Licensure 101
Adam Shisler, DDS, Houston ’12
Agenda
• The Nitty Gritty
• The Controversy
• Where are we on improving the
situation?
We all want to get here?
Where do we start?
• Timeline:
– NBDE Part 1 & 2
– Awarded/On-track diploma status
– Clinical licensure exam
– Application for licensure
– License
– Practice dentistry and love every minute
Slow it down
• First, where do you want to live?
• Find that state board’s website
Can’t sit here?
• Only certain clinical exams are accepted
by certain state boards of dentistry.
– CITA (6 members / 26 accepted)
– CRDTS (16 members / 30 accepted)
– NERB ADEX (20 members / 40 accepted)
– SRTA (6 members / 30 accepted)
– WREB (17 members / 35 accepted)
More than one way to…
• Objective Structured Clinical Exam
– OSCE (1 - MN)
• Portfolio (1 - CA)
• Post Graduate Year – 1
– PGY-1 (5 states)
– CA, WA, MN, NY and CT
Say hello to my little friends
• Council on Interstate Testing Agencies (CITA)
• Central Regional Dental Testing Services
(CRDTS)
• North East Regional Board (NERB)
• Southern Regional Testing Agency (SRTA)
• Western Regional Examining Board (WREB)
Collective Mission of the
Regional Board Exams
•
AADB Mission Statement:
– To serve as a resource by providing a national forum for exchange,
development and dissemination of information to assist dental
regulatory boards with their obligation to protect the public.
•
AADB Values Held Statement
– AADB values protection of the public whenever it seeks dental health
care.
– AADB values collaborative relationships within organized dentistry
among educators, accreditors, examiners and regulators.
– AADB values meeting the needs of all its members.
Fine Lines of Differences
ENDO –
Manikin
PROSTH –
Manikin
PROSTH –
Comp /
CSW
PERIO –
Live Pt
PERIO –
Comp /
CSW
REST Manikin
REST –
Live Pt
DIAG
Comp Ex
COST*
CITA
X
X
X
X
$2500$3000
CRDTS
X
X
X
X
$2095
NERB
X
X
X
X
SRTA
X
X
WREB
X
X
X
X
X
X
X
X
*Fees do not include Prometric/Pearson site fees or school
specific instrument fees.
X
$2085
$2300$2800
X
$1760$2360
Documents to Organize
•
•
•
•
•
•
Notarized Copy of Diploma
Certified Clinical Licensure Exam Results
Nitrous Certification from Dental School
AHA BLS Certification
DL / SSN Card
Part 1 / Part 2 Notarized Copies
Insurance Coverage
Mandate Professional
Liability Coverage
Notes
CITA
No
CITA purchases blanket coverage, included
CRDTS
No
CRDTS furnishes through Brown & Brown,
candidates can opt out
NERB
YES
Req’d $1mill/$3mill coverage
SRTA
No
You must request coverage, not auto
WREB
YES
WREB has a deal with CNA Insurance Co. in
the past for $1mill/$3mill
The Controversy
• WWMGD?
Medical Licensure
• State mandated responsibility
• Successful completion of all three steps of the
United States Medical Licensing Examination
(USMLE).
• The physician should provide the licensing
board with a resume or curriculum vitae
Medical Licensure Model
•USMLE Step 1
• Traditional MC Exam
•USMLE Step 2
•
•
•
•
Clinical Knowledge & Clinical Skills
CK – traditional MC exam over 9hrs
CS – simulated patient interactions
++ Standardized Pts portrayed by actors
•USMLE Step 3
• 16hr exam / 2 days
• Day 1 = MC, Day 2 = combo of MC and clinical cases
• Simulation clinical cases that are input interactive
ASDA Policy
(L1: revised 1998, 2001, 2002, 2005, 2013)
The American Student Dental Association believes that any clinical licensing examination
intended to measure technical skill via a sequence of independent clinical tasks should:
A) be a non-patient based examination emphasizing the recognition, diagnosis, and treatment
planning of disease, in conjunction with the treatment of simulated disease by use of a
typodont.
B) be administered in the final year of dental school.
C) provide opportunities for remediation, at the candidates‘ dental school, prior to graduation.
D) guarantee anonymity of candidates and examiners.
E) be administered by examiners who have been calibrated to provide standardized and
consistent scoring.
F) not include a written examination that duplicates the content of the National Dental Board
Examination Parts 1 or 2.
G) be offered to candidates at the lowest reasonable cost possible.
H) be universally accepted by all state boards of dentistry.
I) be psychometrically sound.
ASDA Policy
(L1: revised 1998, 2001, 2002, 2005, 2013)
While the American Student Dental Association supports continual improvement of existing
examinations and collaborative development of a new examination, the association believes
the following alternatives are preferable to the current licensure process:
A) Initial licensure without an independent clinical licensing examination. Graduates of a U.S.
CODA-accredited dental school should be eligible for initial licensure without taking any
additional clinical examination.
B) A portfolio-type clinical examination based on cases compiled during the final year of dental
school. Such an examination should require a standardized catalog of required clinical
procedures and the portfolio should be evaluated by an examiner independent of the dental
school.
C) A non-traditional patient based clinical licensure examination. Although the American
Student Dental Association does not support the use of live patients in traditional clinical
licensing examinations, the association recognizes the potential for creation of an ethical,
patient based examination.
D) An Objective Structured Clinical Examination designed to evaluate a candidate’s diagnostic
and treatment planning skills.
E) Completion of a one year post graduate residency program. Completion of a U.S. CODAaccredited post graduate program that has a minimum duration of one year should be
sufficient to substitute for the clinical licensure examination requirement in any jurisdiction.
ADA Supporting ASDA’s Efforts
ADA policy
(2005:3351)
• Resolved, that the Association supports the
elimination of human subjects/patients in the clinical
licensure examination process with the exception of
the curriculum integrated format within dental
schools, and be it further,
• Resolved, that the Association encourages all
states to adopt methodologies for licensure that are
consistent with this policy.
The Controversy:
Ethics
1. ADA Principles of Ethics and Code of Professional
Conduct (Nonmaleficence & Beneficence)
2. Comprehensive care
3. Delaying treatment
4. Patient compensation
5. Price of the exam
6. Manipulating radiographs
The Controversy:
Accuracy
1. Subjective nature d/t examiner scoring
2. One-day one-shot mentality
3. Few, if any, opportunities for remediation
at the candidate’s dental school, before
graduation.
The Controversy:
Best Practices
1.
2.
3.
4.
Unnecessary treatment of incipient caries
Invasiveness
Redundancy of content
Reciprocity
Dental educators teach students to consider a patient’s overall
oral health and to work on creating long-term partnerships.
During licensing exams, they see this treatment model
distorted.
– Toni Roucka, DDS, MA & Evelyn Donate-Bartfield, PhD
AGD Impact 2013 Aug;61(5):18.
What’s Ahead
What’s Happened:
• 2000: ADA favors the elimination of live
patients in clinical licensure exams
• 2003: NY option to do PGY-1
• 2004: ADA supports Universal Licensure
• 2007: NY mandate to do PGY-1
• 2007: CA, CT & MN option to do PGY-1
• 2007: ASDA & ADA Define CIF
• 2008: WA option to do PGY-1
What’s Happened:
• 2009: MN option to take Canadian OSCE
• 2010: CA option to submit Portfolio
• 2010: ADA directed to develop Portfolio
Exam
• 2014: CITA to join ADEX
• ~2017: INDBE potential rollout
What’s Happening:
1. ADA Task Force on Portfolio Exam
2. ASDA/ADEA/ADA Strategy
3. State-Level Advocacy
Questions?