Revisiting the National Board Dental Examination

Structures, processes and outcomes of objective structured clinical examinations in dental education during the COVID-19 pandemic: A scoping review

INTRODUCTION

Objective structured clinical examinations (OSCEs) are an essential examination tool within undergraduate dental education. Fear of spread of the COVID-19 virus led to dental institutions exploring alternative means of conducting OSCEs. The aim of this scoping review was to investigate what structures, processes and outcomes of dental OSCEs were reported during the COVID-19 pandemic.

MATERIALS AND METHODS

This scoping review was conducted and reported adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review guidelines (PRISMA-ScR). Published literature was identified through a systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (Eric), ProQuest and Google Scholar. Identified articles were independently reviewed by two authors (KS, AD), followed by synthesis in terms of the reported structures, processes and outcomes. Articles reporting cancellation or rescheduling were also included, extracting data on reasons and any suggestions/recommendations.

RESULTS

The search yielded a total of 290 studies of which 239 sources were excluded after removal of duplicates, leaving 51 studies for title and abstract evaluation. Thirty-four articles were excluded as they did not report on the topic of interest, leaving 17 for full-text evaluation, of which nine were analysed according to the pre-set themes. All dental OSCEs taking place (n = 6) were conducted online whilst the remaining (n = 3) were either cancelled or rescheduled. Data on structures reported specific online videoconferencing software used and provision of staff and student training. Processes on the execution of online OSCEs varied significantly from one study to the other, providing rich data on how dental institutions may carry out such assessments tailored to their need. Information regarding outcomes was sparse, as little attention was paid to the results of the students compared to pre-pandemic, lacking investigation into reliability and validity of online dental OSCEs.

CONCLUSION

Dental OSCEs could be conducted online implementing well-planned structures and processes; however, further evidence is needed to prove its reliability and validity based on outcomes. Dental institutions may need to consider alternative methods to assess practical competencies if online OSCEs are to take place.

Need for Assessment of MDS Paper I Examination at the End of the First Year of MDS: A Survey

Introduction:

Pursuant to the notification published by Dental Council of India, dated May 17, 2018, no. DE-14-MDS-2018/2131, the committee amended the regulation on postgraduate (PG) Masters of Dental Surgery (MDS) students and made provision of giving MDS paper I at the end of the first year. Assessment of this survey will provide clear information between the responses of PG students and teachers. The focus of this article is to report and discuss the characteristics of new learning process.

Material Method:

A total of 150 sample sizes and 50 PG teachers were included. Questions were generated using Google Form to gain access and establish rapport with participants and to obtain open, honest understanding of the participants’ “learning experience.” The link was sent to the participants, using emails or WhatsApp number.

Result:

The analysis of survey data was carried out using Likert scale. The comparison of mean scores was carried out using unpaired t-test. Figures 1 to 10 provide responses of participants.

Conclusion:

Postgraduate students and PG guides are neutral toward the initial protocol of examination. The participants have a positive attitude toward new framework. But curriculum activities such as library dissertation (LD), dissertation selection, and patient work get disturbed somewhere. It might take time for both students and guides to get familiar with the new framework.

Methods and timing of curricular integration in U.S. dental education in preparation for the Integrated National Board Dental Examination

PURPOSE

To characterize methods, timing, faculty training, and barriers pertaining to curricular integration in preparation for the Integrated National Board Dental Examination (INBDE) at U.S. dental schools METHODS: Academic deans at 67 U.S. dental schools were emailed an online survey consisting of questions on the time frame and methods of curricular integration, faculty training, and barriers to curricular integration RESULTS: Approximately 86% of schools have implemented (∼39%) or will implement (∼61%) changes in curriculum in preparation for the INBDE. Curricular integration was completed in 3-4 years in most schools, with those schools with larger class sizes taking longer. While 56% of respondents reported avoiding a complete curricular overhaul, 79% reported course sequencing changes, adding, subtracting, or combining courses, and making some changes in existing courses. Curriculum committees had the most input in curricular changes, while individual instructors had the least influence. Sixty seven percent of respondents reported faculty being trained to teach in an integrated curriculum. Problem/case-based learning and clinical case presentations are being used more for incorporation of biomedical sciences in clinical curriculum; use of clinical examples was the most used mechanism to integrate clinical information in biomedical sciences curriculum. Eighty two percent of respondents indicated that lack of faculty time to prepare courses as the primary barrier for implementing an integrated curriculum.

