BILL ANALYSIS ------------------------------------------------------------ |SENATE RULES COMMITTEE | AB 1524| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ 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 AB 1524 Page 2 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 CONTINUED AB 1524 Page 3 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. CONTINUED AB 1524 Page 4 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 CONTINUED AB 1524 Page 5 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. CONTINUED AB 1524 Page 6 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 CONTINUED AB 1524 Page 7 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 CONTINUED AB 1524 Page 8 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 CONTINUED AB 1524 Page 9 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 **** END **** CONTINUED