In an attempt to exterminate the practice of using live patients, the ADA is working create an exam test that can effectively assess the clinical competency of a dentist, minus the risk. By 2020, the association plans to develop, test, and introduce the exam to states for licensing purposes.
The new format of licensing examination is introducing the dental OSCE, which is a dental objective structured clinical exam. This testing method has been in practice in the fields of medicine, nursing, and physiotherapy since decades to assess a candidate’s clinical and critical thinking skills excluding the risk involved with practical demonstration on a live patient.
Gary Roberts, DDS, President ADA, in a recent interview with Mr. Bicuspid.com, spoke about the ethical concerns associated with practicing on a live patient especially regarding the possible scenario of a student failing and the question about who is to attend to the patient after the job is done?
This notion was first filed in 2005 by the ADA only to end conducting examinations following this pattern. After failed attempts in invoking state boards and testing agencies to abide by the idea, the association took matters into their owns hands and took necessary action to fulfil the need for a valid and ethical testing system.
"We'd been looking for a long time to take patients out of the examination," Dr. Roberts said. "We thought this was going to be the best, quickest, most ethical way to get it started."
During an OSCE, the candidates move through stations, utilizing the skills and knowledge they have gathered in their years at dental school to answer clinically based questions. The comprising stations may feature multimedia, such as x-rays or videos, as well as made up patient history profiles, etc.
Canada has been following the OSCE pattern of licensing examinations since the 1990s and it has proved to be a valid and effective way to assess graduates. Live patient testing, on the other hand, has not just been an ethical concern for many U.S dental professionals but rather many have raised questions regarding the validity of the traditional clinical licensing exams.
In light of these concerns, the states of Colorado, Minnesota, and Washington, now accept Canada’s OSCE layout for handing out licenses in their states. The University of Minnesota School of Dentistry, the state's only dental school, will no longer allow traditional licensing exams onsite in 2018.
States like California and New York follow the portfolio or year-long residency requirement instead of the OSCE pattern. David Chambers, MBA, PhD, claims the problem isn't testing competency on patients, but rather with the "one shot" formula of traditional exams. Chambers, a former associate dean at the Arthur A. Dugoni School of Dentistry, has written several scientific papers on the ethical issues of licensing exams.
"Competence to practice dentistry must be based on performance on patients," he said. "The failure of the current system stems from using too small a sample of each candidate's work to be valid."
While portfolios are a fantastic way of assessing students, Dr. Roberts says that the ADA is working to create an exam that can be followed on a national level as some schools are hesitant to follow the portfolio system due to the cost involved.
The process to introduce the OSCE has already been set in motion. The association plans to have a pilot in states by 2019. Once the ADA has created the exam, the association will license it to states by 2020. The aim is to gradually instigate acceptance for the OSCE for licensing requirements. The process is tedious and may take decades but Dr. Roberts believes the result will be a victory for everyone.