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Background: The validity and reliability of high-stakes examinations such as those used by national, regional and state or provincial dental boards are under intense scrutiny by candidates, dental schools, dental educators, dental associations, and state or provincial dental boards., Methods: The authors followed the progress of 1,063 candidates from nonaccredited dental programs who began the National Dental Examining Board of Canada's (NDEB) clinical examinations between January 1996 and November 1999 through the administration of the examination's final component in December 2003 examine the utility and validity of the patient-based component of the examination process., Results: The results showed that the first three components of the examination were effective in screening out candidates who were not adequately prepared to take the patient-based component. Only 12 (1.1 percent) of the candidates failed the maximum allowed three attempts to pass the patient-based component., Conclusions: The results demonstrated that the patient-based component did not contribute to the overall examination validity or decision making and did not prevent candidates from obtaining certification., Practice Implications: Owing to this lack of utility, the associated costs and ethical concerns, NDEB eliminated the patient-based component of the examination and replaced it with the requirement to complete an accredited, qualifying/degree completion dental program followed by completion of NDEB's written and objective structured clinical examination components.

The purpose of this study was to assess the concurrent validity of the National Dental Examining Board of Canada (NDEB) Written Examination and Objective Structured Clinical Examination (OSCE) by correlating students' scores with their performance in the final year of the D.D.S./D.M.D. program. The subjects of this study were the 2,317 students at nine Canadian dental schools who completed both NDEB examinations between 1995 and 2000. The findings indicate positive correlations (r = 0.43 and r = 0.46, p < .001, for the written and OSCE examinations respectively) between students' examination scores and final year results. Year-to-year and school-to-school variations were minimal. These findings supported the concurrent validity of both NDEB examinations.

Although registration and licensure of dentists in Canada is the purview of the ten provincial licensing authorities in Canada, establishment of standards and certification of candidates has for fifty years been the responsibility of the National Dental Examining Board. The NDEB administers a validated set of written and objective standardized clinical examinations to educationally qualified candidates. Such candidates include those who have graduated from accredited Canadian and United States schools and graduates of non-accredited schools who have satisfactorily finished a qualifying program. The NDEB cooperates closely with U.S. educational and accreditation programs and the American Dental Association.

The National Dental Examining Board of Canada (NDEB) conducts mandatory, high stakes, pass/fail, certification examinations for dental licensure. One of these examinations was a seven-part, simulated clinical examination in which candidates were required to perform procedures on typodonts. These requirements were two intracoronal and two extracoronal preparations, an amalgam restoration, a provisional crown, and a diagnostic wax-up. Feedback from candidates and examiners indicated that one or more of the requirements may not have been contributing effectively to the overall evaluation of candidates. The NDEB's Clinical Examination Committee therefore requested that an in-depth statistical analysis be performed to identify potential areas of concern and to provide a basis for modifying the examinations. The results of two examination sessions with a total of 168 candidates were subjected to both a discriminant and a logistic regression analysis. Every candidate had results for each of the seven requirements, and no candidate participated in both sessions of the examination. The discriminant analysis revealed that six of the seven requirements could be used to reliably assign examinees according to their true pass/fail classifications. Stepwise discriminant analysis resulted in a 98.81 percent classification success rate with a corresponding 2.50 percent false-positive classification error rate. The logistic regression analysis showed that five components correctly predicted 99.40 percent with a 1.25 percent false-positive rate. The Clinical Examination Committee concluded that one requirement (diagnostic wax-up) should be eliminated and that a second requirement (PFM preparation) be significantly modified and reevaluated. This study demonstrates the usefulness of statistical methods in the analysis and modification of a clinical certification board examination.