Guest Editorial: The Non-Patient Based Clinical Examination: An Update

Guest Editorial: The Non-Patient Based Clinical Examination: An Update

Candace Mensing, D.D.S., M.S. *:

Minnesota has become the first state to offer candidates for initial dental licensure the opportunity to take a non-patient based clinical examination. This was a decision made by the Board of Dentistry in June 2009. Now, graduating dental students from the University of Minnesota School of Dentistry will be able to decide which of two clinical examinations to take.

In 2010, the University will offer two types of examinations: one in which the student demonstrates a series of clinical skills on live patients, and another in which the student demonstrates comprehension of clinical skills utilizing a two-part written examination format, but without patients. This two-part written examination is constructed and administered by the National Dental Examining Board of Canada, and includes a clinical comprehensive portion called the OSCE — a non-patient based objective structured clinical examination. This exam has testing stations that feature clinically based examination questions and utilizes dental records, case histories, radiographs, and dental models.

The Board struggled with the decision about accepting a non-patient based licensure examination for some time. The Board created a task force to study the matter, heard testimony from most of the patient-based examining agencies, and participated in discussions with the School of Dentistry and Dean Patrick Lloyd.

Finally, the Board members, including our attorney member, took the OSCE examination themselves, and found it to be very challenging. But, is it challenging and comprehensive enough to replace the patient-based clinical exam that has been the mainstay of the licensure process for so long? This was the primary question involved in making this decision.

What I recall most about the Board’s introduction to the Canadian examination was something that Dr. Jack Gerrow, Executive Director of the National Dental Examining Board of Canada, said to us about how to view testing changes as significant as this one. He said that you have to let yourself think about this in a different way — that you have to let yourself give up what you have always done in order to try something that you have never done. So this is, in part, how it all transpired. Many people and circumstances came together at just the right moment in time to make this significant change.

Now that the Board of Dentistry has taken this big, bold step in testing for licensure, what happens next? What are the Board’s long-term plans to insure that public protection and well-being are safe-guarded? What processes are in place for the Board so that it can accomplish its most important responsibility — public safety? What are the Board’s plans for the non-patient based clinical examination going forward?

First, the Board of Dentistry has a unique and essential opportunity to interact with the University of Minnesota as it evaluates its students, entrance level qualifications, and educational content, among many other things. At the invitation of Dean Patrick Lloyd, the Board is now attending the meetings of several School of Dentistry committees, including the Admissions Committee, the Scholastic Standing Committee, the Educational Policy Committee, and the Competency Review Board, in order to understand and fully appreciate the process for student assessment, promotion, and curriculum design. As the Board’s experience with the Canadian examination continues over the years, the Board and the School of Dentistry will develop a relationship that is unique and strong, thus insuring that the public’s trust is maintained.

Second, the Board will also actively participate with the National Dental Examining Board of Canada by attending meetings, engaging in the development of test questions, and monitoring the testing process. Board members have always taken a very active role in clinical examination testing, and this will continue for both the patient and non-patient based tests now conducted in Minnesota. Thus the Board will be able to evaluate both its own role in the non-patient based testing process and the success of the students taking the examination.

Third, the Board will monitor the reaction to this process by neighboring states. The Board will need to know if any other states will eventually accept the non-patient based testing model for licensure. Clearly, other states will watch this process in Minnesota, and it is up to each individual state board to decide how it wants is dental applicants to be tested. Again, as public safety is the only responsibility of a board, each board will determine its own testing preferences on this basis.

As well, the Board will continue to participate in patient-based testing with agencies such as the Central Regional Dental Testing Service (CRDTS), the Western Regional Examining Board (WREB), the North East Regional Board of Dental Examiners (NERB), the Southern Regional Testing Agency (CITA), and the Council of Interstate Testing Agencies (SERTA). While these agencies have not enthusiastically embraced this decision by Minnesota, they have been in the process of developing additional computer simulation testing, which may actually be a step in the direction of non-patient based clinical examinations. The American Association of Dental Examiners (AADE) also regards this decision with some skepticism, although the possibility has been considered and debated for several years. At the recent Annual Session of the American Dental Association in Hawaii, the National Dental Examining Board, which develops the national board tests, Part I and Part II, suggested the possibility of a Part III for states like Minnesota which have selected a non-patient based testing model. Clearly, the testing climate is changing.

Finally, the role of the dental students is our future. It is the “what happens next” that the Board cares very deeply about. These students are the future professionals who must care for their patients with the highest quality dentistry. The Board and the University School of Dentistry have forged a unique and strong relationship with this as the goal. Both will monitor the participation and success of the non-patient based licensure examination process as time passes.


*Dr. Mensing served as president of the Minnesota State Board of Dentistry in 2009. She is a pediatric dentist in private practice in Rochester, Minnesota. Email is