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Fall 2013

As the fall testing season approaches I want to extend to you warm greetings from the President. This year has certainly been dynamic for CRDTS. Another year of successful testing will pass and the promise of a new and exciting year is on the horizon.

We have recently received requests from several non-member state dental boards for presentations and information about CRDTS and the CRDTS exam process. Our CRDTS team of Dr. Steve Holcomb and Ms. Kim Laudenslager RDH welcome the opportunity to provide information and conduct presentations for states or schools that may be interested.

I would like to welcome our newest member to the CRDTS family, the State of Alabama. Their membership certainly adds strength and knowledge to the organization. We are all looking forward to working with the new members from Alabama in the development, administration and delivery of the CRDTS exam process.

After forty successful years, CRDTS continues to maintain its high standards for producing high quality dental and dental hygiene examinations. CRDTS is recognized as a national leader in test development and post examination analysis thanks to our experts in the dental and dental hygiene exam review committees which are complemented by our professional staff. Their experience and expertise are unparalleled and serve to validate the high quality that overshadows the content, administration and delivery of our examination process.

I am pleased to report that the Annual Meeting was very successful. Many positive comments were received regarding the presentations, activities and social events. I was particularly excited about the “First-Timers” orientation breakfast which I personally attended. It was a great opportunity for “Old-Timers” to mentor and interact with the “First-Timers”. I would like to extend

special thanks to the CRDTS staff, particularly Dr. Barb Mousel and Ms. Liz Thompson for their efforts in planning and facilitating the meeting.

In addition to a suc-cessful Annual meet-ing, many changes to the organization occurred through a By-Laws change. Revisions to the By-Laws were developed through the By-Laws Committee to refine the internal mechanism and governance of the organization.

For the benefit of those who did not attend the Annual Meeting, or simply were less attentive to the business portion of the meeting, I will highlight some of the changes which I feel are significant.

The term of the President and President Elect will be extended from one to two years. The Immediate Past President office will be eliminated.

Each officer has had to successfully complete a (CODA) approved educational program in dentistry or dental hygiene.

The establishment of a transition period for the President and the President Elect from the current one year term to a two year term. The current President’s term will be extended six months. The successor President’s term of office will be eighteen months, from March 1, 2014 to August 31, 2015. From then on each President and each President Elect will serve two year terms and will not be eligible for re-election. (The committee felt that the longer term of service would provide greater continuity and stability for the organization.)

The establishment of a Finance Committee which consists of the President Elect as Chair, Secretary/Treasurer and

The CRDTS ReportCentral Regional Dental Testing Service, Inc. Fall 2013

Mark G O’Farrell, DDS

President’s Message

Volume 12, Issue 2

Highlights from CRDTS Annual Meeting p 2

What’s the Score? p 4

Transition from Old to New p 6

Exciting Changes for 2014 p 6

Application of New Criteria p 7

Technology Update p 8

(Continued on Page 7)

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CRDTS Report

The 41st CRDTS Annual meeting was held August 22 – 24, 2013 at the Hilton Kansas City Airport Hotel. Over two hundred attend the informational workshops and annual business meeting. There were representative from 13 dental schools and 33 dental hygiene programs in attendance this year.

Workshop Evaluations are still in the process of being

tabulated and analyzed, but at first glance this years’ program and presentations appear to be the best yet with praises for organization, implementation and quality of the presenters once again receiving rave reviews.

Dental Deans & Faculty and Dental Hygiene Program Directors & Faculty Roundtable Discussions continue to be a popular venue for sharing ideas and networking. The only complaint was there wasn’t enough time. It IS difficult to pack all the information we have to share into just two days.

Sessions were held to provide examiners with changes for the 2013-14 dental and dental hygiene exams. Although there are a few minor changes these were discussed during concurrent sessions of the respective exam groups.

The Presidents Meet and Greet Reception on Friday night was a great way to meet up with old friends and make new ones. The hors d’oeuvres stations and intimate format received rave reviews! As usual the Hilton catering staff did an excellent job of providing us with delicious food and thirst quenching drinks.

On Saturday morning first time attendees to CRDTS Annual Meeting were treated to a 1st Timers Breakfast & Orientation. Dr. Jim Harris & Ms. Kimber Cobb presented the basics of CRDTS structure, responsibilities as an examiner and which” hat” to wear when. Special presentations and thank yous were given to Dr. Marv Dvorak and Ms. Lynn Ray for their many years of volunteering their time and in providing this presentation for over a decade!

