NMDA Journal Fall 2020

nmdental.org 9 NMDA: Dr. Martin. Youwere amember of the Board for several years, what were the issues that the Board had to deal with or that were part of the Board's discussion regarding licensure. Is there a need for changes? Dr. Martin: One of the things that came into our conversa- tions was the reasons why somebody might face a barrier to come to New Mexico. One of those was foreign-trained dentists. Another was candidates that had outstanding malpractice suits from other states that made them ineligi- ble. I know that since I was on the Board, there has been increasing interest in evaluating the eligibility of foreign- trained dentists. NMDA: What is the pathway that a foreign- trained dentist would take in order to receive licensure inNewMexico? Dr. Martin: That is a good question. Foreign-trained den- tists that have graduated from a CODA-accredited (Com- mission on Dental Accreditation) school are eligible for licensure. If their school was not accredited, they need to complete two years of clinical experience at an accredited dental school or complete a specialty or general practice residency at an accredited dental program. NMDA: So, howdid the COVID pandemic affect the work of the task force? Dr. Martin: When we first began, it was just trying to get a consensus on whether we want to become a member in this modernization taskforce. We also looked at the interest and demand for increased portability. As COVID evolved, the issue became how to license new graduates when the existing regional exams were being sidelined by COVID. The DLOSCE (Dental Licensure Objective Structured Exami- nation) had recently been completed and would be avail- able this summer. We looked at whether that was a good alternative or whether a combination of examination options might be possible. Because everything was closed it became an issue of whether we could even offer a test such as the DLOSCE. You have to go to a test center and you need to be proctored. That conversation has changed over the last nine to ten months. NMDA: This seems like a good place to kind of shif t gears and talk about the examinations. What is wrong with the examination process that we have right now? Dr. Thompson: I think part of the issue of examination is the fact that when you are using a single encounter patient-based exam, it is subject to error and often unforeseen random circumstances. It has been suggested that those single-based encounters are not necessarily the most valid forms of testing and that they are not really reflecting the broad set of knowledge and clinical skills that a dentist actually needs to perform in daily practice. Also, for some, it poses an ethical issue because the examina- tion is focused on a single small carious lesion or a single quadrant for scaling and root planing, and not necessarily addressing the patient's most urgent needs. This raises questions about the standard of care and whether it meets the standards we would typically be providing that patient in real clinical practice. NMDA: Dr. Manz, as an educator, you are somewhat familiar with this discussion about utilizing live patients. What is the difference between using patients in the educational process and using them in the examprocess for licensing? Dr. Manz: Okay, so the main differences really boils down to supervision. In the clinical environment in education, the steps that the student takes both in treatment planning and in actual treatment are all supervised and then approved by a faculty who are licensed. And the concern becomes that when you get into the licensure examination, even though you are examined on what you have done, there is no supervision of what they are doing and there is no supervision on what they are allowed to do. NMDA: So, there are some issues regarding the fairness issues regarding the single encounter and potential ethical issues regarding the live patients. What are the alternative examinations that address one or both of those issues? Dr. Manz: I think there are alternatives that can address those issues in different ways. Manikin exams can address some of those issues. They do have their own concerns and problems, but they definitely address the issue of the ethics of using a live patient. The other issue that they address is the fairness of the playing field. In other words, when you come to take the exam and you have one patient and I come with another patient, they are not the same. And so, we are not being tested to the same degree and the same level. Any single event exam is subject to those complaints. The other alternative is to do something like a portfolio or you need to give the schools the opportunity to make those determinations, but that too has other problems associated with it. Our first chargewas to evaluate: Does New Mexico need to establish a policy statement on licensing and examinations? If so, what would that policy be? continues on page 10  A Conversation on Licensing and Examinations