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In his February JADA article, "Portfolios for Determining Initial Licensure Competency," Dr. David Chambers grossly oversimplifies the complex process that state dental boards utilize as they evaluate candidates for licensure in their respective jurisdictions.

Dr. Chambers incorrectly suggests that there are just four factors in the decision: graduation from an accredited dental school, a criminal background check, passing the national board and a clinical exam. The author then singles out clinical examination, calling it "one-shot" and inadequate, and proposes replacement with a more comprehensive review of the candidate’s performance in dental school.

As viewed by boards of dentistry, the evolution of a newly matriculated dental school freshman to a graduating, competent dentist who is qualified to receive a plenary license to practice is far more comprehensive than Dr. Chambers indicates, and is a system replete with attendant checks and balances.

The prime responsibility for training resides in dental schools. Dental instruction is divided into two basic components: process and product.

Process defines how the teaching is implemented, and includes factors such as admissions, instructional and faculty standards, curriculum, ethics, professionalism, facilities and research.

Product is the ability of the school’s graduates to be competent in the provision of oral health care within the scope of general dentistry. Dental schools work continually to review and improve both their process and their product.

In addition, every aspect of educational process and product is subjected to a secondary, external review. The Commission on Accreditation periodically visits every dental school to ensure that the institution’s process meets Commission standards. The product, a competent dentist, is externally evaluated in two ways: informational and clinical. The Joint Commission on National Dental Examinations administers the national board examinations to test didactic accomplishment, and the regional and state boards administer practical examinations to evaluate clinical skills.

Apparently, because the clinical examination is the final, major challenge of the licensure process, Dr. Chambers, along with many others, fails to understand the limited, but not insignificant, role of the clinical exercise as part of the overall evaluation of candidates for licensure, and disproportionately exaggerates the relevance of the test.

Furthermore, the author demonstrates a disturbing lack of understanding of the totality of the prelicensure experience when he expresses, as a major concern, the failure of the clinical examination to forecast future behavior of the dentist in active practice (predictive validity). He argues, and I agree, that certain aspects of patient care—such as understanding alternatives, managing over time, moral weakness, substance abuse and fraud—are not addressed in the one-shot licensure examination.

However, Dr. Chambers must be reminded that, prior to board examination, accredited dental schools, which are certainly not one-shot, observe students for four years, certify that their graduates have met all requirements, have achieved professional competence and are ready for licensure. If there is a failing in "predictive validity," the responsibility resides with the schools.

The portfolio review that Dr. Chambers proposes would primarily be a redundant exercise of evaluations of procedures already performed by the student and evaluated by school staff, leading to their determination that the dentist is competent for solo practice. Not only would it be difficult to administer but, most importantly, portfolio review would needlessly remove the only secondary, external, independent assessment of clinical skills from the licensure process.

Annually, throughout the nation, the board clinical examinations identify about 4 percent of recent graduates of accredited dental schools who, unfortunately, persistently demonstrate on board examinations that they do not possess the motor skills, the eye-hand coordination, the depth perception or understanding of basic clinical concepts to be granted licensure.

In 2002, the last year for which data are available, 4,349 dentists graduated from accredited dental schools. About 175 of these graduates do not possess the minimal competency to practice. While Dr. Chambers chooses to invoke the pejorative expression "one-shot" for board clinical examinations, he is reminded that, year after year, allowing an additional 175 unskilled practitioners to practice would cause enormous harm to a trusting public.

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				A. L. Yeager IN SUPPORT OF EXAMINATION J Am Dent Assoc, May 1, 2006; 137(5): 589 - 590. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yeager, A. L. Search for Related Content PubMed Articles by Yeager, A. L.