Non-patient-based exams and licensure during the pandemic

This time of the year usually signifies great celebration for graduating dental students across the country. In light of the COVID-19 pandemic, graduation ceremonies look a lot different this year with virtual walks across the stage and celebrations at home in quarantine. How graduates will become licensed is different as well, and non-patient-based alternatives are now coming to the forefront.

ASDA has long advocated for the removal of live patients during clinical testing scenarios, and ASDA members were first informed of a victory toward this in a letter from ASDA President Sydney Shapiro in April. ASDA leadership at the national, district and chapter levels are working on an individual state-by-state strategy to urge dental boards to accept non-patient-based alternatives for initial dental licensure. Letters were sent to all 50 states, Puerto Rico and the District of Columbia, giving dental students a united voice in the fight for dental licensure reform.

The suggested non-patient alternatives outlined in these letters were inclusive of all non-patient-based alternatives available within the United States. These include: the Central Regional Dental Testing Services (CRDTS) all-manikin exam; the American Board of Dental Examiners (ADEX) CompeDont DTX, which will be administered by the CDCA and CITA; the Joint Commission on National Dental Examinations (JCNDE) Dental Licensure Objective Structured Clinical Exam (DLOSCE); the Southern Regional Testing Agency (SRTA) manikin-based restorative skills module; and the Western Regional Examining Board (WREB) all-manikin simulation exam.

Many of the listed testing agencies had been working on non-patient-based exam formats but had no plans of releasing these alternatives so quickly. Motivated by current public health concerns and the numerous calls made by the ASDA Executive Committee, these agencies shifted their focus to expedite development and make their non-patient-based exams available for 2020 graduates.

Thanks in great part to ASDA’s grassroots advocacy campaign, 16 states have accepted the ADEX non-patient-based exam as a valid path to initial dental licensure since it was first released less than two months ago. Some states such as Mississippi and Pennsylvania are temporarily allowing a substitute for the live patient restorative portion of the exam.

Scarlett Johnson, a student at University of Mississippi, piloted the exam at her dental school this past fall. “For those concerned with how the manikin-based boards would be graded over the live-patient boards, the guidelines for the restorations are the same. Nothing changes in this manner, except you remove all the aspects that could negatively impact your patient or you. You prove you can do the same thing on a manikin that you could do with a human.”

New graduates, whose patient-based licensure exams were canceled due to the pandemic, now have a pathway to obtain a dental license during the current health crisis. At the University of Pennsylvania, the class of 2020’s live-patient ADEX exam, originally scheduled for this March had to be canceled. Now, thanks to the recent licensure victories, Pennsylvania’s new graduates have a safe non-patient-based alternative to obtain dental licensure in their state.

With residency programs and jobs starting soon after graduation, students are concerned about obtaining dental licensure as soon as possible to begin serving their patients and communities as licensed dentists. Soren Christensen, a 2020 graduate of Pennsylvania, who now has the option of taking the new manikin-based exam to obtain dental licensure in Pennsylvania, offered his peers some words of encouragement. “Be grateful that you have an opportunity to take a fairer, more ethical exam … When the time comes to take the exam, don’t let yourself get flustered; every tooth you’ve operated on is different, so just treat it like any other day in clinic.”

ASDA’s L-1 policy outlines the association’s ideal licensure exam. This exam does not harm human subjects in a live clinical testing scenario, is psychometrically valid and reliable in its assessment, reflects current dental practice and is universally accepted. Demonstrated by the recent grassroots advocacy campaign, ASDA is committed to advocating for universal state acceptance of non-patient-based exams. Our association will continue to push, based on this success, to ensure future classes have access to non-patient-based alternatives for licensure.

This is a reminder for us all to reach out to our chapter and national leaders, attend advocacy webinars, and share our stories during state and national lobby days. The recent victories were made possible because of ASDA’s student advocates, and the future of licensure reform is counting on you! If the advocacy victories that have occurred since the pandemic began are any indication of what is coming, the future of dental licensure will be bright.

~Casey White, Pittsburgh ’21