Clinical Responsibilities

Entering the clinic is the culmination of the practical aspect of your professional education. It is both rewarding and challenging, and it is a privilege all of us must approach with a high degree of professionalism and dedication to the "patient first" philosophy. Neglect or abuse of a patient may result in withdrawal of clinic privileges.

At this time in your career, you have an opportunity to develop your professional identity. The following pages contain policies and protocols to assist you in the development of your clinical and professional skills.

Dress Code and Personal Hygiene

Personal Hygiene

Personal hygiene must be rigorously maintained by the health professional. Because of the close contact between the patient and dental student, anything but scrupulous personal cleanliness is unacceptable. Hair, beards, and nails must be clean and well groomed. Long hair must be pulled back, according to infection control standards.

Clinic Attire/Name Tags

Students' personal attire must be professional at all times.

Men shall wear shirt and tie. Women shall wear a dress, skirt and blouse, pants or pant skirt (worn with tights or stockings). Scrubs may be worn in lieu of this clothing; no other personal dress is permissible. Jeans are not permitted in clinical areas. Appropriate shoes are to be worn. No open toe shoes are permitted for safety reasons.

Students must wear a disposable gown at every clinic session. Extreme care must be taken when working with an open flame to prevent burns. Experience has shown it to be prudent to keep a clinically acceptable change of clothing in your locker.

Protective clinical gear is restricted to clinical areas only. Clinical faculty will reinforce this policy. Students who do not adhere to the policy will not be allowed in any of the clinical areas for patient care.

Students are expected to wear clinic nametags at all times. The school distributes nametags. They should be worn under the disposable gown. Should a nametag be lost or misplaced, it will be your responsibility to replace it. Please see the clinic director for the vendor's address.


Fee Schedules

All students entering the clinics are provided with a current fee schedule. Students are responsible for providing this information to their patients. Avoid misquoting. Fee schedules are revised annually. Also included in the schedules are brief outlines of the different dental plans.


Clinic Hours and Attendance

Clinic hours vary depending on the curriculum. In general, predoctoral clinic sessions are Monday through Friday (8:30 a.m.- 4:30 p.m.) with an evening clinic on Monday, Tuesday, Wednesday, and Thursday (5 p.m.- 7 p.m.). Saturday clinics are held from September through June from 8:30 a.m.-3 p.m.).

Patient Relations

Treating patients is a privilege that always occurs under the supervision of faculty. Failure to follow directions of the faculty or to act responsibly will result in clinical suspension.


Guidelines for the Student-Dentist/Patient Relationship

To avoid problems that may arise with your patients while you are a student, this summary of DO'S and DON’TS should be a helpful guide.

• DO be professional and courteous at all times.
• DO identify yourself (spell your name) and the School when in conversation with your patients. Identify yourself as a student and the Dental School as a teaching institution.
• DO inform your patient of the proposed treatment alternatives and get his/her informed consent.
• DO document in the chart all patient visits, missed or broken appointments, correspondence and problems. Have an instructor co-sign.
• DO make sure that the operatory is clean and disinfected before you seat your patient and after your patient is dismissed.
• DO have the appropriate instructor check the treatment procedures and sign the record.
• DO avoid arguments with the patient; solicit faculty assistance immediately.
• DO return patient phone calls promptly.
  
  
• DON'T promise anything you can't deliver.
• DON'T cancel appointments, if possible.
• DON'T do any unauthorized treatment (e.g.. temporize crowns) without a contract, treatment plan or supervision.
• DON'T provide patient care without an instructor in the clinic.
• DON'T criticize any treatment rendered by a patient's previous dentist or student.
• DON'T forget that you are a student and have limited experience! Seek your instructor's guidance.

If you have a patient management problem and need assistance please notify your instructor, your mentor, and/or contact the Division of Patient Services.


Mentor Groups

All predoctoral dental students belong to a mentor group. Each group is led by a mentor. The predoctoral students are the primary care dentists treating patients in the clinic. Patients are assigned to students who assume the responsibility for co-coordinating their general comprehensive dental care. Mentor groups were formulated in order to:

• Provide patients with continuous, comprehensive dental care in an efficient, effective manner.
• Establish a sense of teamwork between faculty and students in the delivery of patient care.
• Foster an environment of support and camaraderie between group members to ensure optimum educational opportunities for all students.
• Monitor both patient care and student progress in an effective and timely manner.
• Establish a clinic system that will function synergistically with APEX by providing a mechanism for continuity of patient care and uninterrupted clinic utilization.
  

