1. Updates on Licensure Laura Huling District 1 Trustee

2. 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.

3. What are the regional board examinations and what do they entail? NERB WREB SRTA CRDTS CITA

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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

10. 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.

11. PGY-1 By: Nipa Thakkar, District 3 Trustee

12. 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

13. 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.

14. 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

15. 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

16. 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

17. Licensure Info by State

18. A Survey of Deans and ADEA Activities on Dental Licensure Issues Richard 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

19. 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.

20. 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

21. 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

22. 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

23. Salaries Types of Procedures Performed Number of Patients Seen Length of Program Setting of experience Decisions, decisions… GPR vs. AEGD, Cont’d

24. 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. http://www.agd.org/students/education/postdoctoral.asp Questions/Concerns? Contact me at nipa815@gmail.com.nipa815@gmail.com Thank you!