Clinical Practice 2

Course Details

Course Number: 3005  Spring 2013

Location: Bridwell Hall

Classroom Number: 107 A-B

Days & Times:

Mon.      1:00 - 3:00 PM

Tues.      8:00 - 12:00 NOON   OR 1:00 - 5:00 PM   

Thurs.    8:00 - 12:00 NOON

(All Tues. / Thurs. clinical sessions require arrival 30 minutes prior to start of the clinic)



Course Attachments

Textbooks

MSU Faculty Member
Martha Crump   
view Profile »

Course Objectives

COURSE PURPOSE:  The purpose of this course is to further the student's clinical experience in the practical application of oral prophylaxis techniques.  Emphasis will be placed on further development/refinement of skills acquired in Clinical Practice I, patient assessment and documentation, and sequencing of treatment according to patient needs and time factors.

 

Clinical Practice II consists of ten actual clock hours per week; students receive five credit hours

for successful completion of the course.

 

COURSE

OBJECTIVES:          Given the integration of didactic and clinical experiences, the prerequisite course Clinical Practice I

                                    (DNHY 3114), and consistent student-instructor collaboration, upon completion of this course the student should be able to:

 

1.     Position the dental chair, clinician=s stool, and dental light to insure patient/clinician comfort,communication and effective delivery of dental  hygiene  services. 

2.      Organize dental hygiene instruments and supplies in a manner that enhances clinician efficiency

          and insures effective delivery of services.       

3.      Apply accepted standards of infection control at all times in the clinical setting.                

4.      Maintain a patient care delivery area that is organized, safe and follows proper infection

control protocols.

5.      Sharpen and maintain instruments to insure effective instrumentation and preservation of

instrument.

 6.     Utilize information obtained from the health history to determine possible modifications and/or

          contraindications to treatment.

 7.       Accurately assess and document patients vital signs, making referrals to other health care

         providers as appropriate.                                                 

8.      Perform an extra-oral and intraoral inspection and accurately record significant findings.

 9.       Examine all oral tissues for signs of health or pathological changes and record the findings.

 10.    Perform and accurately document a periodontal evaluation for Class 2/2+/3 level patients: including

          recession, pocket depths, loss of attachment, mobility, furcation involvement and bleeding sites.                  

11.    Graphically represent a patient's teeth with regard to caries, missing teeth or tooth structure, types

          and locations of restorations, fixed and removable appliances and developmental anomalies. 

12.    Apply principles of instrumentation and knowledge of tooth morphology in selecting appropriate

         instruments to detect and remove deposits. 

 13.    Develop treatment plan and present to Class 2/2+/3 level patients.

 14.   Obtain the patient informed consent based on a thorough case presentation.

15.    Present appropriate oral health prevention programs based on patients individual needs.

16.    Select and administer appropriate topical fluoride treatment including varnish, tray, rinse &

         brush-on. 

17.    Complete all clinic paperwork legibly and in a timely manner with appropriate detail in documen-

          tation, as is required for this level of clinical practice. 

18.    Demonstrate proper equipment maintenance.

19.    Provide CPR Basic Life support as may be necessary in clinic.

20.    Perform all Clinic Assistant duties utilizing correct techniques and infection control protocol. 

21.    Correctly and efficiently perform all Clinic Receptionist duties.

22.    Properly take alginate impressions; pour and trim acceptable diagnostic casts.

 23.    Determine need for radiographs based on evaluation of specific areas and/or entire dentition and make appropriate recommendations for such surveys based on patient history and assessment

24.    Electronically document one (1) patient assessment finding utilizing Dentrix computer software.

 

 


Course Expectations

ACADEMIC DISHONESTY

Dental Hygiene Honor System:             

All Dental Hygiene courses adhere to the MSU Code of Conduct. In particular, academic dishonesty, however small, creates a breach in academic integrity.  A student’s participation in this course comes with the expectation that his or her work will be completed in full observance of the MSU Code of Student Conduct.  A student should consult the current Student Handbook for answers to any questions about the code.                                                                        

Many components of dental hygiene courses are designed to be highly interactive with students helping each other learn.  Students are encouraged to take full advantage of many resources available including course resources, Internet sites, other textbooks and journals, faculty, and peers when answering objectives. This interactive collegial learning environment is conducive for life-long learning.

