licensure—hot topics american student dental association western regional meeting november 5, 2011...

LICENSURE—HOT TOPICS American Student Dental Association

Western Regional MeetingNovember 5, 2011

Dr. Ronald P. LemmoAmerican Dental Association

Brittany Bensch DeanAmerican Student Dental Association

© 2010 American Dental Association, All Rights Reserved

Licensure-Related Acronyms

• CDEL- Council on Dental Education and Licensure

• NBDE- National Board Dental Examinations

• ADEX - American Board of Dental Examiners

• CRDTS - Central Regional Dental Testing Service

• CITA - Council of Interstate Testing Agencies

• NERB - North East Regional Examining Board

• SRTA - Southern Regional Testing Agency

• WREB - Western Regional Examining Board


History of Licensure

Since 1902 profession discussing one national exam

In 1928 three part exam proposed

In early 1930s states begin use of NBDE I and II

In early 1970s many individual state boards moved to one of four new regional testing agencies



In 2003 NERB implements the Curriculum Integrated Format (CIF)

In 2004 the clinical testing agencies try (again!) to develop one exam to be used by all

In 2005 ADEX is established using the CIF

Also, fifth regional testing agency-CITA is established



Today – NERB, NV, FL and HI administer ADEX

Exams

Five regional testing agencies and four independent states administer a total of six different exams.


Regional Exam Participation

• ADEX-26 member states, but 40 states accept results (NERB, HI, FL, NV)

• CRDTS- 17 member states and 20 other accepting states

• CITA- 6 member states and 18 other accepting states

• NERB- 18 member states-no information available on other accepting states

• SRTA- 6 member states and 26 other accepting states

• WREB- 15 member states and 21 other accepting states



Since 2002, States have authorized alternative pathways:

PGY-1 – NY, CT, MN, CA, WA

OSCE – MN

Portfolio – CA



Ultimate authority –STATE LEGISLATURE

State Board implements the state laws with authority granted by state legislature

Want change? Best to work with state dental association


History of ADA Activities

1997-2001 -- Invitational Licensure Conferences

2001 -- Resolution 114H-2001 established ADA Task Force on the Role of Patient Based Examinations; the Task Force met 2002-2004

2004 – CDEL adopts recommendation that a graduate of an accredited dental education program should be able to take a single clinical examination that has national acceptance—ultimately led to establishment of ADEX.



In 2005: Resolution 23H-2004 established the ADA National Clinical

Licensing Examination Consensus Committee.

ADA developed proposal for the National Commission on Clinical Dental Licensing



An Ideal Clinical Exam Process• Be an activity involving an independent third party within the

educational process• Allow for assessment of the full continuum of a candidate’s

competence• Instill public confidence• Evaluate competence within the context of a treatment plan that

meets the patient’s needs• Provide valid data for outcomes assessments as required by the

accreditation process• Be provided at a reasonable cost to the candidate



2005-2008 -- ADA met informally with individuals from some clinical testing agencies in effort to keep lines of communications open

2008-2009 -- Communications from the ADA presidents to state boards of dentistry encouraging implementation of ADA policy on acceptance of results of any state or regional clinical examination.



2009 -- Resolution 26S-1

2010- Resolution 42H


ADA House Past Actions Related to Clinical Exams and Part III

100-1991 Development of a Part III Clinical Examination for Dental Licensure

77-1992 and 100-1992 Development of a Standardized Clinical Part III

49-1993 Part III National Clinical Dental Licensure Examination

All were defeated by the House



Resolution 26S-1-2009. Resolved, that the American Dental Association House of Delegates direct the Council on Dental Education and Licensure to study the development of a Part III examination of the National Boards that will evaluate clinical competency, ethics and professionalism, in keeping with ADA policy (Trans.2005:335) Eliminating Use of Human Subjects in Board Examinations.


Resolution 26S-1-2009

ISSUES IDENTIFIED BY ADA HOUSE OF DELEGATES:

CDEL and the JCNDE bylaws responsibilities do not include development of clinical examinations--would need House action to change them

Confusion as to the intent of the resolution and terminology such as “clinical competency,” clinical demonstration, clinical dexterity

Consideration of ADA policy on elimination of patients in clinical licensure examinations.



26S-1 Workgroup recommendation to House--

Initiate a Request for Proposals calling for the development of a portfolio style examination


The RFP for a Portfolio-Style Exam

Concepts in the RFP• Be Ethical and professional• Have Oversight by the state licensing jurisdiction• Assess clinical competencies• Be Psychometrically sound• Be Cost effective and feasible• Have a Built-in system for audit• Have Mechanisms to assess outcomes• Enable portability• Have a Remediation process


ADA Licensure Policies

ADA has several policies to support mutual acceptance of exams.

