First dental students complete licensure by portfolio

The first two dental students in the country have now completed the licensure by portfolio process.

The University of the Pacific, Arthur A. Dugoni School of Dentistry students, Daniel Feldman and Dan Beroukhim, accomplished this by building a portfolio of completed clinical experiences and clinical competency examinations in six subject areas over the normal course of their clinical training. Calibrated UOP faculty evaluated the examinations.

"By obtaining licensure by portfolio, I realized it's a very accurate assessment of a student's clinical work," Beroukhim said.

The portfolio option gives students in California an alternative to being tested on a live patient over the course of one weekend, which is the method of assessing competency used in the Western Regional Examining Board (WREB) exam process, as well as other examinations throughout the country. The portfolio process offers multiple benefits to students and patients; including letting students extend treatment over multiple patient visits, which reduces the stress of a one-time testing event and more closely simulates real-world care; provides an opportunity for patients to receive follow-up treatment as needed; and provides a method by which students are ready for licensure upon graduation.

"The stress of the exam is spread out over several months or weeks instead of cramming it all into one weekend, which worked for me. I think it went fairly smoothly," Feldman said.

The Dental Board of California in November finalized the regulatory process of approval for the portfolio examination model in California's dental schools, which is optional for both the schools and students. This is the first licensure-by-portfolio-exam program in the nation, and UOP is the first school to implement it. The University of California, San Francisco School of Dentistry also engaged in early implementation, though no students have yet completed the process.

Sigmund H. Abelson, DDS, and UOP associate dean for clinical affairs, clinical transition and associate professor, has been responsible for implementing licensure by portfolio at the school. Abelson worked with the dental board to develop the process and helped in the calibration courses for faculty.

"One of the important factors is that it has been our dean emeritus, Arthur A. Dugoni's passion for 30 years that there should be licensure upon graduation and that the dental school faculty and dental school is really the true judge of a student's competency," Abelson said. "He's worked tirelessly for this to happen so when licensure by portfolio was enacted by the state Legislature, we as a school knew we had to implement it."

Under portfolio licensure requirements, students must pass six competency examinations: endodontics, periodontics, oral diagnosis and treatment planning, direct restorations, indirect restorations and removable prosthodontics.

Clinical experiences required per discipline include:

  • Endodontics — five canals completed on minimum of three teeth.
  • Periodontics — 25 cases-scaling/root planing, prophys and recalls.
  • Oral diagnosis and treatment planning — 20 oral exams.
  • Direct restorations — 60 direct restorations.
  • Indirect restorations — 14 (crowns/inlays/onlays/bridges/cast posts).
  • Removable prosthodontics — five removable prosthesis.

Abelson said, in total, UOP has 50 faculty with various expertise in the six areas of disciplines, who have been calibrated to evaluate the work of portfolio students.

"We had the faculty complete the dental board's calibration process multiple times to be sure everyone was on the same page," Abelson said. "In dental school the students are learning, but so are the faculty. The more we calibrate, the more streamlined it is. A lot of faculty said the calibration course was very beneficial."

Feldman said that during the portfolio process he enjoyed working with faculty with whom he probably wouldn't otherwise have worked.

"The faculty who checked my work may have different opinions and expertise than the faculty I work with on a daily basis, so I think that was another beneficial aspect of portfolio," Feldman said. "It's been a very fun journey I would say. It has been a lot more meaningful these last few months and the faculty got to see my work under a microscope."

Stephen Casagrande, DDS, practices dentistry in Sacramento and has served on the dental board since 2006. Casagrande chairs the board's Examination Committee and has been instrumental to the development of portfolio licensure in California.

"Portfolio licensure has been a vision for California for many years. We have worked diligently to create a model examination for dental licensure and are incredibly excited to see the first licensees," said Casagrande, who also is a Fellow of the American College of Dentists, a member of the Sacramento District Dental Society and a CDA and ADA member. "We look forward to full implementation in the fall and to many more graduates availing themselves of this extraordinary pathway to licensure."

A concern that has been raised about the portfolio examination is that, as the first of its kind in the nation, there is no licensure reciprocity with other states. The dental board hopes that as the examination proves itself a model for other states, licensure portability will follow.

For Feldman and Beroukhim, licensure portability isn't an issue because both want to practice in California once they are finished with dental school. Beroukhim is from Los Angeles and plans to move back to the area after graduation. He wants to work as an associate for a while and then eventually own a group practice with other dentists. Feldman's father is a dentist in Long Beach and he plans to join him after dental school.

Abelson said there will be a handful of other UOP students utilizing licensure by portfolio this summer and that he expects it to take off by next year.

"Next year, UOP will have fully implemented the portfolio process into our curriculum, so I would expect a fairly robust group with the next class, maybe 30-40 students," Abelson said.

CDA and ADA policy supports the elimination of the one-time "live patient" clinical licensure exam and California's dental students have been quite active in California's process. Students hosted licensure forums at CDA Presents The Art and Science of Dentistry in Anaheim and San Francisco in 2007, bringing together leaders from the Dental Board of California, CDA and selected dental school deans to discuss the future of licensure. In 2009, Assemblywoman Mary Hayashi (D-Hayward), introduced CDA-sponsored bill AB 1524, calling for the replacement of the California clinical examination with a "portfolio" model exam process that would take place over the course of students' clinical training in dental school. In 2010, Gov. Arnold Schwarzenegger signed the bill into law, and up until this past November, it had been in the development phase.

"CDA has been at the table throughout the creation of the portfolio development process, and we are excited to know that both students and patients will now be able to benefit from this new licensure examination model," said Walt Weber, DDS, CDA president.

For more information on licensure, visit the dental board's website, dbc.ca.gov.

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