The Buffalo Model

Joseph E. Gambacorta, DDSAssistant Dean for Clinical Affairs

University at Buffalo School of Dental Medicine

Background

In 2012 applications for licensuredecreased in New York State and NYSDA forms PGY1 Task Force. November 2014 first planningsession at UB with CDCA & NYSDA.

PGY1 Task Force Pilot Exam

To assure that patient care is protected. Care on patients of recordin a normal course of treatment. Integrated exam to be offeredcontinuously throughout the D3 and D4 year.

Establishing a Process

PGY1 Task Force Report used as a basis to formulate exam model. Advisory Group formed

UB Clinical Staff D3/D4 Group Directors Student Leadership

CDCA NYSDA

Curriculum Integrated Format - CIF

In 2007 ADA House defined CIF as: Treatment performed on patients of

record with sequenced treatment plan. Exam assessment integrated into

dental school curriculum. Multiple exams scheduled during

the academic year.

The Buffalo Model

Is a modification of the traditional licensure exam format which enables the focus of the exam to shift from the candidate to the patient.

Exam Modifications

Faculty & Curriculum integration Patient eligibility restricted Multiple exam dates available Exam part of normal clinic day

Faculty/Curriculum Integration

CDCA faculty calibration session Revised faculty role includes:

Prior to Exam

- lesion/case approval

Exam Day

- competency assessment

- documentation

- supervise definitive treatment

Patient Eligibility

Treatment MUST be rendered on

patients of record as part of

an appropriately sequenced

treatment plan.

Exam Schedule

Six exams were scheduled every 3 weeks January – May. Manikin Exam – one session Retakes offered at all exams. Eligible candidates were allowed to

register with only two sections of the

clinical exam approved.

Normal Clinic Day

Seamless integration of the exam

was achieved as a result of: Control in populating exam UB faculty, staff and student support Available clinic space Flexibility of CDCA CDCA and UB faculty interaction on

the clinic floor.

Intended Consequence

The Buffalo Model

is the

Curriculum Integrated Format

in action.

Orientation

Before each exam UB and CDCA held

a joint orientation session to: Schedule exam patients into database. Review parameters of ADEX exam. Discuss faculty role. Outline documentation requirements.

Exam Day

CDCA established a Buffalo exam team. UB staff coordinate clinical activities. Prescheduled clinical assignments

continue uninterrupted. Continuous interaction between

Examiners and UB faculty/staff. Definitive treatment model established.

Results

Case Approval Competency Exams Class of 2015 Results WREB/ADEX Comparison

Case Approval

EXAM DATE

ACCEPTED REJECTED ACCEPTED REJECTED

JANUARY 20 15 0 9 0

FEBRUARY 10 31 0 14 0

MARCH 24 40 2 16 0

APRIL 14 37 0 23 1

MAY 12 10 0 5 0

98.5% of the restorative lesions and periodontal cases pre-approved by UB faculty were accepted by

CDCA examiners.

RESTORATIVE PERIODONTICS

Competency Exams

EXAM DATE Total D4’s

TotalOPER

TotalPERIO

UBPASS

UBFAIL

ADEX PASS

ADEX FAIL

JANUARY 20 9 8 4 8 4 8 4

FEBRUARY 10 17 9 3 12 0 12 0

MARCH 24 25 11 2 11 2 13 0

APRIL 14 27 8 7 15 0 15 0

TOTAL 78 26 16 46 6 48 4

- NO COMPENCIES OFFERED DURING MAY 12th EXAM.- NO FAILURES IN PERIO.

- TWO CANDIDATES PASSED ADEX BUT NOT UB COMPETENCY.- COMPETENCY OPTION WELL UTILIZED BY STUDENTS.

Class of 2015 Results

EXAM DATE # D4 s

2-SECTION REGISTRATION

3-SECTIONREGISTRATION

TOTAL PASS

TOTAL FAIL

JANUARY 20 9 3 6 5 4FEBRUARY 10 17 4 11 17 0MARCH 24 25 10 10 23 2MARCH 28 61 N/A N/A 49 12APRIL 14 27 8 10 24 3MAY 11 11 N/A N/A 11 0MAY 12 9 3 0 8 1

66.6% of UB candidates passed the ADEX exam on their first attempt.

WREB/ADEX

Nine candidates challenged both exams. Only first attempts were considered. Prosthodontic manikin only part of ADEX. Student comments most important result in this

comparison.

EXAM # D4s RESTOR. PERIO. ENDO.

WREB 39 9 9 7

ADEX 61 9 9 9

Student Perspective

Presence of faculty helped establish trust

between students and examiners. No need to search for “ideal” lesions. Flexible scheduling reduced the stress of “all

or nothing weekend exam”. No extracted teeth to mount and radiographs

to take. It felt like a regular day at school.

UB Next Steps

Establish faculty, da, and runner

coverage schedule. Pre-exam chart review. Treatment plan submitted as part of

patient intake. Move manikin exam to fall semester. Certify D3 candidates to challenge at

the end of the spring semester.

Next Steps Nationally

Educate the dental community

– 2016 ADEA Annual Session

– seminars/publications Pilot The Buffalo Model at other

dental schools – CDCA survey. Standardization of the process to

facilitate ease in implementation.

Thank You

Dr. Michael Glick UB faculty, staff and students CDCA examiners and staff ADEX NYSDA – PGY1 Task Force Mr. Michael Zeder Dr. David Perkins Dr. Guy Shampaine

questions