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Letters: Licensure exam questions

April 17, 2017 It is hard to believe that the powers to be think that a dental licensure practical test should not include live patients ("ADA Board Votes to Create National Dental Licensure Exam," March 20 ADA News. Dental clinicians do not treat mannequins and typodonts. We treat real, live, breathing patients, with saliva and everything. Why would we, as a profession, want to dumb down such a critical and important evaluation of competency?

The idea that there is an ethical issue with live patients is a smokescreen created by the proponents of the new test. The profession allows dental students to treat patients at every level of dental education. While supervised, they often treat patients under barely discernable guidance, with all of the potential risks. Patients understand the situation and accept the consequences. Dental board patients are no different.

They are being treated by a graduate of an accredited dental school and understand that the practitioner is being tested for competency. The test is an accurate reflection of what occurs in dental offices millions of times a day. Shouldn't we test our professionals in a realistic manner?

As a dental patient, I want my doctor to have demonstrated that he or she passed a test that was relevant to the procedures they perform in my mouth; not some diluted version created to minimize stress and potential negative consequences. Real dentistry requires real skills. Those skills include working with live people in a wet, moving and changing environment.

Let's continue to test our new dentists in manner that emphasizes basic skills that are required every practice day, on live patients.

Norm Rosene, D.D.S.
Chico, California

Editor's note: The ADA Council on Dental Education and Licensure notes that an OSCE is a high-stakes test used throughout health care. OSCE tests do assess "real clinical skills" to use Dr. Rosene's terminology. The development of an OSCE for dental licensure reflects several long-standing and current ADA policies on dental licensure, not only the elimination of the use of patients in licensure examinations, but also policies on licensure portability and acceptance by state dental boards of a single, national clinical exam. In particular, the issue of license portability consistently ranks as one of the top three issues for the ADA's new dentist members. High-stakes testing methodologies and psychometrics have greatly evolved, just as dental technologies and dentists' critical thinking skills have evolved. Available psychometric analysis of current patient-based licensure examinations strongly suggests that the patient-based exams do not screen out beginning practitioners with inadequate hand-skills. In other words, the validity and reliability evidence may not support the assertion that the patient-based exams protect the public by keeping incompetent practitioners from obtaining a dental license. Psychometric analyses of the Canadian dental licensure OSCE strongly suggests there is more evidence in support of the reliability and validity of scores on the OSCE, as compared to patient-based exams. Many of the ethical issues of a patient-based examination, as outlined in the Council on Ethics, Bylaws, and Judicial Affairs white paper "Ethical Considerations When Using Human Subjects/Patients in the Examination Process," remain unresolved for the vast majority of candidates taking a patient-based licensure exam. The ADA Department of Testing Services has a long track record of developing and implementing highly valid and reliable high-stakes examinations in both the licensure and admissions arenas.