The scenario presents a professional challenge due to the inherent tension between maintaining the integrity of the Advanced Pan-Asia Gerodontology Quality and Safety Review’s blueprint weighting and scoring system, and the desire to accommodate a highly experienced candidate who may not have met the standard retake policy. Navigating this requires a careful balance of adherence to established procedures and consideration of exceptional circumstances, all while upholding the review’s commitment to quality and safety. The best approach involves a thorough, documented review of the candidate’s prior performance and a formal request for an exception to the retake policy, clearly articulating the rationale. This approach is correct because it respects the established blueprint weighting and scoring mechanisms by not arbitrarily altering them. It also acknowledges the existence of a retake policy, demonstrating an understanding of the review’s governance. By seeking a formal exception, it ensures transparency and accountability, allowing for a structured decision-making process that considers the candidate’s experience against the review’s objectives. This aligns with ethical principles of fairness and due process, while also prioritizing the review’s commitment to maintaining high standards for gerodontology quality and safety. An incorrect approach would be to unilaterally waive the retake requirement for the candidate based solely on their extensive experience, without a formal review or documented justification. This fails to uphold the established blueprint weighting and scoring policies, potentially undermining the credibility of the review process for all participants. It also bypasses the established retake policy, creating an inconsistent and potentially unfair precedent. Another incorrect approach would be to adjust the scoring criteria or blueprint weighting specifically for this candidate to allow them to pass. This directly violates the integrity of the established blueprint weighting and scoring system. It introduces bias and compromises the objective assessment of competency, which is crucial for ensuring quality and safety in gerodontology. Finally, an incorrect approach would be to simply deny the candidate the opportunity to retake the review without any consideration of their experience or a clear explanation of why the retake policy is being strictly enforced in this instance. While adherence to policy is important, a complete lack of consideration for exceptional circumstances or a failure to communicate the rationale can be perceived as inflexible and lacking in professional judgment, potentially leading to dissatisfaction and questions about the review’s fairness. Professionals should approach such situations by first understanding the established policies and guidelines regarding blueprint weighting, scoring, and retake procedures. They should then assess the specific circumstances of the candidate, considering their experience and any mitigating factors. A decision-making framework should involve consulting relevant documentation, seeking guidance from senior colleagues or review board members if necessary, and always prioritizing transparency, fairness, and the ultimate goal of maintaining high standards for quality and safety.

Scenario Analysis: This scenario presents a professional challenge due to the inherent tension between a provider’s desire to improve patient outcomes through advanced review and the strict eligibility criteria designed to ensure the review’s integrity and relevance. Navigating this requires a nuanced understanding of the review’s purpose and the ethical imperative to adhere to established guidelines, even when faced with a seemingly beneficial but ineligible situation. Careful judgment is required to balance the pursuit of quality with the obligation to follow regulatory frameworks. Correct Approach Analysis: The best professional approach involves a thorough understanding and strict adherence to the stated eligibility criteria for the Advanced Pan-Asia Gerodontology Quality and Safety Review. This means recognizing that a patient’s advanced dental needs, while significant, do not automatically qualify them if they do not meet the specific demographic or clinical criteria outlined by the review’s governing body. The ethical justification lies in upholding the integrity of the review process, ensuring that resources are allocated appropriately, and that the data generated is representative of the intended population. This approach prioritizes transparency and compliance with the established framework. Incorrect Approaches Analysis: One incorrect approach would be to submit the patient for the review based solely on the perceived severity of their dental condition, disregarding the explicit eligibility requirements. This fails to respect the defined scope and purpose of the review, potentially skewing results and misallocating review resources. Ethically, it undermines the principle of fairness and adherence to established protocols. Another incorrect approach would be to attempt to subtly alter the patient’s records or presentation to fit the eligibility criteria. This constitutes a serious ethical breach, involving deception and a violation of professional integrity. It compromises the validity of the review and erodes trust in the gerodontology quality and safety process. A further incorrect approach would be to bypass the review process entirely and proceed with advanced treatment without considering the review’s potential benefits or the established pathway for quality assurance. This neglects the opportunity to contribute to broader quality improvement efforts and may indicate a lack of commitment to the systematic evaluation of care within the Pan-Asian gerodontology context. Professional Reasoning: Professionals should approach such situations by first consulting the official documentation outlining the purpose and eligibility for the Advanced Pan-Asia Gerodontology Quality and Safety Review. They must then objectively assess the patient’s situation against these defined criteria. If the patient does not meet the criteria, the professional’s responsibility is to acknowledge this limitation and explore alternative avenues for providing optimal care or contributing to quality improvement initiatives that align with the patient’s specific needs and the review’s established parameters. Ethical decision-making hinges on transparency, integrity, and adherence to the governing framework.

