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Contents for the 21st century: Modernizing an orthodontic residency programme Anne Marie Kuijpers-Jagtman

Department of Orthodontics and Craniofacial Biology Radboud University Nijmegen Medical Centre, The Netherlands


at the German border on the bank of the river Waal

2


Nijmegen is the oldest city of the Netherlands: 2000 years old


Market place and Marieke van Nimwegen


   

Total number of students Medical students Dental students Orthodontic residents

19.000 2.500 500 16 +2


High Field Magnetic Lab

Graphene


Nijmegen destroyed 22-02-1944


Operation Market Garden 17-15 september 1944


1977 a long list of famous actors

AND ‌‌ two of my orthodontic class mates who played soldiers


Radboud University Nijmegen Medical Centre in the 1950’s


Dentistry


Department of Orthodontics

Entrance hall and waiting room


Postgraduate clinic


Postgraduate clinic


Postgraduate clinic


Cleft Palate clinic


Cleft Palate clinic


Craniofacial Biology Lab


16.8 million inhabitants

Groningen

3 dental schools

Amsterdam Nijmegen


Undergraduate dental program

 3 year bachelor  3 year master Costs per year for a dental student Tuition fee € 1.713 If more than 1 year behind schedule € 3.063 Books, dental materials etc. € 550 Health insurance € 1.300

   

 Montly student-allowance (6 yr): € 270  Free public transportation throughout the country


Postgraduate program

 4 year fulltime  2 classes of 8 residents plus 2 German residents Costs per year for an orthodontic resident No tuition fee for Dutch citizen Tuition fee foreigner: € 41.000 Health insurance € 1.300 Camera, laptop, books, meetings etc.

   

 Dutch resident gets salary € 31.500 (after tax deduction)


Week schedule 

5 half days clinic

10 wk rotation with the CLP team

rotations other interdisciplinary clinics

42 courses and other educational sessions are taught on 3 half days/wk

1 day/wk for research

occasionally undergraduate teaching


Certificate in orthodontics  

To finish the program you have to pass the national state exam Committee is appointed by the Specialist Registration Committee  Portfolio

judgment  Presentation of 12 cases  Tx plan discussion of 2 unknown cases  Presentation and discussion of research


My teaching background

   

Involved in postgraduate training since 1977; Program chairman since 1995 Chairperson of the National Committee for development of a competency based revised curriculum and assessment procedures Chairperson of the European Orthodontic Teachers Forum Coordinator of Network of Erasmus Based European Orthodontic Programs


Where do we stand for the orthodontic education in Europe?


European Orthodontic Teachers Forum An open forum for all Universities and Institutes providing orthodontic education in Europe, regardless whether or not they are members of the Network


NEBEOP Group of program directors or orthodontists assigned by institutes with a structured program in orthodontics, whose primary concern is education, specifically related to the specialty of orthodontics. Its main purpose shall be the advancement of orthodontic postgraduate training in Europe.


NEBEOP Founding meeting Geneva, 20-21 November 2008

36 participants from 17 countries


Van der Linden FPGM et al Europ J Orthod 1992;14:85-94

Athanasiou AE et al World J Orthod 2009;10:153-166


1992 3-year postgraduate Erasmus programme in orthodontics Bolender Canut Dermaut Houston Moss Melsen

Miethke Spyropoulos Van der Linden Joho Linder-Aronson Rรถnning

Rygh Ronchin Martina Hegarty Droschl


A. General biological and medical subjects        

Growth & development of the human body Craniofacial anatomy and embryology Genetics , cell biology Physiology of breathing, speech, swallowing Syndromes of head and neck Psychology Biostatistics Research methodology


B. Basic orthodontic subjects        

Facial growth Development of the dentition (Patho) physiology stomatognathic system Tooth movement and facial orthopedics Radiology and other imaging techniques Cephalometrics Orthodontic materials Orthodontic biomechanics


C. General orthodontic subjects        

Etiology Diagnostic procedures Treatment objectives and tx planning Growth and treatment analysis Long term effects Iatrogenic effects Epidemiology in orthodontics Orthodontic literature