Cheating includes, but is not limited to, (1) use of any unauthorized assistance in taking quizzes, tests, or examinations; (2) dependence upon the aid of sources beyond those authorized by the instructor in writing papers, preparing reports, solving problems, or completing other assignments; or (3) the acquisition of tests or other academic materials belonging to the university faculty or staff without permission.

Plagiarism includes, but is not limited to, the use of, by paraphrase or direct quotation without correct citation in the text and on the reference list, the published or unpublished works of another person. Students may NOT submit papers and assignments that they have previously submitted for this or other courses. The use of materials generated by agencies engaged in "selling" term papers is also plagiarism. Students are encouraged to review the tutorials and suggested websites for more information about plagiarism. 

Academic dishonesty (cheating, plagiarism, etc.) will not be tolerated in this class. Whenever a student is unsure of whether a particular situation will be interpreted as academic dishonesty, he/she should ask the instructor for clarification.  If students are guilty of academic dishonesty, a grade of zero (0) will be given for the quiz, assignment, etc.  Cases may also be referred to the Dean of Students for possible dismissal from the university.

               PLEASE NOTE

By enrolling in this course, the student expressly grants MSU a “limited right” in all intellectual property created by the student for the purpose of this course.  The “limited right” shall include but shall not be limited to the right to reproduce the student’s work product in order to verify originality and authenticity, and for educational purposes. Specifically, faculty may submit student papers and assignments to an external agency to verify originality and authenticity, and to detect for plagiarism

MSU COHSHS Student Conduct Appeals Committee

All Midwestern State University (MSU) students may legitimately appeal a course grade if 1) the student has not be evaluated according to the same criteria as his or her classmates, or 2) an error has been made in grading and/or posting (MSU Student Handbook, p. 37.) In addition, the Office of the Dean of Students has the responsibility to enforce standards of conduct for students as outlined in the MSU Student Handbook (p. 70-80).

When enrolled in the College of Health Sciences and Human Services (COHSHS), students are often assigned to community agencies, such as health care facilities, social service agencies, or athletic environments, as part of their academic process. During these experiences, the student is expected to behave in a manner required of professionals working in this environment. COHSHS students may also be required to successfully complete a licensing/certification process following graduation. As a result, students in these programs are often held to a different academic and/or behavioral standard than students in other MSU programs. For example, students may not be allowed to progress in a program if they have been unsuccessful (D or F) in a certain number of courses in the major. In these circumstances, COHSHS faculty and administration, all of whom have had similar professional experience, may make decisions which negatively impact students’ programmatic progress.

COHSHS students have a right to a review of decisions made by the program faculty, which prevent individuals from progressing in their program in a timely manner. However, those who participate in the review must understand the context of the professions involved. Therefore, issues concerning the professional conduct of students in the COHSHS will NOT be brought to the University Grade Committee, but to the COHSHS Student Conduct Appeals Committee. Specifically, the COHSHS Student Conduct Appeals Committee will review faculty decisions related to: 

  • Student conduct in a clinical experience, internship, or other work-related environment that negatively impacts the student’s academic progress. This conduct may include behavior which is prohibited by licensing and/or professional standards or departmental policy.
  • Student removal from a program because of a) professional conduct issues or b) failure to maintain academic standards required specifically by the program*

 

SEE COHSHS WEB SITE FOR A COMPLETE COPY OF THIS POLICY

The American with Disabilities Act:

Midwestern State University does not discriminate on the basis of an individual’s disability and complies with Section 504 and the Americans with Disabilities Act in its admission, accessibility, and employment of individuals in programs and activities. MSU provides academic accommodations and auxiliary aids to individuals with disabilities, as defined by law, who are otherwise qualified to meet academic employment requirements. For assistance call (940) 397-4618 or (940) 397-4515.

It is the student=s responsibility to declare any disabilities.  After declaration, preferably at the beginning of each semester, the student needs to contact individual instructors to determine any reasonable accommodations that may be required.


Grading Standards

 

GRADING RATIONALE

The grade for this course is based on QUALITY (instrumentation quality, assessment / documentation quality, patient management, professionalism, and clinic assistant/ receptionist rotations) and QUANTITY (patient experiences) requirements.  Quality and quantity both play a significant role in the development of student competencies in patient care. Competency evaluations ensure that students can perform procedures at the level of expertise determined necessary for this point in time in their education.  Upon successful completion of the competency evaluations students can then work on improving their abilities, with considerable instructor assistance, on patients in the Gaines Dental Hygiene Clinic (Quality grades). Due to the instructor assistance provided for each student based on his/her needs with each patient QUALITY grades alone are not indicative of student competency.

