Integrated Community Service

Partnership (ICSP) Program

Faculty Guidebook
and
Policy Manual

2021-22

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 Table of Contents

Page

Mission ……………………………………………………………………...………...3

Elements of a Successful Rotation Site ….……………………………………………4

Policies for External Sites ……………………………………………………………..6

Assessment of Student Performance …………………………………………….…..13

 Appendix A. Contacts List………………..…………………………………..16

 Appendix B. ICSP Clearance Sheet ………………………………………….17

 Appendix C. CPAF …………………………….………………….………….18

 Appendix D. External Site Evaluation of Student Form...................................20

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Mission

Founded with the purpose to recruit, train and graduate dentists who will contribute in a significant
way to the public and community Health dental workforce, our mission is as follows:

The Missouri School of Dentistry & Oral Health is an innovative

and socially responsible institution that is committed to the
advancement of educational excellence, scholarship, community
service, diversity, inclusion, leadership, and technology. Graduates
will serve communities in need while engaging in lifelong learning.

The success of our mission depends in large part upon the expertise and dedication of the faculty.
As an external adjunct faculty, we are very pleased to have you as a part of our efforts to identify
and train extraordinary men and women that want to make difference. Your participation with
MOSDOH and the ICSP program will assist us in our efforts to ensure that the clinical skills of our
students are without parallel. We know that these students are caring and compassionate. With your
help we will guide them to being dental providers that you will be proud to call a colleague.

Contacts
Accompanying this Guidebook is a list of key MOSDOH faculty, administration and staff. As an
adjunct faculty you may find it useful to contact any one of these individuals to answer any
questions that may arise regarding a particular student, internal rotations, clinical skills, or policy
and procedure at the school. See Appendix A.

Questions regarding the ICSP Program should be directed to the Vice Dean, Clinical Affairs and
Advanced Dental Education or the Director for the ICSP Program.

The CCU Director is the primary clinical mentor for the students. MOSDOH students are assigned
to one CCU Director for their entire clinical program. These CCU Directors have the most
comprehensive and intimate knowledge of the student’s abilities, strengths and weaknesses. If you
have any questions regarding a student before, during or after a rotation, those questions should be
directed to the student’s CCU Director.

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Elements of a Successful Rotation Site
MOSDOH has developed a number of sites to partner with for positive student rotation
opportunities. We have identified several elements that make the rotation experience a successful
one for the student, the site and the faculty.

1. Hosting the student.

While the external rotation experience is invaluable to the student, a significant amount of sacrifice
is required of them to participate. They bear the expense of travel and living costs, as well as the
modification in their personal and educational lives. It is important to know that this experience is
repeated three times during their academic year. The degree to which the site is able to help ease
this transition from the comfort of the MOSDOH campus to a relatively strange external
environment contributes significantly to the positive experience for both the student and the site. As
we all know, students talk to each other, and a positive experience at a site is very influential when it
comes to selecting preferences for rotations in future years.

Some suggestions to ease this transition:

1. Before the rotation begins, communicate with the student. Ask what procedures or
experiences would be most beneficial for their learning.
2. Ensure that there is a solid organizational commitment to having the students there.
3. Ensure that all appropriate staff, providers and administrators are aware of the student’s
arrival date and number of weeks the student will be at the site.
4. Prepare all appropriate paperwork and orientation procedures before the student arrives.
5. Provide clean, safe, appropriate housing for the student.

2. Student Introduction and Orientation

The words we use make a difference in how patients accept treatment from a student. What we say,
and how it comes across, can instill confidence in individuals and pave the way for a positive
experience. We ask that the staff and providers plan what scripting will be used to encourage
patients to accept treatment from the student dentist. Students tell us that the most effective
statements sound like this:
a. How great it is having the additional help that Student Dentists provide
b. The Student Dentists are well trained, kind, and professional.
c. Choosing treatment by the student means the patient can receive treatment sooner, rather than
having to wait weeks for an appointment with the staff Dentist.
d. Students on external rotation work under the general supervision of the licensed dentist.
They are never allowed to work without a licensed dentist present to provide oversight and
assistance.
e. Students are trained rigorously from a dental school with a strong Public Health emphasis.

