An Update on the National Board Dental Examinations

Dr. Kathleen J. Hinshaw

Sr. Manager, Test Administration

ADEA Dental Student Virtual Fair

February 22, 2014

© 2009 Joint Commission on National Dental Examinations, American Dental Association. All rights reserved.

Dental Licensure and the NBDE • Licensure of dentists in the United States is the responsibility of an individual state,

district, or dependency. A license issued by one such jurisdiction is applicable only within the geographic confines of that particular jurisdiction. Agencies in state government that administer dental licensure under laws adopted by state legislatures typically are called state boards of dentistry. A list of state boards can be found at www.dentalboards.org.

• Specific dental licensure requirements vary among jurisdictions, but all jurisdictions have three basic requirements: an educational requirement, a written examination requirement, and a clinical examination requirement. All jurisdictions accept graduation from a dental school accredited by the Commission on Dental Accreditation (CODA) as fulfilling the educational requirement. Most jurisdictions also accept graduation from a Canadian dental school accredited by the Commission on Dental Accreditation of Canada (CDAC).

• The NBDEs are intended to fulfill or partially fulfill the written examination

requirement, but acceptance of NBDE results is completely at the discretion of the individual state. A state may place any limit on acceptance of NBDE results that it deems appropriate. (e.g. Some states accept NBDE results only if earned within the last five to 10 years.)

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Who is the JCNDE?

• The Joint Commission on National Dental Examinations (JCNDE) is the agency responsible for the development and administration of the National Board Dental Examinations (NBDE Part I, NBDE Part II, and the NBDHE).

• This 15-member Commission includes representatives of dental schools, dental practice, state dental examining boards, dental hygiene, dental students, and the public.

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History of the JCNDE

1928 National Board of Dental Examiners established as a standing committee of the ADA for the purpose of providing & conducting written examinations for use by the state boards of dentistry in licensing dentists.

1933/1934 National Board Dental Examinations first administered.

1962 National Board Dental Hygiene Examination (NBDHE) first administered.

1973 NBDHE became a comprehensive examination.

1980 National Board of Dental Examiners was restructured as the 15 member JCNDE.

1992 Part II became a comprehensive examination.

2007 Part I became a comprehensive examination.

2009 All National Board examinations are computer-based examinations.

Present All U.S. licensing jurisdictions accept the NBDE and NBDHE as fulfillment of the written examination requirement for licensure.

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What is the Relationship of the JCNDE to the ADA?

ADA Governance (established in 1980 with the Association of Dental Examiners/ADE)

• ADA Constitution and Bylaws • Standing Rules for Councils and Commissions • Principles of Ethics and Code of Professional Conduct JCNDE Governance (semi-autonomous agency) • JCNDE Bylaws (Composition and responsibilities) • JCNDE Standing Rules (Exam development protocols) • JCNDE Examination Regulations (Testing policies and procedures)

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What is the Purpose of the JCNDE?

The purpose of the JCNDE is to: • provide and conduct examinations to assist state boards in

determining qualifications of dentists and dental hygienists who seek licensure.

• make rules and regulations for the conduct of National Board examinations and certificates.

• serve as a resource for the dental profession in the development of examinations.

Currently, all United States licensing jurisdictions recognize NBDE results. These jurisdictions include all 50 states, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands.

What is Mission Statement of the JCNDE?

“The JCNDE develops and conducts highly reliable, state of the art cognitive examinations that assist regulatory agencies in making valid decisions regarding licensure of oral health care professionals, develops and implements policy for the orderly, secure, and fair administration of its examinations, and is a leader and resource in assessment for the oral health care profession.”

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What is the Composition of the JCNDE?

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Organization (6 different constituencies)

Number of Members

Length of Term (years)

AADB 6 4

ADEA 3 4

ADA 3 4

ADHA 1 4

ASDA 1 1

Public 1 4

Total 15 -

ASDA Observer (becomes ASDA Commissioner the following year)

1 1

Current members and appointing organizations: http://www.ada.org/JCNDE.aspx

What are the roles of the Commissioners?

Attend a Test Construction Committee Meeting Comply with ADA Standing Rules Consider Appeals Establish & oversee JCNDE policies Liaison: AADB, ADEA, ADA, ADHA, ASDA Maintain confidentiality of JCNDE information Oversee development & administration of JCNDE exams Oversee JCNDE budget Prepare & participate in JCNDE meetings & committees

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JCNDE Committees

• Standing Committees of the JCNDE Committee on Administration Committee on Dental Hygiene Committee on Examination Development Committee on Research and Development

• Ad-hoc Committee Committee for an Integrated Examination (CIE)

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What is the Testing Format?

