BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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                                 THIRD READING


          Bill No:  AB 1524
          Author:   Hayashi (D)
          Amended:  8/9/10 in Senate
          Vote:     21

           
           SENATE BUSINESS, PROF. & ECON. DEVELOP. COMM.  :  6-1,  
            6/21/10
          AYES: Negrete McLeod, Aanestad, Calderon, Correa, Florez,  
            Walters
          NOES: Yee
          NO VOTE RECORDED: Wyland, Oropeza

           SENATE APPROPRIATIONS COMMITTEE  :  6-0, 8/2/10
          AYES: Kehoe, Ashburn, Leno, Price, Wolk, Wyland
          NO VOTE RECORDED: Alquist, Corbett, Emmerson, Walters, Yee

           ASSEMBLY FLOOR  :  68-0, 1/27/10 (Consent) - See last page  
            for vote


           SUBJECT  :    Dentistry: examination requirements

           SOURCE  :     Dental Board of California


           DIGEST  :    This bill repeals the clinical and written  
          examination administered by the Dental Board of California  
          and replaces that examination with a portfolio examination  
          of an applicant's competence to practice dentistry to be  
          administered while the applicant is enrolled in a dental  
          school program.

                                                           CONTINUED





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           Senate Floor Amendments  of 8/9/10 make technical,  
          clarifying changes.

           ANALYSIS  :    Existing law:

          1. Establishes the Dental Board of California (Board) to  
             license and regulate the practice of dentistry in  
             California.

          2. Provides that dentistry is the diagnosis or treatment,  
             by surgery or other method, of diseases and lesions and  
             the correction of malpositions of the human teeth,  
             alveolar process, gums, jaws, or associated structures;  
             and such diagnosis or treatment may include all  
             necessary related procedures as well as the use of  
             drugs, anesthetic agents, and physical evaluation.

          3. Requires examinations by the Board to be sufficiently  
             thorough to test the fitness of the applicant to  
             practice dentistry, and requires questions and answers  
             to be written in English.

          4. Specifies that the subjects in which the applicant shall  
             be examined shall be those subjects as the Board may  
             from time to time prescribe in accordance with curricula  
             provided by dental schools within California, and that  
             dental schools shall be informed two years in advance of  
             any proposed changes in the list of subjects to be  
             provided on the examinations. 

          5. Requires each applicant for dentistry licensure to  
             successfully complete the written examinations of the  
             National Board Dental Examination of the Joint  
             Commission on National Dental Examinations (NBDE); an  
             examination in California law and ethics administered by  
             Board, and one of the following:  A clinical and written  
             examination developed and administered by the Board; or  
             a clinical and written examination administered by the  
             Western Regional Examining Board (WREB).

          6. Authorizes the Board to issue a license to practice  
             dentistry, without requiring the taking of the state  
             exam, to applicants who are currently licensed to  
             practice dentistry in another state, and who meet  







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             specified clinical practice and other requirements.

          7. Provides that when an applicant for a license has  
             received a grading of 85 percent or above in any given  
             subject on the state exam, he or she shall be exempt  
             from re-examination on that subject in subsequent  
             examinations.

          8. Provides that, notwithstanding a general statutory  
             prohibition against imposing additional prerequisites on  
             unsuccessful examinees, applicants who fail to pass the  
             state exam after three attempts must take 50 hours of  
             remedial education for any of the three subjects which  
             the applicant failed in his or her last unsuccessful  
             examination.

          9. States that occupational analyses and validation studies  
             are fundamental components of licensure programs.  

          10.Requires the Department of Consumer Affairs (DCA) to  
             develop, in consultation with boards, programs, bureaus,  
             and divisions under its jurisdiction, a policy regarding  
             examination development and validation, and occupational  
             analysis.  

          11.Requires every regulatory board and bureau, and every  
             program and bureau administered by the DCA to submit to  
             the director on or before December 1, 1999, and on or  
             before December 1 of each subsequent year, its method  
             for ensuring that every licensing examination  
             administered by or pursuant to a contract with the board  
             is subject to periodic evaluation.  Requires the  
             periodic evaluation to include: (a) a description of the  
             occupational analysis serving as the basis for the  
             examination; (b) sufficient item analysis data to permit  
             a psychometric evaluation of the items; (c) an  
             assessment of the appropriateness of prerequisites for  
             admittance to the examination; and (d) an estimate of  
             the costs and personnel required to perform these  
             functions.  States that the evaluation shall be revised  
             and a new evaluation submitted to the director whenever,  
             in the judgment of the board, program, or bureau, there  
             is a substantial change in the examination or the  
             prerequisites for admittance to the examination.







