Are you attacking the correct entity?

Abstract

I read with great interest the special article by Ackerman, Rinchuse, and Rinchuse (Am J Orthod Dentofacial Orthop 2006;130:133-40) titled “ABO certification in the age of evidence and enhancement.” First, I commend the authors for a thought-provoking series of topics ranging from “ideal occlusion” to the “highest standard of excellence” to “an alternative model for certification” and finally to their “recommendations for the board certification process.” I agree with several points in the article. However, I believe that their attack on the American Board of Orthodontics (ABO) was not justified. The ABO is the certifying body for the American Association of Orthodontists (AAO). Its job is to judge the didactic and clinical competency of orthodontists educated in the United States and Canada. Thus, the annual examinations (both written and clinical) given by the ABO are designed to test what residents and private practitioners have been taught in their respective orthodontic residencies. The Council on Education of the AAO and the Council on Dental Accreditation of the American Dental Association provide guidelines for the teaching of various subjects, concepts, theories, techniques, and topics related to the practice of orthodontics. The ABO doesn’t create the curriculum. The ABO doesn’t do the research. The ABO doesn’t determine which concepts of occlusion should be espoused. The ABO creates an examination that reflects the current philosophy of the many fine orthodontic programs in the United States and Canada. If the authors wish to chastise an entity, they should focus on the educational system in dentistry, which has propagated our current concepts of occlusion for over 100 years. Frankly, I am tired of complaints that the ABO is not doing its job, or is doing its job improperly. The ABO is dedicated to creating a fair, comprehensive, reliable, and valid didactic and clinical examination of what an orthodontist has been taught during his or her training and practice. If the authors want evidence-based documentation of the topics that they raise in their article, then they should (1) challenge the faculties of orthodontic programs to produce the evidence-based research that (2) might someday change the occlusal, periodontal, functional, and esthetic paradigms that are taught in universities and (3) could ultimately result in modification of the ABO’s certifying examination. Until that time, quit picking on the ABO. ABO certification in the age of evidence and enhancementAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 130Issue 2PreviewThe American Board of Orthodontics (ABO) phase III certification examination was originally constructed and recently modified to “help the Board determine the candidate’s knowledge of clinical orthodontics and provide a basis to assess the quality of the candidate’s clinical treatment results.” For the most part, the ABO phase III examination measures the orthodontic treatment-induced changes in occlusion in a limited and biased patient sample. The process and outcome measures used in the current model—the discrepancy index and the objective grading system—are so narrowly focused that an orthodontist might lack up-to-date clinical knowledge, psychomotor and critical thinking skills, diagnostic acumen, patient management ability, and patient-centered ethics, and still pass the examination largely because of mechanically morphing the patient’s teeth into the board’s construct of ideal occlusion. Full-Text PDF Authors’ responseAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 130Issue 5PreviewWe want to thank Dr Kokich for his interest in our article. As he suggests, the criteria used by the ABO to examine prospective diplomates should be the same ones used by orthodontic faculties in determining a resident’s proficiency. However, the ABO continues to assess orthodontic competency by invoking the same standard that has been used since its inception in 1929, which is primarily the evaluation of static occlusion. This is in contradistinction to the more comprehensive evaluation of competency including clinical judgment currently used by most orthodontic faculties. Full-Text PDF