General Practice Residency

The purpose of the General Practice Residency program at the University of Nebraska Medical Center and Veteran’s Administration Western Iowa Nebraska Health Care System is to train dental residents to deliver comprehensive health care in both the inpatient and outpatient environment as part of a larger team of health care providers with full consideration of the patient's dental and medical needs. Furthermore, the program strives to instill in the resident office management and production skills that can be translatable to their private practice experience after completing their residency.

1. Develop the capacity in the generalist to participate in the provision of comprehensive health care in the traditional dental environment as well the hospital and associated health care settings (CODA 1-8 Focus – general dentistry, hospital setting).
   Obj 1a: to provide foundation knowledge regarding hospital operations, functions and credentialing. (Standard 2-11)
   Obj 1b: to develop skills in responding to and directing consultations in the hospital floor or with other clinical services and meeting the needs of the patient as a general dentist. (Standard 2-3, 2-9, 2-11)
   Obj 1c: to develop skills in physical assessment and the understanding of the interplay between the systemic and oral environments. (Standard 2-9)
   
   
2. Provide resident learning experiences which focus on the primary care provider role in the delivery of general dentistry patient care, emergency care, referred care, health promotion, disease prevention and the application of behavioral management techniques as relevant to comprehensive health care of the medically, mentally and physically compromised patient as well as the "healthy" patient population (CODA 1-8 Focus – general dentistry, patient care and special needs).
   Obj 2a: to expand on existing foundation knowledge/skills in the areas of operative dentistry, endodontics, periodontics, prosthodontics (fixed/removable/occlusion) and oral surgery (exodontia, biopsy, pre-prosthetic surgery, TMJ management). (Standard 2-4)
   Obj 2b: to develop skills in responding to and directing medical/dental emergency care and pain/anxiety management in the clinical and emergency room setting. (Standard 2-3, 2-5, 2-7)
   Obj 2c: to develop skills in physical assessment and the understanding of the interplay between the systemic and oral environments. (Standard 2-7, 2-9)
   Obj 2d: to develop referral skills as well as skills in the diagnosis, assessment, temporization, prevention, health promotion, transitional and management of patient needs. (Standard 2-3).
   Obj 2e: to develop skills and knowledge base in oral, IV and inhalation sedation and the structuring of the treatment environment or management plan for behavioral modification of patients having varied health backgrounds and oral needs. (Standard 2-6)
   
   
3. Train a generalist capable of interacting with other members of an interdisciplinary health care team in a variety of health care situations including Services to the community. (CODA 1-8 Focus – general dentistry with intra and inter disciplinary interaction and community service).
   Obj 3a: to foster and build relationships between the generalist and other health care members. (Standard 2-3)
   Obj 3b: to develop the skills and knowledge to provide dental care in non traditional settings and environments including the organization and delivery of community service efforts. (Standard 2-3)
   Obj 3c: to provide general understanding and application of laboratory and diagnostic techniques in systemic disease. (Standard 2-7)
   Obj 3d: to develop knowledge basis in the diagnosis, treatment and management of systemic disease. (Standard 2-7)
   
   
4. Refine the clinical skills a generalist brings to the program, providing an opportunity to individualize certain aspects of training while taking into account varying abilities, background and career goals and by applying critical thinking principles, evidence/outcomes based care, and use of information databases in clinical decision making and practice management. (CODA 1-8 Focus – general dentistry and resident education).
   Obj 4a: To develop skills in critical thinking and analysis of care outcomes applied to clinical practice. (Standard 2-10)
   Obj 4b: To develop an understanding of databases and evidenced based care. (Standard 2-10, 2-14)
   Obj 4c: To foster an understanding of basic principles of practice management. (Standard 2-10)
   
   
5. Develop appropriate attitudes, behavior, preventive and business practices in regard to the profession by providing the opportunity for professional development as a clinician, teacher, researcher, manager, community advocate and administrator (CODA 1-8 Focus – general dentistry, education patient care and community service.
   Obj 5a: to develop skills in literature review and the preparation and presentation of a position paper to laymen or a collection of peers within the health care field. (Standard 2-14)
   Obj 5b: to develop ethical behaviors compatible with the profession and the appreciation of diversity. (Standard 2-3, 2-10)
   Obj 5c: To foster the concept of life-long learning and professional growth including service to the community. (Standard 2-3)

