The Buffalo Model Joseph E. Gambacorta, DDS Assistant Dean for Clinical Affairs University at Buffalo School of Dental Medicine

Background In 2012 applications for licensure decreased in New York State and NYSDA forms PGY1 Task Force. November 2014 first planning session at UB with CDCA & NYSDA.

PGY1 Task Force Pilot Exam To assure that patient care is protected. Care on patients of record in a normal course of treatment. Integrated exam to be offered continuously throughout the D3 and D4 year.

Establishing a Process PGY1 Task Force Report used as a basis to formulate exam model. Advisory Group formed UB Clinical Staff D3/D4 Group Directors Student Leadership CDCA NYSDA

Curriculum Integrated Format - CIF In 2007 ADA House defined CIF as: Treatment performed on patients of record with sequenced treatment plan. Exam assessment integrated into dental school curriculum. Multiple exams scheduled during the academic year.

The Buffalo Model Is a modification of the traditional licensure exam format which enables the focus of the exam to shift from the candidate to the patient.

Exam Modifications Faculty & Curriculum integration Patient eligibility restricted Multiple exam dates available Exam part of normal clinic day

Faculty/Curriculum Integration CDCA faculty calibration session Revised faculty role includes: Prior to Exam - lesion/case approval Exam Day - competency assessment - documentation - supervise definitive treatment

Patient Eligibility Treatment MUST be rendered on patients of record as part of an appropriately sequenced treatment plan.

Exam Schedule Six exams were scheduled every 3 weeks January – May. Manikin Exam – one session Retakes offered at all exams. Eligible candidates were allowed to register with only two sections of the clinical exam approved.

Normal Clinic Day Seamless integration of the exam was achieved as a result of: Control in populating exam UB faculty, staff and student support Available clinic space Flexibility of CDCA CDCA and UB faculty interaction on the clinic floor.

Intended Consequence The Buffalo Model is the Curriculum Integrated Format in action.

Orientation Before each exam UB and CDCA held a joint orientation session to: Schedule exam patients into database. Review parameters of ADEX exam. Discuss faculty role. Outline documentation requirements.

Exam Day CDCA established a Buffalo exam team. UB staff coordinate clinical activities. Prescheduled clinical assignments continue uninterrupted. Continuous interaction between Examiners and UB faculty/staff. Definitive treatment model established.

Results Case Approval Competency Exams Class of 2015 Results WREB/ADEX Comparison

Case Approval RESTORATIVE PERIODONTICS EXAM DATE ACCEPTED REJECTED JANUARY 20 15 9 FEBRUARY 10 31 14 MARCH 24 40 2 16 APRIL 14 37 23 1 MAY 12 10 5 98.5% of the restorative lesions and periodontal cases pre-approved by UB faculty were accepted by CDCA examiners.

Competency Exams EXAM DATE Total D4’s OPER PERIO UB PASS FAIL ADEX ADEX FAIL JANUARY 20 9 8 4 FEBRUARY 10 17 3 12 MARCH 24 25 11 2 13 APRIL 14 27 7 15 TOTAL 78 26 16 46 6 48 - NO COMPENCIES OFFERED DURING MAY 12th EXAM. - NO FAILURES IN PERIO. - TWO CANDIDATES PASSED ADEX BUT NOT UB COMPETENCY. - COMPETENCY OPTION WELL UTILIZED BY STUDENTS.

66.6% of UB candidates passed the ADEX exam on their first attempt. Class of 2015 Results EXAM DATE # D4 s 2-SECTION REGISTRATION 3-SECTION TOTAL PASS FAIL JANUARY 20 9 3 6 5 4 FEBRUARY 10 17 11 MARCH 24 25 10 23 2 MARCH 28 61 N/A 49 12 APRIL 14 27 8 24 MAY 11 MAY 12 1 66.6% of UB candidates passed the ADEX exam on their first attempt.

WREB/ADEX Nine candidates challenged both exams. # D4s RESTOR. PERIO. ENDO. WREB 39 9 7 ADEX 61 Nine candidates challenged both exams. Only first attempts were considered. Prosthodontic manikin only part of ADEX. Student comments most important result in this comparison.

Student Perspective Presence of faculty helped establish trust between students and examiners. No need to search for “ideal” lesions. Flexible scheduling reduced the stress of “all or nothing weekend exam”. No extracted teeth to mount and radiographs to take. It felt like a regular day at school.

UB Next Steps Establish faculty, da, and runner coverage schedule. Pre-exam chart review. Treatment plan submitted as part of patient intake. Move manikin exam to fall semester. Certify D3 candidates to challenge at the end of the spring semester.

Next Steps Nationally Educate the dental community – 2016 ADEA Annual Session – seminars/publications Pilot The Buffalo Model at other dental schools – CDCA survey. Standardization of the process to facilitate ease in implementation.

Thank You Dr. Michael Glick UB faculty, staff and students CDCA examiners and staff ADEX NYSDA – PGY1 Task Force Mr. Michael Zeder Dr. David Perkins Dr. Guy Shampaine

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