Resolving Ethical Issues in the Dental Licensure Exam

By Peter Dang, Class of 2023

ASDA Chapter Secretary

Recently, the Joint Commission on National Dental Examinations (JCNDE) an

nounced that they had developed and approved a new Dental Licensure Objective Clinical Examination (DLOSCE). The DLOSCE is intended to replace a clinical exam done on a live patient, like WREB or CDCA. The hope is that the DLOSCE will solve one of the biggest problems with the current clinical exams: the potential to cause patients harm. As dental students, when we are presented with our white coats, we recite the ADA’s code of ethics. One of the things that we

pledge to do as healthcare professionals are to do what is best for our patients and to do

no harm.Using live patient exams as a prerequisite for licensure, unfortunately, does not put

the patient’s best interests first. Students usually start attempting to find patients that would qualifyforthelicensureexamseveralmonthsinadvance. If they do find a patient with a boardqualifying lesion in their patient pool, instead of treating it in the appropriate sequence of care that we are taught, students request that patients put off treatment of that lesion until the date of the exam. The involvement of patients is a grey area where our ethics are put into conflict with what is required of us to obtain our dental license. By eliminating the involvement of patients at all, the DLOSCE eliminates this grey area and evaluates candidates’ clinical skills without risking harm to patients.

There has been some debate around the eliminationoflive-patientclinicalexaminations.

One of the main arguments against their elimination is that a simulation cannot fully replicate all the variables and unpredictability of live patients, and these skills are critical to assessing a student’s clinical competency prior to licensure. However, students already carefully screen their patients for board exams, trying to find the easiest patient within the patient pool who meets the requirements of the exam. The patients chosen for the exam may not be indicative of the patients that they will see in the future.

Though the JCNDE has made the DLOSCE and it is a great step towards the elimination of live-patient clinical examinations, it doesn’t mean that all students will be able to take it or

that live-patient exams are going to be eliminated yet. Each state has different legislation and regulations on what is required for licensure in their state, and it will take time for states to consider whether they will implement the DLOSCE as a valid substitute for a traditional clinical examination. The national ASDA website has a great resource for more information on the

DLOSCE and the ongoing campaign for licensure reform.