Dean Feldman Helps Lead Effort to End Live Patient Licensure Exams

 Dental licensure exams that center around live patients should be replaced by a standardized, nationwide system that avoids the unpredictability of recruiting human patients, said RSDM Dean Cecile A. Feldman, co-leader of a task force that recommended the changes.

The recommendations, which would radically alter the process of licensure, were supported by the American Dental Association (ADA), the American Dental Education Association (ADEA) and the American Student Dental Association (ASDA). Dean Feldman was co-chair of the task force.

The practice of granting dental licenses based on live patients can be fraught with complications and expense for students. In addition to exam fees, students typically pay patients $1,000 or more, so the total cost of the exam can be as much as $5,000, said Dean Feldman.

Students must find patients who need the procedures they’ll be tested on and sometimes patients don’t show up. During the exam process, the experience is often prolonged for patients and students. Dental work that would normally take 45 minutes can take up to three hours during an exam, said Dean Feldman. “Why make the student jump through all those hoops?” she asked.

Dentistry is the only medical profession that requires live subjects for licensure, making the process increasingly outmoded, according to Dean Feldman.

Among the alternatives recommended by the task force is a process similar to the Canadian licensure system, known as an objective structured clinical examination (OSCE), which is comprised of different clinical situations. These include how to interpret radiographs, conduct patient interviews and perform dental work on a typodont head. “The validity of these has been shown to be just as good, if not better, than live patient exams,’’ Dean Feldman asserted.

Other recommendations include graduation from an accredited residency of at least one year and completion of clinical competency assessments conducted at dental schools that could include the review of a work portfolio.

In addition to recommending the end of live licensure exams, the task force also suggested uniform standards that would end a patchwork of requirements that sometimes result in professional dentists taking additional licensure exams when they move to another state.

Dean Feldman said overhauling the system won’t happen overnight. It will require state-by-state change and, in some cases, new legislation. But she remained hopeful. “It could be a long process. But these recommendations provide a great framework in general and a path for advocacy on the state level,’’ said Dean Feldman.