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 f. Students must demonstrate “readiness”. Only those with adequate experiences at the dental
school are allowed to participate in external rotations.
g. The Student Dentist has already been through many years of college (sometimes as many as
7 or more). They are in their fourth year of Dental School.

Also, it is important to discuss how the team introduces the patient to the student. Please refer to
them as “Student Doctor Smith (last name)”. In some cases, the student dentist might prefer
“Student Doctor Cindy (first name)”. Some sites have been successful with “Resident Smith”. This
should be discussed with your staff and with the student before they start seeing patients.

When starting a new role, it best serves everyone to understand “how we do things here”. All
providers perform better when expectations are known and understood. If Policies and Procedures
for your site have not previously been given to the student dentist, please spend the necessary time
orienting them to all relevant policies and procedures once they arrive such as Medical Emergency
process, Occupational Exposure procedure or the preferred way treatment notes are constructed and
what acronyms are used. Also, please orient the student to their patient schedule, working days and
hours.

3. Keeping the student busy.

Students tell us one of the greatest benefits of an external rotation is the opportunity to treat a larger
volume of patients, relative to the volume seen at the school. This is also beneficial to the site, as the
site retains all revenue generated by the student. External rotations are primarily intended to be
educational experiences; however, we believe that a MOSDOH student will arrive uniquely prepared
to contribute significantly to the clinical operation of any site.

Students equate success, in large part, by the contribution they make. They are excited for the
opportunity to spread their wings and learn to become more productive as compared to the slower
pace of the dental school clinic. Sites that provide an adequate number of patient experiences will
generally determine the success of the rotation for the student. We recognize that the number and
types of experiences will depend largely on the skill level of the student, and the confidence of the
external faculty.

While no-shows and cancellations are a well-known part of life in a Community or Public Health
clinic, some ways to ensure that the students reach their potential regarding patient volume are:

1. Provide an effective assistant for the student.

2. Provide the student with their own schedule of patients.
3. If the site is providing patients to the student from another provider’s schedule, ensure that
there is enough volume to keep the student busy.
4. Provide the opportunity to see emergencies when a scheduled patient no-shows or cancels.
5. Plan for the student to see a diverse patient base, and allow them to provide a range of dental
services.

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4. Quality Faculty Feedback

The external rotation is an integral and extremely valuable part of the clinical education of a student
at MOSDOH. The students expect this to be a learning experience, and key to that learning
experience is the feedback and mentoring shared by the faculty.

Students tend to express frustration when they have to constantly seek out faculty for feedback when
it is not readily offered. Obviously, some students are more comfortable with less interaction but
most prefer constructive feedback on their performance and development of clinical skills.

Teachers are most effective when they model, explain and demonstrate suggested improvements.
Many times, constructive feedback relates to a specific clinical procedure, and necessitates giving
instruction chair side with the patient present. However, when the feedback is more critical or
specifically directed toward the student’s behavior, it should be provided one on one in a private
area, away from patients and staff.

Experts tell us that feedback is most effective when:

 It is delivered in a timely and respectful manner.
 It addresses specific actions that students can apply.
 Praise and criticism are well balanced.

This guidebook will describe the written evaluation needed from faculty, but most important is the
verbal, one on one feedback received from faculty during the daily course of treating patients.

Policies for External Sites

1. Teaching Environment/ Professionalism and Collegiality

An extremely important part of the culture of MOSDOH is the concept that all students be treated by
faculty as colleagues. This culture does not allow for adversarial, belittling or condescending
attitudes or actions of faculty toward students.

This, of course, carries with it the necessity that students exhibit the very highest level of
professional behavior.

When MOSDOH students become a part of the clinical and social structure at external sites, the
faculty at that site should treat them as they would want to be treated. From the very first day at
MOSDOH, professionalism and collegiality are strongly emphasized. Please help us continue to
promote this relationship.

