It’s time to end licensure exams on live human subjects
This may come as a surprise for people who aren’t in the dental profession.
But we’re one of the few — — if not the only — — healthcare professions that have licensure testing processes that involve live humans.
This just doesn’t happen in medicine. When you are going to get a license as a physician, you graduate from an accredited university. You might go to a residency, and you graduate that residency. You’re deemed to be competent.
But in dentistry, the system is archaic — and it’s been around for decades.
You graduate from your dental school, and maybe you go to a residency. Then, in order to determine whether the dental school did its job, there’s a licensing exam. And there’s many of them, by the way. There’s the Northeast Regional Board, the Southern Regional Board, the Western Board — — and they’re all basically doing the same thing. They’re testing clinical abilities.
Some things are done on a mannequin — — a root canal, for example. But there’s still a holdover in certain states, where parts of this exam have to be done on a live human patient.
That might involve doing a filling. Sometimes it involves doing a cleaning. We now have mannequin versions of these procedures, by the way. I can do a filling on a mannequin. I can do a cleaning on a mannequin. That technology exists, but there are still some states that don’t use it.
These states demand that a patient be used in this process. Now, why does that matter?
For one, these procedures are being done by people who aren’t real dentists yet.
In a dental school, the student is surrounded by faculty. At any point during a procedure — whether they’re doing their first filling or their 10th — they can raise their hand and ask for help. The faculty is there to make sure that the patient is well cared for.
When we go to a live exam, the person performing the procedure is under significant pressure to complete this exam — especially from a financial perspective. They can’t stop and say, “Hey, can you help me? I don’t know what I’m doing.” If they do that, they fail the exam.
It costs thousands of dollars to take these exams. If you fail one, you have to wait a few months to take it again. Now you’re not earning income. You may even have to get on a plane and fly somewhere else to take the next available test. You have to find a patient that’s in that state that’s willing to have something done. And it’s a very different from the situation in dental school, where a student can tap out at any time, ensuring that the right care is being delivered to a patient.
There are other reasons human testing is archaic and unethical.
If I’m taking the test, I may have a patient with a big cavity. Meanwhile, someone else has a patient with a small cavity that just barely qualifies for the exam. We’re being tested on two very different things, and there’s more opportunity for me to fail.
But here’s my favorite part. If you’re going to move to a different state, and that state has a different exam, you need to re-take it.
If an orthodontist and take a licensure exam that uses mannequins, but then want to move to one of the states that only accepts live patient exams, they would have to retake portions of the exam that the state wants to be done on live patients. That means I would have to perform a filling on a front tooth, a filling on a back tooth, and a cleaning on an actual human, even though the orthodontist hasn’t done those procedures in a decade.
That makes no sense. It’s unethical.
During COVID, we couldn’t do live patient exams for roughly two years.
In a post-COVID world, where mannequin technology is excellent, why are we still doing this? There’s no good reason. Even the President of the Southern Regional Testing Agency — which allows live human exams — says it’s time to move to mannequin-based testing.
We’re certainly heading toward a place where mannequin testing is allowed in all states. But there are still nine important holdouts that allow live human exams: Arkansas, Georgia, Mississippi, New Mexico, North Carolina, South Carolina, Wisconsin, West Virginia, and Wyoming.
The current setup also hinders dentists’ abilities to enter certain states and deliver care. If there are areas of a state where there are access-to-care issues, we’re not doing those people any favors by severely limiting the mobility of dentists.
So what are the next steps? What needs to change?
The boards of these states need to say, “enough is enough.”
They need to allow mannequin exams, as they did temporarily during COVID, and as most other states in the U.S. have done. It’s time to finally move on and allow mannequin-based testing.
The fact is, there’s plenty of people who passed live patient exams in years past who went on to be terrible dentists. And plenty who tested on mannequins who went on to be terrific. There is zero correlation between practicing on a live patient and going on to be good at your job.
We are also creating a scenario where someone operates on a live patient with no safety net. We’re experimenting, and finding out if this person will butcher a tooth or not. With no faculty help, and a backdrop of financial duress.
Working on a mannequin is a great way to learn. The technology is ready. And there’s still plenty of opportunity to make a mistake on a mannequin, even if you’re a very competent dentist.
But at least you won’t be making a mistake on a real human being.
