The development of a reflective portfolio of comprehensive, holistic, patient care as a means of assessing dental undergraduate competence

In a Dental University Hospital the assessment of clinical competence for senior students (4^th and 5^th year students) prior to this change initiative, was achieved by requiring the students to attain numerical targets for specific clinical procedures. These multiple clinical procedures could be carried out on any number of different patients and the focus of attention was on the procedure and not the patient. Under this system there is no incentive for a student to complete a patient’s treatment once the required numerical target is reached. There is also no reward, or progress toward establishing competence, for a student in treating a patient if that patient does not require any of the specific procedures outlined by the numerical targets. This project in educational leadership traces the change to a paradigm of comprehensive patient care, without numerical targets, for the establishment of dental undergraduate competence. The evidence based support for this patient centred approach will be established and the change process and evaluation outlined as it was carried out.

Under the changed system of competence assessment students will build a reflective portfolio of varied completed patient cases as a means of establishing undergraduate clinical competence in dental science. Having first established that the current literature supports this more patient centred comprehensive care model of assessment, this dissertation will continue on to describe how the Health Service Executive model of change management was used to guide and manage the change process. The rational for this change is to foster and develop a more professional student approach to proving clinical competence where the process demands that provision of comprehensive, holistic care and completion of patient treatment are core values of the process, not numerical targets. The use of the HSE change model to initiate, plan, mainstream and implement the new assessment system is crucial to the success of the change strategy. The ultimate value and achievement of the change will be measured, principally, by focus group interview with a group of five students who are piloting the new system in the current academic year. Feedback from clinical teachers on the pilot group students will also form part of the evaluation. These teachers will not be aware of the participation of these students in the pilot. The results of the evaluation have now been used for evidence in the full implementation of the change for future dental undergraduates.