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Clinical license exam process eyed

The work group appointed to study the feasibility of a national clinical licensure examination that does not require the use of live patients hit the ground running March 9 in its first meeting at ADA Headquarters.

Resolution: Members of the 26S-1 work group pause for a photo during a meeting March 9 at ADA Headquarters. Seated from left are Dr. David Perkins, CDEL; and Dr. William R. Calnon (work group chair), ADA 2nd District trustee. Standing from left are Dr. Patrick M. Lloyd, CDEL; Dr. Brian T. Kennedy, CDEL; and Dr. Charles H. Norman, ADA 16th District trustee.

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

The House referred Res. 26S-1 to a Board of Trustees work group for further study. ADA President Ron Tankersley appointed members of the Board and CDEL to the work group, which is chaired by ADA 2nd District Trustee William R. Calnon. Other members include Dr. Charles H. Norman, ADA 16th District trustee; Dr. Brian T. Kennedy, CDEL; Dr. Patrick M. Lloyd, CDEL; and Dr. David Perkins, CDEL. 

For the majority of its first meeting, the 26S-1 work group delved into the history of dental licensure and studied perspectives and policies from the licensure communities of interest and alternative initial licensing methods now in use.

Dr. Calnon said that reviewing the history provided the group with a deeper understanding of the challenges faced by previous ADA committees and work groups that have worked toward a national examination, nonpatient-based exams and mutual recognition of all clinical licensure exams.

"We felt that we needed to understand those issues so we could address them in light of what we know today," said Dr. Calnon. "State licensing boards, individual states and the American Student Dental Association are impatient to see positive change. We are listening to these groups. This is the time to take action and re-evaluate where we are and where we need to be in the future." 

In reviewing the history of ADA activities and policies related to licensure, the work group gained valuable insight from ADA Past Presidents T. Howard Jones and Richard Haught, who during their leadership years facilitated discussions with groups in the licensure communities.

Dr. Jones summarized the activities of the Task Force on the Role of Patient-Based Examinations and the ADA National Clinical Licensing Examination Consensus Committee (2002-05) which sought, among other things, to identify the components of a common clinical exam. Dr. Haught brought the work group up to date on informal meetings held with representatives of clinical testing agencies from 2005-08. At the time, the ADA had hoped to achieve mutual recognition by state dental boards of all regional clinical exams.

Additionally, position papers and policy statements from the American Association of Dental Boards and American Dental Education Association were studied; as were licensure issues and recommendations contained in the Future of Dentistry Report (2001).

"We are looking at the whole arena of licensure and trying to be broad based from all aspects," said Dr. Calnon.

"I think people realize that the subject matter associated with Res. 26S-1 is both politically and emotionally charged," he continued. "Members of the work group strived to put their perspectives on the table in an effort to seek common ground and approach this in as fair and objective a way as we possible can, which is what we have to do to fulfill the directive of the House of Delegates."

One thing that has changed over time, said Dr. Calnon, is that there are now more alternative methods to evaluate candidates for initial licensure, and the work group wanted to learn more about them.

Included among those innovations were the curriculum-integrated format and portfolio exams that evaluate a student’s competency as part of the dental school experience; the Canadian model of the Objective Structured Clinical Examination used in Minnesota; and New York’s requirement of graduation from an accredited postgraduate residency program of at least one year in length, or PGY1, for initial licensure applicants. California, Connecticut, Minnesota and Washington also offer licensure applicants the option of a PGY1 instead of a clinical exam. A special guest, Dr. Tania Markarian of the Case Western Reserve University School of Dental Medicine, was invited to give the work group a presentation on the use of technology and simulation in predoctoral dental education.

A second meeting has been scheduled for May to enable the work group to continue discussion and develop its report to the 2010 House of Delegates.

"Like many in the dental profession, people on the work group have very interesting perspectives, and we are all bringing very distinct, heartfelt feelings to the table," said Dr. Calnon. "We have to sit and listen with open minds and take into consideration each person's point of view. I think we accomplished that at our meeting. What shape that ultimately takes, we won’t know until after next meeting."