Clinical Exams - Patient Selection

Since the season for clinical licensure exams is starting to come back around again - I thought I would make some comments about patient selection, or lack of selection, as the case may be.

It is important, or critical, to realize that for patient-based exams the choosing of the appropriate patient is much of the exam - you essentially create your own exam. This is reasonable, since the examiners are really checking to see how much dentistry you understand, and the ability to tell what to expect from a certain tooth in a patient is an important clinical skill. In other words, they are grading you on JUDGMENT - and we hope you have good judgment and exercise it, but you must realize also that this can't happen unless you collect data from which you must make that judgment. Many people fall down in the data collection part.

That being said - you are graded largely on your ability to determine that a particular patient case is within your skill range - but what if someone else chooses a patient for you?

If you have someone else choose a patient for you - for example if you get a patient from a patient-finding service - you may not see inside the patient's mouth until the start of the exam. This means that someone else is creating your exam for you! Definitely not the way to go....

There are people that would like to do away with patient-based clinical exams for licensure, and just have typodont and theoretical exercises instead. My main argument against these people is that I have seen thousands of dentists and dental students learn a lot more dentistry as they go through the process of getting ready for a clinical exam, and this would be lost. These examinations are not about how much you know now, but how much you can learn before the exam. Very few U.S. dental school graduates are ready to practice dentistry upon being graduated - but most will reestablish their landmarks and standards and ability to evaluate subtleties in patients as they prepare for these exams - and this takes them toward a more independent patient interaction and understanding.

If clinical exams for licensure in the U.S. were run by their providing you with a patient and asking you to do a certain procedure, you can bet that the hew and cry would be stentorious objecting to this exam format. And yet, if you pay someone to find a patient for you, often this is exactly what you are subjecting yourself to.

But even under these circumstances, your skills at looking at a tooth and deciding what needs to be done and what to watch out for while doing the preparation and restoration, and what are the dangerous aspects of each case, will be paramount in determining your success.

Over the last 10 years we have recorded thousands of patient evaluations involving discussion of prospective patient cases and working through what to expect from each - would they be a reasonable board case or not - would they be an acceptable board case or not.

Now a selected set of these evaluations is available for you ONLINE. Check out dentistCEprogram.com for information about our offering!

Whether you are looking for patients yourself, or using one provided by someone else, you need to know that you are looking at and how it will relate to your skill level. Most people looking at a maxillary first premolar DO don't notice several common situations that can make their lives very miserable indeed. Learn to look, learn to see - only this gives you the opportunity to use good judgment!