Dr. John Littlefield, Adjunct Professor in the Department of Comprehensive Dentistry, University of Texas Dental School at San Antonio gave a thought provoking and interactive presentation titled: ePortfolios in Dental Licensure Testing: Pros & Cons and a 21st Century Vision. It was thought provoking and elicited many questions and a few answers.

With technology growing by leaps and bounds within CRDTS, Ms. Kimber Cobb led us through the NEW & Improved website and the examiner module which will let examiners book travels arrangements to exams and meetings, file expense reports and receive updates and correspondence on-line. It is a very user friendly website that will allow for greater communication in “real time”.

Ms. Laura Jacob, Executive Director, gave a “State of the States”. She highlighted each member state and various aspects of legislation, new developments in their laws and laced in a bit of humor along with a few personal

CRDTS 41st Annual Workshop & Meeting

Elizabeth Thompson, RDHVice President

Thanks to all who made this year’s event a success

James Harris, DDS and Marvin Dvorak, DDS

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Fall 2013

experiences as she had visited numerous State Board meetings during the past year.

The Annual Business Meeting followed the President’s Luncheon and was presided over by President Mark O’Farrell. Gifts of thanks and recognition were presented to individuals who have served as members of the CSW committee.

Retiring examiners Dr. Paul Fanning and Dr. Jerry Prahl were recognized for their years of service to CRDTS. They both expressed their appreciation and shared their plans for retirement.

Amended and Restated Bylaws were presented to the general assembly and were voted on favorably by the required 2/3’s majority.

history of gangsters in Kansas City. Dance music of the 50’s & 60’s was punctuated by a guest appearance of Bill & Kim of Walter’s Dance Studio who gave several “show case” ballroom dance performances.

Thanks to all who made this year’s event a success and remember examiners...wear your new CRDTS lapel pin with pride in an exceptional organization of exceptional people.

The following individuals recieved special recognition for their CSW service: Paul Tamisiea, DDS; Gay Derderian, DDS; Jake Lippert, DDS; Joan Sivers, DDS; Deena Kuempel, DDS; George Kinney, Jr., DDS; Scott Dilorenzo, DDS; and Paul Fanning

At the conclusion of the business meeting dental and dental hygiene held their respective Break-Out Question and Answer Questions. These again are popular and well attended with numerous favorable comments to continue these informal and informative gatherings.

The evening concluded with the favorite social event - the Dinner Dance. This years’ theme revolved around the

The O’Farrell family: Mark, Lee Ann, Matt and Mike

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CRDTS Report

Early in the year when some of our CRDTS’ examiners were conducting requested orientations about clinical exams for undergraduate students, a few students raised questions about CRDTS’ retest policy. In particular, they reported that at least one other testing agency had stated that candidates would be required to retake only the procedure that was failed rather than retaking all the procedures in an examination part. In such a case, a candidate who failed Restorative due to an unacceptable Class III procedure, would be required to repeat only a Class III rather than the entire Restorative section. At the time, CRDTS could find no documentation to verify this report, and recognized that candidates may have misunderstood the reported policy. Nevertheless, CRDTS determined that a review of our test/retest policy would be in order. Two measurement specialists, Thomas Haladyna, PhD, and John Littlefield, PhD, were asked to review CRDTS test/retest policy and advise us if it needed to be reconsidered or updated. They both strongly and independently supported CRDTS’ existing policy and said that the accepted standards regarding retests were non-debatable. This review was reported to CRDTS’ Steering Committee on August 23, 2013.CRDTS’ test/retest policy was developed in 1979-1981 when John Eisner, DDS, PhD was working as a consultant to help CRDTS revise our dental exam. It was at this time that criterion-referencing was developed, along with a new scoring system, a standardized administrative protocol, candidate anonymity and a comprehensive statistical analysis. The standardized administrative protocol was particularly important to ensure that failing candidates were retested under the same circumstances and conditions as their initial attempt. Under no circumstances should the tasks be made easier for a candidate whose competence has been called into question by a previous failure. In addition, Dr. Eisner pointed out that there is very little correlation between the procedures that are in the domain of general dentistry, a fact that was confirmed repeatedly in correlation studies that CRDTS conducted in collaboration with WREB and in ADEX. Because of this low correlation, one cannot

