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BOARD EXAMS ‘CRITICAL’
L E T T E R S
pact change. The American Association of Dental Examiners, or AADE, recently announced that it is developing a single clinical examination for use by all state boards. In August 2004, the ADA’s Board of Trustees considered the task force recommendation and directed the appointment of a National Clinical Licensing Examination Consensus Committee to monitor the progress of the AADE initiative, and to advance the development of a common national clinical examination. This action was supported by the ADA House of Delegates at its annual meeting in Orlando, Fla., in October. Watch ADA News for updates on licensure issues. BOARD EXAMS ‘CRITICAL’
Dental board examinations are critical to maintaining the integrity of the educational systems. From the number of recent articles and statements from organized dentistry floating the ideas of accrediting foreign dental schools and eliminating board requirements for licensure, I feel compelled to speak out. The system of board examinations is our check on the quality of the educational product. It in effect holds the dental schools accountable. Without board oversight, I expect—I know—we will see the quality of the educational product, the student, deteriorate. Here in Arizona, there is a new start-from-scratch dental school. The school is trying a different educational approach. Board exams will validate the quality of their educational product. If all their students pass their board examinations, then
the dental community and the community-at-large will be assured of the quality of these new graduates. Accreditation simply does not measure each individual student. Accreditation measures only the overall program. In our profession, we need to measure each practitioner’s individual competency. With a movement stirring to perhaps accredit foreign dental schools, we need to have third-party oversight of dental schools more than ever. In addition, some of our historically excellent schools are changing from a traditional curriculum to a new “problem-based learning” approach. At the University of Southern California in Los Angeles, or USC, for instance, this has meant a significant drop in the preclinical experience for firstyear students. As these students enter the fourth-year clinic this year, they are struggling. If a significant number of these students fail the clinical boards, then USC will have to make adjustments. The school is being held accountable to deliver the education that the students paid for with their tuition dollars. The studies that show that dental school performance does not correspond to board results, such as Dr. Richard Ranney and colleagues’ report in August JADA, further validate my argument. What do grades really have to do with success? At least the board can validate that the student can prepare and place a nice Class II restoration. Accreditation says nothing about the individual. We must all be held individually responsible. Wesley A. Harper, D.D.S. Phoenix
Authors’ response: We agree with the large majority of leaders in dental education who believe that independent thirdparty evaluation of dental graduates is appropriate.1 So in that respect we have no difficulty with Dr. Harper’s contention that the licensure process should fulfill that function. We do have problems with his apparent assumption that clinical licensing examinations as presently conducted provide reliable measures of a candidate’s competence. One-time clinical observations are demonstrably unreliable,2,3 and there are much larger sources of variance in the results of such observations than is accounted for by the examiner’s determination.4 Our study demonstrated very poor year-to-year consistency of a licensing examination, and negligible internal consistency between clinical sections of that examination. Multiple observations provide greater validity for making decisions than do single observations.5 Our faculty (and we presume other faculties) utilize multiple observations for making decisions on pass-fail. Previous study of results in 2001 demonstrated that decisions made during a clinical licensing examination on ability to do the Class II restorations cited by Dr. Harper did not agree with our faculty’s decisions.6 In the face of that lack of consistency, the lack of consistency between clinical licensing examination and faculty determinations seen in our current multiyear study, and the known unreliability of one-shot clinical observation, it is not logical to conclude that it is the clinical licensing examination that provides the correct determination
JADA, Vol. 135, December 2004 Copyright ©2004 American Dental Association. All rights reserved.
1663
pact change. The American Association of Dental Examiners, or AADE, recently announced that it is developing a single clinical examination for use by all state boards. In August 2004, the ADA’s Board of Trustees considered the task force recommendation and directed the appointment of a National Clinical Licensing Examination Consensus Committee to monitor the progress of the AADE initiative, and to advance the development of a common national clinical examination. This action was supported by the ADA House of Delegates at its annual meeting in Orlando, Fla., in October. Watch ADA News for updates on licensure issues. BOARD EXAMS ‘CRITICAL’
Dental board examinations are critical to maintaining the integrity of the educational systems. From the number of recent articles and statements from organized dentistry floating the ideas of accrediting foreign dental schools and eliminating board requirements for licensure, I feel compelled to speak out. The system of board examinations is our check on the quality of the educational product. It in effect holds the dental schools accountable. Without board oversight, I expect—I know—we will see the quality of the educational product, the student, deteriorate. Here in Arizona, there is a new start-from-scratch dental school. The school is trying a different educational approach. Board exams will validate the quality of their educational product. If all their students pass their board examinations, then
the dental community and the community-at-large will be assured of the quality of these new graduates. Accreditation simply does not measure each individual student. Accreditation measures only the overall program. In our profession, we need to measure each practitioner’s individual competency. With a movement stirring to perhaps accredit foreign dental schools, we need to have third-party oversight of dental schools more than ever. In addition, some of our historically excellent schools are changing from a traditional curriculum to a new “problem-based learning” approach. At the University of Southern California in Los Angeles, or USC, for instance, this has meant a significant drop in the preclinical experience for firstyear students. As these students enter the fourth-year clinic this year, they are struggling. If a significant number of these students fail the clinical boards, then USC will have to make adjustments. The school is being held accountable to deliver the education that the students paid for with their tuition dollars. The studies that show that dental school performance does not correspond to board results, such as Dr. Richard Ranney and colleagues’ report in August JADA, further validate my argument. What do grades really have to do with success? At least the board can validate that the student can prepare and place a nice Class II restoration. Accreditation says nothing about the individual. We must all be held individually responsible. Wesley A. Harper, D.D.S. Phoenix
Authors’ response: We agree with the large majority of leaders in dental education who believe that independent thirdparty evaluation of dental graduates is appropriate.1 So in that respect we have no difficulty with Dr. Harper’s contention that the licensure process should fulfill that function. We do have problems with his apparent assumption that clinical licensing examinations as presently conducted provide reliable measures of a candidate’s competence. One-time clinical observations are demonstrably unreliable,2,3 and there are much larger sources of variance in the results of such observations than is accounted for by the examiner’s determination.4 Our study demonstrated very poor year-to-year consistency of a licensing examination, and negligible internal consistency between clinical sections of that examination. Multiple observations provide greater validity for making decisions than do single observations.5 Our faculty (and we presume other faculties) utilize multiple observations for making decisions on pass-fail. Previous study of results in 2001 demonstrated that decisions made during a clinical licensing examination on ability to do the Class II restorations cited by Dr. Harper did not agree with our faculty’s decisions.6 In the face of that lack of consistency, the lack of consistency between clinical licensing examination and faculty determinations seen in our current multiyear study, and the known unreliability of one-shot clinical observation, it is not logical to conclude that it is the clinical licensing examination that provides the correct determination
JADA, Vol. 135, December 2004 Copyright ©2004 American Dental Association. All rights reserved.
1663