Pima ~—J MEDICAL 3 etre Dental Hygiene Clinic COMPETENCY EVALUATION FORM Toothbrush student Name: Wn stina Osh ey vate: 4 fat fat 2= Meets Expectations; Performance is appropriate and the student demonstrates the correct knowledge and skill without any assistance from faculty 1 = Needs improvement: Performance js acceptable; however knowledge base or skill evel could be improved Performance was dane with minimal guidance by faculty, 0 = Unacceptable: Does not meet standards or not clinically useful. Student was dependent of faculty to progress through procedure. Semesteriand ll | Semester ti Semester IV. ‘Semester V Semester Vi Competen: er eans Preclinic Glinie Clinic Gini Gliniciv Toothbrush) 86% 88% 50% 93% 95% | POSSIBLE POINTS aaremer [2 arremPr [3 ATTEMPT (esol e2sisa0eoulszeerls0. PATIENT/OPERATOR PREPARATION 1. Discloses key areas (at least 1 quadrant, facial and lingual), following any directions given by instructor. 2 3. Gives patient 2 hand mirror and makes sure patient uses it during demonstrations." 4, Visualization isideal; chines dental light on teeth, has patient remove dark glasses, gives patient personal glasses. COMMUNICATION AND RAPPORT WITH PATIENT Sits patient upright cal ui ui I 5, Communicatesin a clear, organized, professional manne. i Points out plaquein the patient’s mouth and explains how it relates to bacteria and personal prevention of disease. 7. Questions patient about cuirent brushing habits (frequency, ength | 7 of brushing time), makes recommendations, and sets goals 4 Suggests motivational and problem-soWing ideas to help the patient build new habits \J 9, Considers culture, education levels, age, etc, when commuricating | ‘and avoids dental terms such as “buccal” or “lingual.” lee |_| | TECHNIQUE 20, Verbally explains correct technique before cemonstrating ] (bristles towards gumline at 45, circuaror vibratory motion, / section to section), | Ui, Demonstrates the corect technique inthe patients mouth using mirror 12, Angles bistie motion, grasp, ete. are correc. df iaCOMPETENCY EVALUATION FORM Toothbrush 33. Has patient demonstrate in thelr own mouth, assisting them with technique adjustments until the proper technique is observed.” 14) as. Recommends soft bristles for a manual brush. Has the patient remove all plaque from key areas, following any directions given by the instructor. 16 Points out how long it takes to remove plaque from each tooth/section, cu Discusses care; storage, replacement frequency (every few months or when wear isnoticed), OTALS (33/34 pts) © Key crteriaexsentil to competency —student mustscore a 2" n this section to pass. Asepss is an essential part of every dental hygiene clinical competency and must be correctly maintained ct ll times in order to pass. NS Ore i. Ae one 8-2 Attempt #1: Raw Score:_ 93 _/ se Attempt # 2: Raw Score: 34 PNP LL Date Attempt # 3: Raw Score: /_34 %& PNP LL __ Date _ ‘Attempt 1; -0 Attempt 2; -Spoints fromtotal score ‘Attempt 3: -10 points from total score Attempt 4+: 773s the maximum possible score ae? 5. Final score after deductions: Faculty Signature: bmg Ibert es Faculty Comments: pate oneal patch che of term lice biof In’ because hey prey hot Pec ta eee Vavg phorrysh.