safely generalize that a candidate who demonstrates competence in Procedure X will be equally competent with Procedure Y. Statistical analysis has shown that the size of a candidate’s task, irrespective of its difficulty, will definitely impact the test results. In the past, CRDTS required candidates to submit patients with 15 surfaces of calculus for a hygiene or perio exam; candidates could submit anywhere from 1 to 4 quadrants—whatever it took to qualify the required 15 surfaces. Most practitioners presumed that patients with 15 surfaces of calculus in one quadrant would present a more difficult challenge than a patient with those 15 calcareous deposits scattered throughout 4 quadrants. However, analysis showed that even though candidates who submitted 4 quadrants had pre-screened their patients and knew that most of the tooth surfaces were calculus free, the fact that they had more teeth to treat than the candidates with 15 surfaces in one quadrant caused them to fail at a significantly higher rate. This phenomenon was persistent enough that CRDTS had to change its patient acceptability criteria and disallow treatment selections with 3 or 4 quadrants. Another example is the Curriculum Integrated Format that CRDTS has been administering in the dental exam since 2005. Most examiners understand that the 2-day dental exam remains exactly the same whether its procedures are administered in the CIF or traditional format; the only difference is whether those 2 days occur back-to-back (traditional) or are separated by several months (CIF). Data indicates that the CIF format is a benefit to the candidate, due to the minimized task and time requirements associated with this format. Data also indicates that candidates who fail an exam-ination part do not have an incompetence that is limited to one single procedure. Whether their shortcomings are a lack of clinical judgment, poor time management or poor psycho-motor skills, those incompetencies often show up on different procedures at different times. Indeed when retesting, it is not uncommon to see candidates fail procedures that they have previously passed and pass procedures that led to their initial failure.

Lynn Ray, Director of Analysis

Score? What’s TheScore?

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Fall 2013So what does all this mean to State Boards? It increases the challenge to Boards to ensure that the scores that they accept for licensure from different testing agencies have equivalent meaning. It is not sufficient to compare the content of examinations and assume that scores from different agencies are a comparable measure of competence. The majority of Dental Boards now accept the results of all regional testing agencies, and in 2004-06, there was probably more comparability among the regional testing agencies than ever before, due largely to the AADE Criteria and Scoring projects, and to the initial collaboration within ADEX. Since that time, unfortunately, for our profession, the former commonalities among regions have diverged: • Western Regional Examining Board (WREB)

withdrew from ADEX in 2004 before the ADEX examination was even developed. Their scoring system is substantially different, and there is no clinical requirement for fixed prosthodontics, either manikin or patient-based. Consequently, several states in CRDTS and elsewhere have adopted a regulation requiring CRDTS Part III Fixed Prosthodontics to be eligible for licensure.

• Several years ago, Southern Regional Testing Agency (SRTA) dropped the Periodontal Examination. In 2012, SRTA joined ADEX, creating something of a conundrum for ADEX. ADEX is now espousing a ‘cafeteria plan’—offering up the ADEX exam with or without Periodontics, and advising candidates to choose their options based on the licensure requirements of the states in which they wish to practice.

• Now, it has been announced that in 2014 at least one of the testing agencies that participate in ADEX is going to allow candidates to challenge the Restorative Examination one procedure at a time. There is no word yet whether the rest of the testing agencies administering the ADEX exam will also adopt this policy; nor is there any information yet available regarding what conditions may be placed on such retakes. Are candidates going to be allowed 6 hours or so to complete one procedure? Are time limits going to be imposed on every procedure for all candidates? Currently, candidates are stopped if there is a corroborated critical deficiency or error assigned. If a candidate fails the initial preparation, will they then be allowed to proceed with all of the other restorative procedures during that exam after demonstrating incompetence on the initial procedure? What are the ethical and psychometric implications of such a practice? It is important to

know how agencies who adopt this policy are going to ensure that conditions and circumstances remain the same for test/retest if the reliability and validity of scores are going to be maintained.

