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I HISTORICAL BACKGROUND
In 1906 under the auspices of The Canadian Dental Association (CDA) the Dominion Dental Council was formed to conduct national written examinations, the successful completion of which would grant the candidate a Dominion Dental Council certificate. The National Certificate could then be presented to the Provincial Dental Regulatory Authorities (DRA’s) as evidence of the candidate's ability to meet a basic national standard of competence. Some DRA’s were prepared to grant licenses to practice on the basis of the certificate, however, others chose to accept the certificate as an academic base only and required the candidate to pass provincial practical tests in addition.
The Dominion Dental Council proved to be rather ineffective. A name change to The Dental Council of Canada in 1950 along with attempts to improve the efficiency of the examination mechanism still failed to attract strong support from the DRA’s. This was in spite of the fact that the DRA’s agreed with the general concept. They had indicated a desire to be free of provincial licensing examinations, providing that a strong competent national examination system could be introduced, which they could support.
The following year (1951) the CDA encouraged the ten DRA’s to meet in an attempt to develop a satisfactory plan for a National Examining Board. Its purpose was to provide a facility by which members of the profession could become eligible, on a national basis, to apply for practice privileges in the province of their choice. This meeting resulted in the incorporation of The National Dental Examining Board of Canada (NDEB) in 1952 by an Act of Parliament of Canada. The Act was supported by all ten DRA’s and by the CDA and this support continues today.
Since 1952, the NDEB has issued 21,907 certificates.
II PURPOSE
According to the Act of Parliament, the NDEB is responsible for the establishment of qualifying conditions for a national standard of dental competence for general practitioners, for establishing and maintaining an examination facility to test for this national standard of dental competence and for issuing certificates to dentists who successfully meet this national standard.
The NDEB, in cooperation with the Royal College of Dentists of Canada, is also responsible for the establishment of qualifying conditions for a single standard national certificate for dental specialties.
III STRUCTURE
The National Dental Examining Board of Canada is composed of twelve members. Each DRA appoints one member and two members are appointed by the Commission on Dental Accreditation of Canada.
In 1994, the Board designated representatives from the Royal College of Dentists of Canada, the Commission on Dental Accreditation of Canada, the Canadian Dental Association and the CDA Committee on Student Affairs as official observers. In 2004, the Board designated a representative from the CDRAF as an official observer and appointed a Public Representative.
The Executive Committee of the Board, consisting of the President, President-Elect, Past-President and two other members, meets two or three times a year. The full Board meets annually. The NDEB also has standing committees dealing with examinations, appeals, finances and by-laws.
The NDEB appoints a Chief Examiner for the examinations. Examiners are appointed by the Board from lists submitted by the DRA’s and lists submitted by the Deans of Canadian dental faculties.
The NDEB is a non-profit organization supported financially by fees charged to candidates for examination certification.
IV CERTIFICATION
Certification of Graduates of Dental Programs Accredited by the Commission on Dental Accreditation of Canada and by the ADA Commission on Dental Accreditation
Prior to 1971, a graduate of an undergraduate dental program in Canada was required to successfully complete the NDEB examination (written essay-type) in order to be certified. This policy was changed in 1971, when the NDEB decided to recognize the examinations and evaluation administered by Canadian faculties of dentistry and issue certificates to current graduates of these faculties without further examination. The conditions for certification of current graduates were established at this time to be proper application and graduation from an undergraduate dental program approved by the Commission on Dental Accreditation of Canada.
The NDEB, through its representatives on the Commission on Dental Accreditation of Canada and an appointee on each undergraduate program survey team actively participates in the accreditation process. In addition, the NDEB gives an annual grant to the Commission to be applied to accreditation costs of undergraduate dental programs in Canada and the United States.
In 1988 concern was expressed by several DRA’s about the validity of establishing clinical competence solely by accreditation. This concern was further intensified by the extension of the accreditation cycle from five to seven years. The NDEB, therefore, in 1989 established a committee "to explore whether the granting of a certificate on the basis of accreditation alone continues to be acceptable." This committee (Certification Review Committee or CRC) presented its report at the 1990 NDEB Annual Meeting. The report stated that certification based on accreditation alone was no longer acceptable, a finding which was further supported in the Parker Report.
As a result, the NDEB authorized two pilot projects which introduced and tested the use of NDEB external examiners/observers. In 1991 this involved the University of British Columbia, l’Université de Montréal and the University of Toronto. In 1992, the Universities of Alberta, Manitoba, McGill, Western Ontario and l’Université de Montréal participated in this pilot project. The pilot projects were deemed highly satisfactory by the NDEB. In 1993, certification for graduates of accredited Canadian Faculties of dentistry was based on present requirements and a successful report on the faculties’ participation in the NDEB External Examiner System.
