Change is coming: Four reasons the licensure climate has changed

It’s a tradition: one Class II, one Class III, and scaling and root planing. Three exercises stand between dental school and practicing as a dentist. The single encounter, high stakes, live clinical exam is the most common form of obtaining licensure for a graduating dentist. This exam is just a snapshot of a candidate’s ability to practice on the public, yet it confers a privilege to practice on the public for a lifetime. The exam tests student competence or incompetence on live human subjects and, according to the Journal of Dental Education, no states in this country require this of any other health profession.

ASDA’s white paper, “Use of Human Subjects in Clinical Licensure Examinations,” highlights the validity, reliability and ethical concerns of the clinical licensure exam. This post focuses on the changing climate that has embraced licensure reform and highlights the timeline of developments that will get us where we need to be.

1. Development of the DLOSCE: The American Dental Association (ADA) is developing a new licensure exam. Modeled on Canada’s licensure OSCE, the ADA’s DLOSCE is a virtual station-based critical thinking and diagnostic skills exam. Clinical scenarios will be presented to candidates requiring them to recognize caries, formulate treatment plans and demonstrate clinically competent decision making. The exam will be piloting in spring 2020 and will be available to states for licensure in 2021.
2. Coalition for Modernizing Dental Licensure: The ADA, ASDA and the American Dental Education Association have joined together to advance licensure reform. In October 2018, the three associations signed on to create the Coalition for Modernizing Dental Licensure . Now with over 20 members and supporters, the coalition aims to empower states with resources and expertise needed to enact change at a state level. The coalition meets with members and supporters this month to develop state-specific strategies.
3. Political climate: Professional licensure that protects the public also has the ability to prohibit professionals from practicing across state lines. According the Report of the Task Force on Assessment of Readiness for Practice, this is a barrier to care. Arizona recently passed a law to deregulate professional licensure. Dentists, hairdressers and veterinarians, along with other licensed professionals, can now work in Arizona as long as another state has awarded the individual a license. The current political climate has led to states and the federal government rolling back environmental and labor regulations, as well as occupational licensure. We’ve seen other states such as Pennsylvania adopt measures that allow licensed professionals to more easily move to and work in their state. As the Federal Trade Commission continues to put pressure on professional licensure reform, other states may follow Arizona and Pennsylvania’s lead.
4. Changes at the state level: ASDA has long made an ethically focused argument for licensure reform. States are beginning to listen. In Connecticut, Dr. Monty MacNeil, former dean at UConn School of Dental Medicine, worked with students, practitioners and educators to pass legislation advancing licensure reform. The new law recently signed by the governor bans the use of live patients in clinical licensure exams beginning in 2021. The argument that worked in Connecticut was focused on patient ethics. By eliminating live patient exams, Connecticut would only accept PGY-1 as a pathway to licensure. However, it is possible that the state may accept the ADA’s DLOSCE once it becomes available.

Initial dental licensure is a rapidly changing landscape. Dental students should feel confident that ASDA is working on their behalf to eliminate the live patient exam in favor of a test that evaluates candidates more comprehensively and fairly. I encourage everyone to join the ASDA Council on Advocacy for the licensure advo-cast Thursday, Oct. 17 at 7:30 p.m. CDT. During this short-form webinar, the council will provide an update on ASDA’s licensure reform efforts, highlight reform in specific states and discuss how to start the process in your own state.

Register today for this bite-sized discussion on a big issue. 

~Craig McKenzie, Pennsylvania ’21, ASDA President