CONCLUSIONS

Our results show that most U.S. dental schools are implementing integrated teaching models to prepare their students for the INBDE. However, lack of faculty time and training need to be addressed for more successful curricular integration.

Is There a Correlation Between Comprehensive Basic Science Examination and United States Medical Licensure Examination Step 1 Performance Among Oral and Maxillofacial Surgery Residents?

PURPOSE

Oral and maxillofacial surgery (OMS) applicant Comprehensive Basic Science Examination (CBSE) scores are scrutinized by residency programs and medical schools because of their perceived predictive value for United States Medical Licensure Examination (USMLE) Step 1 performance. The purpose of this study was to answer the following question: Is there a correlation between the OMS applicant's CBSE score and his or her later USMLE Step 1 score?

MATERIALS AND METHODS

We e-mailed all current 45 dual-degree OMS residency programs to request participation in the study. Participating programs submitted residents' CBSE scores and USMLE Step 1 scores.

RESULTS

Of 45 United States-based, dual-degree OMS residency programs, 23 (51%) enrolled in the study, including data for 152 residents from 2012 to 2018. The mean CBSE score was 71 (range, 47 to 99). The mean USMLE Step 1 score was 220 (range, 177 to 266). The Pearson correlation coefficient for the relationship between the CBSE and USMLE Step 1 scores was 0.36. The overall USMLE pass rate was 97%. On the USMLE Step 1, OMS residents outperformed their translated CBSE score by an average of 15 points. Of the 50 residents (33%) with a translated CBSE score below the passing level, 94% passed the USMLE Step 1. Residents who had a translated passing CBSE score outscored residents with a translated failing score by 14 points when taking the USMLE Step 1 (225 vs 211).

CONCLUSIONS

Although no statistically significant difference in the USMLE Step 1 pass rates was found between OMS residents with a translated passing CBSE score and those with a translated failing CBSE score, a weak positive correlation was noted between CBSE and USMLE Step 1 scores. These data do not support the use of a certain cutoff CBSE score for OMS applications by OMS program directors, especially as it pertains to interview offers.

Current state and future directions of the National Board of Chiropractic Examiners

The objective of this paper is to describe changes made to chiropractic national board examinations in the United States, including methodologies in test scoring, and to discuss future directions in test development and administration being considered by the National Board of Chiropractic Examiners (NBCE). Additionally, this paper serves as an introduction to the articles written by the NBCE staff and published in this issue of the journal. Statistical perspective on the properties of a test are presented, and reasons for the NBCE moving to item response theory for test scoring are described. NBCE consideration of on-demand testing and changes implemented in the Part IV practical examination are also discussed.

Values related to professionalism in dental education at the University of Chile: Student and faculty perceptions

OBJECTIVE

It is recognised that professionalism should play a central role in dental education. However, its implementation into the curricula of dental schools is still limited. Our objective was to identify the main values related to professionalism based on the perceptions of students and faculty members from the Faculty of Dentistry, University of Chile.

METHODS

A Dental Values Survey was validated and culturally adapted in order to guarantee the greatest possible internal validity. The adapted survey was administered to students and faculty members (416 and 225, respectively). The final survey contained 64 items rated on a Likert scale of 1-5. Each item was categorised according to five dimensions: Altruism, Consciousness, Personal Satisfaction, Quality of Life and Professional Status. The values were compared between faculty and students and among students at different courses. A values scale was constructed by selecting the five items with the highest average score for each dimension.

