For new dental students, licensure exams are a few years away, but it’s never too early to start getting educated about the current process and what we can do to improve the experience for ourselves as well as future dental students.
The live-patient clinical examination has myriad shortfalls — many of which are outlined in the 2016 ASDA white paper “Use of Human Subjects in Clinical Licensure Examinations” — including issues of validity, reliability and ethics. According to ASDA’s L-1 Initial Licensure Pathways policy, ASDA believes the ideal licensure exam does not use human subjects in a live clinical testing scenario; is psychometrically valid and reliable in its assessment; is reflective of the scope of current dental practice; and is universally accepted.
In addition to the white paper, several entities in organized dentistry have collaborated in changing the course of the licensure debate. ASDA, ADA and ADEA joined together to develop the Taskforce on Assessment of Readiness for Practice, calling upon state boards to “eliminate the single encounter, procedure-based patient exams, replacing these with clinical assessments that have stronger validity and reliability evidence.” Some state dental boards such as California and Washington have begun making changes. In 2014, California allowed students to qualify for dental licensure by Portfolio Examination, while setting competency requirements in six areas of dentistry that they deemed necessary for dental practice. In June 2017, Washington’s state dental board approved the Objective Structured Clinical Examination (OSCE), a station-type exam that requires the use of clinical skills to complete various dental problem-solving tasks.
So why haven’t some states, such as my home state of Oregon, started to make this change? Before alternative paths to licensure can be taken by new dentists, it requires the support of the state dental board and the stamp of approval from state government. The Oregon Dental Association and Oregon Health & Science University (OHSU) have recommended that the state board explore other methods of licensing new dentists. At the state lobby day in February 2019, one of the bills we advocated for was SB 824, which allows the board of dentistry to consider new types of licensure exams such as the OSCE. This bill, overwhelmingly supported in both the House and the Senate, was signed by Oregon Governor Kate Brown on June 20, 2019, effective immediately. This legislation being signed into law is proof that advocacy works.
The ADA is developing another option for clinical licensure examination called the Dental Licensure Objective Structured Clinical Examination (DLOSCE). Along with ASDA, ADEA and the ADA support the elimination of live-patient exams from the licensure process. In fact, in October 2018, the three organizations formed the Coalition for Modernizing Dental Licensure, intended to address these licensure challenges.
Oregon could be one of the dental schools chosen to pilot the DLOSCE, says Dr. David Carsten, a member of the ADA DLOSCE Steering Committee and faculty member at OHSU. He says that this standardized exam will be more objective and that “the DLOSCE tests clinical judgment — the most essential element in differentiating a person who can merely perform procedures and a doctor.” He added that the DLOSCE pilot is planned to start in December 2019.
While the final decision is up to each state’s dental board, dental students can still advocate for their profession and influence outcomes. Be more active in your school’s ASDA chapter, either by joining your advocacy committee or spreading the word about events and legislation that affect dental students. Join your colleagues at state and national lobby days to meet with legislators. The ethical and professional implications of current live-patient licensure exams will continue to impact the future of the profession, but we have the ability to change this if we collectively work to make our voices known. This is why we advocate.
~Jonathan Faris, Oregon ’22