Upon successful completion of the one-year residency program at UNMC, the resident will receive a certificate. The following criteria will be utilized in evaluating the resident for certification. As part of the current competency and proficiency movement in postgraduate general dentistry, it will be the resident’s responsibility to provide documentation of their experiences during the residency. (Competency statements are available on-site for review or can be made available upon request.) Documents will be gathered and presented for review by the faculty on a periodic basis. Documents will be stored through the use of a portfolio. Criteria for successful evaluation will be:

1. Completion of all off site and UNMC rotations with an over-all satisfactory evaluation by the attending staff or their designee.
2. Completion of all medical and dental records in accordance with established quality assurance guidelines.
3. Completion of check out of materials and supplies.
4. Completion of dental treatment on a sufficient number of patients that demonstrate quality comprehensive care.
5. Demonstration of a high degree of professionalism through interplay with other health care professionals in the dental treatment of patients who are medically, mentally, and physically challenged as well as participation in a community service project.
6. Satisfactory completion of record and patient care audits in accordance with established quality assurance guidelines.
7. Satisfactory participation in the program's clinical and didactic curriculum.
8. Completion of one manuscript suitable for publication in a peer refereed journal or participation in clinically based research or formal presentation of a self- investigated topic to a collection of peers within the academic or professional community.

Program Director - The program director is responsible for the day-to-day administration of the clinic. the director also spends a significant percentage of time with the residents in both clinical and educational components of the program. The director has completed a GPR program and has years of private dental practice experience, which is an invaluable resource to the residents as they transition from the dental school environment to preparing for private practice.

Attending Staff - Residents receive guidance, supervision, education and treatment planning advice from both generalists and specialists throughout the program. Specialists are available for consultation on a regularly scheduled basis and include endodontics, oral pathology, oral surgery, pediatric dentistry, periodontics, prosthodontics, and oral-maxillofacial prosthetics. Patients are scheduled by the residents for consultation or supervision of treatment with a specialist when the resident feels the patient has need for special consideration.

Support Staff - Residents are provided with dental assistant support to allow for utilization of four-handed dentistry. A billing / insurance specialist and clinic scheduler are available to ensure efficient administration of patient scheduling, records and finances. Several dental hygienists are also employed to help provide preventive, diagnostic, periodontal and other adjunct services to our patients.

Clinical and Business Operations Manager - The program also has an operations manager responsible for managing all of the administrative functions, patient/staff relations, and financial affairs of the clinic and program.

Attending Staff and Adjunct Faculty

Kathy A. O’Brien-Ausman, DDS, GPR Program Director, Generalist

Sumit Yadav, BDS, MDS, MBA, PhD, Chair of the Department of Growth & Development, Henry and Anne Cech Professor of Orthodontics

• Valmont Desa, DDS, MD, Associate Professor, Director Oral and Maxillofacial Surgery
• Laura Gordon, DDS, Clinical Instructor, Generalist, VA Staff Dentist
• Jay D. Hansen, DDS, AEGD Program Director, Generalist
• Amy Killeen, DDS, Clinical Instructor, Periodontics
• Jeffrey C. Markt, DDS, MS Associate Professor, Oral Facial Prosthodontics
• Scott Morrison, DDS, MS, Clinical Instructor, Periodontics
• Steven Pryor, DDS, MS, Clinical Instructor, Endodontics
• Jim Ruskin, DDS, MD,  Professor, Oral and Maxillofacial Surgery
• Paul Sheridan, DDS, Clinical Instructor, Prosthodontics, Staff Prosthodontist, VA Dental Services
• Jason B. Untrauer, DDS, MD, Assistant Professor, Oral and Maxillofacial Surgery
• Corinne Van Osdel, DDS, Clinical Instructor, Generalist
• Alvin G. Wee, DDS, MS, MPH, Clinical Instructor, Prosthodontics, Staff Prosthodontist, VA Dental Services
• John Young, DDS, Clinical Instructor, Generalist, VA Staff Dentist

UNMC College of Dentistry Dental Clinic
The UNMC College of Dentistry Dental Clinic is located in the University of Nebraska Medical Center Durham Outpatient Center. The clinic was renovated in 2019. The project included 15 fully equipped operatories, a laboratory, sterilization area, radiographic imaging room with a digital pantomograph unit, resident's room, scheduling office, billing office, large waiting room and restrooms.

