BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 2331


                                                                    Page  1


          CONCURRENCE IN SENATE AMENDMENTS


          AB  
          2331 (Dababneh)


          As Amended  August 19, 2016


          Majority vote


           -------------------------------------------------------------------- 
          |ASSEMBLY:  |79-0  |(June 1, 2016) |SENATE: |39-0  |(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.










                                                                    AB 2331


                                                                    Page  2


          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.










                                                                    AB 2331


                                                                    Page  3


          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.


          COMMENTS:


          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  








                                                                    AB 2331


                                                                    Page  4


          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 










                                                                    AB 2331


                                                                    Page  5


          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.









                                                                    AB 2331


                                                                    Page  6



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