D. Orthodontic techniques      

Removable appliances Functional appliances Extra-oral appliances Partial fixed appliances Fixed appliances Retention appliances


E. Multidisciplinary treatment procedures    

Cleft lip and palate treatment Orthodontic-surgical treatment Orthodontic-periodontal treatment Orthodontic-restorative treatment


F. Specific treatment procedures   

Interceptive procedures Adult orthodontics CMD


G. Management of health and safety       

Oral health management Health and safety procedures in the orthodontic practice Office management Use of computers Ergonomy Legislation Professional ethics


patients have changed specialists need other skills than in the past residents have changed insights in adult learning


We respect our cultural heritage !


Update of the Erasmus Program for postgraduate education in Europe In June a Task Force was installed to make proposals Van der Linden FPGM et al The members of theTask Force are:Europ J Orthod 1992;14:85-94 • Kathryn Derringer (UK) • Ted Eliades (Greece) • Marie Filleul (France) • Jan Huggare (Sweden), chairperson • Stavros Kiliaridis (Switzerland) • Anne Marie Kuijpers-Jagtman (the Netherlands) • Roberto Martina (Italy) • Pertti Pirttiniemi (Finland) • Rainer Schwestka-Polly (Germany)


Minimum criteria 1 

The program  Structured

program  Equivalent to a minimum of 3 years full time  Performed in universities or academic institutes


Minimum criteria 2 

Clinical activity  Clinic

activity (chair-side time) minimum 16 h/week (approx 2000h during the education).  Treatment of at least 50 new cases with a variety of malocclusions.  Supervision by an orthodontist specialist, maximum one supervisor for 8 graduate students


Minimum criteria 3 

Theoretical education  Based

on a predefined structured program.  Lectures and seminars equivalent to at least 5h/week (minimum 600h during the education).  Treatment plan or treatment evaluation seminars or discussions equivalent to at least 3h/week.  Assessment of knowledge during the education and a final exam at the end.


Minimum criteria 4 

Research  Research

time and guidance should be provided,  leading to a publication or a congress presentation.


2012 3-year postgraduate Erasmus programme in orthodontics Derringer Eliades Filleul Huggare Kiliaridis

Kuijpers-Jagtman Martina Pirttiniemi Schwestka-Polly


A. General biological and medical subjects  

      

Paediatrics Craniofacial anatomy and embryology Genetics Cell biology, molecular biology, immunology and microbiology Oral pathology and medicine Pharmacology, ENT, phonetics Congenital malformations Psychology Research methodology and biostatistics


B. Basic orthodontic subjects        

Facial growth Development of the dentition (Patho) physiology stomatognathic system Tooth movement and dentofacial orthopedics Radiology and other imaging techniques Cephalometrics Orthodontic materials Orthodontic biomechanics


C. General orthodontic subjects        

Etiology Need and demand for orthodontic treatment Diagnostic procedures Treatment objectives and tx planning Growth and treatment analysis Long term effects Iatrogenic effects Orthodontic literature


D. Orthodontic techniques        

Removable appliances Functional appliances Extra-oral appliances Partial fixed appliances Fixed labial and lingual appliance systems Retention appliances Skeletal anchorage devices Oral devices for OSA treatment


E. Interdisciplinary treatment procedures      

Adult orthodontics Cleft lip and palate treatment Orthodontic-surgical treatment Orthodontic-periodontal treatment Orthodontic-restorative treatment Craniomandibular disorders


F. Management of health and safety   

Oral health management Health and safety conditions in the orthodontic practice Multicultural health care behaviour


G. Practice management, administration and ethics     

Office management Communication Ergonomy Legislation Professional ethics


Is all about knowledge, not about competencies


Competency A competency is the ability to perform a professional activity in a specific context in an adequate manner ď Ž This asks for integrated presence of knowledge, insights, competencies, attitudes and personal characterictics ď Ž


Example? ď Ž

Integrates the result of a 3D soft tissue analysis in the treatment plan of a patient with a Class II division 1 malocclusion