Scenario Analysis: This scenario presents a professional challenge rooted in the inherent conflict between a patient’s autonomy and the clinician’s duty of care, particularly when a patient’s decision-making capacity is in question due to age-related cognitive decline. The geriatric patient’s expressed desire for a specific, potentially suboptimal, treatment, juxtaposed with the clinician’s professional judgment regarding the best course of action for long-term oral health and quality of life, necessitates a careful, ethically grounded, and regulatory-compliant approach. The pressure to act swiftly while respecting patient rights and ensuring optimal outcomes creates a complex decision-making environment. Correct Approach Analysis: The best professional practice involves a comprehensive assessment of the patient’s capacity to understand the proposed treatment options, their risks, benefits, and alternatives, and to communicate a choice. This approach prioritizes obtaining informed consent by first establishing the patient’s decision-making capacity. If capacity is found to be lacking, the next step is to involve the patient’s designated legal guardian or a trusted family member, presenting all relevant information clearly and transparently, and collaboratively developing a treatment plan that aligns with the patient’s known wishes and best interests, as guided by established ethical principles of beneficence and non-maleficence, and adhering to any relevant national guidelines on patient consent and capacity assessment for vulnerable adults. Incorrect Approaches Analysis: One incorrect approach involves proceeding with the patient’s preferred treatment without a thorough assessment of their capacity to consent. This fails to uphold the ethical principle of ensuring informed consent, as a patient lacking capacity cannot truly consent. It also risks providing a treatment that may not be in the patient’s best long-term interest, potentially violating the principle of beneficence. Another incorrect approach is to unilaterally override the patient’s wishes and impose the clinician’s preferred treatment without engaging in a capacity assessment or involving appropriate surrogates. This disregards the patient’s autonomy and right to self-determination, even if their capacity is compromised. It also bypasses the necessary steps for ethical and legal decision-making when a patient’s capacity is in doubt. A third incorrect approach is to delay treatment indefinitely due to uncertainty about the patient’s capacity, without initiating a formal assessment process or seeking guidance. This can lead to the patient’s oral health deteriorating, potentially causing pain and further compromising their quality of life, which is a failure of the duty of care and beneficence. Professional Reasoning: Professionals facing such dilemmas should employ a structured decision-making process. This begins with recognizing the ethical tension and potential conflict. Next, a thorough assessment of the patient’s capacity to make the specific decision at hand is crucial, utilizing validated tools or established clinical protocols. If capacity is confirmed, informed consent is paramount. If capacity is impaired, the process shifts to identifying and involving the appropriate surrogate decision-maker, such as a legal guardian or next of kin, and ensuring they are fully informed. The ultimate goal is to arrive at a treatment plan that respects the patient’s values and preferences to the greatest extent possible, while ensuring their safety and well-being, in accordance with ethical guidelines and relevant legal frameworks governing patient care and decision-making for individuals with diminished capacity.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between patient well-being, cost-effectiveness, and the ethical obligation to maintain the highest standards of infection control. The dentist must balance the immediate financial implications of replacing potentially compromised materials with the long-term risks of cross-contamination and patient harm, all within a regulatory framework that prioritizes safety. Careful judgment is required to navigate these competing demands without compromising professional integrity or patient trust. Correct Approach Analysis: The best professional practice involves immediate cessation of the use of the suspect dental materials and initiation of a thorough investigation. This approach prioritizes patient safety and regulatory compliance by proactively addressing a potential breach in infection control protocols. It involves isolating the materials, documenting the findings, and consulting with relevant authorities or internal quality assurance teams to determine the extent of the issue and the appropriate remediation steps. This aligns with the fundamental ethical principle of “do no harm” and the regulatory imperative to maintain sterile environments and safe practices in dental care. The proactive stance ensures that any potential risk to patients is mitigated swiftly and effectively, preventing further exposure and allowing for a systematic resolution. Incorrect Approaches Analysis: One incorrect approach involves continuing to use the dental materials while attempting to disinfect them externally. This is professionally unacceptable because it fails to address the potential for internal