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3 ways to minimize the ethical pitfalls of a live patient exam


In most states, one of the final steps in becoming a licensed dental professional is the licensing exam. Currently, there are five regional testing agencies: Western Regional Examining Board (WREB), Southern Regional Testing Agency (SRTA), Council on Interstate Testing Agencies (CITA), Central Regional Dental Testing Service (CRDTS), and North East Regional Board (NERB). One component these licensing exams have in common is the use of live patients. Unfortunately, the use of live patients presents a plethora of ethical concerns since many of the essential features of a doctor-patient relationship are absent. In some cases, proper informed consent is deficient, the methods to recruit patients for the exam are unethical, and many patients are not offered comprehensive care beyond the treatment during the exam.

In recent years, ASDA, ADEA, and the ADA have publically denounced the use of live patients during licensing exams. ASDA’s L1 policy clearly states that any clinical licensing 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.”  While much progress has been made to create alternate pathways to licensure including: a PGY1 residency, portfolio review in California, and an Objective Structured Clinical Examination (OSCE) in Minnesota, there is still much work to be done to eliminate the live patient component.

While we work towards this common goal, there are ways to minimize the unethical aspects of live patients that do not disrupt the application of the exam. These changes involve closely working with your school administration to set requirements prior to and following the exam at your school.

  1. Currently, as the examinations only consist of a few specific treatments, many patients are not offered care beyond what is required for the exam. To address this limitation, your school could require all exam patients be offered a written complete treatment plan with the option to become a patient at the school for full comprehensive care following the exam.
  1. The periodontal component for most exams only includes scaling and root planing a fraction of the dentition. Your school could require all examinees to bring back the exam patients within two weeks of the exam to complete the prophylaxis.
  1. In some cases, students have withheld treatment for patients with ideal examination lesions for an extended period of time to save these patients for their exam. Your school could limit the time in which patients can be found prior to the exam in order to prevent delayed treatment.

According to ASDA’s Code of ethics, it is our duty as professionals to practice beneficence. These three changes could greatly improve the quality of care patients will receive following the exam. I challenge you to begin a discussion with your school administration to make these changes at your school. For more information about live patient exams and licensure visit

~James Wanamaker, Buffalo ’16, Legislative Coordinator Districts 1-3

James Wanamaker

James Wanamaker is a 4th year dental student at Buffalo School of Dental Medicine. He currently serves as the Chair of the Council on Advocacy. He previously served as the Legislative Coordinator for Districts 1-3 and Legislative Liaison for Buffalo SDM. When he is not busy with school and ASDA he enjoys spending time with his wife, boating, DJing, and ballroom dancing.

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