In his comments, Dr. Yeager argues that the "one-shot" clinical examination is part of a complex process for granting initial licensure, that dental school graduates must be externally evaluated by this method, that the blame for inappropriately licensed practitioners (those whose licenses are disciplined) rests with the schools, and that it is known that a certain number of graduates who are incompetent are prevented from practicing by these one-shot tests. I will consider these arguments serially.
Dr. Yeager does not describe what (beyond graduation from dental school, freedom from relevant criminal record, passing the National Dental Board Examination, and passing a one-shot clinical test) is necessary for initial licensure. There appears to be something missing following the second sentence of his letter.
Graduates of dental schools should not be automatically granted a license. Each should present sound evidence to an independent body, a state dental board, that is acceptable to establish his or her competence. That is the position I develop in the article Dr. Yeager criticizes. Our difference is that Dr. Yeager believes that one-shot clinical tests are the only acceptable such evidence. I do not believe they are either reliable or valid. My appeal is that boards only accept evidence that meets conventional psychometric standards comparable to those used by other professions, and they accept this evidence from any source that can prove the merits of its evaluation information.
Dr. Yeager argues that one-shot tests are a necessary supplement to dental education and the other criteria for licensure. Although there is abundant evidence that decisions from one-shot tests and graduation differ in a small proportion of the cases, there is no evidence that further testing adds anything to what is already known before testing. Batting last is not the same thing as batting better. This confusion may underlie the comment in the letter that incorrectly licensed dentists are the fault of schools, but not of independent licensure testing.
Dr. Yeager places the number of incompetent graduates in 2002 who were prevented from practicing by initial licensure tests in this country at 175. This estimate would be correct if it could be determined that such tests are perfect—100 percent reliable and 100 percent valid. Because the validity is unknown and the reliability is generally no better then an embarrassing r = .40, there will be some competent dentists who were incorrectly denied a license, and many more incompetent ones who were licensed.
The disagreement between Dr. Yeager and me seems to come down to two points. If one accepts that one-shot tests are perfect, all of his criticisms are sound. They are known, however, to be considerably flawed.
Our second disagreement centers on what to do about that. Many in the testing community appear to believe there is no alternative to the one-shot test as the basis for an independent assessment of competence. In contrast, I feel it is prudent for all of dentistry to work together to define what competencies are necessary to begin independent dental practice, to establish professionally acceptable levels of validity and reliability and to accept any portfolio of evidence that satisfies these standards.
Because these decisions will all remain with state dental boards (they never have been vested in testing agencies), the desirable feature of independent verification of competence to practice will be preserved.