contamination within the materials themselves, which may not be effectively sterilized by surface disinfection. This approach disregards the principle of preventing cross-contamination at its source and violates regulatory guidelines that mandate the use of sterile or appropriately disinfected materials. Another incorrect approach is to ignore the observation and continue with treatment as planned, assuming the materials are safe. This is a grave ethical and regulatory failure. It demonstrates a disregard for established infection control protocols, potentially exposes patients to harmful microorganisms, and violates the dentist’s duty of care. Such inaction could lead to serious patient harm and significant legal and professional repercussions. A further incorrect approach is to dispose of the materials without proper documentation or investigation. While disposal might be necessary, doing so without understanding the root cause of the contamination or its potential impact is insufficient. This approach fails to fulfill the professional obligation to identify and rectify systemic issues within the practice’s infection control procedures, potentially leaving other vulnerabilities unaddressed and risking future incidents. Professional Reasoning: Professionals should adopt a systematic decision-making process when faced with potential breaches in infection control. This involves: 1. Immediate identification and isolation of the suspect item or process. 2. Thorough investigation to determine the nature and extent of the problem, including potential sources of contamination. 3. Consultation with relevant internal or external experts or regulatory bodies if necessary. 4. Implementation of appropriate corrective actions, which may include disposal, sterilization, or replacement of materials, and review of existing protocols. 5. Comprehensive documentation of the incident, investigation, and resolution. This framework ensures that patient safety remains paramount while upholding professional standards and regulatory compliance.

This scenario presents a common ethical challenge in gerodontology, where the patient’s autonomy, the family’s perceived best interests, and the clinician’s professional duty of care intersect. The challenge lies in balancing the patient’s expressed wishes with the family’s concerns about her cognitive decline and potential financial exploitation, while also adhering to ethical principles of beneficence, non-maleficence, and respect for autonomy. Careful judgment is required to navigate these competing interests without compromising the patient’s dignity or the integrity of the professional relationship. The best professional approach involves a multi-faceted strategy that prioritizes direct communication with the patient while acknowledging and addressing the family’s concerns through appropriate channels. This approach begins with a thorough assessment of the patient’s capacity to make informed decisions regarding her dental treatment. If capacity is deemed present, her wishes should be respected, and treatment should proceed accordingly, with clear documentation of the assessment and decision-making process. Simultaneously, the clinician should engage with the family, explaining the patient’s capacity and the ethical obligations to respect her autonomy. If capacity is questionable or absent, the clinician must initiate a formal capacity assessment process, potentially involving a geriatric specialist or legal counsel, and communicate findings transparently with the family, guiding them towards appropriate legal avenues for decision-making if necessary. This approach upholds the patient’s right to self-determination while ensuring her well-being and addressing potential risks identified by the family through established ethical and legal frameworks. An approach that dismisses the family’s concerns outright, focusing solely on the patient’s stated wishes without a comprehensive capacity assessment, fails to uphold the principle of beneficence and could potentially lead to harm if the patient is indeed vulnerable. This neglects the professional responsibility to act in the patient’s best interest, which may include protecting them from exploitation. Another unacceptable approach would be to unilaterally proceed with treatment based solely on the family’s insistence, overriding the patient’s expressed desires without a proper capacity assessment. This violates the principle of respect for autonomy and could constitute professional misconduct. Finally, an approach that involves informing the patient’s bank or financial institutions without a formal legal directive or established capacity assessment is a breach of patient confidentiality and professional boundaries. Such actions could have serious legal and ethical repercussions. Professionals should employ a structured decision-making process that includes: 1) assessing the patient’s capacity to consent, 2) engaging in open and honest communication with both the patient and their family, 3) documenting all assessments, discussions, and decisions meticulously, 4) seeking interprofessional consultation (e.g., geriatricians, social workers, legal advisors) when complex ethical or capacity issues arise, and 5) adhering strictly to professional codes of conduct and relevant legal statutes regarding patient autonomy and decision-making.