CanMEDS Competency Framework 

Developed by the Royal College of Physicians and Surgeons of Canada

Detailed process of consensus building, piloting and evaluating since 1993

Current version released 2005


Medical expert Communicator Collaborator Scholar Health advocate Manager Professional


CanMEDS Competency Framework   

‘Expert’ is the central integrative role Other roles overlap and support expert role Each role is divided into key competencies / roles underpinned by supporting competencies


The 7 roles 1 Orthodontic expert

1

2

3

4

2

3

4

5

6

7

Communicator

Collaborator

scholar

Health advocate

Manager

Professional

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

89 23

10

10

10

9

17

10

4


The 7 roles 1 Orthodontic expert

1

2

3

4

2

3

4

5

6

7

Communicator

Collaborator

Scholar

Health advocate

Manager

Professional

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

89 23

10

10

10

9

17

10

4


1.1 the orthodontist has adequate knowledge and skills to the state of the profession has knowledge of general somatic growth to the extent relevant for the growth of the craniofacial complex and applies this to the orthodontic diagnosis and treatment plan; recognizes the psychological stage of development of his patient and integrates this in the orthodontic treatment plan;


The 7 roles 1 Orthodontic expert

1

2

3

4

2

3

4

5

6

7

Communicator

Collaborator

Scholar

Health advocate

Organisator

Professional

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

89 23

10

10

10

9

17

10

4


3.4

the orthodontist contributes to effective interdisciplinary collaboration

Participates adequately in interdisciplinary collaboration Identifies possible problems in the cooperation and discusses these openly


89 competencies


 Competency profile  Themes  Sample tasks  Theme related competentencies


Content everyday practice

8 - 10 Themes


1. Diagnostics 2. Follow-up of the development of the dentition 3. 4. 5. 6.

7. 8. 9.

and facial growth The growing individual The adolescent and adult Dysgnathia in an interdisciplinary context Orthodontics in interdisciplinary context and orthodontics in special dental care children CLP and craniofacial anomalies Research Orthodontic practice management


Content everyday practice

8 - 10 Themes


Core business Exemplary for different CanMEDS roles Translate canMEDS to clinical situation

8 - 10 Themes


SAMPLE TASKS 1. 2. 3.

Patient with a Classe I, II or III-malocclusion Patient with functional problems Patient with an asymmetrical malocclusion

SHORT SITUATIONAL FEEDBACK (x) x x x

x x x

KNOWLEDGE ASPECTS Orthodontically related deviations of the orofacial region Indications for general and specific diagnostic methods (Erasmus C3) Growth stage and developmental stage of the dentition of growing children and their influence on orthodontic treatment Genetics (Erasmus A3) Oral physiology (Erasmus A7) General and specific pathology Pediatrics (Erasmus A1) Development of the dentition Knowledge of normal and abnormal facial growth Knowledge of the physiology of the orofacial system, including occlusion en TMJ (Erasmus B3) Knowledge of conventional and other radiogical diagnostics (Erasmus B5) Knowledge of 2D and 3D cephalometry and superimposition techniques (Erasmus B6) Orthodontic diagnostics (Erasmus C4) Epidemiological aspects SKILLS Radiograph examination (Erasmus B6) Cephalometric analysis and superimposition (Erasmus B7) Impression taking (Erasmus C3) Making of a diagnostic set-up (Erasmus C3) Making a face-bow registratie en mounting casts in the articulator (Erasmus C3)

TEST

Oral or written exam

TEST OSATS OSATS OSATS OSATS OSATS

professio nal

Health advocate

collabora tor

Organisat ion

Scholar

Communi cation

Medical expert

THEME 1 DIAGNOSTICS


SAMPLE TASKS 1. 2. 3.