National Board Dental Examination Part I Optional Tutorial 15 minutes

Discipline-based, multiple-choice test items with 3-5 testlets (approximately 200 items)

3.5 hours

Optional scheduled break One hour (maximum)

Discipline-based, multiple choice test items with 3-5 testlets (approximately 200 items)

3.5 hours

Optional Post-examination Survey 15 minutes

Total Time 8 hours 30 minutes

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National Board Dental Examination Part II Day 1

Optional Tutorial 15 minutes Discipline-based, multiple choice test items (200 items) 3.5 hours Optional Scheduled Break 1 hour Discipline-based, multiple choice test items (200 items) 3.5 hours

Day 2 Optional Tutorial 15 minutes Patient Case Problems (100 case-based items) 3.5 hours Optional Post-examination Survey 15 minutes Total Time 12 hours 15 minutes

What is the NBDE Part I Test Content? NBDE Part I is a comprehensive examination. The NBDE Part I is comprised of 400 multiple-choice items, evenly distributed across the following disciplines:

• Anatomic Sciences • Biochemistry-Physiology • Microbiology-Pathology • Dental Anatomy and Occlusion

For each discipline, approximately 80% of the items are discipline-based and approximately 20% are grouped in testlets with interdisciplinary focus and clinical application. A testlet consists of a patient scenario/history and a set of items from the various disciplines that are associated with the scenario. One item from each of the disciplines listed above will be designated for the testlets under the topic, Professional Ethics/ Patient Management. These items will require a basic understanding of professional ethical principles in patient management.

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What is the NBDE Part II Test Content? NBDE Part II is a comprehensive examination comprised of 500 multiple-choice items. The discipline-based component includes 400 items and the case-based component includes 100 items based on 8-10 case problems.

Discipline-Based Component (400 items): The discipline-based component includes the following disciplines: Endodontics, Operative Dentistry, Oral and Maxillofacial Surgery / Pain Control, Oral Diagnosis, Orthodontics / Pediatric Dentistry, Patient Management, Periodontics, Pharmacology, and Prosthodontics. Case-Based Component (100 items): The case-based component presents events dealing with patient cases and developed with the approximate distribution: Adults (70%), Children (30%). A minimum of 15% of the questions address the medical management of compromised adults/children (person whose health status requires modification of standard treatment). Each case presentation consists of: synopsis of health and social histories, dental charting, diagnostic radiographs, and clinical photographs (when necessary). Each case contains from 10-15 questions and may derive from any of the basic sciences and clinical disciplines, including Patient Management. The candidate must: 1) interpret the findings and information provided, 2) identify the problems and make diagnoses, 3) select materials, technique, and armamentarium, 4) apply treatment, 5) evaluate progress and complications, 6) establish procedures for prevention and maintenance.

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Test Construction

Ongoing process. Multiple test forms prepared annually. Both new and previously used items. Items drafted by Test Construction Committee (TCC)

• Review and revise items. • Adhere to Test Item Development Guide. • Ensure accuracy and relevance. • Evaluate item quality/performance via item level statistics (item

discrimination and difficulty). • Select items per test specifications.

New items are pretested and reviewed. Items that don’t meet standards are revised/retired.

TCCs suggest content changes. Changes approved by JCNDE.

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Test Construction Committees (TCC) http://www.ada.org/2291.aspx

• The JCNDE appoints test constructors. Each year, the JCNDE’s Committee on Examination Development reviews the credentials of individuals who are interested in serving as test constructors. Based on the recommendations of this Committee, during its annual meeting the JCNDE appoints test constructors who are well qualified to serve and who represent various locations throughout the country.

• Vacancies on Test Construction Committees (TCCs) occur regularly because each test constructor can serve a maximum of five consecutive one-year terms on a TCC.

• Each TCC consists of subject-matter experts and a full-time practitioner. A full-time practitioner is a dentist or a specialist who is currently licensed in the United States and has practiced dentistry full-time (30 or more hours per week) for at least 10 years.

• The selection process is detailed in the following document: http://www.ada.org/sections/educationAndCareers/pdfs/nbde_criteria.pdf

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What are the Quality Control Procedures?

JCNDE quality control procedures:

Multiple quality control procedures during test development and publishing.