This scenario presents a professional challenge due to the inherent conflict between patient autonomy, the dentist’s professional judgment, and the potential for financial implications for the practice. The dentist must navigate these competing interests while upholding the highest standards of patient care and ethical conduct, particularly within the context of gerodontology where patients may have complex needs and varying levels of capacity. Careful judgment is required to ensure that treatment decisions are based solely on the patient’s best interests and not influenced by external pressures or potential financial gain. The best approach involves a thorough, documented assessment of the patient’s oral health status, functional needs, and cognitive capacity, followed by a clear, patient-centered discussion of all viable treatment options, including their risks, benefits, and alternatives. This approach prioritizes informed consent and shared decision-making. Specifically, it requires the dentist to: 1) Conduct a comprehensive clinical examination and gather relevant diagnostic information. 2) Assess the patient’s capacity to understand and make decisions about their treatment. If capacity is questionable, involve a designated caregiver or family member with appropriate consent. 3) Present all clinically indicated treatment options, explaining them in clear, understandable language, tailored to the patient’s comprehension level. 4) Discuss the pros and cons of each option, including the implications of no treatment. 5) Document the entire process meticulously, including the assessment of capacity, the information provided, the patient’s expressed preferences, and the final treatment plan agreed upon. This aligns with ethical principles of beneficence (acting in the patient’s best interest), non-maleficence (avoiding harm), autonomy (respecting the patient’s right to choose), and justice (fair allocation of resources and care). It also adheres to professional guidelines that emphasize patient-centered care and informed consent. An approach that proceeds with a more expensive treatment without fully exploring less invasive or less costly, yet clinically appropriate, alternatives fails to uphold the principle of beneficence and potentially violates the duty to avoid unnecessary treatment. It also risks undermining patient autonomy if the patient was not fully informed of all options and their implications. Another unacceptable approach involves deferring the decision solely to the patient’s family or caregiver without a thorough assessment of the patient’s own wishes and capacity, or without ensuring the family fully understands the clinical nuances. While family involvement is often crucial, the primary ethical obligation remains with the patient. Proceeding with the most expensive treatment option simply because it is available or because the patient’s insurance may cover it, without a clear clinical justification and a thorough discussion of alternatives with the patient, is ethically unsound. This prioritizes financial considerations over the patient’s best interests and violates the principles of beneficence and justice. Professionals should employ a structured decision-making process that begins with a comprehensive assessment of the patient’s clinical needs and functional status. This should be followed by an evaluation of the patient’s capacity to make informed decisions. Open and honest communication with the patient, and their designated support persons where appropriate, is paramount. All treatment options, including their risks, benefits, and costs, should be presented clearly and without bias. The final decision should be a collaborative one, respecting the patient’s values and preferences, and meticulously documented.

This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the clinician’s professional judgment regarding their oral health needs, particularly in the context of geriatric care where cognitive and physical limitations can influence decision-making. The requirement for comprehensive examination and treatment planning in gerodontology necessitates a thorough assessment that goes beyond immediate patient requests to ensure long-term oral health, function, and quality of life. Careful judgment is required to balance patient autonomy with the clinician’s duty of care and ethical obligations. The approach that represents best professional practice involves conducting a thorough, independent clinical assessment, including a comprehensive oral examination, review of medical history, and functional status evaluation, before discussing treatment options with the patient and their caregiver. This approach prioritizes evidence-based care and the patient’s overall well-being. It aligns with ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), as well as professional guidelines that mandate a complete diagnostic workup prior to treatment planning. This ensures that any proposed treatment is medically and dentally indicated, safe, and appropriate for the patient’s specific needs and capabilities, and that the patient is fully informed of all relevant considerations. An approach that solely defers to the patient’s immediate, potentially limited, request without a comprehensive assessment is professionally unacceptable. This fails to uphold the clinician’s duty of care to provide appropriate treatment and could lead to suboptimal outcomes or even harm if the requested treatment does not address underlying issues or is contraindicated. It neglects the ethical principle of beneficence by not acting in the patient’s best long-term interest. Another professionally unacceptable approach is to proceed with a treatment plan based solely on the caregiver’s interpretation of the patient’s wishes without direct, independent verification and assessment of the patient’s actual needs and capacity. While caregivers are important, the primary ethical and professional responsibility lies with the clinician to assess the patient directly and ensure informed consent is obtained from the patient to the greatest extent possible, respecting their autonomy. Finally, an approach that involves imposing a treatment plan that the clinician believes is ideal without adequately exploring the patient’s preferences, understanding their limitations, or involving them in the decision-making process, even if the plan is clinically sound, is also professionally problematic. This can undermine patient autonomy and trust, and may lead to poor compliance or dissatisfaction. Professionals should employ a decision-making framework that begins with a comprehensive assessment, followed by open communication with the patient and their support system, collaborative treatment planning that respects patient values and preferences while adhering to professional standards, and ongoing evaluation of the patient’s response to treatment.