2. Faculty Supervision

At all external sites, students must be supervised at all times by faculty who have applied for and
received clinical privileges at MOSDOH through an Adjunct Clinical Faculty appointment. At no

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time should a student be delivering clinical services without the supervision of appropriate faculty.
Non-credentialed, non-Faculty providers may supervise and interact with students in the
delivery of clinical services if an appropriately appointed and credentialed Adjunct Faculty is
on site to monitor the student and non-faculty provider.

Supervision includes allowing students to perform services for patients only when under the direct
supervision and control of that Adjunct Faculty. Such direct supervision and control shall require,
among other things, that a dentist be physically present and actively participating at all times and in
all activities of Students while at the Clinic.

By and large, MOSDOH is not particularly prescriptive as to the number of times a student is
checked during a procedure. This is left mainly to the professional judgment of the external adjunct
faculty. The faculty should determine the extent to which they need to check student progress based
on the following:

 the clinical skill of the student

 the confidence of the faculty in those skills
 the comfort level of the faculty with the performance of the student.

Bear in mind that the external adjunct faculty retains ultimate responsibility for the treatment
rendered to that patient.

MOSDOH does expect at a minimum that the following occur:

1. Start Check at the beginning of a procedure to ensure the appropriate preparations have been
considered and the proper procedure is about to begin.
2. A prep check in the case of most operative procedures.
3. Finish checks to ensure that the procedure has been completed appropriately and any post-
procedure considerations are addressed.
4. Any other steps as deemed necessary for specialty procedures such as Oral Surgery,
Endodontics and Periodontics.

3. Student Clearance for ICSP Rotations

In order to participate in external rotations each student must complete the following requirements:

1) Be assigned to a rotation group by their CCU Director. This occurs later in the fall semester
of D3 before rotation assignments are made.
2) Participate in at least one Internal Rotation in the following disciplines:
Oral Surgery, Urgent Care, Endodontics, Pediatrics, Special Needs.
3) Obtain clearance from their CCU Director within 30 days of beginning each rotation.

Note: Students are responsible for completing the ICSP Rotation Clearance Form, and are
instructed to follow the directions on that sheet. See Appendix B

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The Rotation Clearance Sheet lists the number of Competency Assessments and Essential
Experiences completed by the student in each of the clinical areas. In addition, a section is provided
for a student’s self-assessment, and Faculty comments regarding student’s skills.

It is important to note that an indication of a weakness in a particular clinical area does not
automatically indicate that a site should avoid providing clinical experiences in that area. Indeed, we
prefer that a site consider this as an opportunity to strengthen the student’s skill in that particular
area.

ICSP Rotation Clearance Sheets will be sent electronically to the site’s Dental Director prior to the
student’s arrival.

4. Treatment Procedures

While students participate in patient treatment at external sites, the students are not the doctor of
record and do not have primary responsibility for patient treatment decisions. While discussion
about treatment decisions is encouraged, all treatment decisions are made by the External Faculty
Dentist. Students may NOT initiate, change, modify or substitute any treatment ordered by an
external faculty without approval from that faculty. Failure to do so could result in academic
discipline and possible dismissal.

Students are acting under the direction of the External Faculty and shall provide the treatment
indicated by the External Faculty, providing the student feels it is within their ability. If students
have concerns regarding the level of difficulty of a procedure, they should bring it to the attention of
the External Faculty. Students may not refuse to provide treatment based on the fact that they have
completed clinical requirements or passed competency in that specialty area.

As students may frequently be delivering treatment previously planned by an external site faculty, it
is important that the student be aware of the diagnostic and planning process that went into
determining the treatment being rendered. Students should not deliver treatment without the
following being present:

1. Appropriate diagnostic information – i.e. radiograph, probing depths, pulp

testing, study models as needed, etc.
2. A recorded diagnosis.
3. A recorded treatment plan.
4. Consent from the patient.

5. Attendance

Attendance is required at external sites during the listed business hours of the site. Furthermore,
students must be in attendance for at least 85% of each rotation unless an excused absence is
obtained. Situations in which a legitimate emergency exists will, of course, always be considered.

The procedure to request time off from an External Rotation is as follows:

 ALL requests for leave from an external rotation must first be made to the Director
for ICSP.

