To obtain dental licensure in the U.S. students are required to successfully complete a patient-based clinical exam. This has recently brought several ethical issues to light. The American Dental Association (ADA), American Dental Education Association (ADEA), and the American Student Dental Association (ASDA) have made recommendations to eliminate or modify the human subject component of the exam. In a study published in June 2016 in the Journal of Dental Education the authors aim to assess the development and implementation of the Buffalo Model.1
The Buffalo Model, developed at the University at Buffalo School of Dental Medicine, is a collaborative model aiming to resolve the many concerns associated with the current exam modality. The main focus is on exam integrity and patient safety. Dental educators have overwhelmingly voiced their concerns regarding the appropriateness of involving patients in tests designed to evaluate a student’s clinical skills.
In a survey published in 2003 deans of dental schools reported the most concerning issue with the current modality of the examination was delayed or inappropriate treatment. Additionally, if a student were to make a critical error the patient would be provided with a temporary restoration and be left to find follow up treatment on their own. Lasky et al. gave a nice summary of the difficulties being faced with current exam modalities noting that “dentistry has expanded its perspective to look at the entire patient, but the clinical examination continues to focus on the tooth”.
In 2007, the ADA approved the use of a Curriculum Integrated Format (CIF). Implementation of the CIF involves clinical skills exams at multiple times throughout the students fourth year of dental school, rather than an end of the year assessment such as the current exam format. Of the schools that implemented the CIF, administrators reported multiple beneficial aspects including the ability to resolve identified deficiencies in student performance and reduced student stress.
The Buffalo Model adheres to the ADA’s recommendation on CIF enabling the focus to shift from the candidate to the ethical treatment of the patient. Although the Buffalo Model still requires patient participation, it allows for the prioritization of effective and ethical patient care while also implementing testing procedures that benefit candidates, dental schools, and patients.
In some instances, patients with exam-eligible lesions are urged to delay treatment until the time of the examination. This is in no way beneficial to the patient. The Buffalo Model offers the opportunity for immediate treatment. This model also relies solely on patients of record with an established comprehensive. It also allows for follow up care, and ensures patients leave with completed treatment.
In the first year of the implementation of the Buffalo Model, there were ten instances in which a candidate did not successfully meet ADEX criteria, because faculty was on hand the patients were provided with the proper complete treatment. In comparison, if this occurred in a traditional exam setting, the patients would be left with incomplete treatment and the burden of finding a dentist for follow up care.
Consider, if patients approved by faculty members for examination criteria were not approved by CDCA on the examination date, these two patients would be dismissed leaving them responsible to seek treatment elsewhere. However, under the Buffalo Model, these patients would simply be reappointed at a later date to have treatment completed. This would make the patients’ needs take precedence over the candidate’s needs.
The Buffalo Model is not without limitations, candidates that are no longer enrolled in dental school that has not met the requirements would require an alternate testing site. A possible solution presented would be to utilize Federally Qualified Health Centers or other community clinics.
The authors conclude by stating “This model successfully addresses ethical concerns surrounding patient participation in clinical licensure examinations by incorporating strategies that shift the focus of the exam from the candidate to the patient.”
Do you feel the current exam format has ethical concerns? Does the Buffalo Model seem like a good option to replace the current modality? Can you see how implementing the Buffalo Model could improve patient care? Would you support the implementation of this model for future licensing exams?
- Gambacorta JE, Glick M, Anker AE, Shampaine GS. The Buffalo Model: Shifting the Focus of Clinical Licensure Exams in Dentistry to Address Ethical Concerns Regarding Patient Care. J Dent Educ. 2016;80(6):641-647.