The dental operatories in the clinic are fully equipped. The clinic utilizes a digital radiographic system and computer workstations for chairside use. The dental units are state-of-the-art equipment with fiber optic capabilities. A surgical endodontic microscope and CEREC Omnicam and Blue-cam with a milling unit for porcelain restoration fabrication are also available for resident’s use. Rotary Endodontic and Implant Placement Systems, including handpieces, are frequently utilized as well as a soft-tissue laser. Several new complete sets of oral surgery instruments are available. A portable radiographic unit (Nomad) and dental unit as well as two portable pulse oximeters are available for treatment rendered in the operating room or on the patient floors.

Omaha VA Clinic
While on rotation at the Omaha VA Clinic, residents enjoy working in the state-of-the-art, newly remodeled, stand-alone dental facility which boasts updated equipment, cabinetry, plumbing, and fixtures. The clinic houses twelve operatories, private offices, a resident’s office area, a reception area, a dental laboratory with two full time laboratory technicians, a large conference room, a staff lounge and restrooms. The Grand Island VA offers an updated and remodeled dental clinic as well with 5 operatories, digital systems and up to date equipment. 

Library
Since the program is located at the University of Nebraska Medical Center, an extensive library facility is immediately available for the resident's use. The McGoogan Health Sciences Library within the University Hospital has all necessary medical and most major dental publications. The C.Y. Thompson Library in Lincoln can supply other dental references or minor publications required for resident use. Library loan or courier service can provide journals, articles or books quickly. In addition, extensive audiovisual files are in the Medical Center Library for the resident's review. Computer access to internet reference sites is available in the clinic's resident room. The VA also maintains library services.

Dental residents spend approximately 75% of their time providing dental care to a wide variety of patients. These groups include:

• Medical/Dental inpatients referred for evaluation and treatment
• Medically, mentally, physically challenged outpatients
• Well outpatients
• Geriatric patients
• Social Services patients 
• Emergency walk-ins
• Military Veterans 

Residents participate in the screening of patients admitted to the program and the development of definitive treatment plans. The treatment plans are presented to the attending staff in the dental clinic and at weekly treatment planning meetings. At that time, the attending staff will review the treatment plan with the residents and make recommendations, review options of treatment and discuss rationale of treatment plan decisions. An active Nebraska state dental license is necessary to participate in this program and to receive the stipend. Incoming residents will be provided with additional information regarding temporary state licensure.

Special emphasis is given to oncology, liver transplant, heart transplant, pancreas transplant, cardiac valve replacement, HIV patients and their problems. The dental residency program works closely with these services preparing and managing these patients.

Inpatient Care
The dental residency program provides the resident with a wide variety of operating room experiences in both general dentistry and oral surgery. Dental rehabilitation cases on patients with medical, psychological and social disorders serve as the main source of patients. Dental residents are also required to assist the oral surgeons or perform delegated procedures under the supervision of the oral surgeons while on rotation at the VA hospital.

Training in physical evaluation is provided during the first months of the program to allow the residents to more actively participate in the care of patients. Additional experience in physical evaluation is provided during the rotations in Emergency Medicine, Oral and Maxillofacial Surgery, and Anesthesia. By the completion of the program, residents are capable of performing a complete history and physical, and ordering appropriate laboratory tests prior to performing the necessary dental treatment for each patient. The residents are able to manage the patient from admission to discharge, determining when consultations or assistance in patient management are necessary. The residents also learn to dictate all portions of the patient's dental and medical records. Inpatient care is also provided as consultant to all the medical services at UNMC especially those relating to transplantation and cardiac surgery.

Safe Work Environment
The program follows State, Federal, and National regulatory bodies with respect to asepsis and safety within the workplace. Emergency preparedness and safe work environment materials are available for review. Some of these documents will be provided to the resident during orientation.

