Volume 2, Issue 2 October 2010

Spotlight on EthicsEthics of Patient-based Exams and California Licensure by Portfolio

As governor Arnold Schwarzenegger signed bill AB1524 into law on September 29 2010, he createdthe first viable alternative to “live patient” clinicalexaminations for licensure in California. This billoutlines in principle the foundations for licensureby dental school portfolio, whereby students willbe evaluated by their body of work across differentclinical competencies rather than one “highstakes” human subject exam. This licensure optionis designed to counteract the many complicatingissues inherent in the human subject clinicalexamination such as the current California boardexam or the WREB exam often favored over theCalifornia exam.

One of the major driving factors for this recentmovement away from live subject-based exams isthe stressful parameters of these exams strainingthe ethical boundaries of licensure candidates. In alarge number of these instances, not also was theintegrity of the student dissolved, but also thehealth of the patient put into question. In a studyon clinical licensure exams by Feil et al. it wasdetermined that at least 13.7% of studentsreported that they knew of patients that werecoerced into treatment that would not have beenrecommended otherwise. Furthermore, 19% ofstudents admitted knowledge of other studentstreating a lesion prematurely solely forexamination purposes1. The procedures reservedfor examination are undeniably destructive andthese acts represent an inexcusable breach inacademic integrity. More importantly, thesestudents are betraying the ethical standards ofpatient care that have long distinguished dentistryas a respected and trusted field of healthcare. It issimply against all ethical obligations as healthprofessionals to alter treatment plans based uponself-serving motivations.

The issues above do not even fully envelop the

spectrum of ethical dilemmas raised by theseexamination procedures. Dr. Brooke Loftis, formerASDA president, states that she will “never forgetthe students that were delaying treatment ofpatients, over-radiating patients, over-treatinglesions, and paying outside services for the supplyof patients to use during the exam”2.Unfortunately, none of these actions are in linewith expectations of professional integrity nor arethey reflective of the best interests of the patient.However, the root of the issue does not only lie instudents looking for an edge, but also in thestrenuous and sometimes unreasonableparameters of the examination process. This is whyASDA, the CDA and others are so committed to thesuccessful implementation of licensure byportfolio. As discussed in ASDA’s white paper onethics, now is the time for examination boards totailor their methodology to eliminate confusionabout their expectations for professionalism andethics. These organizations and others believe thatthe bill just signed will represent a new alternativefor licensure that is sensitive to the ethical conflictsthat detriment both students and patientscommonly encountered with patient-based exams.

The California dental association and dentalstudents across the state are looking forward tobeing at the forefront of innovation in dentallicensure. As a result of this innovation, dentalstudents in California hope to be part of anexamination process that presents a fair, balancedand ethical evaluation of candidates for licensure.

For more excellent insight into ASDA and the field of dental ethics, please refer to ASDA’s white paper on ethics, found at http://www.asdanet.org/uploadedFiles

References 1. Feil P, Meeske J, Fortman J. Knowledge of Ethical Lapses and other experiences on Clinical Licensure examinations. Jounal of Dental Education. 1999, 63 (6) 453. 2. American Student Dental Association. The American Student Dental Association White Paper on Ethics and Professionalism in Dental Education. 2009. Chicago. 3. Hitchins B, Cobb J. When Will We be Ready for Academic Integrity? Journal of Dental Education. March 2008 (72) 3.

Matt SandrettiUCLA Class of 2013District 11 Ethics Chair

Contents:

Spotlight on Ethics Page 1

Beautifying Golden Gate Park Page 2

District 11 Legislative Committee Page 3

California Ethics Day Page 4

UCLA Children’s Hospital Volunteer Program

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Editor:Teresa Tran

Upcoming Events:

ASDA District Conference

California Ethics Day

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Jan

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Beautifying Golden Gate Park:

San Francisco Dental Students on a Mission

I’m privileged to serve as this year’s ASDA NorthernCalifornia Community Outreach Coordinator. This positionallows me to be an ambassador between the University ofthe Pacific, Arthur A. Dugoni School of Dentistry and ourneighbor dental school, the UCSF School of Dentistry. I’mconstantly working to create community serviceopportunities which will allow us to collaborate and servethe city of San Francisco. My goal is to organize one eventper quarter to encourage students from both schools toserve the community and build relationships with futurecolleagues from across town.

Our most recent event was a park beautification effort inGolden Gate Park. Students from both Pacific and UCSFwoke up early on Saturday, August 21 to join together andhelp clean up the park. The area that we worked on was inthe western side of Golden Gate Park, next to the Angler’sLodge and the Bison Paddock (yes, there were live bisonroaming in a meadow across the street from us). TheAngler’s lodge is a popular place for fisherman to practicetheir casting and while we were there we saw severalchildren learning how to cast a line. Between the parkinglot and the ponds is a wooded hill with native plantsincluding beautiful rhododendrons and flowers of all sorts.They were being overrun and choked out by weeds thatwe removed and piled up to be hauled away. When wewere finished the landscape looked significantly better.The park ranger we worked with told us that we were ableto complete more work in three hours than wouldtypically happen in three weeks!

While we did a lot of work, the time went by quicklybecause the entire time we were getting to know eachother and hearing about all the nuances of a differentdental school experience. Despite going through differentdental programs we share commons goals, includingcommunity service as a priority. We finished off the day ata nearby picnic area with ice cream and root beerfloats. I’m looking forward to getting to know the UCSFstudents even better while exploring and giving back toSan Francisco. Stay tuned for updates from future events!