Patient with a Classe I, II or III-malocclusion Patient with functional problems Patient with an asymmetrical malocclusion

SHORT SITUATIONAL FEEDBACK (x) x x x

x x x

KNOWLEDGE ASPECTS Orthodontically related deviations of the orofacial region Indications for general and specific diagnostic methods (Erasmus C3) Growth stage and developmental stage of the dentition of growing children and their influence on orthodontic treatment Genetics (Erasmus A3) Oral physiology (Erasmus A7) General and specific pathology Pediatrics (Erasmus A1) Development of the dentition Knowledge of normal and abnormal facial growth Knowledge of the physiology of the orofacial system, including occlusion en TMJ (Erasmus B3) Knowledge of conventional and other radiogical diagnostics (Erasmus B5) Knowledge of 2D and 3D cephalometry and superimposition techniques (Erasmus B6) Orthodontic diagnostics (Erasmus C4) Epidemiological aspects SKILLS Radiograph examination (Erasmus B6) Cephalometric analysis and superimposition (Erasmus B7) Impression taking (Erasmus C3) Making of a diagnostic set-up (Erasmus C3) Making a face-bow registratie en mounting casts in the articulator (Erasmus C3)

TEST

Oral or written exam

TEST OSATS OSATS OSATS OSATS OSATS

professio nal

Health advocate

collabora tor

Organisat ion

Scholar

Communi cation

Medical expert

THEME 1 DIAGNOSTICS


SAMPLE TASKS 1. 2. 3.

Patient with a Classe I, II or III-malocclusion Patient with functional problems Patient with an asymmetrical malocclusion

SHORT SITUATIONAL FEEDBACK (x) x x x

x x x

KNOWLEDGE ASPECTS Orthodontically related deviations of the orofacial region Indications for general and specific diagnostic methods (Erasmus C3) Growth stage and developmental stage of the dentition of growing children and their influence on orthodontic treatment Genetics (Erasmus A3) Oral physiology (Erasmus A7) General and specific pathology Pediatrics (Erasmus A1) Development of the dentition Knowledge of normal and abnormal facial growth Knowledge of the physiology of the orofacial system, including occlusion en TMJ (Erasmus B3) Knowledge of conventional and other radiogical diagnostics (Erasmus B5) Knowledge of 2D and 3D cephalometry and superimposition techniques (Erasmus B6) Orthodontic diagnostics (Erasmus C4) Epidemiological aspects SKILLS Radiograph examination (Erasmus B6) Cephalometric analysis and superimposition (Erasmus B7) Impression taking (Erasmus C3) Making of a diagnostic set-up (Erasmus C3) Making a face-bow registratie en mounting casts in the articulator (Erasmus C3)

TEST

Oral or written exam

TEST OSATS OSATS OSATS OSATS OSATS

professio nal

Health advocate

collabora tor

Organisat ion

Scholar

Communi cation

Medical expert

THEME 1 DIAGNOSTICS


SAMPLE TASKS 1. 2. 3.

Patient with a Classe I, II or III-malocclusion Patient with functional problems Patient with an asymmetrical malocclusion

SHORT SITUATIONAL FEEDBACK (x) x x x

x x x

KNOWLEDGE ASPECTS Orthodontically related deviations of the orofacial region Indications for general and specific diagnostic methods (Erasmus C3) Growth stage and developmental stage of the dentition of growing children and their influence on orthodontic treatment Genetics (Erasmus A3) Oral physiology (Erasmus A7) General and specific pathology Pediatrics (Erasmus A1) Development of the dentition Knowledge of normal and abnormal facial growth Knowledge of the physiology of the orofacial system, including occlusion en TMJ (Erasmus B3) Knowledge of conventional and other radiogical diagnostics (Erasmus B5) Knowledge of 2D and 3D cephalometry and superimposition techniques (Erasmus B6) Orthodontic diagnostics (Erasmus C4) Epidemiological aspects SKILLS Radiograph examination (Erasmus B6) Cephalometric analysis and superimposition (Erasmus B7) Impression taking (Erasmus C3) Making of a diagnostic set-up (Erasmus C3) Making a face-bow registratie en mounting casts in the articulator (Erasmus C3)

TEST

Oral or written exam

TEST OSATS OSATS OSATS OSATS OSATS

professio nal

Health advocate

collabora tor

Organisat ion

Scholar

Communi cation

Medical expert

THEME 1 DIAGNOSTICS


 Competency profile  Themes  Sample tasks  Theme related competentencies


 Structure of the programme  Assessment of skills  Portfolio


ď‚  Quality assurance system



05 ak contents handout (2)