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

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

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

4. Disclosure  I am a full time faculty member of SUNY at Buffalo School of Dental Medicine.  I am a consultant for the Commission on Dental Competency Assessments - CDCA.

5. Presentation Overview  Recent Background  Exam Modifications  Orientation/Exam Day  Results  Questions

6. “live patient” “use patient”

7. Recent Background  In 2012 applications for licensure decreased in New York State and NYSDA formed PGY1 Task Force  2013 ADEA Council of Deans  November 2014 first planning session University at Buffalo  July 2015 ASDA adopts (interim) L-1Initial Licensure Pathways Policy

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

9. 2013 Council of Deans  Standard of care compromised - human subjects and not patients  Validity/reliability of current format  Novice providers  Educational institutions liability - testing agency assumes no responsibility - litigation concerns Eliminate Patient Exam Recommendation Based On:

10. ASDA L-1Initial Licensure Pathways Policy  Eliminate patients  Universally accepted, standardized exam  Valid and reliable  Reflective of the scope of current practice

11. Positive Step Forward  The Buffalo Model begins to address ethical concerns of patient exams Recognize:  Patients still utilized  High Stakes Testing  Candidates at risk with dependence on patients to present on day of exam  Other options being utilized OSCE - Minnesota PGY-1- N.Y./MN./WA./CT. Portfolio - California

12. Establishing a Process Advisory Group Formed UB Clinical & Facilities Staff D3/D4 Group Directors Student Leadership CDCA New York State Dental Board NYSDA

13. 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

14. 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 ethical treatment of the patient.

15. Exam Modifications  Faculty & Curriculum integration  Patient eligibility restricted  Multiple exam dates available  Exam part of normal clinic day  Clinical competency in Operative and Periodontics independently assessed by faculty

16. Faculty/Curriculum Integration  CDCA faculty calibration session (for patient assignment)  Revised faculty role includes Prior to Exam - lesion/case verification Exam Day - competency assessment - documentation - supervise definitive treatment

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

18. Exam Schedule  Six exams were scheduled every 3–4 weeks January–May Using ADEX criteria  Manikin Exam – one session  Retakes offered at all exams  Patient “no-shows” managed with reappointment for another session  Eligible candidates were allowed to register with only two sections of the clinical exam approved

19. CIF Registration University at Buffalo Endo./Pros. December 5, 2015 Perio./Restor. January 26, 2016 February 23, 2016 March 15, 2016 April 19, 2016 May 10, 2016 – retake session Initial Registration by the candidate

20. 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

21. Intended Consequence The Buffalo Model is a true Curriculum Integrated Format in action

22. 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

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

24. Results  Case Verification  Competency Exams  Class of 2015 Results  Student Perspective

25. Case Verification EXAM DATE ACCEPTED REJECTED ACCEPTEDREJECTED JANUARY 20 15 0 9 0 FEBRUARY 10 31 0 14 0 MARCH 24 40 2 16 0 APRIL 14 37 0 23 1 MAY 12 10 0 5 0 98.5% of the restorative lesions and periodontal cases verified by UB faculty were accepted by CDCA examiners RESTORATIVE PERIODONTICS

26. Competency Exams EXAM DATE Total D4’s Total OPER Total PERIO UB PASS UB FAIL ADEX PASS ADEX FAIL JANUARY 20 9 8 4 8 4 8 4 FEBRUARY 10 17 9 3 12 0 0 MARCH 24 25 11 2 2 13 0 APRIL 14 27 8 7 15 0 0 TOTAL 78 36 16 46 6 48 4 GOAL IS TO EDUCATE TO A HIGHER LEVEL THAN EXAM TESTS COMPETENCY OPTION WELL UTILIZED BY STUDENTS NO CPE FAILURES IN PERIO

27. Class of 2015 Results EXAM DATE# D4 s 2-SECTION REGISTRATION 3-SECTION REGISTRATIO N TOTAL PASS TOTAL FAIL JANUARY 20 9 3 6 5 4 FEBRUARY 10 17 4 11 17 0 MARCH 24 25 10 23 2 MARCH 28 61 N/A 49 12 APRIL 14 27 9 11 23 4 MAY 11 11 N/A 11 0 MAY 12 10 4 0 9 1 UB candidates fell within the national average for passing the exam on their first attempt.

28. Student Perspective  Presence of faculty helped decrease the anxiety of exam day  No need to search for “ideal” lesions  Flexible scheduling gave patients and candidates more options  School competency option well utilized  Patients and assistants were not financially compensated

29. Limitations  clinic space  available calibrated faculty  remediation of failures after graduation  dedicated exam coordinator and support staff

30. 2016 Buffalo Model at UB  Establish assigned faculty, da, and runner coverage schedule  Pre-exam chart review  Treatment plan submitted as part of patient intake  Move manikin exam to fall semester  Utilization of E4D technology to assist students in manikin exam preparation  Create Buffalo Model candidate manual

31. Next Steps Nationally  Present Findings to the Dental Profession - 2016 ADEA Annual Session - seminars/publications  Pilot The Buffalo Model at other dental schools  Standardization of the process to facilitate ease in implementation at other institutions  Begin discussion on National Exam

32. Standardization  Conference calls between CDCA and participating Buffalo Model institutions  Review individual exam protocols – What worked? – What didn’t? – Why?  Student/faculty/staff surveys What level is acceptable ?

33. Protocols of Interest  Case verification rates  Patients of record  Flexible scheduling/Retake frequency  Competency option  Definitive Treatment  Documentation  Student acceptance

34. Thank You

35. questions Contact Information Joseph E. Gambacorta, DDS Assistant Dean for Clinical Affairs University at Buffalo School of Dental Medicine 325G Squire Hall Buffalo, New York 14214-8006 Tel.: (716)-829-5787 E-Mail: jeg9@buffalo.edu