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          12.Indicates that the evaluation may be conducted by the  
             board, program, or bureau, the Office of Professional  
             Examination Services of the DCA, or pursuant to a  
             contract with a qualified private testing firm.  States  
             that a board, program, or bureau that provides for  
             development or administration of a licensing examination  
             pursuant to contract with a public or private entity may  
             rely on an occupational analysis or item analysis  
             conducted by that entity.  Requires the DCA to compile  
             this information, along with a schedule specifying when  
             examination validations and occupational analyses shall  
             be performed, and submit it to the appropriate fiscal,  
             policy, and sunset review committees of the Legislature  
             by September 30 of each year. 

          This bill:

          1. Repeals the requirement that a dentistry applicant  
             complete and pass a clinical and written examination  
             developed and administered by the Board and replaces it  
             with a portfolio examination.

          2. Requires the portfolio examination specified in item #  
             1) above to be conducted while the applicant is enrolled  
             in a dental school program at a board-approved school in  
             the state.  Requires the examination to utilize uniform  
             standards of clinical experiences and competencies, as  
             established by the Board.

          3. Requires an applicant to additionally pass a final  
             assessment of the submitted portfolio at the end of his  
             or her dental school program.  

          4. Provides that before any portfolio assessment may be  
             submitted to the Board, the applicant must remit a $350  
             fee, to be deposited into the State Dentistry Fund, and  
             a letter of good standing signed by the dean of his or  
             her dental school or delegate stating that the applicant  
             has graduated or will graduate with no pending ethical  
             issues.

          5. Prohibits the portfolio examination from being conducted  
             until the Board adopts regulations, requires the Board  







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             post notice on its Internet Web site when these  
             regulations are adopted and provide written notice to  
             the Legislature and the Legislative Counsel when these  
             regulations have been adopted.

          6. Requires the Board to independently monitor and audit  
             the standardization and calibration of dental school  
             competency instructors at least biennially to ensure  
             standardization and an acceptable level of calibration  
             in the grading of the examination.  Requires the board  
             to audit each dental school's competency examinations.

          7. Requires the Board to oversee all aspects of the  
             portfolio examination process, but shall not interfere  
             with the dental school authority to establish and  
             deliver an accredited curriculum.  Requires the Board to  
             determine an end-of-year deadline, in consultation with  
             the current board-approved dental schools, to determine  
             when the portfolio examinations shall be completed and  
             submitted to the Board for review by its examiners.

          8. Requires the Board, in consultation with the current  
             board-approved dental schools, to determine portfolio  
             examination competencies and the minimum number of  
             clinical experiences required for successful completion  
             of the portfolio examination.

          9. Provides that the Board shall require and verify  
             successful completion of competency examinations that  
             were performed on a patient of record at a  
             board-approved dental school, including but not limited  
             to: 

                  A.        Comprehensive oral diagnosis and  
                    treatment planning. 
                  B.        Periodontics. 
                  C.        Direct restorations.
                  D.        Indirect restorations.
                  E.        Removable prosthodontics.
                  F.        Endodontics.

          10.Clarifies that an applicant must successfully complete  
             Part I and Part II of the NBDE written examinations.








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          11.Requires the Board to review the portfolio examination  
             to ensure compliance with the requirements of current  
             law and certify that the portfolio examination process  
             meets those requirements. If the board determines that  
             the portfolio examination fails to meet those  
             requirements, the portfolio examination will no longer  
             be an option for applicants. The Board's review and  
             certification or determination shall be completed and  
             submitted to the Legislature and the Department of  
             Consumer Affairs by December 1, 2016.

           Background
           
           Licensure Requirements for Dentistry Applicants  .  The Board  
          regulates over 38,000 dentists in California, and five  
          approved dental schools in the state, namely, the  
          University of the Pacific School of Dentistry, UCSF School  
          of Dentistry, Loma Linda School of Dentistry, UCLA School  
          of Dentistry, and the USC School of Dentistry.  The  
          examination requirements for dentistry licensure are as  
          follows:  1) passage of Part I and Part II of the NBDE; 2)  
          passage of the California law and ethics examination and 3)  
          passage of either the clinical or written examination  
          administered by the Board or the WREB.  Additionally, an  
          applicant who has completed a minimum of 12 months of a  
          general practice residency or advanced education in general  
          dentistry program approved by the ADA's Commission on  
          Dental Accreditation is also eligible for licensure.  

