The Buffalo Model: Shifting the Focus of Clinical Licensure Exams in Dentistry to Address Ethical Concerns Regarding Patient Care

Abstract

Most jurisdictions grant dental licensure to graduating students following successful completion of a clinical exam. Testing agencies, which are independent of dental schools, nevertheless conduct their exams at school facilities. Patient participation in these exams raises ethical concerns regarding such issues as unlicensed providers' performing irreversible procedures with minimal supervision and graduates' limited accessibility to provide follow-up treatment. To address these concerns, a collaborative effort between University at Buffalo School of Dental Medicine faculty and testing agency personnel was launched. The aims of this article are to describe the development and implementation of the resulting Buffalo Model, to highlight ethical advantages in its application, and to identify areas of improvement to be addressed in future iterations. With the Buffalo Model, modifications were made to the traditional exam format in order to integrate the exam into the school curriculum, enabling candidates to take it at various points during their fourth year. In addition, after calibration of school faculty members, 98.5% of cases verified by faculty were accepted by the Commission on Dental Competency Assessments for use in the exam. In two cases, restorative treatment completed during the exam did not meet the school's competency standard. This new approach ameliorates ethical concerns associated with clinical licensure exams because treatment is provided only to patients of record within a sequenced treatment plan and timely and appropriate treatment is provided to all patients. The results of this first year of implementation also suggest that calibrated faculty members will not show bias in the selection of lesions or competency evaluations of candidates.

Expected Changes in Regulation and Licensure: Influence on Future Education of Dentists

“…California uses a portfolio examination format, reviewing patient charts from the dental schools, and California and some other states (Colorado, Delaware, New York, Minnesota, and Ohio) allow a postgraduate residency year instead of an exam to secure licensure 55 , 56 . More recently, a number of states have been using for licensure the Curriculum Integrated Format (CIF), defined as “an initial clinical licensure process that provides candidates an opportunity to successfully complete an independent ‘third party’ clinical assessment prior to graduation from a dental education accredited by CODA.” 57 , 58 The licensing/examination agency works with the dental school to examine students’ clinical skills several times throughout their fourth year of dental school. This approach utilizes patients of record of the dental school and faculty‐approved treatment plans.…”

“…Moreover, the agency recommends that the procedures and treatments examined in this process are related to the competencies associated with dental school curricula. This model was formally evaluated at the University at Buffalo School of Dental Medicine with very favorable results 58 …”

Dental hygiene educators’ knowledge and implementation of objective structured clinical examination in United States dental hygiene programs

“…However, the efficacy of these practices has been scrutinized as unreliable, subjective, and in many cases, unethical. 1,2 The majority of health care professions recognized the significant limitations of live-patient examinations (LPE), and for decades have used alternative assessment models such as simulation to create clinical learning and testing experiences. 3 Furthermore, the United States (US) and Canadian medical and dental clinical professions now offer licensure examinations that are simulation-based.…”

Moving Toward 21st‐Century Clinical Licensure Examinations in Dentistry

“…This issue of the Journal of Dental Education contains two articles describing alternatives to the typical one‐time, live patient exam process 4 , 5 . The CIF model piloted at the University of Buffalo represents transactional change, 4 while the Canadian‐based model used by the University of Minnesota represents a transformational change 5 . In both models, the authors emphasize the collaboration and cooperation that are necessary elements in moving to an alternate approach.…”

“…It is notable that both the transactional change in Buffalo and the transformational change in Minnesota involved building communication and collaboration across the divide between the education and licensure communities. In the Buffalo process, the Commission on Dental Competency Assessments (CDCA) and educators and students at the University at Buffalo School of Dental Medicine worked together to develop the CIF described in the Gambacorta et al article 4 . These innovators used an advisory board comprised of faculty, students, clinical staff, organized dentistry, and licensing exam administrators to address the challenges and engender the change.…”