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  In general, requests for leave MUST be submitted at least 30 days before the
requested date. Possible exceptions may be made for graduate program interviews if
late notice is received.
 Leave requests will NOT be considered for
o Study time for Boards.
o Board examination dates if submitted within 30 days of requested date.
o Extra travel time to and from the site.
o Personal time if that leave will result in less than 85% attendance at the
rotation.
o Time off for conferences or meetings if that leave will result in less than 85%
attendance at the rotation.
o Job interviews
o Attendance at other externships not previously arranged with MOSDOH.

 If it is determined by the Director that a legitimate reason exists for a leave request
and the leave will NOT result in less than 85% attendance at the rotation, the request
will be forwarded to the site and you will be notified if the leave has been granted.
 If it is determined by the Director that a legitimate reason does NOT exist for a leave
request or if the leave will result in less than 85% attendance at the rotation, the
request will be denied and not forwarded to the site for consideration.
 The same procedure applies before AND after arrival at the site.
 In the event that a student calls in sick during a rotation site, the Director must be
notified by the student within 24 hours.

6. Emergency Health Care / Needle Stick Protocol

It is in the interest of both MOSDOH and the External site to provide a safe environment for the
student. Students are required to have and maintain health insurance while in dental school.
In the event a student requires emergency or urgent health care while serving at the site, the site
should, to the extent possible, facilitate entry into the health care system or provide appropriate care
for the student.

Due to the time sensitive nature of needle stick injuries, the site should provide the student with post
exposure testing and follow-up care in accordance with their infection control policy and procedure.
It is understood that the site will not be expected to cover the cost for these services.

7. Emergencies / Problems at External Sites

In spite of our best planning and preparation, unexpected problems or issues can arise with various
aspects of an external rotation. These may include unexpected problems with housing arrangements,
conflicts with site staff or faculty, personal problems that arise or unsafe circumstances.

Any problem or issue related to the external rotations must be communicated directly to the ICSP
Director, who will consult with the Vice Dean, Clinical Affairs and Advanced Dental Education, for
a resolution.

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In the event that a student arrives at a site and is unable to access the housing arrangements or finds
them unacceptable, they are to secure appropriate hotel accommodations, for which the school will

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reimburse the student, until the housing issue can be addressed. A student shall not leave to return
home before the end of that rotation without authorization from the Vice Dean, Clinical Affairs and
Advanced Dental Education.

Conflicts with staff or faculty should be communicated to the ICSP director and the Vice Dean,
Clinical Affairs and Advanced Dental Education for a resolution. A student is not to leave the
clinical site without the permission of the onsite faculty or the authorization of the Vice Dean.

The obvious exception to this policy is if the student feels they are in a situation in which their health
or safety is in imminent danger. The student should then remove themselves from the situation and
contact the director or Vice Dean for further consultation. Likewise, if the faculty feels that the
student is placing the patients or staff in danger, they should remove the student from the clinical
situation and contact MOSDOH.

8. Reporting Operational Changes

In order to maintain a safe and appropriate clinical and educational environment for dental students,
sites must report certain changes occurring in their clinical operation immediately to MOSDOH.
These changes include but are not limited to the following:

 Addition of clinical staff that will supervise students and/ or evaluate Essential
Experiences.
 A decrease in Adjunct Faculty at the site.
 A change in the clinical administration of the site, i.e. a change in Dental Director or
a change in the principal clinical contact for the site.
 A decrease in operatories at sites to which students are assigned.
 The closure of a site to which students are assigned.
 A decrease in the scope of services provided to patients.
 A change in the patient demographic served, i.e. a change from adult to pedo patients.
 Any other changes in operations that would significantly modify or change the
clinical environment or experiences the students will encounter.

Any of these changes should be directly reported to the Director of ICSP.

