Journal of the American College of Dentists

Editorial
From the Editor
Lessons in Shifting the Burden:
#2. Competence to Practice
The one-shot format is
constitutionally flawed
as a means of supporting
a conclusion about the
skill level of candidates.
Dr. R. P. Thomas made these
remarks at the meeting of the
National Association of Dental
Examiners: “Dental education has reached
a state of perfection where the schools
can be entrusted with determining who
shall be eligible for public service.”
Certainly, at one point in the evolution
of the profession, that was a goal shared
by the educational and licensure communities
and by the profession and the
public. But perhaps Dr. Thomas was a
few years ahead of his time. The meeting
where he spoke took place in 1938.
Licensure boards predated dental
schools as indispensable protectors of
the public from unqualified individuals
who are self-declared as meeting professional
standards. During the formative
years of dental education in the first
half of the twentieth century, examiners
and schools were partners in the task
of defining what dentistry should be.
The early issues of the Journal of
Dental Education are largely given
over to collaborations on this project.
But we did not finish our work and the
partnership fizzled.
Currently, licensure boards work with
state legal structures for the regulation
of commerce and with testing services
to secure the funds they need. We hear
little today of the original goal of defining
the standards of what it means to
practice dentistry at the highest level of
professional competency.
Recently I have noticed a pattern in
discussions in the national committees
I participate in. Bad-mouthing “some
elements in the profession” is becoming
a new art form. It must make some
feel good to do that because I am certain
it does little or nothing for the general
level of patient health. Among the
complaints I hear are lack of scientific
basis for treatment options; poor judgment
or overly narrow and routine
treatment; greed leading to practices
that are overly commercial or of questionable
legality; and personal problems,
such as substance abuse, inappropriate
relationships with staff or patients, and
practicing beyond one’s skill level. I do
not recall hearing much about less-thanperfect
root planing and amalgam or
composite restorations.
There may be some wisdom in a
one-shot, live-patient test of mechanical
skill under artificially circumstances.
This is the “independent assessment of a
minimal standard” argument: if we are
uncertain about what students routinely
do two years before graduation, how
could they be expected to be competent
overall? There are ethical issues with the
boards placing candidates in positions
of moral hazard and their unwillingness
to accept responsibility for the patients
of candidates the boards fail. Otherwise
it makes good sense—provided that two
conditions are met: the testing must be
done right and it must not be a substitute
for doing something more in need
2
2011 Volume 78, Number 4