Volume 2, Issue 2

Spotlight on Ethics

October 2010

Ethics of Patient-based Exams and California Licensure by Portfolio
As governor Arnold Schwarzenegger signed bill AB 1524 into law on September 29 2010, he created the first viable alternative to “live patient” clinical examinations for licensure in California. This bill outlines in principle the foundations for licensure by dental school portfolio, whereby students will be evaluated by their body of work across different clinical competencies rather than one “high stakes” human subject exam. This licensure option is designed to counteract the many complicating issues inherent in the human subject clinical examination such as the current California board exam or the WREB exam often favored over the California exam. One of the major driving factors for this recent movement away from live subject-based exams is the stressful parameters of these exams straining the ethical boundaries of licensure candidates. In a large number of these instances, not also was the integrity of the student dissolved, but also the health of the patient put into question. In a study on clinical licensure exams by Feil et al. it was determined that at least 13.7% of students reported that they knew of patients that were coerced into treatment that would not have been recommended otherwise. Furthermore, 19% of students admitted knowledge of other students treating a lesion prematurely solely for examination purposes1. The procedures reserved for examination are undeniably destructive and these acts represent an inexcusable breach in academic integrity. More importantly, these students are betraying the ethical standards of patient care that have long distinguished dentistry as a respected and trusted field of healthcare. It is simply against all ethical obligations as health professionals to alter treatment plans based upon self-serving motivations. The issues above do not even fully envelop the
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.

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Beautifying Golden Gate Park Page 2 District 11 Legislative Committee Page 3 California Ethics Day

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UCLA Children’s Hospital Volunteer Program Page 4

spectrum of ethical dilemmas raised by these examination procedures. Dr. Brooke Loftis, former ASDA president, states that she will “never forget the students that were delaying treatment of patients, over-radiating patients, over-treating lesions, and paying outside services for the supply of patients to use during the exam”2. Unfortunately, none of these actions are in line with expectations of professional integrity nor are they reflective of the best interests of the patient. However, the root of the issue does not only lie in students looking for an edge, but also in the strenuous and sometimes unreasonable parameters of the examination process. This is why ASDA, the CDA and others are so committed to the successful implementation of licensure by portfolio. As discussed in ASDA’s white paper on ethics, now is the time for examination boards to tailor their methodology to eliminate confusion about their expectations for professionalism and ethics. These organizations and others believe that the bill just signed will represent a new alternative for licensure that is sensitive to the ethical conflicts that detriment both students and patients commonly encountered with patient-based exams. The California dental association and dental students across the state are looking forward to being at the forefront of innovation in dental licensure. As a result of this innovation, dental students in California hope to be part of an examination process that presents a fair, balanced and ethical evaluation of candidates for licensure.

Upcoming Events:

Oct Jan


ASDA District Conference California Ethics Day

Teresa Tran

Matt Sandretti UCLA Class of 2013 District 11 Ethics Chair

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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 Northern California Community Outreach Coordinator. This position allows me to be an ambassador between the University of the Pacific, Arthur A. Dugoni School of Dentistry and our neighbor dental school, the UCSF School of Dentistry. I’m constantly working to create community service opportunities which will allow us to collaborate and serve the city of San Francisco. My goal is to organize one event per quarter to encourage students from both schools to serve the community and build relationships with future colleagues from across town. Our most recent event was a park beautification effort in Golden Gate Park. Students from both Pacific and UCSF woke up early on Saturday, August 21 to join together and help clean up the park. The area that we worked on was in the western side of Golden Gate Park, next to the Angler’s Lodge and the Bison Paddock (yes, there were live bison roaming in a meadow across the street from us). The Angler’s lodge is a popular place for fisherman to practice their casting and while we were there we saw several children learning how to cast a line. Between the parking lot and the ponds is a wooded hill with native plants including beautiful rhododendrons and flowers of all sorts. They were being overrun and choked out by weeds that we removed and piled up to be hauled away. When we were finished the landscape looked significantly better. The park ranger we worked with told us that we were able to complete more work in three hours than would typically happen in three weeks! While we did a lot of work, the time went by quickly because the entire time we were getting to know each other and hearing about all the nuances of a different dental school experience. Despite going through different dental programs we share commons goals, including community service as a priority. We finished off the day at a nearby picnic area with ice cream and root beer floats. I’m looking forward to getting to know the UCSF students even better while exploring and giving back to San Francisco. Stay tuned for updates from future events!

