DA PRACTICUM BOOKLET

WESTERN COMMUNITY COLLEGE
Dental Assistant
Practicum
Booklet
WESTERN COMMUNITY COLLEGE – DENTAL ASSISTANT WORK EXPERIENCE AGREEMENT
Student’s Name:
Cohort:
Name of the Clinic:
Dates of Practicum:
This agreement entered this .................................................... (date)
Parties to this agreement:
Western Community College (referred here as WCC)

Unit 201, 8318, 120 Street, Surrey, BC V3W 3N4
And
Name of the Dental Clinic:

Address:
And
(student)
(Dental Clinic) agrees to provide training to the

Western Community College Dental Assistant students under the following terms.
……………………………………………………………………………..
……………………………………………………………………………..
……………………………………………………………………………..
WCC agrees to.

1. Provide WCC and staff with WCB coverage.
2. Maintain liability insurance to protect WCC, WCC employees and agents and the
students during their performance of agreement.
Dental Clinic ( ) agrees to.

1. Familiarize the students with all the working and environment of the clinic.
2. Provide one or more designated supervisor(s) to whom the WCC on-site instructor and
students will be reporting.
3. Provide training and experience in the areas agreed upon by the parties.
4. Instruct the students in the use of relevant safety equipment and procedures.
5. Participate in an evaluation of student’s performance during work and at the end of the
work placement.
Termination of Agreement:
Any party to this agreement may terminate it on the delivery of written notice of termination given
to other part at the address mentioned in this agreement.
Indemnity:
WCC agree to indemnify and hold unless the clinic, its employees, and agents from any and all
claims, demands, actions and costs whatsoever that may arise out of the negligent acts or
omissions to the college, the college’s employees or agents, or the students, in their performance
of this agreement, unless such negligent acts or omissions are at the direction of or occasioned
by the Clinic employees or agents.
The Clinic agrees that it will not require a student to perform any task unless such task might
reasonably be expected to be within the scope of the student’s training and abilities and within
Worker’s Compensation Act Health and Safety Rules.
WCC will not be responsible for any loss or damage to the Clinic property unless such loss or
damage is due to willful act or omissions of the student or it caused by the student acting outside
the student’s assigned duties.
Practicum Responsibilities
1. Supervisor Responsibilities
a. Orientates students to the training place host, layout, staff, policies & procedures,
parking, breaks, & safety guidelines etc.
b. Assign a supervisor, who guides the student and asses the performance of the
student.
c. Assigns students to appropriate areas and client depending upon experience,
capability and expressed learning needs. Reassesses continuing need.
d. Demonstrates, models and guides students through all procedures needed for
learning Dental Assistant skills.
e. Supports and encourages students throughout their practice education learning
process.
f. Integrates theory with workplace: appreciating the difference between theory,
reality, and program standards of performance.
g. Meets independently (1:1) with student regarding specific learning needs and or
concerns.
h. Provide students with verbal and written feedback in a timely and non-judgmental
manner.
i. Answer queries of the student related to the Dental Assistant practice.
j. Models ethical and professional behaviors.
k. Communicates unresolved and/or serious concerns with western community
College Program Coordinator.
2. WCC Responsibilities
a. Arrange practicum host for the student.
b. Provide WCB coverage to the students.
c. Monitor the progress of the student at the practicum.
d. Ensure the student has met the minimum requirement to start the practicum.
e. Provide any other support to the student and host site, as required for successful
completion of the practicum.
3. Student Responsibilities:
a. Perform the duties of a Dental Assistant as outlined in the CDSBC By-Laws
under the Health Provisions Act of British Columbia.
b. As an entry level practitioner, practice and competently perform procedures
related to chairside assisting, obtaining and interpretation of diagnostic
information, independent intra-oral skills, patient care and other duties by the
dentist.
c. Becomes familiar with the clinic’s policies, procedures, & routines.
d. Applies learnt knowledge to provide quality of service.
e. Contribute to the maintenance of complete and accurate documentation of all
patient information.
f. Use computer and other technological tools to perform routine tasks.
g. Communicate clearly and coherently using written and spoken formats and
interact with others in groups or teams in ways that contribute to effective
working relationships.
h. Apply problem solving skills using a variety of strategies.
i. Take responsibility for her/his own actions.
j. Manage the use of time and other resources to complete tasks and attaining
goals.
k. Maintain a safe environment for learning, practicing of skills and inter-personal
relationship building.
l. Practice in a professional manner.
Professionalism
1. Students continue to develop an understanding of the professional Dental Assistant’s

role. They develop professionalism by actively engaging in learning partnerships with
supervisor, clinical instructors, and multidisciplinary agency staff. Students continue to
use reasoning and reflection in the pursuit of professional attitudes, judgments,
knowledge, and skills.
2. Students demonstrate appropriate knowledge, skills, behaviors, and attitudes.
3. Students acknowledge that the patient is the primary focus of care as they provide safe,
humanistic care and service in the public interest.
4. Students continue to develop professional competencies by applying knowledge and
skills and continuing to prioritize and problem solve issues.
5. Students independently perform initial, focused, and ongoing care, perform clinical
techniques, and organize and prioritize their client care.
6. Students continue to evaluate the care they provide.
7. Attendance at practicum is required. The clinical training hours may include weekends
and shifts other than day shift. Hours may vary in accordance with the host Clinic.
Practicum sites may require influenza vaccination (during flu season), more current CRC
and TB testing (to be done at the student’s expense).
8. Attendance will be initialed daily by the practicum supervisor and submitted to the
college at the end of the practicum.
9. Students are expected to notify the clinic and campus instructor(s) if they will be late or
absent.
10. An excessive number of absences or tardiness may be grounds for dismissal from the
program.
11. If a student has demonstrated incompetence, performed unsafely, acted unethically, or
failed to meet the program goals set for the practicum setting, the student may be
dismissed from the program.
12. All students are responsible for their own transportation to and from the practicum sites
and for travel expenses.
13. Practicum placements will be conducted at a variety of clinics and locations. Selection
of practicum placements depends on availability of practicum clinics providing a quality
experience for students.
Dress Code
1. Professional dress and appearance are expected of the student during the practicum.
2. Nametag, uniform, footwear (comfortable shoes with low heels are required – clogs and
open-toed shoes are not acceptable according to WCB regulations).
3. Hair is to be clean, neat, and tidy.
4. No perfume or scented body products to be used.
Effective Period:
This agreement shall, unless sooner terminated, be effective from to
Clinic Signature Date:
College Signature: Date:
Student Signature Date:

