The ADA took a giant step forward in February to create a national exam to assess a licensure candidate’s entry-level clinical knowledge, skills and competency — while averting the potential ethical issues involved in the use of patients for dental licensure examinations, according to ADA News.
The ADA Board of Trustees voted last month to approve the development of an objective structured clinical examination (OSCE), a type of high-stakes exam that evaluates clinical and critical thinking skills, widely used in health sciences, including optometry, medicine, nursing and physical therapy.
The Board directed that a pilot of the Dental Licensure Objective Structured Clinical Examination (DLOSCE) be available in 2019; and an exam deployment in 2020.
“The OSCE has the potential to become a prominent exam,” said Dr. Gary Roberts, ADA president. “This type of dental exam has been given in Canada for many years and has proven to be a reliable way to test competency.”
Details of the exam — from content and structure to policies and staffing resources — remain in the works. The Board is creating a DLOSCE Steering Committee tasked to:
- Identify and establish content areas and test specifications for the examination.
- Conduct a practice analysis.
- Establish general structure for examination (number of stations) and permissible item formats (manikin, haptic feedback device, etc.).
- Identify and contract with key vendors, including technology and administration, in support of the exam.
- Identify and establish test construction committee structure.
- Develop the candidate guide.
- Call for test constructor applications.
- Identify appropriate governance structure for DLOSCE administration.
- Identify first state(s)/region(s) for the DLOSCE field test.
The DLOSCE will be a national exam, based on an analysis of U.S. dental practice. It will remain the same regardless of the region of the country where it is administered, and will become a third-party assessment of competencies regularly evaluated at accredited dental schools.
Both the ADA Council on Dental Education and Licensure and the ADA/American Dental Education Association Joint Licensure Task Force endorsed the initiative, which has been working closely on licensure issues over the past couple of years.
“A key element of our efforts together has been to promote opportunities to assess the competency of graduating dental students and dentists applying for initial licensure that do not require the involvement of patients in that process,” said Dr. Richard Valachovic, ADEA president and CEO. “The [OSCE] presents us with that opportunity. We applaud the ADA Board of Trustees for supporting this initiative, and we look forward to continuing to work with the ADA as it develops the examination.”
The Board decision comes more than a year after the Council on Dental Education and Licensure recommended in December 2015 the development of a business plan for an OSCE. The development of the DLOSCE supports current ADA policy calling for the elimination of patients from the dental licensure examination process.
In creating the business plan, the council and the Board considered advancements in high stakes clinical testing over the past 20 years and sought the expertise of the ADA Department of Testing Services, which received input from selected state dental boards during a forum at the 2016 ADA annual meeting in Denver.
Currently, only Colorado accepts an OSCE for initial licensure with no restrictions. Minnesota accepts the OSCE administered by the National Dental Examining Board of Canada for initial licensure, which is administered annually at the University of Minnesota for their graduates only.
In the Canadian exam model, dental students rotate through various stations and answer extended match multiple choice questions using simulated clinical scenarios and patient situations. According to the National Dental Examining Board of Canada, which administers the Canadian OSCE exam, the exam is developed based on the “Competencies for a Beginning Dental Practitioner in Canada,” which list nearly 50 items a beginning dental practitioner must be competent to do.
There are skeptics. During the October 2016 forum at the annual meeting, representatives of some dental boards raised public safety concerns over dental licensure examinations that don’t involve candidates performing dental procedures on patients. Others asked the ADA to make sure that the Association adequately addresses any conflict of interest in creating the DLOSCE. The new steering committee has been tasked to address those concerns.
Dr. Roberts said the DLOSCE is simply new option for state dental boards to consider.
“This is another way to test competency,” he said. “Another tool in their toolbox.”