression,
disease prevention, health promoting behavior, and oral health service
organization and delivery.
5. Advocating for oral health policies (See VIII).
6. Providing information on maintaining and improving oral health at
the community and individual level. (See VII)
7. Communicating with groups and individuals on oral health issues.
(see VII)
8. Serving as a resource for professional and community groups concerning
evidence for the effectiveness of preventive and treatment interventions
and the rationale for their use. (See VII)
9. Collaborating with other health professionals, agencies, and private
groups in disease prevention and health promotion activities. Examples
include tobacco cessation, community water fluoridation, and early childhood
caries prevention programs. (See I-5, II-4, III-1, VII, VIII-4)
III.
Develop resources, implement and manage oral health programs for populations
Implementation
and management reflect:
1. Communicating with, gaining the support of, and collaborating with
critical partners and constituents for plan development, implementation
and evaluation. (See I-5, II-4, 7-9, VII, VIII-4)
2. Organizing, managing and securing resources according to program
plans.
a.
human resources
1.
hiring and selecting program staff
2. training and development
3. continuing education
4. negotiation and conflict resolution
b.
physical resources
c. fiscal resources
d. information (See IX, X)
3.
Periodically monitoring and measuring progress indicators against program
goals. (See V)
4. Making appropriate program adjustments.
5. Administering policies and procedures.
IV.
Incorporate ethical standards in oral health programs and activities
This
competency reflects:
1. Applying the acceptable principles of ethical behavior and professional
conduct (principles of autonomy, nonmaleficence, beneficence, justice,
voracity, and professionalism) as reflected in the code of ethics and
standards of professional conduct of public health, dentistry, and employing
organizations.
V.
Evaluate and monitor dental care delivery systems
Evaluating
and monitoring reflect:
1. Identifying involved individuals, consumer groups, agencies, and
organizations and obtaining their perspectives and organizational policies.
2. Collecting, organizing, analyzing and interpreting data (See I-2,
I-3, VI, IX, X)
3. Assessing outcomes, including safety, efficacy, costs, cost-effectiveness,
quality, consumer satisfaction and health consequences. (See IX, X)
4. Evaluating changes and trends in demographics, health status,risk
factors, utilization of services, dental personnel, structure of delivery
systems, financing, regulations, legislation, policies. (See I-2, I-3,
III-3, IX)
5. Determining extent that goals, objectives and budget allocations
are met.
6. Applying findings to program decisions.
VI.
Design and understand the use of surveillance systems to monitor oral
health
Designing
and using a surveillance system reflects:
1. Determining and documenting rationale and feasibility of surveillance
and monitoring. Examples include the Behavioral Risk Factor Surveillance
System (BRFSS), water
fluoridation census, and cancer registry.
2. Developing an operational definition of a case.
3. Identifying data sources.
4. Using surveillance tools, e.g., screening, lab reports.
5. Analyzing and using data and distributing findings. (See V-6, VII,
IX)
VII.
Communicate and collaborate with groups and individuals on oral health
issues
This
competency
reflects:
1. Ability to effectively communicate orally and in writing, including
electronically (implies knowledge of subject, current and accurate information,
understanding of audience).
2. Articulating a vision for the organization.
3. Developing a communication plan and network for getting things done
(coalition, steering committee)
4. Selecting appropriate approaches and relevant information for targeting
messages and format to audience/individual (appropriate language and
grade level of communication, choice of written, oral, or audiovisual
format, use of media or other methods)
5. Applying risk communication skills to explain levels of risk from
real or potential hazards.
6. Collaborating sensitively and effectively with persons from diverse
cultural, socio-economic, educational, and professional backgrounds,
and with persons of all ages and lifestyle preferences (See I-5, II-8,
III-1, VII, VIII-4).
VIII.
Advocate for, implement and evaluate public health policy, legislation,
and regulations to protect and promote the public's oral health
This
competency reflects:
1. Understanding legislative, regulatory and political processes.
2. Conforming to statutes and regulations regarding areas such as liability,
restraint of trade, conflict of interest, credentialing, certification
practices, confidentiality and discrimination.
3. Analyzing issues and determining appropriate legislative or regulatory
pathways to accomplish goals.
4. Collaborating with community partners to advocate for legislative
and budgetary resources to meet identified oral health needs including
oral health expressions of general health needs. (See I-5, III-1, VII)
5. Assisting groups and communities, especially at risk for oral disease
to advocate for themselves.
IX.
Critique and synthesize scientific literature
This
competency reflects:
1. Applying the principles of hypothesis development and testing.
2. Identifying appropriate, valid and reliable measures of oral health,
disease and associated factors.
3. Identifying the characteristics of and rationale for different types
of study designs and analytic methods used in epidemiologic studies,
experimental studies, health services research and policy analysis.
4. Identifying possible sources of bias in studies.
5. Identifying and understanding procedures for training, standardization
and calibration of examiners.
6. Identifying appropriate statistical procedures such as those for
measuring examiner reliability.
7. Evaluating generalizability and validity of study findings.
8. Translating study findings into recommendations.
X.
Design and conduct population-based studies to answer oral and public
health questions
Designing
and implementing studies reflect:
1. Defining a problem.
2. Critically reviewing the literature. (See IX)
3. Formulating research objectives and hypotheses.
4. Developing a research protocol. This process includes:
a.
designing research using epidemiologic principles and other discipline-specific
methods (e.g. health services and behavioral science methods)
b. selecting measures of oral health, disease, and associated factors
c. identifying the study population, and inclusion and exclusion criteria
d. developing appropriate sampling methods
e. planning for recruitment and retention of participants
f. if appropriate, allocating subjects to treatment or control groups,
using randomization or matching
g. collecting, managing and controlling the quality of data
h. choosing statistical techniques for sample size estimation and
data analysis
i. developing a budget appropriate for the research question
j. collaborating with other members of the research team and consulting
experts in pertinent disciplines
5.
Using human subjects' review and informed consent conscientiously, including
sensitivity to individual rights.
6. Implementing the protocol.
7. Interpreting research findings.
8. Identifying study limitations.
9. Providing results/feedback to community authorities once study is
completed (See VII).
10. Formulating and disseminating conclusions and recommendations.
*
Journal of Public Health Dentistry, Volume 58, Supplement 1, 1998, p.
119-122.
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