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Licensure 101

Licensure 101. Adam Shisler, DDS, Houston ’12 . Agenda. The Nitty Gritty The Controversy Where are we on improving the situation? . We all want to get here? . Where do we start? . Timeline: NBDE Part 1 & 2 Awarded/On-track diploma status Clinical licensure exam

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Licensure 101

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  1. Licensure 101 Adam Shisler, DDS, Houston ’12

  2. Agenda The Nitty Gritty The Controversy Where are we on improving the situation?

  3. We all want to get here?

  4. Where do we start? • Timeline: • NBDE Part 1 & 2 • Awarded/On-track diploma status • Clinical licensure exam • Application for licensure • License • Practice dentistry and love every minute

  5. Slow it down • First, where do you want to live? • Find that state board’s website

  6. Can’t sit here? • Only certain clinical exams are accepted by certain state boards of dentistry. • CITA (6 members / 26 accepted) • CRDTS (16 members / 30 accepted) • NERB ADEX (20 members / 40 accepted) • SRTA (6 members / 30 accepted) • WREB (17 members / 35 accepted)

  7. More than one way to… • Objective Structured Clinical Exam • OSCE (1 - MN) • Portfolio (1 - CA) • Post Graduate Year – 1 • PGY-1 (5 states) • CA, WA, MN, NY and CT

  8. Say hello to my little friends • Council on Interstate Testing Agencies (CITA) • Central Regional Dental Testing Services (CRDTS) • North East Regional Board (NERB) • Southern Regional Testing Agency (SRTA) • Western Regional Examining Board (WREB)

  9. Collective Mission of the Regional Board Exams • AADB Mission Statement: • To serve as a resource by providing a national forum for exchange, development and dissemination of information to assist dental 
regulatory boards with their obligation to protect the public. • AADB Values Held Statement • AADB values protection of the public whenever it seeks dental health care.  • AADB values collaborative relationships within organized dentistry among educators, accreditors, examiners and regulators. • AADB values meeting the needs of all its members.

  10. Fine Lines of Differences *Fees do not include Prometric/Pearson site fees or school specific instrument fees.

  11. Documents to Organize • Notarized Copy of Diploma • Certified Clinical Licensure Exam Results • Nitrous Certification from Dental School • AHA BLS Certification • DL / SSN Card • Part 1 / Part 2 Notarized Copies

  12. Insurance Coverage

  13. The Controversy • WWMGD?

  14. Medical Licensure • State mandated responsibility • Successful completion of all three steps of the United States Medical Licensing Examination (USMLE). • The physician should provide the licensing board with a resume or curriculum vitae

  15. Medical Licensure Model USMLE Step 1 • Traditional MC Exam USMLE Step 2 • Clinical Knowledge & Clinical Skills • CK – traditional MC exam over 9hrs • CS – simulated patient interactions • ++ Standardized Pts portrayed by actors USMLE Step 3 • 16hr exam / 2 days • Day 1 = MC, Day 2 = combo of MC and clinical cases • Simulation clinical cases that are input interactive

  16. ASDA Policy (L1: revised 1998, 2001, 2002, 2005, 2013) The American Student Dental Association believes that any clinical licensing examination intended to measure technical skill via a sequence of independent clinical tasks 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. be universally accepted by all state boards of dentistry. be psychometrically sound.

  17. ASDA Policy (L1: revised 1998, 2001, 2002, 2005, 2013) While the American Student Dental Association supports continual improvement of existing examinations and collaborative development of a new examination, the association believes the following alternatives are preferable to the current licensure process: Initial licensure without an independent clinical licensing examination. Graduates of a U.S. CODA-accredited dental school should be eligible for initial licensure without taking any additional clinical examination. A portfolio-type clinical examination based on cases compiled during the final year of dental school. Such an examination should require a standardized catalog of required clinical procedures and the portfolio should be evaluated by an examiner independent of the dental school. A non-traditional patient based clinical licensure examination. Although the American Student Dental Association does not support the use of live patients in traditional clinical licensing examinations, the association recognizes the potential for creation of an ethical, patient based 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. Completion of a U.S. CODA-accredited post graduate program that has a minimum duration of one year should be sufficient to substitute for the clinical licensure examination requirement in any jurisdiction.

  18. ADA Supporting ASDA’s Efforts ADA policy (2005:3351) • Resolved, that the Association supports the elimination of human subjects/patients in the clinical licensure examination process with the exception of the curriculum integrated format within dental schools, and be it further, • Resolved, that the Association encourages all states to adopt methodologies for licensure that are consistent with this policy.

  19. The Controversy:Ethics ADA Principles of Ethics and Code of Professional Conduct (Nonmaleficence & Beneficence) Comprehensive care Delaying treatment Patient compensation Price of the exam Manipulating radiographs

  20. The Controversy:Accuracy • Subjective nature d/t examiner scoring • One-day one-shot mentality • Few, if any, opportunities for remediation at the candidate’s dental school, before graduation.

  21. The Controversy:Best Practices • Unnecessary treatment of incipient caries • Invasiveness • Redundancy of content • Reciprocity Dental educators teach students to consider a patient’s overall oral health and to work on creating long-term partnerships. During licensing exams, they see this treatment model distorted. – Toni Roucka, DDS, MA & Evelyn Donate-Bartfield, PhD AGD Impact 2013 Aug;61(5):18. 

  22. What’s Ahead

  23. What’s Happened: • 2000: ADA favors the elimination of live patients in clinical licensure exams • 2003: NY option to do PGY-1 • 2004: ADA supports Universal Licensure • 2007: NY mandate to do PGY-1 • 2007: CA, CT & MN option to do PGY-1 • 2007: ASDA & ADA Define CIF • 2008: WA option to do PGY-1

  24. What’s Happened: • 2009: MN option to take Canadian OSCE • 2010: CA option to submit Portfolio • 2010: ADA directed to develop Portfolio Exam • 2014: CITA to join ADEX • ~2017: INDBE potential rollout

  25. What’s Happening: • ADA Task Force on Portfolio Exam • ASDA/ADEA/ADA Strategy • State-Level Advocacy

  26. Questions?

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