Competency and QUALITY evaluations ensure that students can perform procedures at the determined level of competence. Quantity requirements are set to ensure that each student has appropriate experiences to develop entry level competencies in patient care. Student abilities in management of patient care are ultimately reflected by the number of patients in each classification level for which the student completes treatment.  Therefore, the number and type of patients treated have a bearing on the student=s final course grade for Clinical Practice 2, 3 and 4.

 

            QUALITY GRADE   

            The QUALITY portion of the Clinical Practice 2 grade is broken down as follows:

40%        Instrumentation (From Clinic Grade Sheets & Process Evaluations)          

30%        Assessment/Documentation (From Clinic Grade Sheets)

20%        Patient Management (From Clinic Grade Sheets)

  5%            BW X-rays

  5%        Clinic Assistant/Receptionist

                              100%    = QUALITY GRADE

              

               Clinic Assistant/Receptionist Grade

               Students will start with 100 points in this area.  Infractions will result in deduction of points from the applicable “100”

               starting points. Each infraction will incur a five (5) point deduction from the initial 100 points. (See Assistant/Receptionist

               Forms, objectives & criteria – Student Handbook/Clinic Manual, Section 6.7).

               Breach of Professionalism Protocol

               During a clinical session a breach of the professionalism protocol not directly related to the treatment of a patient will

                result in: 

                         1st   Infraction - Formal warning

                         2nd   Infraction - 5 point deduction from the FINAL clinic QUALITY grade

                          (See Student Handbook/Clinic Manual, Sections 2.8 & 2.9)

 

                    Competency Evaluations

There are six competency evaluations in Clinical Practice 2: 

  1. Topical Fluoride Application- On fellow students -To be scheduled by instructor
  2. Coronal Polishing- On fellow students -To be scheduled by instructor
  3. Instrumentation -On fellow students & / or typodont - To be scheduled by instructor
  4. Medical History Review - On fellow students - To be scheduled by instructor
  5. Cleaning of Dental Prostheses - To be scheduled by instructor
  6. Management of Class 2-2+ Level Patient Treatment - March 26, 2013

      

        COMPETENCY EVALUATION PROTOCOL:

If student is unsuccessful in demonstrating the specified competency the following will apply:

 1st Remediation Session:               Remediate one-on-one with instructor outside of regular clinic session (Instrumentation on typodont)

2nd Remediation Session:              Remediate on the eval patient or equivalent classification patient during a regular clinic session. No quantity points and/or grade are earned for treatment provided during this session. 

1st  Competency Re-eval:               Re-eval on equivalent classification patient during a regular clinic session.

                                             No quantity points and/or grade are earned for treatment provided during this session.    

If student is unsuccessful on 1st Competency Re-eval he/she can repeat the series of steps listed above two (2) more times. If competency is not demonstrated at the 3rd Competency Re-eval student will be dropped from Clinical Practice 2 and not be permitted to advance into the next semester of the program. The remediation required by unsuccessful demonstrations of competency result in reduced patient experiences, which could in turn result in reductions to the final QUALITY grade. All competency eval & re-eval grades will be included in student=s average.

The dental hygiene department has the right to make arrangements on an individual basis for students failing to maintain a passing grade in any course.  Whatever arrangements made will be based upon an examination of the individual student=s overall dental hygiene scholastic record. This will be decided by the Department Chair and at least two other dental hygiene faculty.  Readmission is not automatic.    

 

            QUANTITY

Patient Equivalency Number

During Clinical Practice II, emphasis is placed on skill development rather than speed (within reason). Due to the extensive collaboration between student and faculty during all patient treatment, the Clinic Grade-sheet grades alone are not an accurate assessment of competency levels. How proficient a student is in the overall management of patient care is reflected in the number and type of patients for which the student completes treatment.  A student must have adequate patient experiences for his/her QUALITY grade to accurately reflect level of competency.  Patient Equivalency Numbers (PEN) have been established for Clinical Practice 2.

