Concurrence in senate amendments csa1 Bill Id: ab 2331

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AB 2331



CSA1 Bill Id:AB 2331


As Amended Ver:August 19, 2016

Majority vote



(June 1, 2016)



(August 23, 2016)

Original Committee Reference: B. & P.

SUMMARY: Allows an applicant to satisfy the licensure examination requirement for a dental license by receiving a passing score on a clinical and written examination developed by the American Board of Dental Examiners, Inc. (ADEX) subject to prior review and approval of the examination by the Office of Professional Examination Services, as provided. This bill would also authorize the Director of Finance to accept funds for the purposes of implementing the dental examination developed by the ADEX. Specifically, this bill:

  1. Provides that a passing score on an examination developed by the ADEX, fulfills part of the examination requirements for the Dental Board of California (DBC).

  2. Specifies that the DBC shall determine the passing score for the examination.

  3. Indicates that the Department of Consumer Affair's Office of Professional Examination Services shall review the ADEX examination to ensure compliance with the requirements of Section 139 and to certify that the examination process meets those standards, prior to implementation of the examination.

  4. Specifies that if the department determines that the examination process fails to meet those standards, or if the ADEX fails to pay the costs and expenses the DBC incurs, it shall not be implemented. The review of the ADEX examination shall be conducted during or after DBC's occupational analysis.

  5. Requires the ADEX to pay all reasonable costs and expenses the DBC incurs, as specified.

  6. Permits the Department of Finance to accept funds for the purposes of reviewing and implementing the examination developed by the ADEX.

The Senate amendments add language to avoid chaptering out issues with SB 1478 (Hill) of the current Legislative Session.

FISCAL EFFECT: According to the Senate Appropriations Committee, this bill will result in:

  1. Initial costs of about $20,000 for an occupational and psychometric evaluation of the new examination to ensure that it complies with the occupational requirements for dentists and state law regarding non-discrimination (State Dentistry Fund). The DBC will incur a similar cost every seven years to validate the continuing appropriateness of the examination. The costs to validate the examination will be reimbursed by the ADEX.

  2. One-time costs of $90,000 and ongoing costs of $82,000 per year to develop regulations and to process additional licensure applications by the DBC (State Dentistry Fund). By providing an additional examination for licensure, the DBC anticipates some growth in the number applicants for licensure who trained at out-of-state dental schools.


Purpose. This bill is sponsored by the American Board of Dental Examiners, Inc. According to the author, "AB 2331 will facilitate the recognition of the ADEX Patient Centered Curriculum Integrated Dental Examination Format (PC-CIF) as an option for initial licensure in California. This additional exam option will allow out-of-state dental students seeking to practice in California, including California residents choosing to return to their home state, the opportunity to take the ADEX PC-CIF test in other states where it is administered. This exam format meets the American Dental Association and California Dental Associations guidelines for the ethical use of patients during a licensure exam."

Background. Examination Requirements. The DBC requires that applicants for licensure as a dentist meet a number of examination requirements including: 1) passing Parts I and II of the written examinations of the National Board Dental Examination of the Joint Commission on National Dental Examinations, and 2) obtaining a passing score on either the Western Region Examining Board examination written or clinical examination, or a portfolio examination. Applicants must also complete a California law and ethics examination.

History of the DBC Portfolio Examination. In 2008, the DBC commissioned Comira Psychometric Services to conduct a study of competencies in dental education programs. The Board had concerns about existing clinical examinations, especially in terms of validity of the content tested and the reliability of judgments made on examinee performance. Comira identified four alternatives to initial licensure based on interviews, observations, and documentation; those alternatives were: 1) Curriculum Integrated Format (CIF), 2) Objective Standardized Clinical Examination (OSCE), 3) traditional portfolio, and 4) a hybrid portfolio examination. The hybrid portfolio examination was an alternative based upon the synthesis of the traditional portfolio and test cases (or competency cases) used in the dental schools for competency evaluations.

In February 2009, Comira prepared a report for the DBC entitled, Alternative Pathways for Initial Licensure for General Dentists, Final Report, February 9, 2009, which provided findings and evidence to support the feasibility of an additional examination for the DBC to add as a pathway to initial licensure. The report supported the conclusion that the hybrid portfolio examination model satisfied the criteria identified by the DBC and the psychometric consultants. Subsequently, Comira prepared an additional report for the DBC entitled Portfolio Examination to Qualify for California Dental Licensure, December 1, 2009 which defined the competencies to be tested in the portfolio examination and provided background research for the examination's implementation process.

Using the findings of these two reports, the DBC sponsored legislation, AB 1524 (Hayashi), Chapter 446, Statutes of 2010. AB 1524 eliminated the clinical and written examination administered by the DBC and replaced it with a portfolio examination of an applicant's competence to enter the practice of dentistry, to be conducted while the applicant is enrolled in a DBC-approved dental school located in California.

The DBC implemented the Portfolio Examination process in 2014. The Portfolio Exam is currently offered at four of the six dental schools in California including: 1) University of California, Los Angeles, 2) University of California, San Francisco, 3) University of the Pacific, and 4) University of Southern California

Portfolio Examination Application Process. The portfolio examination is to be conducted while the applicant is still enrolled in a DBC-approved dental school located in California. The portfolio examination is required to utilize uniform standards of clinical experiences and competencies approved by the DBC. An applicant is required to pass a final assessment of the submitted portfolio at the end of his or her dental school program. Before the portfolio may be submitted to the DBC, the applicant must pay the Board a $350 application fee and provide a letter of good standing signed by the dean of the dental school, or his or her delegate, stating that the applicant has graduated or will graduate with no pending ethical issues.

The ADEX Examination. The ADEX examination has been recognized in 43 states. The new PC-CIF, which the author compares to the DBC's Portfolio Exam, is only recognized in New York. The PC-CIF includes structured patient involvement, informed consent, and patient follow-up.

The author purports that graduates from out-of-state dental programs, including California residents, have to pass the Western Regional Examining Board examination which requires out-of-state students to travel to California to take the examination. The author believes that by adding the ADEX's PC-CIF as an option, students will be able to take this examination in the state they are located in

Occupational Analysis. An occupational analysis generally employs survey methodology to gather job information. That information may be used to help establish recruitment and selection criteria for entry into the occupation, and identify training standards for evaluating training efficacy and efficiency. Prior to the DBC accepting the ADEX PC-CIF, an occupational analysis must be completed. In addition, this measure allows the DBC to accept funding from entities to cover the costs associated with conducting the occupational analysis of the ADEX examination to ensure it meets California's standards.

Analysis Prepared by: Le Ondra Clark Harvey Ph.D. / B. & P. / (916) 319-3301 FN: 0004892

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