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By Karen Fox

Nearly a year after the ADA House of Delegates stopped short of supporting an accreditation process for international dental education programs, the Board of Trustees has asked that the House re-consider its decision.

"What has changed is that a number of state legislatures and agencies are asking their state boards of dentistry to recognize international dental schools," said ADA President Richard Haught. "We believe the ADA Commission on Dental Accreditation is the appropriate body to accredit international programs, not state legislatures or agencies directed by states."

After reviewing a report from the Ad-Hoc Committee on International Consultation and Evaluation this month, the Board passed a resolution backing the commission's initiative to create a program that offers consultation and accreditation services to international dental education programs.

	Board: Officers and trustees consider international accreditation Aug. 8. Clockwise from left are Dr. Haught; Dr. Ronald Gross, 3rd District Trustee; Dr. Mark Feldman, treasurer; Bill Zimmermann, chief financial officer; Dr. Brandjord; and Dr. Bramson.

"After a year of additional data gathering, the Board agreed with the commission and determined it was time for visionary leadership here," said ADA Executive Director James B. Bramson. "They realized this was controversial but believed this Association action was needed, prudent and timely."

To be considered by the 2005 House of Delegates in Philadelphia in October, Res. 39B calls for the ADA and Board to support the commission's initiative to offer consultation and accreditation services to international dental schools, and also establish a standing joint advisory committee to guide the commission in the selection, development and implementation of the program.

It's through the advisory committee that the ADA and its members are ensured of input in this process, said ADA President-Elect Bob Brandjord.

"The U.S. Department of Education would not consider international accreditation part of their regulation of the ADA commission," said Dr. Brandjord. "The ADA must operate at an arm's length from the commission when it comes to programs in the United States, however international programs are outside the scope of the commission's recognition by the DOE."

Res. 39B also requires that the advisory committee include two representatives from the commission and three representatives from the ADA — one from the Board as chair and two at-large members from the practicing community appointed by the president. ADA representatives would have a staggered three-year term and be eligible for one additional term of appointment.

Strongly influencing the Board's decision were recent state actions indicating the willingness of states to approve or accredit international dental programs regardless of ADA involvement. So far, at least three states have bypassed the ADA and taken steps to recognize international dental programs — mainly in search of solutions to the access problem.

California and Minnesota have adopted mechanisms for graduates of international dental schools to become licensed without graduation from a Commission on Dental Accreditation-accredited program. A school in Mexico currently has approval; a school in India has applied and is being evaluated.

The Minnesota dental board is evaluating the authenticity of the credentials of graduates of international dental schools, too. If the board of dentistry determines that an international graduate's training is equivalent to or higher than that provided by a dental school accredited by the ADA commission, the international graduate cannot be disqualified from examination to become licensed to practice dentistry.

Most recently, in May, Florida's Department of Health/Medical Quality Assurance posted a notice of a proposed rule change titled, "Certification of Foreign Educational Institutions." Its purpose is to provide for the evaluation of foreign dental schools and the certification of those foreign dental schools that provide an education that is reasonably comparable to that of similar accredited U.S. institutions.

"This is our primary concern," said Dr. Brandjord, who served on the ad-hoc committee. "If we start having different accreditation agencies, the authority of the ADA Commission on Dental Accreditation is undermined. We need one unified accrediting organization."

For several years, the commission has monitored globalization and international migration and their effect on the quality of dental education, said Dr. Morris L. Robbins, chair of the Commission on Dental Accreditation.

"The shrinking world has been enhanced by progress in communications, treaties linking countries and the freedom of information that brings interested international parties together," said Dr. Robbins. "Dentistry is part of this global information explosion and the commission has felt that as the predominant accreditation body for dentistry, it should be part of the globalization process bringing the best of dental accreditation expertise."

The commission already has one reciprocal relationship that works, he added.

"While it may sound best to accredit only U.S. programs, the commission has had a long-term reciprocal relationship with Canada that has been quite effective," said Dr. Robbins.

When the House adopted Res. 41H-2004, which urged the commission to make available upon request fee-based consulting services and evaluation to international dental schools preparing general dentists for practice, the delegates believed accreditation of international schools was premature.

Even so, Res. 41-H acknowledged there is a compelling need for the ADA and the commission to promote improvement in the quality of dental education and oral health care.

"The ADA has a vital interest in elevating dental education standards worldwide," said Dr. Haught earlier this month. "If a school comes to us to elevate their standards, we should have the ability to help them do that."

It remains to be seen whether the House of Delegates will agree with the Board's decision, or how an international accreditation program would affect dentistry in the United States.

Based on the ad-hoc committee's questionnaire, at this time only about six international programs have an interest in paying for ADA consultation and evaluation services. Creating a new accreditation program means it could be several years before a program could be accredited.

In addition, "dentists who wish to practice in the United States are subject to the same licensure process that all dentists go through," said Dr. Brandjord.