Dr. Meskin’s editorial, "Freshly Washed Little Cherubs" (August JADA), at least affords the opportunity for important dialogue on this controversial subject of patient utilization during clinical board examinations. He has liberally and, for the most part, accurately, quoted from my editorial in the American Association of Dental Examiners Bulletin.1
However, as a 64H-2000 "detractor," I believe a number of points he raised need clarification and embellishment.
When Res. 64H, submitted by the American Student Dental Association, or ASDA, was discussed at the reference committee, human subjects were not discussed and identifying the incompetent candidate was not mentioned. The discussion centered on ADA membership issues. I was there.
When 64H was brought to the House of Delegates, it was indeed late in the day and only three speakers were allowed to voice opinions before the question was called and a vote taken. I was there. I hardly think this truncated debate was adequate over an issue that, if implemented, would radically alter the way all examinations are administered in this country.
Of course I "pooh-poohed" the concept put forth in a January editorial in a large state dental association journal that called for not only the elimination of patients from examinations, but also the elimination of all entry-level exams and, while we’re eliminating redundancies, the elimination of accreditation of dental schools.
How can anyone not consider this an effort to eliminate all of our standards for licensure in the interest of political and economic expediency? Is this truly the way the ADA wants to strengthen membership numbers?
A central theme in the editorial is the unfortunate candidate who fails the examination simply because the patient doesn’t show. In the history of the Central Regional Dental Testing Service, or CRDTS, a fraction of 1 percent of our candidates has failed because the patient didn’t make it. Albeit stressful for the candidates, statistically it is a nonissue.
Dr. Meskin also mentions our disaster in Kansas City last August when the water main broke, necessitating the continuance of the exam in Chicago three weeks later. In fact, CRDTS not only did not charge additional fees, as Dr. Meskin pointed out, we also refunded their entire examination fee at significant expense for the testing agency. They took the exam for free.
Another common misconception is that all candidates eventually pass without further training. This is simply not true. Again within CRDTS, 7 percent of all candidates who have taken our exam have never passed. Admittedly, many of these were simply license-gatherers or successfully completed another exam elsewhere. However, conservatively, 2 to 3 percent of candidates nationally never pass. These people are our target.
CRDTS has utilized manikins for a large portion of our exam since 1995. What we have found is that the statistical analysis shows that the amount of deviation for manikin-based procedures is actually higher than the deviation for patient-based procedures, suggesting that the manikin-based procedures are actually less reliable. They are certainly not valid in approximating all that needs to be tested on patients.
So why have entry-level examinations at all? This is actually what ASDA and the American Dental Education Association are calling for: the elimination of all competency assessments for licensure. The argument is that if they have graduated from an accredited school, they are, de facto, competent. If so, why would the schools be worried that harm would come to patients during the examination?
Why do people call this "barbaric experimentation" if these people are competent by graduation? I personally believe the term "barbaric" directed at recent graduates is an insult to our entire dental education system. The point is that the accreditation system evaluates the process; entry-level examinations evaluate the product of that process. Wouldn’t it be a novel idea if the schools actually had the fortitude to eliminate the truly incompetent student before graduation?
I agree that the entry-level exam should be a requirement for graduation. If they don’t pass, they don’t graduate. Thus, they would have the opportunity to improve their skills and the schools would exhibit more educational responsibility during their years in school. If a board exam is merely a snapshot of that person’s abilities, the school and faculty have the whole photo album. When this small minority of students is counseled by the school to seek employment in the food service or housekeeping industries rather than our profession, we will no longer need board exams.
ASDA knows what’s best for dental students. The ADA knows what’s best for their member dentists. The state boards and clinical testing agencies know what’s best for the consumer and competency testing. We must keep this healthy division of responsibilities and reject self-serving efforts to lower our standards. When we lower our standards, our profession becomes a trade.
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