This scenario presents a professional challenge because it requires balancing the immediate need for a candidate to demonstrate competence with the ethical obligation to ensure that preparation resources are fair, equitable, and do not confer an undue advantage. The pressure to pass an advanced review, especially in a specialized field like Gerodontology, can lead individuals to seek shortcuts or materials that may compromise the integrity of the assessment process. Careful judgment is required to uphold the standards of the review and maintain public trust in the qualifications of practitioners. The best professional approach involves proactively seeking official guidance from the examination body regarding recommended preparation resources and timelines. This approach is correct because it aligns with the ethical principles of fairness and integrity in professional assessments. By adhering to officially sanctioned materials and timelines, candidates ensure they are preparing based on the intended scope and depth of the review, as defined by the credentialing body. This minimizes the risk of using outdated, inaccurate, or unfairly advantageous materials. It also demonstrates a commitment to a transparent and equitable examination process, which is crucial for maintaining the credibility of the Advanced Pan-Asia Gerodontology Quality and Safety Review. An incorrect approach involves relying solely on informal study groups and unofficial online forums for preparation materials and timeline advice. This is professionally unacceptable because these sources are often unvetted, may contain inaccurate or incomplete information, and can lead to a skewed understanding of the review’s requirements. There is a significant risk of encountering outdated or misleading content, which could negatively impact performance and undermine the validity of the assessment. Furthermore, relying on such informal networks can create an uneven playing field, potentially disadvantaging candidates who do not have access to the same informal networks or who choose to adhere to more structured, official preparation methods. Another incorrect approach is to prioritize speed over thoroughness, focusing only on cramming key topics identified through anecdotal evidence from past candidates. This is professionally unacceptable as it neglects the comprehensive nature of an advanced review focused on quality and safety. Gerodontology requires a deep and nuanced understanding, and superficial cramming is unlikely to equip a candidate with the necessary knowledge and critical thinking skills to address complex quality and safety issues. This approach risks superficial knowledge acquisition, leading to potential errors in practice and a failure to meet the high standards expected of advanced practitioners. A final incorrect approach involves purchasing commercially available “guaranteed pass” study packages without verifying their alignment with the official curriculum or the examination body’s recommendations. This is professionally unacceptable because such packages may not be developed or endorsed by the credentialing body, potentially leading to preparation that is misaligned with the actual review content. The promise of a “guaranteed pass” can be misleading and may encourage candidates to bypass legitimate preparation methods, ultimately compromising their understanding and the integrity of the certification process. It also raises ethical concerns about exploiting candidates’ anxieties about the examination. Professionals should adopt a decision-making framework that prioritizes seeking official guidance, engaging in structured and comprehensive study, and maintaining ethical conduct throughout the preparation process. This involves actively consulting the examination body’s website, official syllabi, and recommended reading lists. When in doubt, direct communication with the examination administrators is paramount. Furthermore, professionals should critically evaluate all study resources, ensuring they are current, relevant, and aligned with the stated objectives of the review. This proactive and ethical approach ensures preparedness that is both effective and fair.