In 1994, at the request of the DRA’s, the NDEB abandoned the External Examiner System and required that Canadian graduates pass the Written Examination. The NDEB committed to develop and implement an Objective Structured Clinical Examination (OSCE).
As a result of changes adopted at the 1993 Annual Meeting, in 1995 and onwards, graduates of dental programs accredited by the Commission on Dental Accreditation of Canada were required to pass both the NDEB Written Examination and the NDEB Objective Structured Clinical Examination (OSCE) in order to be certified.
In 1995 and 1996 an intense and lengthy consultation process with the DRA’s, the Commission on Dental Accreditation of Canada (CDAC), the Association of Canadian Faculties of Dentistry (ACFD), the American Association of Dental Schools (AADS) and the Commission on Dental Accreditation of the American Dental Association (ADA) was held. As a result a Notice of Motion was presented to the 1995 Annual Meeting that would significantly change the Board’s certification process. This Notice of Motion was circulated to the communities of interest and as a result, was revised, outlining conditions that required action by the ADA, the ACFD and the CDAC. In addition, to preserve national portability, the motion had to be ratified by all ten DRA’s.
During 1996, the ADA, CDAC and ACFD confirmed that the required changes would be made. The motion was subsequently passed by the NDEB at the November 1996 Annual Meeting and was ratified by all ten DRA’s.
As a result of the ADA Commission on Dental Accreditation making requested changes to their accreditation procedures, including the addition of state and national licensing board representatives to all site survey teams, the codification of the relationship between the ADA Commission on Dental Accreditation and the CDAC that ensures formal representation and involvement in each other’s process, the identification of the requested outcome measurement similar to the CDAC’s the Clinical Outcomes Review (CORE) Process. The NDEB was able to verify that the CDAC and the ADA accreditation processes were equivalent. Therefore, as of January 1, 1997, graduates of both US and Canadian accredited undergraduate dental programs were considered “accredited graduates”. To be certified, these graduates must pass the Written and OSCE Examinations within a specified period of time.
Until December 31, 1999, graduates of accredited programs who did not successfully complete the Written and OSCE Examinations within 7 years of graduation were granted a certificate by the Board following successful completion of the Examination for Certification of graduates of non-accredited dental programs established by the Board.
After January 1, 2000, graduates of accredited dental programs who do not successfully complete the Written and OSCE Examinations within 7 years of graduation were eligible to receive the Board’s certificate by successfully completing a Qualifying Program and then successfully completing the Written and OSCE Examinations.
As a result of wide consultation during a Strategic Planning process in 2003, the Board revised the “7 year rule” and allowed graduates of accredited programs who were more than 60 months past the date of their graduation to apply for special consideration to participate in the Board’s certification process. Also, in 2003, the Board placed a limit on the number of times a candidate could take an examination and added a public official observer.
Since the changes to the certification process for graduates of non-accredited dental programs in 1996, the Executive Committee of the National Dental Examining Board of Canada (NDEB) has been continually monitoring the results.
The 1996 changes introduced the 2 year Qualifying/Degree Completion Programs. The Commission on Dental Accreditation of Canada’s (CDAC) Standards for the Qualifying/Degree Completion Programs initially required that these programs be two academic years in length. Presently, these are approximately 80 students accepted into these programs each year. These programs work extremely well, faculties report that virtually every student requires the full 2 years in the programs to meet the national standard. However, it has been reported that there have been a few students who may not have needed the full 2 years.
In 2001, to provide more flexibility, the NDEB and the Canadian Dental Regulatory Authority Federation, (CDRAF) requested the CDAC change the standards to allow a student to demonstrate competence in a shorter time. Although CDAC modified the standards, the Qualifying Programs find it difficult to satisfactorily evaluate students until they have almost completed the programs. In addition, as of 2006, all Faculties of Dentistry in Canada have moved to Degree Completion Programs which, due to university regulation, have 2 year residency requirements.
The NDEB has requested that the CDAC investigate the potential of establishing reciprocal recognition of accredited programs with other countries in addition to the US. The CDAC has decided to monitor this issue.
Currently, the CDRAF has initiated a certification process for graduates of non-accredited dental specialty programs, and several Provincial Dental Regulatory Authorities (DRA’s) have indicated the need to develop an alternative process for certification of general dentists.
Current Examinations
a) WRITTEN EXAMINATION
The Written Examination consists of 2 papers, each with 150 multiple choice type questions. Each paper is given in a 2 hours and thirty minutes examination session. The sessions are held in the morning and afternoon of one day.