Student’s Record of Attendance
Student’s Name:
Cohort:
Name of the Clinic:
Dates of Practicum:
Date Shift Time Time Total Supervisor’s Initial

IN OUT Hours
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30.
Total Hours Instructor’s

Completed Signature
WEEKLY JOURNALS BY STUDENT
Describe what you learnt during this week. In your journal, you may record:
a) Any challenges that you faced and what skills did you use to overcome those challenges.
b) Any new skills that you learnt.
c) How you were able to apply any concept of the knowledge you acquired in theory in real life work
situation.
You may use additional pages to write if you want.
Week # 1 Journaling Notes
Student’ Name & Cohort:
Day 1
Day 2
Day 3
Day 4
Day 5
Instructor Comments:
Day 1
Day 2
Day 3
Day 4
Day 5
Day 1
Day 2
Day 3
Day 4
Day 5
Day 1
Day 2
Day 3
Day 4
Day 5
Final Evaluation by Host
Student Name: Student Number:

Instructor/Supervisor
Name:
Name of Clinic:
Experience Dates: to
day / month / year day / month / year
Scheduled hours − Absent hours = Total clinical hours
Clinical Outcomes Midterm Evaluation

Key
MP = Making Progress
ME = More Experience Needed MP ME NI
NI = Needs Improvement
Chairside Assisting
Dental Laboratory Skills
Dental Office Administration Skills
Practice of Safety Procedure
Communication Skills
Problem Solving
Collaborative practice/teamwork
Signature indicates that this evaluation has been reviewed by the Supervisor and the student.
Supervisor’s Signature Date
Student’s Signature Date

Did the student meet your work expectations? Yes 🖵 No 🖵

If no, please explain:
Student's Strengths & Achievements:
Student’s Weaknesses:
Other Comments:
Thank you very much for your help, and please be assured that your comments will be
treated in confidence by the College.
Host Site Supervisor (Mentor)’s Name & Signature:
Date:
Final Evaluation by Instructor
Instructor’s Comments:
Satisfactory Unsatisfactory Incomplete Provisional Pass
Date
Instructor’s Signature
Student’s Signature Date

Work Experience Joint Evaluation
Institution Name Institution Contact Name
Work Experience Placement Host Name Host Contact Name
Student Name Student Number
Program Name
Work Experience Start Date Work Experience End Date
Student Evaluation of Work Experience Placement:

Please indicate your level of agreement with each statement below by circling the appropriate number:
1 = Need’s improvement 2 = Satisfactory 3 = Good 4 = Excellent
The host made his/her expectations clear. 1 2 3 4

The host outlined the site’s policies and procedures to me. 1 2 3 4
The host made sure I was always supervised and that I had the support I 1 2 3 4
needed to feel comfortable completing tasks at this site.
Completion of this work experience has enhanced my ability and made 1 2 3 4
me more confident in the skills I learned during my program.
Comments:
Signature of Student
Date Signed

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WESTERN COMMUNITY COLLEGE

Name of the Clinic:

This agreement entered this .................................................... (date)

Parties to this agreement:

Western Community College (referred here as WCC)

Name of the Dental Clinic:

(Dental Clinic) agrees to provide training to the

WCC agrees to.

Dental Clinic ( ) agrees to.

1. Students continue to develop an understanding of the professional Dental Assistant’s

Clinic Signature Date:

College Signature: Date:

Student Signature Date:

Student’s Record of Attendance

Name of the Clinic:

Date Shift Time Time Total Supervisor’s Initial

Total Hours Instructor’s

WEEKLY JOURNALS BY STUDENT

Week # 1 Journaling Notes

Student’ Name & Cohort:

Week # 2 Journaling Notes

Week # 3 Journaling Notes

Week # 4 Journaling Notes

Final Evaluation by Host

Student Name: Student Number:

Scheduled hours − Absent hours = Total clinical hours

Clinical Outcomes Midterm Evaluation

Supervisor’s Signature Date

Student’s Signature Date

Did the student meet your work expectations? Yes 🖵 No 🖵

Student's Strengths & Achievements:

Host Site Supervisor (Mentor)’s Name & Signature:

Final Evaluation by Instructor

Satisfactory Unsatisfactory Incomplete Provisional Pass

Student’s Signature Date

Work Experience Joint Evaluation

Institution Name Institution Contact Name

Work Experience Placement Host Name Host Contact Name

Student Name Student Number

Work Experience Start Date Work Experience End Date

Student Evaluation of Work Experience Placement:

The host made his/her expectations clear. 1 2 3 4

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