Score audits.

Review post test surveys.

Major infrastructure improvements:

– Application and score reporting system – Item banking software

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Reliability and Validity Reliability

Validity

A prerequisite of validity; a test must be reliable in order for it to provide meaningful measurement. Precision, consistency, and stability of test scores.

Validity is “the degree to which accumulated evidence and theory support specific interpretations of scores entailed by proposed uses” (AERA, APA, & NCME, 1999, p. 84). For every examination program, there is a purpose. To fulfill this purpose, a test score has a desired interpretation and an intended use.

The Joint Commission uses two indices to report score reliability for NBDE Part I and NBDE Part II. One index is Kuder-Richardson Formula 20 (i.e., KR20). This index provides internal consistency estimates for tests with items that are scored dichotomously (e.g., right or wrong). The second index used by the JCNDE is stratified alpha. This index provides internal consistency estimates for tests with multiple components. An example of this would be an examination composed of testlets.

In the licensing of dentists in the United States, all candidates for licensure must meet a number of criteria before they are licensed to practice in a state. Each state has the authority to issue the license, although in dentistry, as in many other professions, national standards exist. With the NBDE Part I, the intended interpretation is the knowledge of basic biomedical and dental sciences that dentists should have. The use of the Part I scores is to recommend passing or failing the candidate. With the NBDE Part II, the intended interpretation is the professional knowledge of clinical dental sciences including professional responsibility and patient management abilities that dentists should possess. The use of the Part II scores is also to recommend passing or failing the candidate.

The NBDE Technical Report contains validity evidence and references to validity evidence that support both interpretations and uses of scores. It is organized to address major categories of validity evidence and contains narrative and validity documentation. Also, reference is made to one or more standards (AERA, APA, & NCME, 1999).

http://www.ada.org/sections/educationAndCareers/pdfs/nbde_technical_report.pdf

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Test Administration and Fees Electronic application process;

6 month eligibility period. Monitor NBDE website for upcoming enhancements to website and application process.

Administered nationwide at Prometric Test Centers, any business day. Approximately 284 professional level testing centers in North America with 5,243 available seats.

Secure test environment/process. Biometric check-in. Video monitoring.

https://www.prometric.com/en-us/for-test-takers/prepare-for-test-day/pages/what-to-expect.aspx

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2014 Fees NBDE Part I Fee includes official score reporting to you and the dean of an accredited dental school. Your score report is sent to the address on your application.

$410

NBDE Part II Fee includes official score reporting to you, the dean of an accredited dental school, and three licensing boards if requested on the application. Your score report is sent to the address on your application.

$455

Additional score report Fee for recipients not selected at time of application.

$33

Audit Request $65

National Board Certificate You may order a certificate with optional frames after successful completion of the NBDE Part I and Part II.

http://www.ada.org/sections/educationAndCareers/pdfs/cer

tificate_request_form.pdf

Testing Accommodations Candidates may request testing accommodations in compliance with the Americans with Disabilities Act upon submission of the following:

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Testing Accommodation Request Form describing the disability and the need for accommodations. Accommodations should align with the identified functional limitation so that the adjustment to the testing procedure is applicable to the identified impairment. A functional limitation is defined as the behavioral manifestation of the disability that impedes the individual’s ability to function.

Current evaluation report (within the past five years) from an appropriate licensed professional. The document must be on official letterhead and should include the professional’s credentials, signature, address, and telephone number. The report must indicate the examinee’s name, date of birth, and date of evaluation. The report should include: • The specific diagnostic procedures or tests administered. Diagnostic methods used should be appropriate to the

disorder and in alignment with current professional protocol.

• The results of the diagnostic procedures and/or tests and a comprehensive interpretation of the results.

• The specific diagnosis of the disorder, with an accompanying description of the examinee’s limitations due to the disorder.

• A summary of the complete evaluation with recommendations for the specific accommodations and how they will reduce the impact of the identified functional limitation.

Documentation of any previous accommodations provided by educational institutions or other testing agencies. If no prior accommodations were provided, the licensed professional should include a detailed explanation as to why no accommodations were given in the past and why accommodations are needed now.

Testing Checklist This checklist is a summary of the most frequent issues that will create problems on the day of testing. Please read the Guides, specifically the rules and regulations.

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Bring two original, current (not expired) IDs to the testing center:

1. One government issued ID, with

photograph and signature (driver license or passport).

2. One ID with signature (social security card,

credit card, debit card, library card).

