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California OKs nation’s first portfolio exam for licensure

Sacramento, Calif.—Dental students in California will soon have a new pathway for obtaining initial licensure. Last month the state became the first in the nation to create a dental school-based portfolio examination process.

A multiyear lobbying effort resulted in Gov. Arnold Schwarzenegger signing Assembly Bill 1524 Sept. 29. Once regulations are adopted, students will have the option of taking a school-based licensure exam that allows them to build a portfolio of completed clinical experiences and competency exams in seven subject areas over the entire course of their final year of dental school.

ADA policy on live patients, curriculum-integrated format, PGY1 detailed

While the ADA recognizes and supports the state’s right to regulate dental licensure, the Association has adopted policies on a number of licensure topics, including the elimination of human subjects from the clinical licensure examination process and exams that evaluate students while they are still in dental school.

Ten years ago, the ADA House of Delegates passed Resolution 64H-2000 which called for the elimination of human subjects from licensure exams by 2005, a goal that was reaffirmed by the 2005 House. Res. 20H-2005 also supported the curriculum-integrated format of licensure exams that evaluate dental students while they are in dental school.

In 2003, the House amended the Guidelines for Licensure and Policy on Dental Licensure to state that the clinical exam requirement for initial licensure may be met by successful completion of a one-year, CODA-accredited postgraduate program in general dentistry that contains competency assessments (or in an ADA-recognized dental specialty program).

In 2007 the Council on Dental Education and Licensure—with input from the American Student Dental Association, American Association of Dental Examiners (now the American Association of Dental Boards) and the American Dental Education Association—developed a definition of the curriculum-integrated format, which the 2007 House adopted in Res. 1H-2007. That definition called for independent third-party assessment while stating that if live patients are used, they should be patients of record and that treatment should be provided within the school year as part of the normal treatment plan. The definition also calls for the exam to be given multiple times during the school year and encourages remediation.

Most recently, the 2009 House of Delegates directed the Council on Dental Education and Licensure to study the feasibility of a new Part III examination of the National Boards that would evaluate clinical competency, ethics and professionalism in keeping with the 2005 ADA policy on the use of human subjects. A workgroup appointed by ADA Immediate Past President Ron Tankersley has been studying that issue for the past year and submitted a report to the 2010 House, which was meeting in Orlando, Fla., at press time for this issue of the ADA News.

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The Dental Board of California sponsored the measure with support from the California Dental Association and all six California dental schools.

“CDA is very pleased and proud to have been an active participant with the board and the dental schools in the development of AB 1524,” said Dr. Thomas Stewart, California Dental Association president. “As chair of the dental board’s examinations committee, Dr. Stephen Casagrande has exercised tremendous leadership over the last two years in bringing all parties together to build this exciting new licensure option for California dental students.”

With the passage of AB 1524, California joins Minnesota, New York, Connecticut and Washington as states at the forefront of bold new licensure initiatives.

In 2009, Minnesota became the first state to offer a nonpatient based clinical licensure exam when the Minnesota Board of Dentistry approved the National Dental Examining Board of Canada’s two-part exam, starting in May 2010 for graduates of the University of Minnesota School of Dentistry. The board based its decision on increased collaboration with the dental school that showed board members how students are admitted, progressed and clinically evaluated. In addition to a written component, the NDEBC exam includes a nonpatient based objective, structured clinical exam. Officials at the UM dental school said that 26 out of 101 graduates opted to take the NDEBC exam in 2010.

The portfolio licensure exam process in California replaces the clinical exam administered by the dental board. CDA officials say that exam was rarely taken in recent years as students have had the option of taking the Western Regional Examining Board’s exam since 2005. The WREB exam will continue to be an option for candidates for initial licensure. In fact, candidates who seek greater mobility in practice may prefer to take the WREB exam, as it is accepted in 15 states. At least for now, candidates opting for the school-based portfolio exam process will be limited to practicing in California.

According to a CDA statement, the portfolio exam process will work like this: “The portfolio licensure exam model created by AB 1524 will allow students at the six California dental schools to complete the licensure process over the course of their final year in dental school instead of waiting until after graduation. If they choose this option, students will be required to complete specific clinical experience benchmarks in seven categories and pass a final assessment in each area whenever they and the dental school faculty feel they are ready. Once all experience benchmarks and assessments have been completed satisfactorily, the students will submit their finished portfolio to the Dental Board for final approval and licensure.”

Even though the new law becomes effective Jan. 1, 2011, the dental board will need time to adopt and obtain approval for the regulations containing the more detailed structure of the portfolio exam process, which will likely take one to two years. Each dental school will then be required to develop its own process, calibrate faculty examiners and make the portfolio exam available to students.

“Although the implementation phase will take some time and will vary by school, we are delighted to be launching this process with the enactment of AB 1524,” said Dr. Stewart. “California is now at the forefront of an exciting new era in dental licensure, and CDA is pleased to be a part of it.”

Candidates for initial licensure in California have other options, too.

Since 2008, the state has accepted a 12-month general practice residency or advanced education in general dentistry program accredited by the ADA Commission on Dental Accreditation as an alternative to a clinical licensure exam. In 2007, New York began requiring that candidates for initial licensure complete a year-long postgraduate residency (also known as PGY1) in lieu of taking an exam. Minnesota, Connecticut and Washington state also permit graduates the option of completing a PGY1.

California is also one of 46 states that offer licensure by credentials.