9. Incident Reporting

If any untoward event involving a patient, faculty or staff occurs at an external site that in any way
involves a student, especially if that event results in that site preparing their own incident report that
mentions the student in any way, the student must:

 Immediately complete a separate report describing the incident using the “ICSP Incident
Report” form and forward it to the Vice Dean, Clinical Affairs and Advanced Dental
Education or the Director of ICSP.
 Request that any incident report completed by the site be forwarded to the Vice Dean,
Clinical Affairs and Advanced Dental Education or the Director of ICSP.
 Contact the Vice Dean or Director before signing any incident report completed by the site.

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Failure to do so may result in loss of professional liability coverage for that incident and may result
in the student being held fully liable for any claims made in conjunction with that incident.

10. FERPA: Maintaining the Privacy of Student Records

FERPA is an acronym for Family Educational Rights and Privacy Act, a Federal law that was
enacted in 1974. FERPA is similar to the HIPAA policies we are familiar with in a clinical setting, in
that the purpose of FERPA is to protect the privacy of student records. The U.S. Department of
Education oversees institutional compliance and investigates violations through the Family Policy
Compliance Office, located in Washington, D.C.

MOSDOH faculty, administration, and staff are required to take annual training for FERPA, and the
information provided here serves only as an overview, not complete in depth training. If you have
an interest in learning more about FERPA, please visit this website:
www.atsu.edu/registrar/ferpa/ferpa_policy.htm

The FERPA Act guarantees the following rights to students:

1. The right to inspect and review their education records.
2. The right to seek to amend their education records.
3. The right to consent to disclosures of personally identifiable information contained in the
student’s education records, except to the extent that FERPA authorizes disclosure without
consent.
4. The right to file a complaint with the Department of Education against any institution for
an alleged violation of their FERPA rights.

The FERPA Policy applies to all students who are or have been in attendance at a college or
university. The term “in attendance” means a student is officially registered for a class and that class
has begun. These rights continue after the student leaves the institution and are only terminated
upon written request or death.

Student information can be released without prior written consent in some situations. External
Faculty have a legitimate educational interest in the progress reports and information pertaining to
student progress. Also, information may need to be shared with you, and you may need to share
information with other faculty, regarding student progress and performance when students
participate in external rotations. This will frequently be done without prior written consent.

School officials with a legitimate educational interest may share student information without prior
written consent. In accordance with FERPA, a school official has a legitimate educational interest if
the official needs to review an education record in order to fulfill his or her professional
responsibility. This includes purposes such as:
 Performing appropriate tasks that are specified in his or her position description or by a
contract agreement.
 Performing a task related to a student’s education.
 Performing a task related to the discipline of a student.

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  Providing a service or benefit relating to the student or student’s family, such as health care,
counseling, job placement or financial aid.

An education record is any record which is maintained by the University, or agency or party, acting
for the University and from which a student can be personally identified. Records may be in any
form: written documents, computer media, video or audio tape, photographs, electronic files, etc.

The following are examples of ICSP education records:

• ICSP Clearance Sheet.

• CPAF/CAS electronic grading.

• External Site Evaluation of Student.

Violations of FERPA can occur if educational information is shared with those that do not have a
legitimate educational interest in student progress.

To help avoid violations of FERPA we suggest the following general rules:

1. Shred student information when no longer needed.
2. Do not leave confidential information displayed on an unattended computer.
3. Cover or put away papers that contain confidential information if you are going to step away
from your desk.
4. Do not discuss confidential student information in a manner in which others who do not have
a legitimate interest in knowing such information can hear.
5. Do not share student educational record information with other ATSU school officials unless
a legitimate educational interest exists.

Specific suggestions for ICSP sites:

1. Do not discuss prior MOSDOH students conduct, behavior, or clinical aptitude with other
students or those that do not have a legitimate educational interest. Do not solicit
information regarding upcoming student conduct, behavior or clinical aptitude from other
students.
2. Use good judgment when discussing private matters with a student.
3. If a MOSDOH student discusses an issue which they deem a private or personal matter, DO
NOT discuss anything shared with you to other MOSDOH students or clinic staff.
4. If you see unprofessional behavior by a MOSDOH student, please feel free to address it with
the student IMMEDIATELY. If the behavior continues, we ask that you contact the Vice
Dean of Community Partnerships or the Director of ICSP to discuss the issue and a plan for
resolution.