A number of educational programs have been developed for the dental residents. These educational programs are designed to provide the residents with additional exposure to both medical and dental problems and developments. The following programs are regularly scheduled for the resident's benefit:

• Educational seminars presented by guest lecturers, attending staff or specialists in Medicine/Dentistry
• Educational seminars presented by the residents
• Periodontal Treatment planning and Case Conference
• Implant Treatment Planning and Case Conference
• Journal Club/Ethical Dilemmas
• Practice Management
• Operative Dentistry
• Fixed and Removable Prosthetics; including implants and introduction to maxillofacial prosthetic concepts
• Continuing education for credit
• Joint conferences with other residency programs
• Meetings with dental representatives to discuss new materials, continuing education, job placement and more

Educational seminars presented by the attending staff, guest lecturers or medical/dental specialists will focus on advanced techniques in the individual's specialty or interest areas. Educational seminars presented by the residents will focus on management of dental patients with special needs or complex management and also on implant placement/restoration patient cases.

Oral pathology conferences are presented by an oral pathologist. The conferences review and augment the resident's knowledge of oral and general pathology as well as oral medicine.

Oral surgery conferences are presented by various medical or oral surgery attending staff or residents. The subjects covered include a variety of dental and medical problems, techniques important to diagnosis and management of patients and techniques or problems in oral surgery. Seminar subjects will cover basic and special considerations for inpatient and outpatient care of dental patients undergoing combined medical and dental procedures. Principles of fluid balance, laboratory interpretation, pain management, TMJ disorders, infection and medication management are just a few examples of subjects presented. A physical assessment course is also provided through the Oral Surgery Service. 

A 12-week lecture course on a restorative approach to implants is also provided with the oral surgeons—this addresses both surgical and restorative aspects of implant placement and restorative. Weekly implant case conferences are held at the VA amongst the prosthodontist, generalists, oral surgeons and residents to discuss cases prior to implant placement and to achieve the best results surgically and restoratively. 

Treatment planning/case review seminars are weekly presentations of difficult or unusual dental patients. The residents are requested to present the patient's medical and dental problems, how they affect the patient and his/her treatment, and what treatment was prescribed and carried out. The program focuses the majority of its didactic efforts into the Monday afternoon treatment planning and case conference. The conference has associated with it operative dentistry, prosthodontia, practice management, literature reviews, professional ethics, ethical dilemmas and systemic disease in dentistry lectures on a rotation basis. Supplemental guest lectures are also provided on topics of interest to the program; TMD, Implants, etc.

Emergency On-Call
Each dental resident is assigned to emergency on-call duty by the program co-directors. Dental residents will alternate call as scheduled and will on occasion support the oral surgery residents in order to gain trauma experience. Dental residents will be expected to provide palliative care to patients admitted to the Emergency Room. The experience will include common general dental problems as well as minor and major traumatic injuries. Residents will not be required to stay on-site when on call.

Off-Site Rotations
Residents will spend two weeks in the Anesthesia rotation and two weeks in a rotation of Emergency Medicine. The length of the VA rotation is dependent upon the total number of residents in the program and currently is six months in duration. A portion of the VA rotation will be held at the facility in Grand Island, Nebraska. Additional rotations are available in pediatric dentistry, oral maxillofacial prosthodontics or any other area of interest within the hospital. 

The resident's rotations will be supervised by the various attending staff and residents on the specific services. The residents are expected to participate in patient care while on rotation and assist the physicians or oral surgeons during procedures and examinations. The rotations are designed to increase the resident's exposure to clinical medicine and allow them to utilize and apply diagnostic skills learned during their training in the residency program.

Immunizations
See University of Nebraska Medical Center Immunization Policy. 

Cardiopulmonary Resuscitation (CPR)
Each student is required to be certified and maintain certification in basic CPR. A copy of the current and valid certification in basic CPR must be maintained at the College of Dentistry. Certification in Advanced Life Support (ACLS) also is encouraged.

Stipend
The estimated stipend will be approximately $46,000, and is not determined until June of the residency year. GME-eligible postgraduate students are eligible for a flexible benefit package which includes choices among health, life, and disability insurance. Future income is contingent upon continued availability of federal funds and, therefore, is subject to change at any time.