 

A student must provide treatment for a minimum of 12 patient equivalencies (only 4 of which should be Class 1 level- 16 quads).  A  Patient Equivalency Number (PEN) less than 12 will result in point deductions from the final Quality Grade as indicated below:

PEN = 12            No points deducted from Quality Grade

PEN = 10-11       4 points deducted from Quality Grade

PEN =   8- 9        8 points deducted from Quality Grade

PEN <   8           10 points deducted from Quality Grade

 

 

COMPUTATION OF PATIENT EQUIVALENCY NUMBER (PEN)

Add total quads treated and divide by 4 (4 quads to a patient) to compute the Patient Equivalency Number (PEN)

The Patient Equivalency Number (PEN) is rounded up to the next level, if greater than a whole number, for the student=s benefit. This is unique for this course only and this policy will not be duplicated for any other dental hygiene course.


Submission Format PolicyNote: You may not submit a paper for a grade in this class that already has been (or will be) submitted for a grade in another course, unless you obtain the explicit written permission of me and the other instructor involved in advance.

Plagiarism Policy Plagiarism is the use of someone else's thoughts, words, ideas, or lines of argument in your own work without appropriate documentation (a parenthetical citation at the end and a listing in "Works Cited")-whether you use that material in a quote, paraphrase, or summary. It is a theft of intellectual property and will not be tolerated, whether intentional or not.

Student Honor Creed

As an MSU Student, I pledge not to lie, cheat, steal, or help anyone else do so."

As students at MSU, we recognize that any great society must be composed of empowered, responsible citizens. We also recognize universities play an important role in helping mold these responsible citizens. We believe students themselves play an important part in developing responsible citizenship by maintaining a community where integrity and honorable character are the norm, not the exception. Thus, We, the Students of Midwestern State University, resolve to uphold the honor of the University by affirming our commitment to complete academic honesty. We resolve not only to be honest but also to hold our peers accountable for complete honesty in all university matters. We consider it dishonest to ask for, give, or receive help in examinations or quizzes, to use any unauthorized material in examinations, or to present, as one's own, work or ideas which are not entirely one's own. We recognize that any instructor has the right to expect that all student work is honest, original work. We accept and acknowledge that responsibility for lying, cheating, stealing, plagiarism, and other forms of academic dishonesty fundamentally rests within each individual student. We expect of ourselves academic integrity, personal professionalism, and ethical character. We appreciate steps taken by University officials to protect the honor of the University against any who would disgrace the MSU student body by violating the spirit of this creed. Written and adopted by the 2002-2003 MSU Student Senate.

Students with Disabilities The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides comprehensive civil rights protection for persons with disabilities. Among other things, this legislation requires that all students with disabilities be guaranteed a learning environment that provides for reasonable accommodation of their disabilities. If you believe you have a disability requiring an accommodation, please contact the Disability Support Services in Room 168 of the Clark Student Center, 397-4140.

Safe Zones Statement The professor considers this classroom to be a place where you will be treated with respect as a human being - regardless of gender, race, ethnicity, national origin, religious affiliation, sexual orientation, political beliefs, age, or ability. Additionally, diversity of thought is appreciated and encouraged, provided you can agree to disagree. It is the professor's expectation that ALL students consider the classroom a safe environment.

Contacting your Instructor All instructors in the Department have voicemail in their offices and MWSU e-mail addresses. Make sure you add your instructor's phone number and e-mail address to both email and cell phone lists of contacts.

Attendance Requirements

Mon.      1:00 - 3:00 PM

Tues.      8:00 - 12:00 NOON   OR 1:00 - 5:00 PM   

Thurs.    8:00 - 12:00 NOON

(All Tues. / Thurs. clinical sessions require arrival 30 minutes prior to start of the clinic)

 

ATTENDANCE:

The Dental Hygiene Faculty feel very strongly that maximum participation in all clinical and laboratory exercises is critical to the development of clinical competencies. Therefore, more than two absences for any reason will result in a loss of 5 points from the final course grade for each absence over 2.  

ANYONE MISSING MORE THAN FOUR (4) CLINICAL SESSIONS FOR ANY REASON WILL BE DROPPED FROM CLINICAL PRACTICE 2.  YOU CAN NOT MATRICULATE INTO THE SECOND YEAR WITHOUT SUCCESSFULLY COMPLETING CLINICAL PRACTICE 2. 

A student on Probationary Status will not be permitted absences for any reason until he/she is taken off of probationary status by the Dental Hygiene Admissions Committee.