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11. Faculty/ Student Conduct

Title IX: Discrimination, Harassment, and Retaliation (ATSU General Order 90-210)
 Protects categories of: race, color, religion, ethnicity, national origin, sex (including
pregnancy), gender, sexual orientation, gender identity, age, disability, veteran status, or any
other status protected by law.
 Applies to managers, administrators, supervisors, co-workers, students, or non-University
personnel including clients, vendors, and suppliers.

An important responsibility of faculty members is to promote an academic environment conducive

to the maximum development of students. MOSDOH expects faculty and students to exhibit
professional behavior at all times. MOSDOH believes that an atmosphere of mutual trust and respect
is essential to a healthy educational environment. This environment can be diminished when persons
in positions of authority abuse their authority, discriminate, harass or engage in inappropriate
relationships between faculty and students.

Abuse of authority, discrimination, harassment or inappropriate relationships between a faculty

member and a student is misconduct when the faculty member has professional responsibility, such
as grading or advising, for the student. In the case of an inappropriate amorous relationship with a
student, even if consent were to be shown, a clear conflict of interest would exist which might create
the appearance of discrimination or favoritism in grading or access to educational opportunities.
Faculty members engaged in unethical conduct of the type described are subject to the normal
disciplinary procedures which may include dismissal from the ICSP program. Such behavior may or
may not constitute sexual harassment as defined in the harassment policy.

ASSESSMENT OF STUDENT PERFORMANCE

1. Essential Experiences and Competency Assessments

Rather than a requirement based clinical curriculum, the clinical curriculum at MOSDOH is based
on achievement of competency in each clinical discipline. This means that rather than a certain
number of procedures required for graduation, the student must demonstrate competency, regardless
of how many procedures it takes to achieve competency in that area.

In order for a student to demonstrate competency, they must receive permission from a CCU
Director or a Specialty Director to sit for a Competency Exam. If that director feels that a student is
prepared to sit for a Competency Exam, a patient is chosen and, in most cases, two separate
calibrated faculty members will evaluate the procedure without providing any assistance to the
student. The faculty will then assess the student’s performance on a 5-point scale. A minimum of 4
points is needed to pass the Competency Exam. Competency Exams are completed only at
MOSDOH with internal faculty.

Any procedure completed by the student that is not done for a Competency Exam is termed an
Essential Experience. Essential Experiences are based on a Pass/ Fail system using the following
criteria.

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 Professionalism
A= Acceptable - Student demonstrated appropriate behavior, skill and judgment independent
from faculty direction or assistance. (4-5, with 5 being exceptional)
I= Improvable - Student demonstrated behavior, skills and judgment with areas of deficiency
requiring some instructor direction or assistance. (3)
U= Unacceptable - Student demonstrated behavior, skills and judgment that were either
inadequate or inappropriate in nature (0-2 with 0 being a critical error)

Clinical Skills
A= Acceptable – Student performed the procedure/demonstrated appropriate technique or
critical thinking without instructor assistance. (4-5, with 5 being exceptional clinic skills)
I = Improvable – Student performed part of the procedure/demonstrated appropriate techniques
or critical thinking with either instructor assistance or some minor areas of deficiency. (3)
U = Unacceptable – Student performed part of the procedure/demonstrated techniques or
critical thinking with either significant instructor assistance or deficiency. (0-2 with 0 being
a critical error)

Students must receive an “A” or an “I” on an Essential Experience in order to receive a “Pass”. Any
“U” or “Unacceptable” on a procedure results in a “Fail” on the Essential Experience.

In assessing student performance on the basis of A (4-5), I (3) and U (0-2), faculty are
encouraged to focus more on the critical thinking and student self-assessment skills rather
than simply the degree to which the student was assisted in the procedure by the faculty.

Grading Overview for the academic year 2021-2022:

Essential Experiences are completed and assessed at ICSP sites with the use of our Clinical
Assessment System (CAS) - electronic grading in conjunction with the MOSDOH Clinical
Procedure Guidebook.
Completion of the Evaluation of Essential Experiences should be done by the Adjunct Faculty that
worked with the student.