The examination will test:
(i) basic science knowledge as it relates to:
- tooth morphology, growth and development of the craniofacial complex
- oral physiology
- microbiology and immunology of oral diseases
- pain
- pharmacology
- biological effects of radiation
- human anatomy
- human physiology
- human histology
- human biochemistry
- nutrition
- neurological sciences
(ii) applied clinical science knowledge and judgement including diagnosis, treatment planning, prognosis, treatment methods and clinical decisions in the areas of:
- general medicine and general pathology
- oral medicine and oral pathology
- radiology
- periodontics
- preventive dentistry
- operative dentistry
- endodontics
- prosthodontics
- dental materials
- orthodontics
- pediatric dentistry
- geriatric dentistry
- oral & maxillofacial surgery
- therapeutics
- dental biomaterials
- behavioural sciences
- dental public health and epidemiology
- ethics
Prior to the Written Examination, candidates are provided with an examination outline and a list of reference texts commonly used in Canadian dental programs along with all necessary logistical detail.
Written Examinations are held at selected examination centres in Canada.
b) OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE)
The OSCE is a station type examination.
The majority of the stations have 2 questions and require the candidate to review the information supplied (e.g. case history, photographs, radiographs, casts, models) and answer extended match type questions. Each extended match type question has up to 15 answer options and one or more correct answer(s). A few stations may require the candidate to review the information supplied and write an acceptable prescription for a medication commonly prescribed by general dentists in Canada.
Candidates will have 5 minutes at each station to answer the questions. After 5 minutes the candidate will move to the next station. Frequently Asked Questions for this examination is available on the website at www.ndeb.ca.
The list of competencies from which examination items are developed is included in the Examination Regulations and References.
V COMPETENCIES FOR A BEGINNING PRACTITIONER IN CANADA
In 1993, the NDEB in cooperation with the ACFD, CDA and CDAC conducted a process to establish competencies for Beginning Practitioners in Canada. These competencies, which were the first national accepted competencies, were used to establish examination blueprints, guide educational programs and included in accreditation standards. They have also been used as a reference for many national and international processes in dentistry and other professions.
In 2004, the NDEB initiated a process that resulted in the revision of the competency document. This revised document has been endorsed by all stakeholders.
VI RELATIONSHIPS WITH RELATED ORGANIZATIONS
The NDEB closely integrates its personnel and activities with a number of other dental organizations. These inter-relationships are conducive to good intraprofessional communications and they greatly assist the NDEB in fulfilling its mandate. Two such relationships, one with the DRA’s and the other with the Commission on Dental Accreditation of Canada have already been briefly mentioned.
1. PROVINCIAL DENTAL REGULATORY AUTHORITIES
The NDEB is in reality an extension of the ten DRA’s - each appointing one member to the NDEB. Every major policy decision that is made by the NDEB must carry the approval of the DRA’s. The NDEB is autonomous only by virtue of the fact that it possesses an Act of the Parliament of Canada.
2. COMMISSION ON DENTAL ACCREDITATION OF CANADA
The Commission on Dental Accreditation of Canada appoints two members to the NDEB and the NDEB appoints two members to the Commission.
3. THE CDA COMMITTEE ON STUDENT AFFAIRS
Undergraduate dental students as well as recent dental graduates are either directly or indirectly affected by NDEB policies. As of 1997, the Board invites the CDA's Committee on Student Affairs to appoint two student representatives/observers to attend NDEB Annual Meetings. The NDEB is invited in turn to have a representative at the annual Canadian Dental Students' Conference.
4. THE CEO’S AND REGISTRARS’ MEETING
An opportunity to exchange information between the national and provincial Executive Directors and Registrars occurs as a result of the NDEB Executive Director/Registrar regularly attending this conference.
5. ASSOCIATION OF CANADIAN FACULTIES OF DENTISTRY, THE ACFD DEANS COMMITTEE, THE AMERICAN DENTAL EDUCATION ASSOCIATION AND THE AMERICAN ASSOCIATION OF DENTAL EXAMINERS
As a result of many overlapping interest areas, formal and informal invitational relationships exist between the NDEB, the ACFD, the ACFD Deans Committee, the ADEA and the AADE.
6. ADA COMMISSION ON DENTAL ACCREDITATION
Through its relationship with the Commission on Dental Accreditation of Canada, which has a formal relationship with the ADA Commission on Dental Accreditation, the NDEB is informed regarding accreditation issues in the U.S. and cooperates with the CDAC to arrange suitable appointments to ADA Commission Committees and site visit teams.
7. ADA JOINT COMMISSION ON DENTAL EXAMINATION
The NDEB and the ADA Joint Commission on National Dental Examinations invite staff observers to attend annual meetings. Staff of both organizations share information of interest.
8. ROYAL COLLEGE OF DENTISTS OF CANADA
Discussions between the NDEB and RCDC, concerning the possibility of a portability certificate for dental specialists in Canada, began in 1971. In 1973 the NDEB Act was amended, establishing the RCDC as the national examining facility for specialists and the NDEB as the national certifying authority.
