Dr. Page suggests that we should have compared our curriculum and results on licensure examinations to those of other schools. During the period of our report, 1994 to 2002, the North East Regional Board, or NERB, provided graphs indicating the pass rates of our school’s graduates relative to those of other schools. The mean of our yearly positions relative to the other schools for the nine years was eighth from the top, in a mean of 22 participating schools. Our annual relative positions included a first, second and third (once each) and fifth (twice). Our median position over the nine years was fifth best.
So, if one were to accept Dr. Page’s suggestion as meaningful, the appropriate conclusion from the data would be that, on average, the curriculum of our school prepared our students better than did the curricula of most other schools for passing NERB’s clinical examination. We do not make that comparison, however, because the year-to-year unreliability of NERB’s examination as seen in our study, and the demonstrated unreliability of onetime clinical examinations,1–3 remove much, if not all, of the meaning from the reported relative positions.
Dr. Page’s citation of Stewart and colleagues4 does not substantiate his point. Not only did that article relate only to the endodontic section of the Florida licensure examination, but also, during the period of comparison, the Florida board changed its test requirements from endodontics in a two-rooted tooth to allow use of a single-rooted anterior tooth. As far as one can tell from the study, the change ikn performance of candidates could have been due more to the change in the examination than to anything in the school’s curriculum.
Efficacy of mock boards in predicting performance on licensing examinations is not clearly established. Stewart and colleagues5 found significant relationships between four aspects of mock board performance in Florida’s dental school and performance on the Florida licensure examination but could not demonstrate significance for five other mock board procedures. Jessee6 considered data representing 50 dental schools and four regional licensing examinations, plus several independent clinical testing agencies, and could find no aspect of mock boards that had a significant relationship to the outcome of the licensing examinations. Dr. Page’s point is moot anyway, since our school does conduct mock board examinations in the periodontic, endodontic, simulation and restorative procedures that are in NERB’s examination.
With respect to Dr. Page’s last paragraph, our students’ grade point averages, or GPAs, and class rank, therefore, derive not just from written examinations, but depend significantly on other types of evaluation, including laboratory and clinical examinations, clinical competency demonstrations and performance against clinical requirements. We believe that is the case for most U.S. dental schools.
We have reported previously that performance of discrete clinical procedures, not just GPA or class rank, had no relationship to performance on corresponding sections of the NERB examination.7 While state boards of dentistry are indeed charged with protecting the public, there is no proof that clinical licensing examinations as presently conducted contribute reliably or validly to their ability to do so. Available evidence, in fact, suggests otherwise. As Chambers3 pointed out, their lack of reliability can result in false positives, as well as false negatives.
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