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The NDEB Equivalency Process

Internationally trained dentists who have graduated from a non-accredited dental program must complete the NDEB Equivalency Process (EP) or an accredited degree completion program followed by the Certification Process prior to being licensed as dentists in Canada. The EP comprises three examinations, the Assessment of Fundamental Knowledge (AFK), the Assessment of Clinical Judgement (ACJ) and the NDECC. On Successful completion of the EP, an individual is considered equivalent to a graduate of an accredited dental program and eligible for the certification examination which all dentists are required to take to become licensed in a Canadian province.

Changes to the Equivalency Process Blueprint

As part of its five-year strategic plan and as best practice for testing agencies, the NDEB undertook a review of the EP blueprint. This process involved a detailed review of each of the examinations. The review took place over several years and involved multiple stakeholders including dental regulatory authorities. In February 2021, the NDEB announced many changes to the EP, including a reduction in questions on the AFK, a requirement to pass the ACJ before taking the skills exam, removing the maximum of 3 attempts for the skills exam, and changing the blueprint, what is tested, on the skills exam. At the time, the clinical examination was still being referred to as the ACS. Because the blueprint for the third examination was significantly changed, the NDEB rebranded the ACS as the NDECC.

Comparing the ACS to the NDECC

The previous clinical examination, the ACS, required candidates to complete 12 clinical procedures over two days. Candidates could fail one procedure and still pass the exam. Unlike the ACS, the NDECC requires candidates to complete seven clinical procedures in a single day. The clinical procedures are basic procedures that a dentist would encounter regularly in practice. The second day includes10 stations that test judgement in the competency in the domains of professionalism, communication and collaboration, patient-centred care, health promotion, and practice management. These competencies are not assessed in any other exam in the EP and were identified as areas that should be tested by the provincial dental regulatory authorities.

With the implementation of the new NDECC, the NDEB also updated its appeals process for the examination. The NDEB now offers three appeal options for the NDECC and all other examinations: a verification of score, a compassionate appeal, and a conduct of the exam appeals. There is no appeal of the evaluation of the examination. This is in line with other national testing agencies.

NDECC Grading

Evaluators for the NDECC are a diverse group of dentists who are recommended by their dental regulatory authority to be NDEB examiners. They are then reviewed by the Examinations Committee and appointed by the Board.

The training process for NDECC examiners mirrors that of the ACS. Examiners receive training and calibration for each NDECC evaluation session. Each NDECC requirement is graded by two separate examiners. If these two examiners are not in agreement, then a third examiner is brought in to facilitate. Only when two examiners are in agreement on the grading is it considered complete.

When a candidate receives their NDECC results, they receive a pass or fail for each requirement. Grading criteria are published for the clinical skills requirements. A pass is awarded for criteria in the “competent” category and “minimally competent” category. A fail is awarded when the procedure falls in the “not competent” category.

Candidates are not expected to perform perfect procedures during the examination. Candidates scoring in the “minimally competent” category may have made multiple errors and would still receive a pass. When a candidate receives a fail, it is because the procedure has been graded as has having:

-Errors that are correctable but indicate significant lack of clinical skills or judgement and compromise clinical outcome.
-Errors are not correctable and compromise clinical outcome.
-Errors requiring alternative treatment (e.g., more extensive restoration, extraction, root canal treatment).

Why is the passing standard for the NDECC different than the ACS?

It is the NDEB’s statutory obligation to certify only those who are qualified to enter the dental profession in Canada. In the interest of public health, the NDEB establishes standards necessary to ensure competency. The passing standards for NDEB examinations are determined through a process called standard setting. The purpose of standard setting is to determine the minimum acceptable level of performance in the competency domains targeted by the examinations. Standard setting is a rigorous process by which a panel of dentists from across Canada reviews all questions in an examination to establish the score required for the minimally competent dentist. As part of the blueprint review process a standard setting for the clinical examination of the EP was held. It was determined that all dentists entering practice should be able to demonstrate minimal competence on the clinical skills being assessed and therefore a candidate must pass all the clinical skills requirements. Additionally, for the situational judgement component, candidates must pass 6 of 10 stations and cannot fail two stations in the same domain.

The NDECC is a crucial step in the evaluation of non-accredited dentists prior to licensure. Dental education and clinical experience vary widely around the world. The clinical requirements tested during the NDECC are basic procedures that dentists in Canada must be competent to perform: cutting a tooth for a silver filling, making a silver filling, making a white filing on a back tooth, making a white filling on a front tooth, starting a root canal treatment to relieve a toothache, cutting a tooth to receive a crown (cap), fabricating a temporary crown. The NDECC is the only time practical skills of internationally trained dentists are assessed before they can work on patients.