The analysis reveals a scenario that is professionally challenging due to the inherent conflict between a patient’s expressed wishes and the clinician’s professional judgment regarding the necessity of a specific diagnostic procedure. This situation requires careful ethical and clinical reasoning to balance patient autonomy with the duty of care and the principles of evidence-based practice. The core of the challenge lies in determining how to proceed when a patient, who may be experiencing anxiety or misunderstanding, refuses a procedure deemed essential for accurate diagnosis and treatment planning, particularly in the context of potential oral pathology in an elderly patient. The correct approach involves a comprehensive and empathetic discussion with the patient, aiming to understand the root of their refusal and provide clear, accessible information about the procedure’s benefits, risks, and alternatives. This approach prioritizes patient education and shared decision-making. It acknowledges the patient’s right to refuse treatment while fulfilling the clinician’s ethical obligation to ensure the patient is fully informed and capable of making such a decision. This aligns with the ethical principle of autonomy and the professional standard of informed consent, ensuring that any decision made by the patient is truly voluntary and based on adequate understanding. Furthermore, it respects the patient’s dignity and fosters trust, which is crucial in geriatric care where communication barriers can exist. An incorrect approach would be to proceed with the procedure without adequate patient understanding or consent, thereby violating the principle of autonomy and potentially leading to legal and ethical repercussions. Another incorrect approach is to dismiss the patient’s concerns outright and insist on the procedure without attempting to address their anxieties or provide further clarification. This demonstrates a lack of respect for the patient’s feelings and autonomy, potentially damaging the patient-clinician relationship and leading to non-compliance or further distress. Finally, abandoning the patient due to their refusal without exploring all avenues for communication and understanding would be professionally negligent, failing to uphold the duty of care. The professional reasoning process in such situations should involve: 1) Active listening to understand the patient’s concerns and the reasons behind their refusal. 2) Providing clear, jargon-free explanations of the procedure, its purpose, potential findings (linking back to craniofacial anatomy, oral histology, and oral pathology), risks, and benefits. 3) Assessing the patient’s capacity to understand the information and make a decision. 4) Exploring alternative diagnostic pathways if feasible and appropriate, while explaining their limitations. 5) Documenting the discussion, the patient’s decision, and the rationale for the chosen course of action.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the clinician’s professional judgment regarding the necessity of a specific preventive intervention. The geriatric patient’s resistance to fluoride varnish, despite evidence of increased caries risk, necessitates a delicate balance between patient autonomy and the clinician’s duty of care. Navigating this requires careful consideration of the patient’s capacity, understanding of their rationale, and exploration of alternative strategies while adhering to ethical principles and professional standards of care. Correct Approach Analysis: The best professional practice involves a thorough exploration of the patient’s concerns and a collaborative approach to decision-making. This includes actively listening to the patient’s reasons for refusing the fluoride varnish, assessing their understanding of the risks and benefits of both receiving and declining the treatment, and exploring alternative preventive measures that might be more acceptable to them. If the patient has the capacity to make informed decisions, their autonomy must be respected. This approach aligns with the ethical principles of autonomy, beneficence, and non-maleficence, ensuring the patient’s values are considered while still striving to achieve the best possible oral health outcomes. It also reflects a commitment to patient-centered care, fostering trust and adherence to future recommendations. Incorrect Approaches Analysis: One incorrect approach involves proceeding with the fluoride varnish application without adequately addressing the patient’s concerns or confirming their understanding and consent. This disregards the principle of patient autonomy and could lead to a breach of trust, potential patient distress, and a failure to achieve genuine informed consent. It prioritizes the clinician’s preferred treatment over the patient’s expressed wishes and understanding. Another incorrect approach is to simply accept the patient’s refusal and abandon all preventive measures without exploring alternatives or understanding the underlying reasons. This fails to uphold the clinician’s duty of beneficence, potentially exposing the patient to preventable oral diseases. It represents a passive approach that does not actively seek to find a mutually agreeable solution or mitigate risks. A third incorrect approach is to dismiss the patient’s concerns as unfounded or irrational without proper investigation. This demonstrates a lack of respect for the patient’s perspective and can damage the therapeutic relationship. It also misses an opportunity to identify potential underlying issues, such as fear, past negative experiences, or misunderstanding, which could be addressed to facilitate better care. Professional Reasoning: Professionals should employ a shared decision-making model. This involves: 1. Eliciting the patient’s preferences and values. 2. Presenting evidence-based treatment options, including the rationale for each. 3. Discussing the potential benefits, risks, and uncertainties associated with each option. 4. Assessing the patient’s understanding and capacity to make decisions. 5. Collaboratively reaching a decision that aligns with the patient’s values and the clinician’s professional judgment. If capacity is questionable, a formal assessment process should be initiated.