Transcript The Licensure Puzzle - Where Do You Fit?

Updates on Licensure
Laura Huling
District 1 Trustee
What are licensure exams?
• 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.
What are the regional board examinations
and what do they entail?
• NERB
• WREB
• SRTA
• CRDTS
• CITA
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
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
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
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
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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.
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
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
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.
PGY-1
By: Nipa Thakkar, District 3 Trustee
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
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.
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
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
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
Licensure Info by State
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
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.
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
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
GPR vs. AEGD
GPR
• Treat more children (10-
49% of the patient pool)
• Care for more medically
intensive and inpatient/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
GPR vs. AEGD, Cont’d
• Salaries
• Types of Procedures Performed
• Number of Patients Seen
• Length of Program
• Setting of experience
Decisions, decisions…
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.
• Questions/Concerns? Contact me at [email protected].
Thank you!