Patient Eligibility

Boston University School of Dental Medicine is an educational institution that provides patient treatment. In general, all persons who are able to afford the time and the cost will be treated at the school. In some instances, patients may not be accepted for treatment at the school (e.g., patients whose dental needs do not meet the requirements of the teaching program, who present with a complex treatment challenge above and beyond the skills of students, who request partial treatment, or who request changes in diagnosis that are contrary to the teaching principles of the school.) Furthermore, patients whose medical or emotional management would be beyond the ability of the dental student in a school setting may not be accepted for treatment.


New Patients

Appointments for new patients for consultations, radiographs, or emergency services are scheduled at the first floor reception desk or by calling 638-4700. Appointments are scheduled Monday afternoons; all day Tuesdays; all day Wednesdays; and Thursday afternoon. Thursday and Friday mornings are open for walk-in clinic.


Radiology

Appointments for radiographs may be made during the same times as new patients at the first floor reception desk.

Students who wish to take radiographs on their own patients may stop by the radiology clinic to ascertain the availability of chair time. The clinic will try to accommodate each student at that time. Before the patient can be seen in radiology, the blue radiographic permission sheet must be signed by a Boston University faculty dentist and a receipt for payment of the films is needed.


Patient Assignment Procedures

Patient assignment at BUSDM is for the comprehensive dental treatment for each patient either by an individual student or by an assigned team of students.

All patients are screened by the oral diagnosis faculty and categorized according to the complexity of their dental needs. Student assignment is made by the clinic director and is intimately linked to the need of providing appropriate clinical experience to students based on their need to achieve and maintain clinical competency.


Referral Patients

Students are encouraged to invite patients to present to BUSDM and to register as new school patients. Only new patients whom the student has referred into the school are considered "referral" patients. Students may not receive patients from friends and colleagues or other students at the school without the endorsement of their mentor or clinical director. Patients in treatment at the school are, by definition, school patients and will be assigned according to school guidelines.


Notification of Assignments

Students are notified of assignments as they occur. Students will be notified about assignments via email. Students are provided with the patient's chart number. Students must promptly review the chart and arrange for the patient's care. Students are required to contact the new patient without delay, even if the patient's next appointment has to be scheduled a week or two in advance due to the student's current rotation schedule. Patients expect to hear from their assigned student dentists as soon as possible. Students who do not arrange to contact their patients will lose their place in the assignment process; patients who are not contacted will be reassigned. In addition, no clinical credit will be given for work rendered on a patient not officially assigned.

Students are authorized to treat only their own officially assigned patients. Any student performing a procedure on a patient to whom he/she is not formally assigned is in direct violation of clinic rules and is subject to appropriate disciplinary actions.


Patient Transfers

Reassignments and patient transfers originate with the approval of the mentor, in record reviews, and on an individual basis in the Division of Patient Services. Transfers are official only if processed by the mentor or clinical director.

Patient care is transferred when the assigned student graduates. The transfer of patient care is a formal procedure and is an adjunct activity of the overall patient assignment process.

Transfer is usually affected within the graduating students' mentor group. For continuity of care and to prevent misunderstanding, it is best for both students to be present during the transfer meeting.

It is never permissible for students to arrange transfers independent of official school approval.


How to Schedule Patient Appointments

in person

To schedule an appointment for a patient who is present, accompany your patient to the fifth-floor reception desk and arrange for the next available appointment. Fill out an appointment card with day, time, location, and name of student. Appointments can also be made with clinic coordinators on the phone

for new patients

The educational support staff will notify you of an assignment via email. You are required to review the chart in advance and check the medical history/consultation. The key to efficient treatment is preparation. Also, please remember to confirm you appointments.

missed appointments

When a patient cancels or fails to keep an appointment, the student must make a record entry. If a patient misses three or more consecutive appointments, the student should alert his/her mentor and appropriate educational support staff. The staff will assist you in sending a letter informing the patient of the consequences of missed appointments. A copy of any letter sent is to be placed in the patient record.