RESULTS

Survey respondents composed 34.32% of the universe, of which 50.46% were faculty and 49.54% were students. Values associated with Altruism, Consciousness and Professional Status, were the highest rated by students and faculty. Values associated with Personal Satisfaction and Quality of Life received the lowest scores for both groups.

CONCLUSIONS

To provide the best possible attention to patients (Consciousness), and that patients have access to affordable dental care (Altruism), are the values at the top of our scale. On the other hand, to maintain financial stability and to be well paid (Quality of Life) were the less considered.

Preliminary Performance of the Advanced Dental Admission Test (ADAT): Association Between ADAT Scores and Other Variables for Applicants to Residency Programs at a U.S. Dental School

Historically, dental residency programs have used numerical assessment criteria to evaluate and identify qualified candidates for admission. Recent elimination of such assessment tools has undermined many programs' holistic evaluation process. The Advanced Dental Admission Test (ADAT) was developed and recently piloted in hopes of addressing this issue. The aim of this study was to evaluate the preliminary performance and validity of the ADAT by exploring the association between ADAT scores and other variables for a sample of applicants to residency programs. The WebAdMIT admissions database was used to identify the test scores and educational and demographic information of 92 individuals who completed the pilot ADAT and were seeking a 2017 postgraduate specialty position at Indiana University School of Dentistry. The results showed that the ADAT had strong to weak correlations with certain applicant variables (p<0.05). No significant differences were found for age, race, school location, or country of origin. However, males performed better than females (p<0.05), and non-Hispanics performed better than Hispanics (p<0.01). ADAT component scores were also higher for individuals with a history of research activity (p<0.05). This study found that significant associations existed between the ADAT and indices typically associated with competitive applicants. These findings suggest that the ADAT may serve as a useful numerical assessment instrument, with the potential to identify high-performing candidates. Furthermore, the ADAT seemed to be a plausible option for programs seeking to incorporate a quantitative assessment instrument as part of a holistic candidate selection process.

Should Pass/Fail Grading Be Used Instead of Traditional Letter Grades in Dental Education? Two Viewpoints: Viewpoint 1: Pass/Fail Grading Improves Learning Experiences for Students and Viewpoint 2: Traditional Letter Grading Provides Objective Evaluation for Dental Education

Discussions about which grading system (letter grade or pass/fail) is more effective in dental education have been occurring for several decades. As more institutions continue to consider the change from the traditional five-tier letter grading system (A/B/C/D/F) to a two-tier grading system (pass/fail), this debate will likely continue. This point/counterpoint article examines arguments for and against each type of grading system, taking into consideration academic performance, learning outcomes, psychological well-being, learning environment, acceptance/performance in postgraduate educational programs, and student motivation. Viewpoint 1 supports the position that a pass/fail system improves learning experiences for dental students, whereas Viewpoint 2 argues that the traditional letter grading system provides for more objectivity and reliability in student evaluation.

The International Landscape of Medical Licensing Examinations: A Typology Derived From a Systematic Review

BACKGROUND

National licensing examinations (NLEs) are large-scale examinations usually taken by medical doctors close to the point of graduation from medical school. Where NLEs are used, success is usually required to obtain a license for full practice. Approaches to national licensing, and the evidence that supports their use, varies significantly across the globe. This paper aims to develop a typology of NLEs, based on candidacy, to explore the implications of different examination types for workforce planning.

METHODS

A systematic review of the published literature and medical licensing body websites, an electronic survey of all medical licensing bodies in highly developed nations, and a survey of medical regulators.

