Updates on LicensureLaura HulingDistrict 1 Trustee

What are licensure exams?

•What are licensure exams? • the dental licensing exam is the exam you take after

completing all the requirements of your dental school and part's I and II of the NBDE which allows you to become a practicing dentist (also is an in school, curriculum integrated format). The exam is conducted over several days includes both a written portion and a clinical portion in most cases.• Each state develops its own standards for licensure and

states can either accept, recognize, or not recognize certain exams.

What are the regional board examinations and what do they entail?

• NERB •WREB• SRTA• CRDTS• CITA

Has there ever been any attempt to nationalize licensure exams?

• Yes, there have been a few attempts in history to nationalize the regional board exams. These attempts have failed due to third party company disagreements and questions within the states

• In order to have more universal acceptance, some states have adapted legislation for equivalency

What are the ethical considerations surrounding the current form of licensure exams?

• Timely provision of treatment• Treatment under a high stress environment• High cost• Financial exploitation by the patients• Undermines the accreditation process

ADA Stance on Licensure Exams

• Curriculum Integrated format of the exam• Patient of record• Timely sequence in the treatment plan• Exam available at multiple times

• Eliminating Human Subjects in Exams• Support elimination of human subjects• Encourages each state to adopt this policy

ASDA Stance on Licensure

• L1 policy• Until a new exam format can be developed, the current exam

should• 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.• be administered in the final year of dental school.• provide opportunities for remediation, at the candidates’ dental school, prior to graduation.• guarantee anonymity of candidates and examiners.• be administered by examiners who have been calibrated to provide standardized and consistent scoring.• not include a written examination that duplicates the content of the National Dental Board Examination Parts

1 or 2.• be offered to candidates at the lowest reasonable cost possible.

ASDA Stance on Licensure

• L1 continued• The following methods of assessment would be preferable to the

current exams• Initial licensure without an independent clinical licensing examination• A portfolio-type clinical examination based on cases compiled during

the final year of dental school• A non-traditional patient based clinical licensure examination• An Objective Structured Clinical Examination designed to evaluate a

candidate’s diagnostic and treatment planning skills.• Completion of a one year post graduate residency program

ASDA Stance on Licensure

• L2 policy• Supports licensing of foreign trained dentists only by methods

approved by the ADA

• L3 policy• Similar standards as stated in the ADA stance on Licensure

• L4 policy• Supports a single exam that is fair and quantitative in the

assessment

Current State of Licensure

• A lot of FLUX!• Minnesota accepting the OSCE exam• All mannequin based and computer based

• California developing and accepting the portfolio examination

• ADA task force in developing a portfolio examination that may be used universally.

PGY-1By: Nipa Thakkar, District 3 Trustee

Outline

•What is PGY-1?•A Dental PGY-1 National Background•ASDA’s PGY-1 Policy• Licensure Info by State•Dental PGY-1 vs. Medical PGY-1•ADEA’s Outlook•AADE’s Outlook•GPR vs. AEGD•How to Apply

What is PGY-1?

• PGY-1 stands for post-graduate year-1, or the first year of post-doctoral training in a professional healthcare field.

A Dental PGY-1 National Background

1994: Clinical licensing exams were yielding a 50-80% failure rate for dental licensure

1995: >1000 candidates failed licensing exams

2003: NY PGY-1

2003: ADA HOD Policy on Dental Licensure amended

2007: PGY-1 for licensure mandated in NY

2007: California, Connecticut, and Minnesota offer option of PGY-1 for licensure

2008: Washington offers PGY-1 option

“Licensure Change– A Timeline,” http://www.ada.org/5469.aspx

ASDA’s PGY-1 Policy• A-1 Additional Year of Dental Education (1983, revised

2002)

The American Student Dental Association strongly supports high quality dental education, and favors voluntary postgraduate training and the creation of additional postgraduate opportunities. The American Student Dental Association is opposed to a mandatory one-year postgraduate program or the addition of an additional year to the present dental curriculum. The American Student Dental Association supports students having the option to complete an ADA accredited postgraduate residency program in lieu of a clinical licensure exam for the purpose of initial licensure.

www.asdanet.org

My State…

•Mandate PGY-1: New York, Deleware (+ licensing exam)•Recommend PGY-1: Many specialty programs, most state dental boards•Accept PGY-1: Connecticut, Minnesota, Washington and California• California- Must be an AEGD or GPR, IF WREB is

taken and failed, you must re-take and pass to obtain licensure

• Washington- Must be in a low-income clinic• Minnesota- PGY-1 must be completed in Minnesota

Licensure Info by State

A Survey of Deans and ADEA Activities on Dental Licensure

IssuesRichard R. Ranney, D.D.S.; N. Karl Haden, Ph.D.; Richard W. Weaver, D.D.S.; Richard

W. Valachovic, D.M.D.

•A survey was performed 2003 of all deans at all dental schools in the US• 76% felt that PGY-1 completion at an accredited GPR or AEGD was an appropriate alternative to clinical testing.• 64% felt specialty training PGY-1 should also apply for licensure.

Journal of Dental Education, Vol 67, No 10

American Association of Dental Examiners

• “Assessment of students for licensure should be conducted by independent third parties whose sole responsibility is in protecting the health, safety and welfare of the public.”• “Postgraduate education will help to create better-trained, more seasoned practitioners, but is it economically feasible as a mandate for licensure in the present landscape of diminished funding and escalating student indebtedness?”

American Association of Dental Examiners Position Statement“Post-Graduate Year-1, A Flawed Alternative Pathway to Licensure”By: Delma H. Kinlaw, D.D.S., et. al.

ADEA 2008-2009 Vice President for Students

“As it currently stands, there is not enough evidence to collectively support a mandatory postgraduate year for all dental graduates. We first need to collectively decide if this proposal stems from curricular change in dental education, access to care for underserved populations, or the desire to replace live patient state licensure exams. Once we examine all perspectives, we can arrive at an ideal treatment plan.“ “Where Does PGY-1 Fit In?” by Dr. Rick Valachovic,

Executive Director- American Dental Education Association

A Mandatory Residency, like Med School?

• “postgraduate dental residencies were not designed to satisfy licensing requirements. They do not contain a unified integrated curriculum prescribed by an independent agency.”• “it is unknown whether the faculty, institutions, outcome assessments, and residency evaluations conform to established standards such as in the first residency year in medicine.”

“The New York State Postgraduate Fifth-Year Dental Residency as a New Licensure Path: Concerns for Public Protection,” By Ronald I. Maitland, D.M.D. Journal of Dental Education, Vol 67, No 3

GPR vs. AEGD

GPR

•Treat more children (10-49% of the patient pool)•Care for more medically intensive and in-patient/same-day surgery patients•Provide more care to lower fee populations

AEGD

•Treat fewer children (<10% of population served)•Treat a larger population of healthy adults•Treat more insurance/private pay individuals.

“Characteristics of Civilian Postdoctoral General Dentistry Programs”By: Ronald S. Mito, D.D.S., F.D.S. R.C.S., et al. Journal of Dental Education, Vol 66, No. 6

• Salaries• Types of Procedures Performed•Number of Patients Seen• Length of Program• Setting of experience

Decisions, decisions…

GPR vs. AEGD, Cont’d

How to Apply

• Follow the steps!•Check out http://

www.agd.org/students/education/postdoctoral.asp for a full list of AEGD and GPR programs by program length and state.

• Questions/Concerns? Contact me at nipa815@gmail.com.

Thank you!