When the student has an open appointment time due to a No-show, cancellation, or no scheduled patient the student will be expected to work on impression requirements, help the clinic assistant or receptionist as needed, or assigned a specific skill to practice.  YOU MUST REMAIN IN THE CLINIC AREA. The dressing/locker room is not considered a clinical area (See Professionalism Criteria - Student Handbook) 

DO NOT SIT IN THE RECEPTION ROOM OR AT THE RECEPTION DESK unless you are the scheduled receptionist. If an instructor and/or the department secretary has to ask you to leave the reception desk FIVE (5) points for Breach of Professionalism WILL BE DEDUCTED FROM your FINAL clinic grade. You may study in your clinic unit with clinic instructor permission. 

ALL STUDENTS MUST CHECK WITH AN INSTRUCTOR BEFORE LEAVING THE CLINIC AREA

(See Professionalism Criteria - Student Handbook)

 


Other Policies

RADIOLOGY GRADING FOR CLINICAL PRACTICE 2   

                  Technique

        Bite-Wing Series – (95 Minimum passing grade)

        A five (5) point deduction will be made for each major error as listed on the film grade form.

        A five (5) point deduction will be made for each unnecessary BW film exposed. 

        (Ex: 4 films exposed when only 2 are needed on a child will result in a loss of 10 points from technique grade)

 

                  CRITIQUE/LANDMARKS/FINDINGS       

        Minimum passing grade is 75 points.  A FIVE (5) point deduction will be made for each omission/error. 

          PAPERWORK/DOCUMENTATION

         

                         1.      ALL X-RAYS MUST BE GRADED and the findings sheet attached to the patient’s chart.

                                  Radiographic surveys MUST be evaluated & turned in for grading within one (1) week of exposure.

                                 

                                  If the case involves retakes to be made at a later date from the original appointment, then the one-week clock

                                  starts running from the retake date.  It is therefore, important for the retake date to be stated on the grade form,

                                  as well as the date of the original exposures. Failure to comply with this policy will result in the case NOT

                                  COUNTING toward clinical requirements, even if technique grade is above the 95% level.

 

          2.      X-RAY AUTHORIZATION FORM MUST BE SIGNED by a clinical instructor PRIOR to exposure.

                   An UNAUTHORIZED set of films must be evaluated but WILL NOT count toward requirements.

                   IN ADDITION a 30 point deduction will be assessed against the critique/landmark/findings grade.

 

          3.      Patient's chart MUST be turned in with radiographs to be graded.  MUST have Radiology Prescription,

                   proper notation on Treatment Summary, Disposition Form & Radiology History/Authorization Form and Mount

                   properly labeled.

 

                     Complete documentation consists of:

                     a.   Properly Labeled Mount - patient and student names and date of exposure

                     b.    Completed Critique/Landmarks/Findings Forms.  "Findings" must be in ink.

                     c.     Essential data on Radiology Grade Form.

                     d.    Patient Instruction / Referral Form –

                            When radiographic findings indicate that the patient will be referred for any reason (caries,

                            periodontal disease, etc) this MUST be indicated on the referral form BEFORE the radiographs are

                            turned in for evaluation, EVEN if treatment has not been completed on the patient & a faculty

                            member has not yet signed form.

                               e.     Proper notation on Treatment Summary with Radiology RX form stapled to top of page.

                              f.     Radiology paperwork/forms must be turned in for grading in the following order in the patient file:

                                             1.  X-rays

                                             2.  Radiology Grade Form

                                             3.  Critique/Landmarks/Findings Forms  

                                             4.  Referral Form

                                             5.  Treatment Summary w/ Radiology Rx form stapled to top of page      

 

          4.      Films presented for grading with incomplete documentation or out of order (See #3 a-f) will have twenty

                   five (25) points deducted from the Landmark Grade.

 

          5.      ALL x-rays will be checked against the Radiology Film Check-Out Log

                   Failure to annotate the log will result in disqualification of the films from Quantity requirements, even if set is at

                   competency level.

 

 CLINICAL RADIOLOGY PROTOCOL

In the MSU Dental Hygiene Program, patient=s needs take precedence over the grading and/or requirement needs of students at all times.  All radiographs must be of the highest diagnostic quality possible. All precautions must be taken to ensure that patients/clients are exposed to the minimum necessary amount of radiation.  Long-cone, paralleling technique produces the most accurate diagnostic films.  Students should use this technique in all but extenuating circumstances.