RESULTS

The evidence gleaned through this systematic review highlights four approaches to NLEs: where graduating medical students wishing to practice in their national jurisdiction must pass a national licensing exam before they are granted a license to practice; where all prospective doctors, whether from the national jurisdiction or international medical graduates, are required to pass a national licensing exam in order to practice within that jurisdiction; where international medical graduates are required to pass a licensing exam if their qualifications are not acknowledged to be comparable with those students from the national jurisdiction; and where there are no NLEs in operation. This typology facilitates comparison across systems and highlights the implications of different licensing systems for workforce planning.

CONCLUSION

The issue of national licensing cannot be viewed in isolation from workforce planning; future research on the efficacy of national licensing systems to drive up standards should be integrated with research on the implications of such systems for the mobility of doctors to cross borders.

Is the Advanced Dental Admission Test (ADAT) the Metric Needed to Assist with Postgraduate Admissions? Two Viewpoints: Viewpoint 1: The ADAT Provides a Viable Solution to Help Postgraduate Programs Differentiate Applicants and Viewpoint 2: The ADAT Has Questionable Utility and Value for Postgraduate Admissions

In 2012, when the National Board Dental Examination (NBDE) was changed from a numerical scoring system to pass/fail, advanced dental education programs lost a metric widely used for differentiating applicants to those programs. The American Dental Association (ADA) has developed the Advanced Dental Admission Test (ADAT) to address this issue. Implementation of the ADAT began in 2016 with a pilot program, which has not yet been widely accepted in the overall admissions process. This Point/Counterpoint explores the benefits and challenges of using the ADAT for postgraduate admissions. Viewpoint 1 supports use of the ADAT, arguing that the test provides a viable, long-term solution to this immediate need. In contrast, Viewpoint 2 questions the need for and appropriateness of this additional academic measure for postgraduate admissions.

Interstate Practice of Dental Teleradiology in the United States: The Effect of Licensing Requirements on Oral and Maxillofacial Radiologists' Practice Patterns

BACKGROUND

In the United States, each state has independent licensing standards. Dentists wishing to practice in more than one state must apply to each individually. The goal of this study was to assess whether board-certified oral and maxillofacial radiologists interpreted images taken outside the states in which they were licensed and whether coverage provided by the malpractice insurance plans to which they subscribed affected their behavior.

MATERIALS AND METHODS

An electronic survey was sent to all current members of the American Board of Oral and Maxillofacial Radiology, with a response rate of 74%. Descriptive statistics were calculated.

RESULTS

The majority of respondents (54.6%) indicated they write reports for patients in states for which they do not have a dental license. An even larger majority (80.0%) do not know whether their malpractice insurance protects them in these cases. Qualitative responses indicate that there is confusion among practitioners as to what is legally permitted pertaining to teledentistry of this nature.

CONCLUSIONS

Much of the work in which oral and maxillofacial radiologists engage may be considered teledentistry. In other settings, teledentistry has been proposed as a means to improve access to care for vulnerable populations, yet current licensure laws may make this more difficult to implement. Based on the results of our survey, many oral and maxillofacial radiologists in practice may be considered to be practicing without a license. Portability of diagnostic images may make it more difficult to enforce geographic practice boundaries. A national licensure system would be easier to enforce while maintaining high levels of patient safety.

Relationship between assessment item format and item performance characteristics

OBJECTIVE

To evaluate the relationship between assessment item formats (case-based versus noncase-based) and item performance characteristics.

METHODS

Assessment items (1,575) were collected from examinations administered in several therapeutics courses over 4 academic years. Items were categorized as either "case-based" or "noncase-based" and item performance characteristics (discrimination index and level of difficulty) were evaluated.

RESULTS

Noncase-based items represented approximately three-fourths of all items that were evaluated, and demonstrated a higher discrimination index than case-based items. Case-based items were generally lengthier and included more detailed information than noncase-based items; however, they were not more difficult and exhibited a lower discrimination index. Secondary analyses revealed that 5-foil multiple-choice items are more difficult and have a higher discrimination index compared to 4-foil items.

CONCLUSION

The format used for an examination/test item (case-based or noncase-based) has an impact on item performance characteristics.