Armin VahidniaASDA Northern California Community Outreach CoordinatorUniversity of the Pacific Arthur A. Dugoni School of DentistryClass of 2012

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Welcome to the District 11 Legislative CommitteeThis committee is designed to facilitate the transfer oflegislative information from national, state, and local sourcesto the California ASDA chapters. Additionally, bimonthlyconference calls are conducted in order to enhancecommunication and collaboration between the LegislativeLiaisons at each of the 6 California dental schools. Primarygoals of the committee are to serve as a resource for chapteractivities such as legislative lunch n’ learns, voter registrationdrives, and promotion of advocacy through ADPAC drives. TheDistrict Licensure Chair also serves as an integral part of thecommittee by keeping chapters updated on national and statelicensure policies. The district legislative committee will serve

as a means of coordination between the California ASDAchapters for the National Dental Student Lobby Day which isjointly hosted by ASDA and ADEA. With current legislativechanges such as national healthcare, the introduction of mid-level providers and the drive to eliminate the live patientlicensing exam, now is an exciting time to be a dental studentand make your voice heard!

Brittany HazardDistrict 11 Legislative LiaisonUCLA School of Dentistry 2013britthaz@ucla.edu

National Health Care

Obama’s Health Care Reform has been a topic of national debate since it surfaced.Dentistry is an integral component of health care and the ADA took a strong stanceagainst the bill in March 2010. The ADA’s view is based on the fact that the bill willnot improve access to oral health care for millions of low-income Americansbecause of the lack of funding delegated toward Medicaid dental services. Throughallied efforts, progress has been made and the Senate Appropriations Committeehas increased oral health care funding for the 2011 fiscal year, but it has yet to go tothe Senate floor.

Original ADA statement: http://www.ada.org/news/3507.aspxCurrent news: http://www.ada.org/2389.aspx

Mid-level Providers and Access to Care

Access to care is a substantial issue facing dentistry today and the introduction ofmid-level providers is becoming a popular solution. Alaska and Minnesota havealready incorporated mid-level providers into their dental systems and other statesare quickly following suit. The trend is weaving its way into California. If dentistswant to have an impact on the decision making process rather than leaving it up tothe lawmakers, then it is necessary to approach the issue by introducing alternativesolutions rather than simply voicing their disapproval of the mid-level providerconcept. In June 2010, Tim Stuart, the president of the CDA, held an all-memberconference call to address this concern.

To access the recorded conference call, login to the CDA websiteConference call recording: http://www.cda.org/advocacy_&_the_law/access_to_care

Licensure by Portfolio

In an attempt to eliminate the live patient licensing exam, Canada and Minnesotahave both implemented alternative testing methods. Currently, California is on theforefront of this effort by creating a “licensure by portfolio” method of assessment.The bill was signed by Governor Schwarzenegger on September 29th, 2010. Theportfolio method of licensure will replace the California state dental board exam inJanuary 2011. However, the date of implementation may be postponed as theDental Board of California develops a method to standardize evaluators for theportfolio competencies.

California State Senate: http://info.sen.ca.govClick on the “Legislation” link on the left-hand side Bill #1524

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Children’s Hospital Volunteer ProgramUCLA School of Dentistry

At UCLA School of Dentistry, the student body is relentlesslypursuing means of reaching out to children of all ages andbackgrounds in efforts to provide oral health instruction andideals for preventative care. In an endeavor to continue thepractice of reaching to children of all background, UCLA’sdental students have developed and fostered a program inwhich we make monthly visits to Children’s Hospitals in thecommunity. Starting with Children’s Hospital Los Angeles,students have had monthly visits in which we interact withmedically compromised patients and their families. Thesechildren, which are receiving care through hospital dentistry,have typically had severe medical challenges whichovershadow their oral health needs. Many of these childrencome from lower socio-economic families in which oral healthcare is not emphasized until a concern has arisen. In order totry to provide oral health awareness, as well as to reach out tothese children and their families, our dental students haveraised money to donate bags with toothbrushes, toothpaste,stickers, floss, coloring books, and mouthwash given to eachchild and any of his/her siblings. We take advantage of ourtime with them to speak to their parents and to the childrenabout maintaining their smiles.

While we cannot interact and reach out to many of the in-patient children such as those currently being treated atMattel Children’s Hospital at UCLA as well as those at CHLA,we have a continued effort to raise money in order to donatethese materials to the children, which we have successfullydone at Mattel’s. Our future goals are to continue our visits athospital dentistry at the various Children’s hospitals as well asto continue donating to those children whom we cannotphysically visit with. If nothing at all, this program allows thedental students to not only interact with these kids, but tolearn something from their perseverance as well as theirfamilies’. We just hope we can somehow put a smile on theirfaces.

Upcoming Event:

California Dental Ethics Day

Presented by ASDA District 11

A series of seminars and lunch meetings at California dentalschools designed to raise awareness and promote discussion ofethical issues currently affecting California dental students.

Scheduled for January 31, 2011

Speaker and sponsor opportunities still available

For more information, please contact Matthew Sandretti at sandrettim@ucla.edu

To Donate or Learn More Contact: Adi Avital UCLA School of Dentistry c/o 2013 -adiavital25@ucla.eduOr Kerry Hahn UCLA School of Dentistry c/o 2013 -kfhahn15@ucla.edu

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