Negotiations between the two organizations continued for another two years and resulted in the modification of the Part I RCDC Examination. The alteration of the Part I or Membership Examination consisted of the addition of an oral (viva voce) component and the orientation of the examination to test a candidate's clinical competence in his/her specialty. It was agreed that successful candidates in the modified Part I RCDC Examination, would be eligible to receive the NDEB/RCDC specialty certificate which in turn would be recognized by the DRA’s. Since, the RCDC has eliminated the Membership Examination and has indicated that it does not wish to endorse a portability process, the NDEB/RCDC Portability Certificate has little relevance.
9. AMERICAN DENTAL ASSOCIATION
The NDEB enjoys a friendly and cooperative arrangement with the American Dental Association's Joint Commission on National Dental Examinations and its several working committees. Accreditation programs, licensure qualifications, examination methods and techniques have problems and interests common to both sides of the border. Sharing the problems and experiences has been beneficial. Staff are invited to attend each others annual meetings.
10. CANADIAN DENTAL ASSOCIATION
The NDEB and the CDA have a reciprocal annual reporting relationship. The NDEB appoints 1 member to the CDA Council on Education.
11. CANADIAN DENTAL REGULATORY AUTHORITIES FEDERATION
The Executive Director/Registrar and the President are official observers at meetings of the Conference. The Conference normally meets twice a year.
VII ASSISTANCE TO OTHER ORGANIZATIONS
The NDEB provides consultation and existing examination related material to the DRA’s on request. Since 1998, the NDEB has assisted the ACFD in the administration of the ACFD Eligibility Examination. In 2001, formal agreements between the NDEB and the ACFD were signed. These agreements related to the administration of the ACFD Eligibility Examination and to administrative services provided by the NDEB for the ACFD. The NDEB also provides examination services on request to any DRA and has formal agreements for provisions of services to L’Ordre des Dentistes du Québec. The NDEB has also provided assistance to the Western Regional Examining Board, the American Board of Prosthodontics and the American Association of Dental Examiners and the Dental Council of Hong Kong.
VIII RESEARCH AND PUBLICATION
The NDEB consistently supported research and the dissemination of scholarly information. The following is a list of publications supported by the NDEB.
• Concurrent Validity of Written and OSCE Components of the Canadian Dental Certification Examinations
• Use of Discriminant and Regression Analyses to Modify a Clinical Certification Board Examination
• Competencies for a Beginning Dental Practitioner in Canada
• Modifications To the National Dental Examining Board of Canada's Certification Process
• Competencies for Dental Licensure in Canada
• Manual for Developing and Formatting Competency Statements
• An Analysis of the Contribution of a Patient-Based Component to a Clinical Licensure Examination
• A Validity Survey of Competencies for the Beginning Dental Practitioner in Canada
• Review and Revision of the Competencies for a Beginning Dental Practitioner in Canada
IX SUMMARY
The NDEB is conscious of its responsibility to certify only candidates who meet the national standard for the purpose of public protection. The Board has proposed and followed a series of Strategic Plans.
Each year, the NDEB assesses its certification and examination procedures and the responses of the candidates, making adjustments where indicated to improve the validity and reliability of the examination. The Examination Committee annually reviews the standards and procedures of the respective examinations and make recommendations to the Board.
In addition to this ongoing internal review, the NDEB has initiated several external evaluation procedures over the years:
1. A Report by the Commissioner of Examinations. Malcolm G. Taylor, Ph.D.-1966
2. A Study of the Accreditation Mechanism - 1983
3. Workshop on Preclinical and Clinical Examinations - 1985
4. 1989/90 Certification Review Committee (CRC) to explore whether the granting of a certificate on the basis of accreditation alone continues to be acceptable
5. A Report of NDEB by-laws and policies by the Honourable W.D. Parker - 1990
6. A psychometric analysis of examination evaluation methods by Dr. A. Rothman - 1991
7. Symposium - 1992
8. A Workshop on Clinical Competencies - 1993
9. A Consensus Conference on Certification of Graduates of Dental Programs accredited by the ADA Commission of Dental Accreditation - 1995
10. Conference on Competency in Oral Health Care, Education & Practice – 2000
11. NDEB Program Evaluation – André Boulais – 2001
12. Strategic Plan for 2006 – 2010
13. Review and Validation of Statistical Procedures – Mr. Thomas Maguire – 2004
14. CDA/DCF Teaching Conference: Review of Competencies for a Beginning Dental Practitioner in Canada. – 2004
15. Standard setting for NDEB Examinations- Buros Institute, University of Nebraska 2007-2008.