Use of Clinical Competency Examinations for Dental Hygiene Licensure

Dental hygiene licensure with a clinical competency examination (CCE) using a live patient has been required by state licensing boards since 1929. Clinical competency examinations were initially used when dental training was poorly developed, non-standardized, and largely based on the apprenticeship model. Currently, Canada and the state of California have removed the requirement of passing a CCE for dental hygiene licensure, provided certain requirements have been met. Dentistry is the last health care profession to mandate that graduates pass a CCE. The vast majority of dental licensing boards continue to require that third party testing agencies validate the clinical skills of candidates that were acquired through accredited dental and dental hygiene education programs. Originally, there were 53 individual CCEs within the United States. As the profession became more uniform, regional examinations have replaced individual state examinations. Clinical competency examinations have come under scrutiny over the past few decades largely due to ethical concerns regarding human subjects and perceived limitations in manikin-based testing. Concerns about high stakes, single-encounter live patient exams and manikin exams have also been raised regarding their validity and reliability of measuring competency and readiness for clinical practice. In spite of the lack of peer-reviewed scientific evidence supporting the use of CCEs as reliable and valid instruments, dental boards continue to require them for initial licensure. While CCEs were initially developed to protect the public by ensuring the clinical competency of licensed clinicians, there is no predictive validity to support this intent. Ethical concerns regarding live patient, procedure-based dental and dental hygiene CCEs have been covered extensively in the literature. This short report will examine the ongoing concerns and updates on the use of CCEs for dental hygiene licensure.