NMDA Journal Fall 2020

14 New Mexico Dental Journal, Fall 2020 examinee’s control. A patient failing to show up or return can mean instant failure. It can be exorbitantly expensive to ensure that patients remain cooperative. It often requires examinees to travel to unfamiliar settings and transport patients at great cost. The examinations them- selves may focus on particular steps in the treatment pro- cess and have little relationship to clinical outcomes. Educators argue that students that have been proved “competent” over time are labeled “incompetent” based on a single encounter. Even examiners may find the process unfair and unsatisfying, but many will argue that it is this pressure environment that better represents the stress of real practice, which is rarely “fair.” These arguments have been around for decades and have come into sharper focus by astronomical student debt which can cause dev- astation when practice is delayed by test failure. 3. Mobility This was probably the original licensing issue. As our soci- ety has changed with a more diversified workforce, the pressure to allow greater mobility between states has also increased. Originally, the focus was on reciprocity and the use of credentials for established practitioners, but these issues have become one of the fundamental issues of the licensing debate with a greater emphasis on standardized testing and a national standard for all jurisdictions. This flies directly in the face of states being the licensing gate- way. The majority of dentists favor greater mobility, which is reflected in ADA policy. Leadership, both locally and nationally, have held on to the principle that states should remain the authority on licensing issues. State boards (and legislatures) have been caught in the middle of this debate. These competing perspectives have given ADA activity on licensing a somewhat schizophrenic feel. 4. Ethics The principles of treating live patients during licensing examinations are not different from treating patients in an educational setting or ultimately in doing so in “real life.” The responsibilities to patients are identical and obviously the application of ethical principles is highly situational and far from black and white. It is certainly a justifiable debate, but there are intelligent, thoughtful, and ethical people on both sides. On one side, those who oppose live- patient exams argue that it is unethical to treat patients citing both the lack of follow-up and the conundrum of a potentially “failed” procedure being performed. Live patient advocates balk at such characterizations and believe that these issues are overcome by appropriate structuring of the process and assuring ethical outcomes. This relies upon patients being willing to “waive” certain privileges that might be considered ethical necessities. The ethical dilemma results from whether even an informed patient can absolve a dental candidate of these responsi- bilities. Like all ethical dilemmas this pits the priority of one ethical principle over another. These scenarios are debated all the time and almost never “resolved.” History Until the mid-70s, nearly all states administered their own licensing examination. States possessed licensing author- ity in the same way they licensed other entities for activity in their state. This process preserved a control over the educational process, especially for states that did not have their own dental school. CODA established standards for the educational process, but state boards ensured that those standards resulted in competent graduates. Beginning in New England, states began to “outsource” the test process to regional testing agencies. Initially these agencies relied exclusively on members of licensing boards to act as examiners allowing states to realize some effi- ciencies while substantially preserving board control over the process. A series of lawsuits against state and regional examining agencies during the late 70s and early 80s drove most states to abandon their own state exams. At the same time, regional exams adopted a much more regi- mented protocol for standardizing procedures and cali- brating their examiners. While state boards continued to have administrative control over the testing, the actual examination process became less subjective and based on pre-determined metrics. Many states elected or were forced to accept results from agencies where they were not members and that further diluted the power of boards over the process. Testing has become big business and regional exams likely view each other as competitors. Recent grads often elect or are forced to take multiple exams to preserve mobility and the costs of testing become significant hurdles to be overcome when entering the profession. The co-op approach with which regional tests began has given way to aggressive growth strategies and reduced the number of testing agencies to five. A couple of states still maintain their own tests, but they are very few. New Mexico joined the Western Regional Examination Board (WREB) in 1987 and joined the Central Regional Den- tal Testing Service (CRDTS) a few years later. In the late 1990s the NM legislature mandated that the Board accept testing from all regional agencies, which they began to do. Over the years, the Board has dropped a couple of the tests that no longer met the requirements that had been continues on page 16  Testing has become big business and regional exams likely view each other as competitors. Recent grads often elect or are forced to take multiple exams to preserve mobility, and the costs of testing become significant hurdles to be overcome when entering the profession. License to Disagree  continued from page 13