• For approximately 2½ years CRDTS and the Council of Interstate Testing Agencies (CITA) have been engaged in collaborative discussions about how we might work together. While we found many commonalities, the biggest difference was the scoring systems. In 2011, CITA revised their scoring system from the 4-point, criterion-based, rating scale developed by AADE and adopted by ADEX and CRDTS, to a 3-point rating scale. For almost a year, the two agencies conducted a criterion-by-criterion cross-comparison of one another’s scoring systems. CRDTS’ review concluded that CITA’s scoring rubric was somewhat harsher in terms of the points deducted for ‘minor errors’ that might be likened to our ‘Substandard’ category. Conversely, CITA’s system was more lenient with ‘Critical

Deficiencies’. While one confirmed ‘Critical Deficiency’ results in a failure for CRDTS, it takes two ‘major errors’ to result in failure for CITA; however, they do have defined ‘Critical

Errors’, such as remaining caries, that result in automatic failure. CITA’s scoring system became a sticking point and as efforts were made to define a working collaborative relationship, negotiations stalled until August when the announcement was made that CITA would be administering the ADEX exam in 2014. Concomitantly, NERB has announced that they “may” be using a 3-point rating scale for manikin procedures in 2014. It should be noted that the same measurement specialist, Dr. Chad Buckendahl, who designed the original ADEX scoring rubric, also designed the 3-point CITA scoring system, and also defended SRTA’s decision to eliminate Periodontics from their clinical exam.

So now State Boards have a more difficult challenge in determining the equivalency of the exams they accept for licensure. Not only must they look at the content, but also at the scoring rubrics and the administrative policy to determine if the answer to the question “What’s the score?” means the same thing across the country. Ultimately, the elusiveness of a national exam with a single standard of competence creates roadblocks for many in our profession and hinders the effectiveness of those responsible for determining acceptable entry-level standards.

Data indicates that candidates who fail an examination part do

not have an incompetence that is limited to one single procedure.

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CRDTS Report

Transition from

Old to NewIt has been a busy time for CRDTS. New Bylaws are in place with a transition plan from old to new. I will remain your President Elect until March 1, 2014, but am including our incoming President Elect, Joan Sheppard, in all the activities assigned to the President Elect. I continue to work closely with our President, Mark O’Farrell. His leadership inspires me and he will be a tough act to follow.

The newest activity for this office is to act as the Chair of the Finance Committee. The other members of the Finance Committee are the Treasurer, Jane Lott and Anthony Malaktaris. Renee Gideon and our accountant has been walking us through the office processes when we have questions. We have been working toward reviewing our current procedures, refining our ability to project for future budgets. Our goal is to prepare the 2014-2015 budget for presentation at the June 2014 Steering Committee. I am very appreciative of the time and effort that Jane, Tony, Joan and Renee have committed in this effort.

A similar process is in place for the Annual Meeting. Joan Sheppard, Liz Thompson and I are working in concert to create an informative networking opportunity for all CRDTS examiners, school coordinators, and program directors. Your feedback from this year has helped us refine our goals. Many thanks again to Liz, who did so much to create the success of this year’s program.

Please put the annual meeting on your calendar for August 22-23, 2014.

I also want to thank our professional staff, Lynn Ray, Kimber Cobb, and Kim Laudenslager for their advice and counsel on the detail of their work. It has been a great learning experience for me.

I invite any of you to contact me with questions or concerns. During my upcoming tenure as your President, my goal will be to contact our member state boards to offer support via presentations, as needed. I would also like to continue to develop communication to schools and programs.

Thank you for your support.

Barbara L Mousel, DDSPresident–Elect

ExcitingChanges for 2014 testing

It has been an outstanding 2013-hygiene clinical exam-ination season and we are still going strong in the testing arena! Our dental hygiene clinical testing season will end with the final seven examinations in the months of November and December. Hygiene Examination Review Committee members, examiners and staff worked hard to strive toward our goal of an outstanding national hygiene clinical examination. Through their collaboration, we continue to build a valid and reliable hygiene clinical examination.

The 2014-hygiene clinical testing season is just around the corner with some exciting changes to the hygiene examination. For the 2014 testing season, there will be no content changes to the hygiene examination. However, during the CRDTS Annual meeting, the Steering Committee approved the following changes to criteria and scoring for the 2014 hygiene-testing season.

• Oral Assessment: Change from seven categories worth fourteen total points to eight categories worth sixteen points by separating category D. Mucosa/Lips/Alveolar Ridge into categories D. Mucosa/Lips and E. Alveolar Ridge.

• Scaling: Change treatment selection criteria from fourteen surfaces of qualifying calculus with nine on posteriors, three of which must be on molars worth four points each to twelve surfaces of qualifying calculus with eight on posteriors, three of which must be on molars worth five points each.

