A Sea-Change in American Dentistry: A National Clinical Licensure Examination, or a Residency-Based Pathway?

Abstract

Evidence is not available from any controlled studies for many decisions that affect the quality of dental patient care. This is certainly true for entry-level dental licensure. If the purpose of licensure is to protect the public, is there evidence that it does so? Its proponents point to educational accreditation as a process-driven system, without valid or reliable outcome assessments. For many years, the educational community has relied upon the accreditation process for its educational standards, pointing to the licensure process as the external audit of educational outcomes. More recently, leaders in the educational community have called for the elimination of clinical licensure examinations on live patients. Educators have suggested that Bin-house[ solutions, such as portfolios of student performance, are more valid, reliable, and ethical. The other parties in this arena, the dental examiner and organized dentistry communities, have now weighed in. In its most effective role, the American Dental Association has facilitated conversations, conferences, and consensus to bring about licensure by credentials to as many as 44 states. The examiner community, through the American Association of Dental Examiners (AADE), has responded by developing a single national clinical licensure examination. The 2 major organizations within this community, the American Board of Dental Examiners (ADEX) and the Western Regional Examining Board (WREB), are now poised to offer clinical exams that would be accepted by virtually all states and jurisdictions. There is another community of interest, however, the candidates. They have a variety of opinions, but their principal interest is mobility; or, phrased another way, freedom of movement. They want licensure in any and all jurisdictions to result from one exam process. Who can blame them? Their educational institutions are accredited. Their faculty certify them for their doctoral degrees. Why should they have to jump through hoops in 53 different jurisdictions in a mobile society? They are frustrated with what they see as turf battles. That may be, but examiners know (and students know) that every graduate of every accredited dental school is not competent at minimal standards. They’ll tell youVjust ask them. Some of us have a frustration from being members of every one of these communities of interest. We see a system designed over 100 years ago to solve a problem that no longer existsVproprietary diploma mills that had no educational standards, ethical standards, or accreditation. And then, along comes a real pioneering ideaVscrap the clinical licensure exam and substitute another outcomes assessment. After all, why should Dentistry be the only clinical health care profession requiring a university-based doctoral degree recipient to undergo a process requiring clinical treatment procedures on live patients to achieve entry-level licensure? So, the New York State Dental Association successfully lobbied their legislature to eliminate clinical licensure exams. But they didn’t ask for a free ride. They sought and achieved the substitution of an ADA Commission on Dental AccreditationYapproved residency program completion for entry-level licensure. That’s a sea-change, if there ever was one. Who has it right? As one of the cable news networks states: We report, and you decide. Our speakers are: