Dental Education at the Crossroads Challenges and Change (1995) / Chapter Skim
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8 Dental Schools the Profession, and the Public
8 Dental Schools the Profession, and the Public
Pages 228-253
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From page 228... ...
Accreditation and licensure are components of a broad social strategy to ensure the quality of dental care. In examining the patient care mission of dental schools, Chapter 6 discussed basic concepts of quality assurance and improvement.
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From page 229... ...
In theory, accreditation is voluntary. In practice, it has become a virtual requirement for schools because graduation from an accredited school is a prerequisite for dental licensure in most states, although some states have special provisions for licensing those who have graduated from foreign dental schools.
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From page 230... ...
The Commission on Dental Accreditation formulates and revises accreditation standards, establishes procedures for applying those standards, and determines accreditation status for individual pro TABLE 8.1 Number of Programs Accredited by Commission on Dental Accreditation No. of Accredited Programs: Predoctoral dental programs Specialty programsa General practice residency/advanced general dentistry programs 54 421 325 233 Dental assisting programs 212 Dental hygiene programsa 41 Dental laboratory technology programs 1,286 Total number of programs accredited as of January 1994 aIncludes accreditation eligible programs.
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From page 231... ...
Second, CDA also accredits programs in dental hygiene, dental assisting, and dental laboratory technology. Programs for some other allied health professions, for example, occupational therapy and physical therapy, are accredited by independent bodies.
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From page 232... ...
for dental schools in eight broad areas: administration, financial resources and facilities, faculty and staff, students, curriculum, patient care and clinic management, research, and outcomes. The curriculum area is the most extensive.
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From page 233... ...
Given the breadth of the commission's responsibilities for dental school accreditation, it is not surprising that the typical site visit involves a large team of visitors. In contrast to the usual four-person survey team for medical accreditation, the average survey team for a dental school has fifteen members including five consultants for the predoctoral program and one consultant for each advanced education or allied education program.
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From page 234... ...
The Commission on Dental Accreditation has, in recent years, made numerous changes in its processes and standards. It has, for example, shifted the accreditation cycle from ten to seven years.
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From page 235... ...
This argument assumes the validity and reliability of the licensure examinations, which are questioned later in this chapter. Of the 54 dental schools, 53 are accredited without qualification.
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From page 236... ...
It places excessive burdens on satisfactory schools while inadequately protecting students and the public from unsatisfactory programs. Even if accreditation results were valid, the confidentiality of accreditation results for specific dental schools raises questions about how well the process can protect students and the public.
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From page 237... ...
First, the reouirement for a state or regional clinical examination distinguishes dentistry and dental hygiene from most other neaten professions. Physicians, for example, take national written examinations but face no clinical examination at either the national or the state level.
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From page 238... ...
Some include representatives of the general public. The National Practitioner Data Bank and the American Association of Dental Examiners collect information on disciplinary actions against dentists taken by state boards, hospitals, or professional organizations.
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From page 239... ...
The regional boards and the states that recognize their examinations are listed in Table 8.2. TABLE 8.2 States Participating in Regional Dental Testing Agencies, January 1994 Central Regional Dental Testing Service Colorado Nebraska Illinois North Dakota Iowa South Dakota Kansas Minnesota Missouri Wisconsin Wyoming Northeast Regional Board of Dental Examiners Connecticut New Jersey District of Columbia New York Illinois Ohio Maine Maryland Massachusetts Michigan New Hampshire Pennsylvania Rhode Island Vermont West Virginia Southern Regional Testing Agency Arkansas Kentucky Georgia Tennessee Illinois Virginia Western Regional Examining Board Alaska Oklahoma Arizona Oregon Idaho Texas Montana Utah New Mexico Nonparticipating States (administer their own examinationsJ Alabama Louisiana California Mississippi Delaware Nevada Florida North Carolina Hawaii South Carolina Indiana Washington NOTE: Under certain conditions, states (e.g., IllinoisJ may accept examination results from more than one regional organization.
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From page 240... ...
These guidelines set forth a conceptual and methodological framework for analysis and included data from the ADA's 1990 Survey of Dental Services, a 1990 examination of the clinical content of licensure examinations, and special surveys of dental schools and testing agencies. The recommendations from this conference have influenced the efforts of two of the four regional licensing boards to develop a common clinical examination (AADE, 1993b)
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From page 241... ...
{As described earlier, the Commission on Dental Accreditation oversees accreditation of advanced specialty education programs.) The recognized specialties are dental public health, endodontics, oral and maxillofacial surgery, oral pathology, orthodontics, pediatric dentistry, periodontics, and prosthodontics.
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From page 242... ...
As evidence of problems, they cite the initial failure rates on regional board examinations displayed in Figure 8.1 for the 1993 Northeast Regional Examination Board {NERBJ examinations. In addition, in testimony to this committee the Central Regional Dental Testing Service {CRDTS)
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From page 243... ...
SOURCE: Northeast Regional Board of Dental Examiners, Inc., 1993. In contrast, critics of current licensure arrangements argue that the clinical licensure examination is itself a flawed measure of competency.
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On occasion, the committee heard that some state examiners have a stake in working closely and cooperatively with dental schools in the state to ensure that students are prepared to pass the examination. The committee also heard more dubious arguments for state clinical examinations.
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Indeed, concern about the sterility and artificiality of written examinations has led medical specialty groups to consider how "standardized patients" {often actors) might be used to assess diagnosis and treatment planning skills for purposes of specialty certification.
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This procedure has finally been eliminated entirely or made optional in state and regional examinations, but only after years of lobbying-and largely wasted curriculum time. Faculty recruitment may also be complicated by state licensure requirements.
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From page 247... ...
None of these states, however, requires periodic reexamination for in-state dentists. Those who favor periodic assessment of competency argue that state boards do not satisfactorily monitor continued competency and that required continuing education is inadequate because courses are too variable in content and impact.
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From page 248... ...
. On a few state licensing boards, the dental hygiene member or members may vote only on matters relating to hygiene, whereas the public or consumer member has full voting privileges (AD HA, 1994~.
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From page 249... ...
Second, a uniform clinical examination would be accepted by all state licensing authorities.3 This step would be an extension of those that led to the regional examination organizations. One initiative that would support both incremental and major change is a technology-oriented effort to improve competency assessments organized by the Dental Interactive Simulations Corporation or DISC {Foti, 1992~.
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From page 250... ...
Those who would eliminate clinical exams and adopt the medical model were supported by the Pew Health Professions Commission, which recommended that "graduates should be granted entry-level licensure based upon graduation from an accredited dental school, successful completion of the national board examinations, and completion of a postdoctoral training program" {Pew Health Professions Commission, 1993, p.
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From page 251... ...
Some believed that disclosure would promote defensiveness and work against cooperative and candid analyses of educational deficits and strategies for correcting them. The committee agreed that after steps are taken to improve the validity and reliability of licensure and accreditation processes, the AADS, AADE, and CDA should investigate the relationships among accreditation results, school-wide pass rates on national written examinations and on regional or state clinical licensure examinations, student grades, and graduates' subsequent performance in practice.
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From page 252... ...
To improve the current system of state regulation of dental professionals, the committee recommends that the American Association of Dental Examiners, American Association of Dental Schools, professional associations, and state and regional boards work closely and intensively to · develop valid, reliable, and uniform clinical examinations and secure acceptance of the examinations by all state
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From page 253... ...
Greater agreement on reliable and valid methods for assessing clinical competency in all settings would reduce tensions as would greater agreement on the clinical skills that need assessment. Both would pave the way for state acceptance of uniform clinical examinations and for less procedurally oriented accreditation standards.
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