 

  • Students must be in scrubs for exposure of any radiographs.
  • X-ray authorization form must be signed by a clinical instructor prior to exposure.

            An UNAUTHORIZED set of films must be evaluated but will not count toward requirements.

            In addition a 30 point deduction will be assessed against the critique/landmark/findings grade 

  • All films must be documented in x-ray log prior to exposure.
  • Retakes:  Only 4 retakes per FMS / 1 retake per BWS only! Film will be distributed by faculty, only after evaluating the original survey.  Violation of this policy will be construed as ACADEMIC DISHONESTY (see MSU 2006-08 Student Handbook), and subject to DISCIPLINARY ACTION.
  • Radiographic surveys MUST be evaluated and turned in for grading within 1 week of completion of the case.  If the case involves retakes to be made at a later date from the original appointment, then the one- week clock starts running from the retake date.  It is therefore, important for the retake date to be stated on the grade form, as well as the date of the original exposures.  Failure to comply with this policy will result in the case NOT COUNTING toward clinical requirements, even if technique grade is above the 95% level. 

            All cases should be completed as quickly as possible as we have the ethical and moral responsibility to  inform the patient of any pathology that we note on their case.  If a patient refuses retakes, this should  be noted in the treatment summary and the case must be turned in for grading as-is.  All cases must be    evaluated by Dr. Davis regardless of the circumstances.

  • No patient radiographs will leave the Dental Hygiene Department unless requested by patient to be sent to a dentist. 

            Radiographs will be kept in the patient=s file - files will be located in reception area file cabinets, student wall    box, reappoint box, or in clinic operatory during treatment.  At no time should files be kept in student lockers or           treatment areas unless patient is in the chair. 

  • Film packets will be available in prepared packets according to the following schedule

1)   Adult FMS - 20 films (12 #2-8 #1)

2)   Adult BWS - 4 films (#2)

3)   Mixed Dentition BWS - 2 (#2)

4)   Pedo BWS - 2 (#0)

5)   For special cases see your Instructor

FAILURE TO COMPLY WITH ABOVE PROTOCOL CONSTITUTES PROFESSIONAL DISHONESTY AND GROUNDS FOR DISMISSAL FROM THE PROGRAM.

6.    IMPRESSIONS/DIAGNOSTIC CASTS              

Each student must take two (2) maxillary and two (2) mandibular impressions (1 complete set per patient) at a 75% competency level according to the stated criteria. Impressions must be taken in a regularly scheduled clinical session utilizing proper infection control protocol.  The clinician must be in scrubs.  An instructor must watch the process of placing the impression trays.  Diagnostic casts from impressions must be matched sets (a maxillary and mandibular from same patient) and must be on two (2) separate patients - each of whom will be a fellow student.  Fewer than the required number will result in a TWO point deduction from the FINAL QUALITY GRADE for EACH MISSING SET OF CASTS.

CASTS MUST BE TRIMMED AND TURNED IN FOR GRADING WITHIN 7 DAYS OF POURING. CASTS TURNED IN AFTER 7 DAYS WILL NOT COUNT TOWARD REQUIREMENTS. ALL CASTS MUST BE TURNED IN NO LATER THAN 5:00 PM ON THURSDAY APRIL 25, 2013

FAILURE TO MEET THE MINIMUM NUMBER OF ASSESSMENT/ DOCUMENTATION, BITEWING RADIOGRAPHS, FLUORIDE APPLICATIONS AND DIAGNOSTIC MODEL REQUIREMENTS WILL RESULT IN A 2 POINT REDUCTION OF THE QUALITY GRADE FOR EACH MISSING REQUIREMENT.


Writing Proficiency Requirement All students seeking a Bachelor's degree from Midwestern State University must satisfy a writing proficiency requirement once they've 1) passed English 1113 and English 1123 and 2) earned 60 hours. You may meet this requirement by passing either the Writing Proficiency Exam or English 2113. Please keep in mind that, once you've earned over 90 hours, you lose the opportunity to take the $25 exam and have no option but to enroll in the three-credit hour course. If you have any questions about the exam, visit the Writing Proficiency Office website at http://academics.mwsu.edu/wpr, or call 397-4131.