Improving Ethical Licensure Options for Graduates: Non-Patient Exams

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By Jennifer Goodrum, Director of Government Relations
From the Summer 2016 Journal of the Colorado Dental Association

The 2015 CDA House of Delegates charged the CDA to work to implement alternatives to a live patient exam for licensure, given concerns about some ethical implications of the current examination structure.

In 2016, substantial progress was made through Colorado Dental Board regulatory channels in implementing alternatives to a live patient exam. Since January 2016, CDA leadership along with ASDA representatives have been heavily involved in Colorado Dental Board rulemaking sessions on this topic – providing input about shortfalls of the current patient-based exam structure. Consistent with these conversations, the dental board made significant revisions to Policy 1A addressing licensure examination pathways for dental applicants.

In January 2016, the dental board voted to adjust its participation in current (live patient) clinical exams from direct participation (membership in organizations, roles in examining) to acceptance of those exams only, giving additional distance between the licensure and examination processes to avoid perceptions of endorsement. In the interest of license portability for applicants, the dental board voted to accept all current, existing clinical exams including:

  • Exams developed by ADEX and administered by CDCA and CITA; and
  • Exams developed and administered by CRDTS, Delaware, SRTA and WREB.

All portions of an exam (including those considered optional by a testing agency or another state) are required to be taken for Colorado licensure. It was noted during discussions that the dental board does not have current interest in developing its own examination process due to fiscal and liability concerns. The dental board will continue to rely on third parties to provide exams, though the dental board is on record as requesting the examination industry to develop one single, non-patient exam for all dental applicants.

In addition, in February 2016, the dental board invited spokespersons from the administrators of three non-patient examinations to present to the dental board on these licensure pathways. Representatives from the California portfolio examination, Canadian OSCE examination and New York PGY-1 shared detailed information about the methodology of each exam, validation measures and passage rates. Following robust discussions, the dental board modified Policy 1A to allow dentist graduates three new options for fulfilling exam requirements in Colorado with the following limitations:

  • Successful completion of a PGY-1 or portfolio examination will be accepted for dentists applying for licensure by endorsement (original licensure must be obtained in the state where the PGY-1 or portfolio examination was completed since the state of Colorado does not have a current methodology for direct scoring or evaluation of the sufficiency of these types of examinations).
  • Successful completion of the OSCE examination will be accepted for dentist candidates applying for original licensure (given that the exam uses a pass/fail methodology that is simple for the licensure division to administer).

The dental board will track data on examination method related to future disciplinary actions, and may always revisit its policy of accepting all three current non-patient exam methodologies if adverse trends are observed in relation to a particular exam.

As PGY-1 and portfolio methods are developed and implemented by Colorado-based schools, the dental board may reexamine this policy. State law already provides sufficient flexibility for the dental board to accept these pathways toward licensure should they be made available in the state. Continued conversation is needed among Colorado stakeholders on the development of these local residency and portfolio models. The CDA will continue to support local educators as they work to develop these non-patient exam offerings in Colorado.