• Acceptance of Successful Completion of State or Regional Licensure Examinations by State Boards of Dentistry (1998:725)

• Acceptance of Results of Regional Boards (1992:630; 2001:468

• Standardization of State Dental Examinations (1992:629)

• Guidelines for Licensure (1976:919; 1977:923 1989:529; 1992:632; 1999:938; 2000:401; 2003:340)



Eliminating Use of Human Subjects in Board Examinations (2000)

Resolved, that the Association supports the elimination of the use of human subjects in the clinical licensure examination process by 2005, and be it further

Resolved, that the Association transmit this policy to all clinical testing agencies.



Eliminating Use of Human Subjects in Board Examinations (2000; 2005)Resolved, that the Association supports the elimination of human subjects/patients in the clinical licensure examination process with the exception of the curriculum integrated format within dental schools, and be it further

Resolved, that the Association encourages all states to adopt methodologies for licensure that are consistent with this policy.



Definition of CIF (2007)Curriculum Integrated Format: An initial clinical licensure process that provides candidates an opportunity to successfully complete an independent “third party” clinical assessment prior to graduation from a dental education program accredited by the ADA Commission on Dental Accreditation.

If such a process includes patient care as part of the assessment, it should be performed by candidates on patients of record, whenever possible, within an appropriately sequenced treatment plan. The competencies assessed by the clinical examining agency should be selected components of current dental education program curricula.

All portions of this assessment are available at multiple times within each institution during dental school to ensure that patient care is accomplished within an appropriate treatment plan and to allow candidates to remediate and retake any portions of the assessment which they have not successfully completed.


ADA House of Delegates

ADA House of Delegates is the supreme authority on ADA policies.

ASDA’s Policy on Licensure

Until a fair and ethical, reliable and reproducible, valid, and clinically relevant national common-content evaluation of minimal competence for initial licensure has been developed, and until all dental licensing jurisdictions of the United States and its territories accept such an examination, the American Student Dental Association supports the universal acceptance of all regional and state clinical licensing examinations.


Regardless of the examining authority or the jurisdiction in which the exam is administered, the American Student Dental Association believes that any clinical licensing examination intended to measure technical skill via a sequence of independent clinical tasks should:

• be a non-patient based examination emphasizing the recognition, diagnosis, and treatment planning of disease, in conjunction with the treatment of simulated disease by use of a typodont.

• be administered in the final year of dental school.• provide opportunities for remediation, at the candidates’

dental school, prior to graduation.• guarantee anonymity of candidates and examiners.• be administered by examiners who have been calibrated to

provide standardized and consistent scoring.• not include a written examination that duplicates the content

of the National Dental Board Examination Parts 1 or 2.• be offered to candidates at the lowest reasonable cost

possible.


While the American Student Dental Association supports continual improvement of existing examinations and collaborative development of a new examination, the association believes the following alternatives are preferable to the current licensure process:

• Initial licensure without an independent clinical licensing examination: Graduates of dental schools accredited by the Commission on Dental Accreditation should be eligible for initial licensure without taking any additional clinical examination.

• A portfolio-type clinical examination based on cases compiled during the final year of dental school: Such an examination should require a standardized catalog of required clinical procedures and the portfolio should be evaluated by an examiner independent of the dental school.


• A non-traditional patient based clinical licensure examination: Although the American Student Dental Association does not support the use of live patients in traditional clinical licensing examinations, the association recognizes the potential for creation of an ethical, patient based examination.

• An Objective Structured Clinical Examination designed to evaluate a candidate’s diagnostic and treatment planning skills.

• Completion of a one year post graduate residency program: Completion of a postgraduate residency program that has been accredited by the Commission on Dental Accreditation and has a minimum duration of one year should be sufficient to substitute for the clinical licensure examination requirement in any jurisdiction. However, the American Student Dental Association opposes a mandatory postgraduate residency in any licensing jurisdiction.

Taken from ASDA’s L-4 Policy


What is ASDA doing about it?

• Nationally:– Made the request that ASDA be a part of the RFP

workgroup – 2 year appointment

– Council on Licensure is working on a White Paper on the licensure examination process


What is ASDA doing about it?

• Locally:– With state dental associations

– Working with the state legislators and dental boards

YOU can be this voice!YOU can be this voice!


Where does this leave us TODAY?

• YOU………ASDA have a VOICE

• and an OPPORTUNITY

• and an OBLIGATION


Final Thoughts……

• Work with ADA component, constituent dental societies to determine common principles

• Advance ASDA policy through these relationships

• Engage State Dental Boards and legislators as needed


QUESTIONS

THANK YOU! Dr. Ronald P. Lemmo

[email protected]

Brittany Bensch Dean

[email protected]

licensure—hot topics american student dental association western regional meeting november 5, 2011...

Documents

state dental association

clinical dental licensing

member states

independent states

s states

accepting states cita

clinical testing agencies

new regional testing