A Response to the ADHA Call to Action
As soon as the Call to Action hit my newsfeed, I had it filled out and sent off before the comments even started streaming in. Then the comments started streaming in… and I was surprised at them. Here is why I was surprised, I sat in the room as the topic of clinical boards came up at the ADHA House of Delegates last summer. I sat and listened as both sides of the issue were presented. I watched the process of how we are represented as a profession and I felt proud. I walked away from that experience supporting the ADHA’s stance of “The American Dental Hygienists’ Association supports elimination of the patient procedure-based, single encounter clinical examination for candidates who are graduates of Commission on Dental Accreditation (CODA) accredited dental hygiene programs and who are eligible to take the National Board Dental Hygiene Examination.” I have worked in three different hygiene programs, all of which go above and beyond CODA requirements. This year is also the first year that I have been more involved in the self-study process, a process where schools show that they are meeting and often exceeding CODA standards to ensure competency in Dental Hygiene through the education process. Guys, it’s INTENSE. I am a proponent of licensure upon graduation of a CODA accredited program because of my experience. We have been graduating students above the competency requirements. Yes, I have had students who aren’t at the “top” of the scaling game upon graduation but, were they going to go willy nilly chopping people’s papilla off? No! Do I feel like those who have graduated were at a competency that was safe for the public?. Do I feel that clinical competency is only part of what makes a competent Dental Hygienist? Yes. Do I believe that Dental Hygiene is a profession of LIFE-LONG learning and progression? YYYYEEEEESSSSS!
With that being said, there are some legitimate concerns I have heard- not the “I had to do it, so you have to do it” outcries I have been hearing… we don’t eat our young. The concerns where programs may feel pressure to push students through to graduation without meeting competency. I am open to these discussions of how to address these concerns WITHOUT the “patient procedure-based, single encounter clinical examination” ONE day does not legitimize or decimate the MONTHS of growth and clinical competency already shown. It is important to listen to other’s concerns because it is through that dialogue that GENIUS is born and we can come up with a summative assessment that is ethical, practical and will show the competency of our professional future. This is why we need ALL voices as members of OUR Association, to listen, to understand and to grow. My colleague Chanci and I were up way too late texting about this very topic. Looking at it from differing sides of the issue.
Chanci Oyler, MEd, BSDH, RDH:
When I first heard about the idea of discontinuing the single-encounter clinical exam several years ago, I was taken aback. It was all I had ever known as a hygienist. Was it stressful and hard? Yes. But it wasn’t impossible and most everyone passes on the first try so what’s the problem with it? As the discussion continued I gained some valuable insight that eventually led me to a change of heart and it was more than just the questionable ethical implications the exam has on patients.
As a dental hygiene educator I have always strived to hold my students to a high standard. Most of them meet or exceed those standards and some fall short on occasion. I sometimes worried about some of their futures as dental hygienists. In the back of my mind I always thought, well if they graduate and pass boards then they must be good enough! So as an educator on the front lines of licensure, the thought of taking away that security blanket that was the clinical board exam was a little unsettling. At first I thought, well if they are going to nix the clinical exam then we need to adjust our CODA standards to compensate for that! I have been part of three dental hygiene programs and have associated with countless instructors at many more. We all do things so differently. Won’t CODA need to set a standard as far as showing competency goes? Or is it all ok if individual schools and instructors to create their own competencies within the CODA standard? Well guess what? That is already what is happening and has been happening for decades and everything has been ok!
In our discussion, I also brought up the point that students can pass clinic and not get a passing score on any of their Type 3 quads, and then they can just go get licensed? The horror! To which Jessica replied “is being able to scale the only thing that makes a dental hygienist competent?”. Ok, good point, I probably didn’t pass my fair share of Type 3 quads in school. Being able to scale does not a competent hygienist make (hello not wanting dental assistants to be able to scale with just on the job training), it is our in-depth education that sets us apart. Are new graduates the best they will ever be? No, not even close. We have to remember that the goal is NOT to graduate perfect dental hygienists (that’s not even possible), the goal is to graduate dental hygienists that are competent at the entry level. Now, think about that for a moment. I have told my students many times, when you are done with school your dental hygiene education is not over, not even close! We have the opportunity to learn so much more out in the real world. We should always be evaluating ourselves, our techniques, our knowledge, our patient rapport. What can we improve and how can we improve it? There shouldn’t be a dental hygienist out there that feels like the peak of their career was when they passed the clinical dental hygiene exam right? Right! So why do we put so much importance on that one-time clinical exam? Again, as an educator I have seen many students pass that I didn’t think would and many fail that I was surprised about. Did the outcome of that one exam negate everything I had seen them struggle with or accomplish as students? No. So it’s not that unrealistic to think that maybe we should stop putting so much importance on that one clinical experience and instead focus our energy on making sure that programs are graduating competent hygienists who will be able to continue assessing and improving themselves throughout their entire career!
I think the most important realization I had last night was this- the ADHA is not asking for an exception to be made for the students this year just because of everything going on right now. Students still have to successfully finish school requirements and successfully pass the NBDHE. ADHA members, your voting delegates from your local components and states, already voted to discontinue the clinical portion of the exam last year. The ADHA is just using this circumstance as a catalyst to begin this process of change. This isn’t an exception, this will be a long lasting and far reaching change that I believe will be beneficial to our beloved profession in the long run.
Do we have more questions than answers right now? Yep, and that’s ok. Will this be a learning and growing process where mistakes will probably be made? Yep, and that’s ok too. It’s going to be a process and that process is going to go a lot smoother and benefit our profession more if we are all willing to work together and support each other.
We’d love to hear YOUR thoughts on this new Call to Action effecting students right now. What do you think?