I am writing regarding the position taken by Drs. Richard Ranney and Ronald Hambleton in January JADA’s Point/Counterpoint, "Do Portfolio Assessments Have a Place in Dental Licensure? (
JADA 2006;137:31, 33, 35[Medline]
).
When I was first appointed to the New Jersey State Board of Dentistry, along with many of my colleagues, I wondered why a clinical examination was needed to grant licensure to graduates of fully accredited dental schools. After all, the schools had four years to evaluate the abilities of their students; what more could be learned during a few days of clinical testing? It did not take long for me to find the answer.
During my initial and ensuing participation as a regional board clinical examiner, I have consistently found a significant percentage of candidates unable to demonstrate the most minimal skills needed to adequately practice dentistry. These were not minor discrepancies. Inabilities to detect caries remaining in preparations, unrecognized pulp exposures, restorations with wide-open proximal contacts, and failure to locate and remove calculus were typical. Clearly, these individuals were not ready for independent practice. How could that be?
The answer became more apparent when I was appointed to serve as a Commissioner on the Commission on Dental Accreditation, with responsibility to accredit dental schools. At that time, the Commission’s mission was to ensure the quality of the educational process and to work for improvement.1 While Commission teams evaluate standards for instruction and scope of student experience on site, they do not assess the ability of students to perform clinical tasks. Therefore, a program meeting all accreditation standards indicates that the school’s process of educating is in compliance; it does not address the actual product—the competency of a graduate of that institution [to practice dentistry].
Further, according to the ADA’s Division of Education, "Schools do not certify competence of individuals; schools certify that students have met requirements for graduation."2 If the accreditation process and the schools themselves are not willing to assure the public that their graduates are clinically competent, then, obviously, an extrinsic clinical examination is required.
In spite of the appearance of irresponsibility inherent in official refusal to attest to graduates’ competency, one would suppose that by now schools would have instituted an internal "portfolio" system to periodically evaluate their students as they move through four years of education, from matriculation through to graduation. It is shocking to find that, apparently, no such evaluations are routine at many dental schools.
Apparently, when he was a dean, Dr. Ranney was not impressed with the portfolio concept, because Drs. Ranney and Hambleton in their counterpoint now call for "more research" on topics such as what tasks are needed to appraise competence; how to score them; how to train and standardize evaluators; what quality controls are needed; and how to adjust for cheating and grade inflation. It is not unreasonable for the profession to assume that these tasks would have been implemented long ago, and would not be in need of further study.
With accreditors and schools unwilling to confirm the competence of their dental school graduates and, as the authors infer, with inadequate tools for evaluation within the schools themselves, it is obvious why clinical examinations must remain a primary factor in the licensure process.
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