Discontinuation of Patients

Terminating a patient is a serious responsibility for both the student and the school. Your mentor must review all patient discontinuation decisions. If such a decision seems fully justified the following procedures should be followed:

• An accurate and complete notation must be made in the patient record describing in detail the problem that exists and why treatment is to be discontinued.
• The student and the instructor responsible for the primary care of the patient must sign the record. If the patient's care involves other departments, appropriate instructors must also sign the record.
• The Division of Patient Services should be notified.
• You must send the patient a letter and leave a copy in the patient’s chart. The educational support staff can help you with this.
• NO patient may be refused or abandoned in an emergency situation.

Patient and Case Management During Rotations

The basic principles of patient care and management during APEX, Externship, and In-House rotations are as follows:

Case Preparation: Prepare each case as needed to be ready for your time away from school, i.e., attend to caries control teeth, perform prophylaxis, arrange for specialty services relevant to the treatment plan, etc. Attend also to case management aspects such as initiating MassHealth prior approval, making lab arrangements, requesting medical consults, etc.

Work closely with your mentor and educational support staff, asking for and receiving their guidance along these lines.

For students going out on externship, a record review with your mentor must take place approximately four weeks before you are scheduled to leave. A classmate and generally another student will be assigned to cover your patients while you are gone. The mentor, externship student, and covering students meet at this record review and determine what treatment, if any, is appropriate for the patients during their assigned student’s absence. A letter is sent to the patient notifying him/her about your pending absence and the plan for their treatment. Good communication is imperative to avoid misunderstanding. Please note: the oral diagnosis
emergency rotation service is always available for patients with acute emergencies.


Official Dental School Discount Policy

BUSDM student

Must be a full-time registered student with the BUSDM registrar responsible for certification of eligibility if need arises. Student discount is 100% and work must be performed by a graduate or undergraduate student. Anesthesia for oral surgery is not covered by this discount. Eligible student must pay all inside or outside lab charges plus gold. All work normally requiring a contract must be contracted. All current clinic manual policies must be followed for all discounted students. Discount eligibility ends at graduation, withdrawal, or leave of absence, whichever occurs first. Following the aforementioned action, prevailing school rates and payment policies will be in effect for new or unfinished treatment.

Student Family Discount Policy

To lessen the financial burden of caring for dependents, students and residents are granted the privilege of treating their own immediate family at no cost other than applicable laboratory fees. The immediate family of students and residents may also be treated by other approved members of the dental school community at a discount of 50% from regular fees or 50% from the remainder of regular fees after all laboratory expense have been paid. "Immediate family," for purposes of this discount, will be defined as a current spouse and /or dependent children. All other family members will be required to pay our regular fees, which are significantly below those in outside private practice.

Students and residents applying for the discount will be asked to sign a statement affirming that the patient is, in fact, their current spouse or dependent child. A misrepresentation on this point will be considered a serious offense and appropriate and severe sanctions will follow.

The administration is confident that these changes in the "Family Discount Policy" will enable the school to continue to offer a well-deserved courtesy to the tuition paying members of our school--those who need it most.

Application forms for this discount selection are available in Room 529 located of the fifth floor of BUSDM
.
Note: The Oral Surgery Group Practice and any other group (faculty) practices are not covered by this discount policy. Also, implant procedures in periodontics and prosthetics are not covered by this discount policy.


Prescription Form Availability

Prescription forms are currently available for faculty from oral diagnosis (Room 104). These prescription forms conform to the recommendations of the Massachusetts Public Health Council and must be used when prescribing medication.

The procedure for obtaining prescription pads is as follows:

• Any faculty member may requisition a prescription pad from oral diagnosis. A record will be maintained including the prescription numbers in the pad. The instructor must record individual prescriptions as they are dispensed. Instruction for keeping this log will be available from oral diagnosis.
• Students may obtain individual prescriptions only. These may be obtained from a faculty member holding a pad. Only the person dispensing the individual prescription may sign for the medication.
• The procedure for dispensing prescription forms has been developed to aid in the tracking of individual prescription if the need arises. Although it does require additional record keeping for all concerned, you can appreciate the necessity for controlling the forms. The procedure is in no way intended to hinder the writing of prescriptions by faculty, but rather as a control for the forms.

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