Armin Vahidnia ASDA Northern California Community Outreach Coordinator University of the Pacific Arthur A. Dugoni School of Dentistry Class of 2012

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Welcome to the District 11 Legislative Committee
This committee is designed to facilitate the transfer of legislative information from national, state, and local sources to the California ASDA chapters. Additionally, bimonthly conference calls are conducted in order to enhance communication and collaboration between the Legislative Liaisons at each of the 6 California dental schools. Primary goals of the committee are to serve as a resource for chapter activities such as legislative lunch n’ learns, voter registration drives, and promotion of advocacy through ADPAC drives. The District Licensure Chair also serves as an integral part of the committee by keeping chapters updated on national and state licensure policies. The district legislative committee will serve as a means of coordination between the California ASDA chapters for the National Dental Student Lobby Day which is jointly hosted by ASDA and ADEA. With current legislative changes such as national healthcare, the introduction of midlevel providers and the drive to eliminate the live patient licensing exam, now is an exciting time to be a dental student and make your voice heard! Brittany Hazard District 11 Legislative Liaison UCLA School of Dentistry 2013 britthaz@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 stance against the bill in March 2010. The ADA’s view is based on the fact that the bill will not improve access to oral health care for millions of low-income Americans because of the lack of funding delegated toward Medicaid dental services. Through allied efforts, progress has been made and the Senate Appropriations Committee has increased oral health care funding for the 2011 fiscal year, but it has yet to go to the Senate floor. Original ADA statement: http://www.ada.org/news/3507.aspx Current 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 of mid-level providers is becoming a popular solution. Alaska and Minnesota have already incorporated mid-level providers into their dental systems and other states are quickly following suit. The trend is weaving its way into California. If dentists want to have an impact on the decision making process rather than leaving it up to the lawmakers, then it is necessary to approach the issue by introducing alternative solutions rather than simply voicing their disapproval of the mid-level provider concept. In June 2010, Tim Stuart, the president of the CDA, held an all-member conference call to address this concern. To access the recorded conference call, login to the CDA website Conference 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 Minnesota have both implemented alternative testing methods. Currently, California is on the forefront of this effort by creating a “licensure by portfolio” method of assessment. The bill was signed by Governor Schwarzenegger on September 29th, 2010. The portfolio method of licensure will replace the California state dental board exam in January 2011. However, the date of implementation may be postponed as the Dental Board of California develops a method to standardize evaluators for the portfolio competencies. California State Senate: http://info.sen.ca.gov Click on the “Legislation” link on the left-hand side Bill #1524

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Upcoming Event:

California Dental Ethics Day
Presented by ASDA District 11
A series of seminars and lunch meetings at California dental schools designed to raise awareness and promote discussion of ethical 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

UCLA School of Dentistry

Children’s Hospital Volunteer Program
While we cannot interact and reach out to many of the inpatient children such as those currently being treated at Mattel Children’s Hospital at UCLA as well as those at CHLA, we have a continued effort to raise money in order to donate these materials to the children, which we have successfully done at Mattel’s. Our future goals are to continue our visits at hospital dentistry at the various Children’s hospitals as well as to continue donating to those children whom we cannot physically visit with. If nothing at all, this program allows the dental students to not only interact with these kids, but to learn something from their perseverance as well as their families’. We just hope we can somehow put a smile on their faces.

At UCLA School of Dentistry, the student body is relentlessly pursuing means of reaching out to children of all ages and backgrounds in efforts to provide oral health instruction and ideals for preventative care. In an endeavor to continue the practice of reaching to children of all background, UCLA’s dental students have developed and fostered a program in which we make monthly visits to Children’s Hospitals in the community. Starting with Children’s Hospital Los Angeles, students have had monthly visits in which we interact with medically compromised patients and their families. These children, which are receiving care through hospital dentistry, have typically had severe medical challenges which overshadow their oral health needs. Many of these children come from lower socio-economic families in which oral health care is not emphasized until a concern has arisen. In order to try to provide oral health awareness, as well as to reach out to these children and their families, our dental students have raised money to donate bags with toothbrushes, toothpaste, stickers, floss, coloring books, and mouthwash given to each child and any of his/her siblings. We take advantage of our time with them to speak to their parents and to the children about maintaining their smiles.

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

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