ICSP grade recording is done electronically. This minimizes the impact to participating dental
partners while simultaneously ensuring timely reporting of clinical grades. The graded procedures
become part of the student’s permanent academic record as well as provides documentation of the
student’s efforts while at your organization.
 
To complete the grading survey, using the student iPad (or a cell phone, laptop, etc.), the student
launches the grade collection survey at/near the conclusion of the procedure with student and faculty
entering their respective information. This option takes less than one minute to complete.
 
Grading information is collected and recorded independent of the participating practice operations.
In the event of a power failure or loss of internet connectivity, a hard copy of the grade collection

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document can be used. All adjunct faculty will receive an email with the QR code to do a
practice grade.

2. Summary Assessment of Student Performance

All ICSP sites are required to complete a summary evaluation for each student rotating through their
site.

Accompanying this guidebook is a copy of the External Site Evaluation of Student form (see
Appendix D). You will receive an e-mail reminder with a link to complete the evaluation on-line in
E-value during the last week of each rotation. We ask that this evaluation be completed by at least
one provider that worked consistently with the student(s). We welcome multiple evaluations as it
will assist us in providing feedback to the student. If an adjunct faculty did not work with a student,
they can dismiss the evaluation in E-value. The Guidebook and the Evaluation are divided into two
sections:

I. Professionalism Section
II. Clinical Skills Section.

For evaluation criteria to complete the External Site Evaluation of Student, please refer to the
Clinical Procedure Guidebook.

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Appendix A

MOSDOH Administration Kirksville and St Louis:

Dwight McLeod, DDS, MS

Dean, Missouri School of Dentistry & Oral Health
314-833-2731
Dmcleod@atsu.edu

Poonam Jain, BDS, MS, MPH

Vice Dean, Clinical Affairs and Advanced Dental Education
314- 833-2734
poonamjain@atsu.edu

Grishondra Branch-Mays, DDS, MS

Vice Dean, Academic Affairs
660-626-2802
shonbranchmays@atsu.edu

MOSDOH St Louis Contacts:

Patricia Inks, BSDH, MS Nae’ Wanda Moore

Director, DIC/ICSP Senior Administrative Assistant
314-685-3563 314-833-2733
peinks@atsu.edu Naewandamoore@atsu.edu

Michael Abels, DMD Michael Greaves, DMD

CCU 1 Director CCU 1 Director
314-685-3565 314-685-3565
mabels@atsu.edu Michaelgreaves@atsu.edu

Herbert Silva, DMD David Greaves DDS

CCU 2 Director CCU 2 Director
314-833-2798 314-685-3576
hsilva@atsu.edu Davidgreaves@atsu.edu

Matthew Greaves, DDS, MS Ahmed Zarrough, DDS

CCU 3 Director CCU 3 Director
314-685-3571 314-685-3574
matthewgreaves@atsu.edu Ahmedzarrough@atsu.edu

Shaista Rashid, BDS, MS, MPH

CCU 4 Director
314-685-3537
Shaistarashid@atsu.edu

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Appendix B

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Appendix C – Sample Grading Form

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Positive comments regarding student performance are always welcome and useful. Comments regarding
weaknesses or concerns that external faculty have regarding student performance are particularly helpful
in assessing what areas need emphasis while back at MOSDOH to help the student progress. Please
comment on any particular weaknesses or concerns that you as an adjunct faculty have observed with the
student.

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Appendix D – Sample – Actual survey generated through E-value

External Site Evaluation of Student

IMPORTANT: This evaluation must be filled out by the External Faculty and reviewed with the student upon
completion of the rotation following the guidelines contained in the ICSP Faculty Guidebook and Policy
Manual. This evaluation is completed electronically in E-Value.

Date ______________

Student Name __________________________________________

External Site __________________________________________

Faculty Name _________________________________________

Faculty Signature _______________________________________

Student Signature ____________________________________________

Professionalism Section
Please refer to the appropriate section of the ICSP Faculty Guidebook and Policy Manual for a
description of expectations and evaluation guidelines.