The dental resident will be responsible for the timely payment of established program fees and will receive a salary. Established program fees which are the responsibility of the resident include $1,025 per semester equipment tax fee ($2,050 total) and background check fee of $37.45.

Student Loans and Loan Deferment
Currently, postgraduate students are considered students of the College of Dentistry for financial aid purposes. Postgraduate students may get financial aid information from the UNMC Financial Aid Office and student loan payments for postgraduate students can be deferred.

Vacation/Sick Leave
Postgraduate students shall have fifteen (15) scheduled working days of paid Leave per year. Leave includes vacation, sick leave, and professional development leave. Leave in excess of fifteen (15) days per year must be taken as Leave Without Pay from the College or as Family Leave. Such extended leave may result in extension of the training program without pay. Leave requests must be submitted as per the policies of the program and the College.

Private Practice
Students are allowed to participate in private practice (moonlighting activities) but must arrange their schedules with the program co-directors to prevent conflict with program responsibilities.

State of Nebraska Residency
As employees of the University, GME-eligible postgraduate students are considered residents of the State of Nebraska.

The University of Nebraska has in force professional liability insurance covering all enrolled students of the College of Dentistry performing services as part of the College's program.

Current coverage is $1,000,000.00 per person, per occurrence, with $100,000.00 deductible. The University provides self-insurance for the $100,000.00 deductible through the University's general and professional liability insurance program.

Postgraduate students are required to have a Nebraska Dental License (temporary or regular) by the time they are to begin the postgraduate program. Those who accept GME funding are expected to have a Nebraska Dental License (temporary or regular) and federal and state DEA licenses before July 1 of the year of the commencement of their program so they can participate in the After Hours Emergency Care Program.

It is possible for a student who has graduated from an A.D.A. accredited American or Canadian dental school and is licensed in another state, territory, or District of Columbia to obtain a temporary Nebraska Dental License during the time he or she is enrolled as a full-time postgraduate student. The temporary license is only for practice-related and clinical teaching activities within the College of Dentistry and does not allow extramural private practice.

After acceptance into the postgraduate program, licensure information may be obtained from the State of Nebraska Department of Health, Bureau of Examining Boards.

For a regular license, the State Board accepts the results of the clinical examination given by the Central Regional Dental Testing Service. The State Board also has provisions for licensure by credentials for individuals licensed in other states.

Applicant Eligibility
Must have a professional dental degree from an A.D.A.-accredited dental college or school with the degree designation of Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD). Provisional acceptance exists for students in the final stages of dental education. In addition, the applicants must have a valid license to practice within the United States of America or be licensed as such by the time they are to begin the postgraduate program in general practice residency.

Once accepted, a Nebraska dental license is required to participate in the program. At the present time foreign trained dentists (non-U.S. or non-Canadian dental degrees) are not being accepted for the general practice residency training program. This is because of licensing restrictions.

Selection Factors
Additional criteria upon which applications are viewed include:

• Grade point average
• Class standing
• Academic achievements
• National board examination scores
• Recommendations (3)
• Personal statement of goals (include explanation for choice of graduate field, expectations for learning in your chosen field of study, and anticipated career goals)
• Other supporting evidence such as a CV or résumé

Applicant Process
The General Practice Residency program participates in PASS. All applicants must follow the guidelines established by this service to be eligible for the program.

1. Those interested in applying to the program should complete the Postdoctoral Application Support Service (PASS) Request for Applicant Agreement. PASS is a central application service that allows applicants to complete one standard application which is then distributed to each of the participating programs to which the applicant wishes to apply. PASS deals with the initial stages of the recruitment process prior to the evaluation of applicants by the programs. PASS has been designed and is being administered by the American Dental Education Association (ADEA). The application deadline is March 15, but may be extended until all open positions are filled.
2. Those individuals who have completed their application and meet standards for acceptance will be invited for an interview. Personal interviews are conducted by invitation. The application deadline is March 15, but may be extended until all open positions are filled.

See University of Nebraska Medical Center Non-Discrimination and Harassment Policy.