Follow the instructions of the test administrator and the testing center rules. I will: • Leave non-essential items at home. • Store my personal items in the testing center

locker. • Check my pockets to ensure they are empty

before I begin testing. • Not access any personal items during testing or

an unscheduled break. • Not use my cell phone during testing or on an

unscheduled break. • Make arrangements for my ride home prior to my

testing appointment.

The name on my IDs match the name I submitted on my NBDE application exactly. o Matching: Joseph Anthony Smith and

Joseph A. Smith o Non-matching: Joseph Anthony Smith and

Joseph Smith-Johnson

If I experience a problem with testing conditions, I will notify the test administrator immediately. Concerns not resolved must be submitted in writing to JCNDE within 5 business days of my testing appointment.

When should I schedule testing appointment?

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Part I Monthly Volumes

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When should I schedule my testing appointment?

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Part II Monthly Volumes

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Score Reports/Scoring Score Reports Scoring

The results for the NBDE will be reported as pass/fail only for candidates who pass the test. For remediation purposes, candidates who fail the examination will receive numerical scores for each of the major disciplines covered on the test. If you tested prior to 2012, your numerical scores for prior attempts will still be reported.

A candidate’s total score is computed by the total number of correct answers selected. The total score is then converted to a scale score, which adjusts for any minor differences in difficulty across NBDE forms. Scale scores range from 49 to 99, with a score of 75 representing the minimum passing score (regardless of the particular test form completed). Because the NBDE is a criterion-referenced examination, the minimum passing score is determined by experts through standard setting activities.

Results are mailed approximately three weeks after the examination. JCNDE regulations prohibit reporting results by telephone, fax, email, or in person.

Detailed score analysis provided in NBDE Technical Report.

By signing the application, you give permission to provide results to the entities you indicated on your application. If misconduct has occurred in a past administration, your score report may contain information concerning the incident (see Testing Irregularities and Misconduct).

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Retesting

90-day wait required between retests. Candidates who have passed a NBDE (Part I or Part II) may not retake the examination unless required by a state board or relevant regulatory agency. NBDE candidates who have not passed an examination after three attempts will be required to wait 12 months after their third attempt before they can apply for reexamination. After the 12-month waiting period has lapsed, a new cycle will apply. Candidates are encouraged to seek formal remediation before reexamination. Under the JCNDE’s 5 Years/5 Attempts Eligibility Rule, candidates must pass the examination within five years of their first attempt or five examination attempts, whichever comes first. This applies to examination attempts occurring on or after January 1, 2012.

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Reschedule Policy

To improve rescheduling process and permit last minute rescheduling, the following reschedule policy has been adopted. You must contact Prometric directly and pay a fee to reschedule. Contractual agreements require JCNDE payment for no-show appointments.

Fee Schedule (Saturday and Sunday are NOT business days)

$100 the day before to 5 business days prior to the testing appointment

$60 6 to 30 business days prior to the testing appointment

$25 31+ business days prior to the testing appointment

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Testing Irregularities and Appeals

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Definition of Irregularity: there is a question about the validity of test results accurately reflecting the ability/skills of a candidate. Reasons for withholding scores include, but are not limited to:

• Unusual answer patterns. • Atypical score increases from one testing

attempt to another. • Inconsistent performance on different parts

of test. • Improper access to secure test content. • Test administration irregularity. • Discrepancy/falsification of personal

identification. • Engaged in misconduct or violation of

rules/regulations. • Falsification of application

information/supporting documents. • Falsification of score report. • Information indicating the results may not

be valid.

Irregularities detection and investigation: Testing vendor Irregularity reports. Information sources (e.g., anonymous tips,

routine audit procedures). Conduct investigation. Take action to applicable regulations/rules;

withhold score and wait to retest.

Notification/Appeal Process Candidate notification; 30 days to submit

appeal. Appeal received; forwarded to Chair for

screening (60 day deadline to respond to candidate with final decision).

Chair grants/denies/or forwards appeal to JCNDE for ballot.

Candidate notified of decision.

What can I use to prepare for the NBDE? What? Where?

Counsel with your Academic Advisor Your academic institution and dental school.