• Tissue Trauma: Change tissue trauma from: twelve scorable points (three errors allowed at four points each with four errors considered a Critical Error) to ten possible penalty points (two errors allowed at five points each with three errors considered a Critical Error).

• Supra-Deposit Removal: Change supra-deposit removal from six scorable points worth one point each to six scorable points worth two points each for a total of twelve scorable points.

It has been a pleasure to work with committed, professional colleagues this past testing season and I look forward to the 2014 calendar year!

Penny Fudally, RDH, MEdDental Hygiene

Examination Review Committee Chair

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Fall 2013

The 2014 CIF (Curriculum Integrated Format) cycle is off to a great start as the candidates and examiners apply many of the updated criteria to the manikin examination process. We are excited about the entrance of Alabama into the CRDTS family of member states and look forward to the growth of that relationship as we build the future of clinical dental licensure testing together. Special thanks to Dr. Tom Willis (AL) for his expertise and input in facilitating the membership process.

The Dental Calibration Committee will be meeting in December to work on the calibration and standardization materials for the upcoming patient-based dental examinations. Kudos are sent out to Dr. David Linde (MN) and Dr. John Cosby (SC) for building our bank of images by providing their time “on camera” at exam sites.

The members of the Dental Examination Review Committee (ERC) continue to work tirelessly to review, refine and update the dental examination using current teaching methodologies, clinical dental practice techniques and applicable research materials. The special blend of educators and practitioners, working together for the same goals, produce the CRDTS examination that is well-respected throughout the country. Thanks to the subcommittee chairs, Dr. Gay Derderian (WI), Dr. Vince Jones (SD) and Dr. Tom Lengowski (ND) for their leadership and organizational skills. In CRDTS we know that these meetings do not occur without the special efforts of central office staff making the necessary arrangements for us. Thanks Topeka! The ERC’s right hand darlings are Ms. Kimber Cobb, RDH and Mrs. Lynn Ray, RDH of the professional staff. Their talents of professional input, wordsmithing and organization put the efforts of the ERC into a usable form.

The ERC recommends that all examiners pay special attention to the changes in the manual and calibration in the areas of criteria and protocol. We have new and innovative scoring protocols (from the Dr. Tom Cavel wish list) that we believe will strengthen the accuracy of our assessments and the validity of the scores we submit to our participating jurisdictions.

Steve Holcomb, DMDDental Examination Review

Committee Chair

Application of updated criteria begins one member at large with the support of the Executive

Director. The committee is designed to facilitate the work of the Secretary/Treasurer and provide a long range view of the financial and budgetary needs of CRDTS.

The establishment of a Bylaws and Governance Committee. The committee will be responsible for the maintenance and review of the Internal Policy and Procedures Manual that will be developed for the organization.

The establishment of the Nominating Committee which includes the immediate Past President and two former officers of CRDTS of which one of the members is to be a dental hygienist. (The Committee will be responsible to identify and present worthy candidates to be considered for election to the officers of CRDTS.)

I personally feel that these changes will provide a strong framework for the inner workings of the CRDTS organization. With new leadership on the horizon, I would like to extend my best wishes to the strong guidance of Dr. Barbara Mousel and Dr. Joan Sheppard who will continue to navigate CRDTS to a bright future. I would also like to thank the Executive and Steering Committees along with the professional and administrative staff for their support and commitment. It has truly been my honor and privilege to serve with these wonderful people of CRDTS.

President’s Message (continued from Page 1)

SAVE THE DATEThe Annual Meeting for 2014 is scheduled August 22 - 23

CRDTS1725 SW Gage BlvdTopeka, KS 66604

CRDTS Report

Technology UpdateExaminers can now access

their profiles onlineWe are pleased to announce that examiners can now access their profiles online! Instructions for access were released with availability. Initially, examiners will be able to update their demographic information and complete required forms. Beginning with the Spring Exam Series, examiners will also be able to utilize the post-exam options to complete feedback, Peer Evaluation and expense forms. Additionally, an online directory will be available as well as examiner materials to prepare for evaluation. We look forward to the interaction and advantages these updates will provide.

Scoring updates for the 2014 Exam Season are almost completed and after 5 years of extensive development within the scoring system and our post-exam analysis, the system is stable and requires minimal updates at this point. Many thanks for the input of all our staff members and the many hours of midnight oil our programmers at Premiere One have burned implementing the many updates and improvements to our Scoring System.

Kimber Cobb, RDH, BSDirector of Dental

Examinations and Data Management