          The clinical and written examination administered by the  
          Board is offered two to five times a year.  Currently, the  
          examination subjects include Endodontics, Removable  
          Prosthodontics Evaluation; Periodontics; Class II Amalgam  
          Restoration; Class III or IV Composite Resin Restoration;  
          and Simulated Fixed Prosthetics.  The Endodontics  
          examination is a written, 50-multiple choice questions that  
          test the candidates ability to diagnose, treatment plan,  
          interpret radiographs and critically evaluate treatment,  
          strategies for pulpal and periapical pathoses as well as  
          systemic conditions. The Removable Prosthodontics  
          Evaluation, conducted in a laboratory setting, tests the  
          candidate's knowledge, understanding and judgment in the  
          diagnosis and treatment of complete dentures, partial  
          dentures and implants.  Candidates evaluate cases in a  







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          laboratory station-based examination providing answers to  
          50 multiple-choice questions.  The Periodontics examination  
          consists of three parts: clinical examination and  
          diagnosis; scaling of a patient; and a written examination  
          comprised of 54 multiple-choice questions based upon  
          projected slides.  The candidate must provide a patient for  
          both the clinical periodontal examination and diagnosis and  
          scaling portions of the examinations.  If a patient is  
          deemed unacceptable, it is the candidates' responsibility  
          to provide another patient who is acceptable.  Specific  
          patient requirements are included for Class II amalgam  
          restoration, Class III or Class IV composite resin  
          restoration.  The Simulated Fixed Prosthetics examination  
          involves a typodont or a model of the oral cavity,  
          including teeth, gingival, and the palate, that is mounted  
          in manikin.  This examination tests for partial denture,  
          and crown preparation.

          Since candidates provide their own patients, there are  
          general requirements that apply to these patients,  
          including completion of a medical history, and the taking  
          and recording of blood pressure.  Additionally, candidates  
          are required to furnish their own instruments, handpieces,  
          typodonts, and materials necessary to carry their  
          assignments to completion.  

           State's Requirements for Examination Validation and  
          Occupational Analysis  .  Occupational analyses and exam  
          validations are critical components of appropriate and  
          legally defensible licensure programs.  Both types of  
          reviews help the State ensure that the standards for entry  
          into professions are consistent with the skills required in  
          those professions.  Section 139 of the Business and  
          Professions Code also expresses the policy of the State  
          that any licensing examination provided in California for  
          purposes of licensure must be evaluated and reviewed to  
          assure it has been appropriately validated and has had an  
          occupational analyses conducted that meets both the legal  
          requirements and testing standards of California.  

          Examinations recognized and used by State licensing boards  
          must also meet the requirements of subdivision (a) of  
          Section 12944 of the Government Code to assure that they do  
          not have an adverse impact on any class by virtue of its  







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          race, creed, color, national origin or ancestry, sex, age,  
          medical condition, physical disability, mental disability,  
          or sexual orientation.  

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  No

          According to the Senate Appropriations Committee: 

                          Fiscal Impact (in thousands)

           Major Provisions                2010-11     2011-12     
           2012-13   Fund  
          Develop of portfolio
            examination                 $100-$150           Special*

          Implement portfolio
            examination assessments                    $175-$210**  
          annually            Special*
                                   fully offset by certification fee

          *State Dentistry Fund
          **Estimated 500 to 600 assessments 

           SUPPORT  :   (Verified  8/4/10)

          Dental Board of California (source) 
          Loma Linda University
          UC Los Angeles Dental School
          UC San Francisco Dental School

           ARGUMENTS IN SUPPORT  :    According to the Dental Board of  
          California, this bill streamlines the licensure process for  
          California dental school graduates by eliminating the  
          requirement of a clinical examination administered by the  
          board.  It points out that the current clinical examination  
          is administered over three days, costs each applicant over  
          $2,000, and requires the participation of a volunteer  
          patient provided by the student.  Supplying the patient has  
          been especially problematic for dental students, as finding  
          an appropriate test subject raises practical and ethical  
          issues.  Additionally, concerns have been raised about the  
          reliability judgments made about candidate performance in  
          these one shot examinations.  The Board points out the new  







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          examination requirements proposed by this bill will provide  
          a higher probability that candidates who successfully  
          complete the process will meet minimum competency  
          standards, while also providing greater protection and  
          safety to consumers. 


           ASSEMBLY FLOOR  :  
          AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill  
            Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,  
            Bradford, Brownley, Buchanan, Caballero, Charles  
            Calderon, Chesbro, Cook, Coto, De La Torre, Emmerson,  
            Eng, Evans, Feuer, Fletcher, Fong, Fuentes, Fuller,  
            Furutani, Gaines, Galgiani, Garrick, Gilmore, Hagman,  
            Harkey, Hayashi, Hernandez, Hill, Huber, Huffman,  
            Jeffries, Jones, Knight, Lieu, Logue, Bonnie Lowenthal,  
            Ma, Mendoza, Miller, Monning, Nava, Nestande, Niello,  
            Nielsen, John A. Perez, Portantino, Ruskin, Saldana,  
            Silva, Skinner, Smyth, Solorio, Audra Strickland,  
            Swanson, Torres, Torrico, Tran, Villines, Yamada
          NO VOTE RECORDED: Carter, Conway, Davis, De Leon, DeVore,  
            Hall, V. Manuel Perez, Salas, Torlakson, Bass


          JA:nl  8/10/10   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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