NBDE Guides http://www.ada.org/sections/educationAndCareers/pdfs/nbde01_examinee_guide.pdf http://www.ada.org/sections/educationAndCareers/pdfs/nbde02_examinee_guide.pdf

NBDE FAQs http://www.ada.org/sections/educationAndCareers/pdfs/nbde01_faq.pdf http://www.ada.org/sections/educationAndCareers/pdfs/nbde02_faq.pdf

NBDE Checklist http://www.ada.org/sections/educationAndCareers/pdfs/nbde01_checklist.pdf http://www.ada.org/sections/educationAndCareers/pdfs/nbde02_checklist.pdf

NBDE Application Instructions http://www.ada.org/sections/educationAndCareers/pdfs/nbde01_app_instructions.pdf http://www.ada.org/sections/educationAndCareers/pdfs/nbde02_app_instructions.pdf

Testing Accommodations http://www.ada.org/sections/educationAndCareers/pdfs/nb_accommodation_request.pdf

NBDE Tutorial https://www.prometric.com/ClientFiles/ada/NB1/index.htm https://www.prometric.com/ClientFiles/ada/NB2/index.htm

Resources on JCNDE website http://www.ada.org/2287.asp http://www.ada.org/2288.aspx

NBDE Released Item Sets http://www.ada.org/sections/educationAndCareers/pdfs/nbde01_sample_test.pdf www.asdanet.org

Prometric FAQs https://www.prometric.com/en-us/for-test-takers/Prepare-for-Test-Day/frequently-asked-questions/Pages/default.aspx

Prometric What to Expect on Test Day https://www.prometric.com/en-us/for-test-takers/Prepare-for-Test-Day/Pages/what-to-expect.aspx https://www.prometric.com/en-us/our-solutions/test-delivery/id-management/Pages/default.aspx

Licensure Overview http://www.ada.org/489.aspx

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Website http://www.ada.org/JCNDE.aspx

Please note: updates to the website are scheduled for March/April. The appearance may be different at the time of this presentation.

Step 1: Read the Guide Step 2: Retrieve your DENTPIN® and Apply to take the Examination Step 3: Schedule a Time to Take the Examination Step 4: Take the Examination at a Prometric Test Center Step 5: Score Reports

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NBDE Guides http://www.ada.org/sections/educationAndCareers/pdfs/nbde02_examinee_guide.pdf http://www.ada.org/sections/educationAndCareers/pdfs/nbde01_examinee_guide.pdf

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NBDE Resources

http://www.ada.org/2287.asp http://www.ada.org/2288.aspx • Case Materials • JCNDE Actions • Meeting Presentations • Newsletters • Reference Texts • Technical Report (detailed scoring information)

• Test Item Development Guide

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What about the new INBDE? http://www.ada.org/5553.aspx

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What is the INBDE?

• In 2009, the JCNDE appointed an ad hoc committee, the Committee for an Integrated Examination (CIE), to develop and validate a new examination instrument for dentistry that integrates basic, behavioral, and clinical sciences to assess entry level competency in dental practice, to supplant Part I and Part II.

• The integrated examination retains the same fundamental examination purpose as Part I and Part II: to assist state boards of dentistry in determining qualifications of dentists who seek licensure to practice in the US.

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How did the CIE and INBDE come about? • A convergence of factors led to the INBDE, all intent upon

finding better ways of serving communities of interest.

• Specific opportunities were seen to: o Increase the appropriateness of test content and align

content with contemporary dental education. o Improve processes and the experience of candidates. o Better assist regulatory agencies.

• There was also recognition of examination content trends

and a movement towards integration and clinical relevance.

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Model of the Domain of Dentistry

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Model of the Domain of Dentistry

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Model of the Domain of Dentistry

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INBDE Implementation Timeframe

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• The JCNDE will provide stakeholders and communities of interest with at least four years’ notice prior to the full implementation of the INBDE.

• The JCNDE and the CIE recognize that the development of the INBDE takes place within a much larger context.

• State boards are viewed as key stakeholders, and educators, students, dental professionals, and the public are viewed as critical communities of interest.

• Communication, participation, and feedback are critical to the success of the effort.

• Visit the INBDE web site and subscribe to the mailing list. Please direct any questions and feedback to jcndecie@ada.org.

Contact Information

Dr. Kathy Hinshaw will be available to answer your questions from 2:00 p.m. to 4:00 p.m. (EST) in the Presenter Q & A Chat Room.

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Joint Commission on National Dental Examinations 211 E. Chicago Avenue, Suite 600

Chicago, Illinois 60611 800-232-1694

nbexams@ada.org

Kathleen J. Hinshaw, L.D.H., Ed.D. Senior Manager, Test Administration