We agree with the large majority of leaders in dental education who believe that independent third-party evaluation of dental graduates is appropriate.1 So in that respect we have no difficulty with Dr. Harper’s contention that the licensure process should fulfill that function. We do have problems with his apparent assumption that clinical licensing examinations as presently conducted provide reliable measures of a candidate’s competence.
One-time clinical observations are demonstrably unreliable,2,3 and there are much larger sources of variance in the results of such observations than is accounted for by the examiner’s determination.4 Our study demonstrated very poor year-to-year consistency of a licensing examination, and negligible internal consistency between clinical sections of that examination. Multiple observations provide greater validity for making decisions than do single observations.5 Our faculty (and we presume other faculties) utilize multiple observations for making decisions on pass-fail.
Previous study of results in 2001 demonstrated that decisions made during a clinical licensing examination on ability to do the Class II restorations cited by Dr. Harper did not agree with our faculty’s decisions.6 In the face of that lack of consistency, the lack of consistency between clinical licensing examination and faculty determinations seen in our current multiyear study, and the known unreliability of one-shot clinical observation, it is not logical to conclude that it is the clinical licensing examination that provides the correct determination when it is different from the academic decision. In fact, the evidence suggests otherwise.
At the very least, the way licensing examinations are currently done is highly suspect for reliability and validity. Better means of third-party evaluation should be sought.
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