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Examiners, state boards rethinking traditional use of practical exams, scored exams, and live patients

Even before the COVID-19 pandemic hit, three licensing test practices enshrined in some occupations' traditions for decades got some unexpec- ted demotions in recent months: the use of numerical scores, the use of practical exams, and the use of live patients for testing of clinical skills.

The broadest-impact change occurred with the U.S. Medical Licensing Exam (USMLE). The USMLE decided to change its Stage I exam, administered while prospective physicians are still in medical school, from numeric scoring to Pass/Fail. The move was in line with the goal of emphasizing use of the USMLE, at all stages, to make decisions about competency for licensure rather than to rank prospective medical residents by their USMLE scores.

The second change is significant mainly because it is virtually unprece- dented: the Alaska Board of Barbers and Hairdressers decided to drop its practical exam. In its place will be a proficiency exam that graduates of barber or hairdresser training programs must take.

A third testing tradition—use of live patients to test dental practitioners’ skills—fell by the wayside with the April 2 vote by the American Board of Dental Examiners to approve a new “manikin tooth” technology to replace human patients for dental licensure candidates to demonstrate their competence at restorative examination.

The format chosen, called CompeDont, is a manufactured tooth viewed as a high-fidelity replacement for a living patient. CompeDont accurately represents infected, affected, and sclerotic dentin, according to the Commission on Dental Competency Assessments (CDCA), which is the largest third-party administrator of dental and dental hygiene assessments in the U.S. “Both examiners and students reported that the tooth mimics decay, stickiness, and tug-back and can be restored as if it were a natural tooth in this way,” says CDCA director of examination Guy Shampaine.

CDCA partnered with Acadental, Inc., to develop and produce the new technology. Independent psychometricians, says the ADEX, analyzed pilot data showing the simulated tooth identified the same critical deficiencies in skill that would be typically revealed by treatment of natural teeth.