Each year, more than 6,000 dental students across the United States obtain dental licenses through a patient-based clinical licensure exam. As a dental student, I’ve learned all about what the test will entail: performing two fillings and a cleaning on a live patient, and then preparing a crown, bridge and an anterior root canal on plastic teeth. I’ve also learned about the controversies surrounding the exam. From requiring students to perform irreversible procedures on patients without comprehensive supervision to not being psychometrically valid and reliable in its assessment, the discussion surrounding the exam is extensive.
Despite all of this information, I found that I was uncertain about what the actual day of the exam would look like for me and my patients. To gain real-life perspective from someone who just went through the exam, I interviewed Mollie Helf, Alabama ’19.
The following outlines the timeline of her exam experience.
6:30 – 6:45 a.m.: I arrived on Saturday to find my operatory, set up equipment and wait for my patient. In case she didn’t show, I had back-up patients, and so did my classmates. These patients were paid even if they weren’t needed.
6:45 – 8 a.m.: My patient arrived at 6:45 a.m. Before 8 a.m., you can only set up and have the testing agency approve the patient’s cavities. A nice thing about my case was that I only needed one patient for all three of the procedures. Some students had three different patients to satisfy the test’s criteria. This really added up the costs.
8 – 8:15 a.m.: I started drilling to remove the cavity in the front tooth at 8 a.m. and wrapped up in about 15 minutes.
8:15 – 9 a.m.: My patient was anonymously sent to the judges. Preparations were reviewed, and candidates were either cleared to fill or told to stop. If you’re told to stop, you failed, and you receive directions to place a temporary filling. Your patient then requires follow-up care by a licensed dentist. The judges took about 45 minutes to review my patient before I was cleared to continue.
9 – 9:20 a.m.: I filled the tooth in about 20 minutes, making sure it was the most beautiful filling I had ever done, and sent it back to be graded.
9:20 – 9:50 a.m.: Grading took about 30 minutes.
9:50 – 11:30 a.m.: The back tooth filling was next. I starting drilling and realized there was more cavity once I had hit the maximum size guideline. I then had to submit for a modification. I sent the patient back, and about 25 minutes later was granted permission to extend my prep and drop a mesial box. After excavating all decay, the patient was sent back for the preparation grading. All in all, that whole process took about an hour and a half.
11:30 – 11:50 a.m.: The patient returned to my operatory. I filled for about 20 minutes before sending her to be graded.
11:50 a.m. – 12:20 p.m.: This phase of grading took about 30 minutes.
12:20 – 1:05 p.m.: Once she returned, it was time to perform the deep cleaning. I numbed the patient and sent her back to be approved by the judges, which took another 45 minutes.
1:05 – 1:35 p.m.: I then cleaned her teeth for roughly 30 minutes before sending her back for final grading.
Despite the time-consuming judging and modification, Mollie passed all portions of the live-patient exam. Her experience helped me understand how students are financially burdened and how unreliable the licensure exam is. It’s clear these exams can’t be standardized, as no two humans are anatomically, physiologically, pathologically and psychologically identical. What’s more, the exam did not test the breadth of skills I believe are necessary to practice as a dentist.
As I continue to advocate for the removal of the live patient from the exam, Mollie’s timeline provides a real-life scenario that can be shared with stakeholders. It’s vital to highlight the facts and statistics of the exam, but oftentimes, the most impactful message for stakeholders comes from real-life scenarios. We’ll each have our own live-patient examination story by the time we become dentists. I challenge you to share your stories with stakeholders to make ASDA’s Ideal Licensure Exam a reality.
~Kai Huang, Alabama ’20, District 5 Trustee