Please evaluate the student in this section according to the following guidelines:

Acceptable: Student demonstrated appropriate behavior, skill and judgment independent from
faculty direction or assistance.

Improvable: Student demonstrated behavior, skills and judgment with areas of deficiency
requiring some instructor direction or assistance.

Unacceptable: Student demonstrated behavior, skills and judgment that were either inadequate or
inappropriate in nature.

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 Professionalism

Acceptable Improvable Unacceptable

Ethics/Integrity
Willingness to Accept Instruction
Patient Record Management
Work habits/time utilization/punctuality
Student Attire/Grooming
Adheres to rules and procedures

Comments on Professionalism

Skills and Traits

Acceptable Improvable Unacceptable

Confidence/Independence
Reaction to Stress
Manual skills
Interpersonal Skills
Introduction of Patient to Instructor
Medical History Presentation

Comments on Skills and Traits

Procedure management

Acceptable Improvable Unacceptable

Preparation for Procedure
Instrument and Materials Set-up
Infection Control/Cleanliness
Laboratory Communication

Comments on Skills and Traits

Patient Management

Acceptable Improvable Unacceptable

Introduction of patient to instructor
Medical History Presentation
Review of Dental History
Informed Consent
Anesthesia
Patient Empathy
Evidence Based Dentistry
Implementation
Biomedical Integration

Comments on Patient Management

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 Clinical Skills Section
Please refer to the appropriate section of the ICSP Faculty Guidebook and Policy Manual for a
description of expectations and evaluation guidelines.

Please evaluate the student in this section according to the following guidelines:
Acceptable –
Student performed the procedure/demonstrated appropriate technique or critical thinking without
instructor assistance.

Improvable –
Student performed part of the procedure/demonstrated appropriate techniques or critical thinking
with either instructor assistance or some minor areas of deficiency.

Unacceptable –
Student performed part of the procedure/demonstrated techniques or critical thinking with either
significant instructor assistance or deficiency.

Oral Diagnosis

Acceptable Improvable Unacceptable Did Not Observe

Examination/ Diagnosis
Oral Radiology

Operative Dentistry

Acceptable Improvable Unacceptable Did Not Observe

Operative Dentistry - Amalgam
Operative Dentistry - Composite
Operative Dentistry – Direct
Veneers
Operative Dentistry - Bleaching

Endodontics

Acceptable Improvable Unacceptable Did Not Observe

Endodontics

Oral Surgery

Acceptable Improvable Unacceptable Did Not Observe

Oral Surgery - Pre-operative
Assessment
Oral Surgery – Extractions
Oral Surgery – Alveoloplasty
Oral Surgery – Biopsy
Oral Surgery – Implants

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Periodontology

Acceptable Improvable Unacceptable Did Not Observe

Periodontology – Perio exam
Periodontology – Non-surgical
treatment
Periodontology – Re-evaluation/
Maintenance Exam
Periodontology – Surgery

Preventive Dentistry

Acceptable Improvable Unacceptable Did Not Observe

Preventive Dentistry – Oral Risk
Assessment
Evaluation of Preventive Dentistry
- Sealants

Fixed and Removable Prosthodontics

Acceptable Improvable Unacceptable Did Not Observe

Fixed Prosthodontics
Removable Prosthodontics –
Removable Partial Dentures
Removable Prosthodontics –
Complete Dentures
Removable Prosthodontics –
Immediate Dentures

Orthodontics

Acceptable Improvable Unacceptable Did Not Observe

Orthodontics - Consultation
Orthodontics – Limited Therapy

Pediatric Dentistry

Acceptable Improvable Unacceptable Did Not Observe

Pediatric Dentistry - Exam
Pediatric Dentistry – Oral
Radiology
Pediatric Dentistry – OHI
Pediatric Dentistry – Sealants
Pediatric Dentistry – Amalgam
Pediatric Dentistry - Composite
Pediatric Dentistry – Stainless
Steel Crowns
Pediatric Dentistry – Pulp Therapy
Pediatric Dentistry – Extractions
Pediatric Dentistry – Space
Maintenance
Areas where the student improved the most:

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