I am writing to comment on Dr. Richard Ranney and colleagues’ August JADA article, "The Relationship Between Performance in a Dental School and Performance on a Clinical Examination for Licensure: A Nine-Year Study," regarding the reliability of the North East Regional Board of Dental Examiner, or NERB, examination.
I have served as a NERB consultant examiner in the evaluation station for three years. A consultant examiner is not a voting member of NERB, nor a current or past member of a state board of dentistry. I have been in private practice as a general dentist for 25 years, and have never taught at a dental school. Enough of the disclaimers!
It is my opinion that a candidate taking this exam for licensure to practice unsupervised should be able to recognize the difference between enamel and dentin in the preparation of a small Class II or Class III carious lesion. They should reliably be able to avoid a mechanical exposure of the pulp in a small carious lesion, and they should reliably be able to restore these small lesions without a visually open proximal contact. They also should be able to remove nine "boulders" of calculus from 12 surfaces of six teeth that they, the candidates, have preselected.
It is the charge given to NERB by the respective state boards that candidates show that they are minimally competent to practice without supervision.
Didactic abilities are only a portion of the requirements to be a surgeon. A surgeon also must possess skilled hands. Testing a candidate’s independent clinical ability (the candidate making all treatment decisions) cannot be done through the use of a multiple-choice examination.
The cases in which I have given a failing mark are not based on subtle judgment calls. These failures include Class II amalgam preparations completely in enamel, Class II preps that have draw like an inlay (do schools teach inlays any more?), unrecognized mechanical pulp exposures (teeth with lesions that appear to encroach on the pulp on a preoperative radiograph are not assigned, thereby precluding the occurrence of a carious exposure during the examination), gross damage to the adjacent proximal surface (a size 57 bur buried halfway into the adjacent tooth), and Class II or Class III restorations that have visually open contacts.
These are basic clinical skills and judgments that should be mastered prior to taking a licensing examination. These critical errors only call into question the reliability of the candidate—not the reliability of the examination or the examiners. I firmly believe that the NERB examination accomplishes what state boards ask it to do: to protect the public from the licensure of incompetent candidates in dire need of remedial clinical training.
