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In September 2022, the NDEB introduced the NDECC as the third examination in the Equivalency Process for graduates of non-accredited undergraduate dental programs. This examination replaced the ACS and tests both the clinical skills and situational judgement of individuals prior to their entry into practice.

Following the release of the first series of NDECC results, the NDEB received comments and concerns related to the new exam. In response to these concerns, the NDEB commenced a consultation and review process which included meetings with the Fairness Commission in Ontario, the Canadian Dental Regulatory Authorities Multi-Stakeholder Working Group to review the Certification Processes for graduates of International Dental Programs, the NDEB Examinations Committee and the NDEB Board. A comprehensive review of the consultation and development process of the NDECC blueprint and standard setting was also undertaken with input from a psychometric expert.

The review focused on four areas: the time allotted for the Clinical Skills component of the NDECC, the passing standard for the Clinical Skills component, the requirement to pass at least one station in each blueprint area of the Situational Judgment component, the relevance of testing amalgam, the material provided for the amalgam restoration, and the size of the Class II amalgam restoration.

The time allotted for the Clinical Skills component of the NDECC

The Clinical Skills component requires candidates to complete seven clinical skills in an eight-hour period. To determine if this time was adequate, the NDEB reviewed the process for establishing the time allocated to the Clinical Skills component. During the development of the NDECC, the NDEB consulted with four different groups of experts regarding the time required to complete the clinical skills requirements. These groups recommended that four to five hours would be adequate for well-prepared candidates to complete the seven clinical skills requirements. The decision was made to allot eight hours for the Clinical Skills component which was double the amount of time recommended by the experts consulted. In addition, over the past year, the NDEB has received feedback from candidates indicating that they had sufficient time to complete the clinical skills requirements. Therefore, as a result of this review, the decision to allot eight hours for the Clinical Skills component is appropriate as it allows for more than sufficient time for a well-prepared candidate to complete the examination.

The passing standard for the Clinical Skills component

To receive a passing grade on a requirement a candidate does not have to produce an ideal result but rather demonstrate minimal competence with no major errors. To review the passing standard for the Clinical Skills component, the NDEB consulted with dental regulators, reviewed the recommendations of the standard setting exercise that was undertaken for the ACS, and consulted with a psychometrician. The review supported that the passing standard is accurate and that the processes used to establish it were in accordance with accepted psychometric processes. This decision is supported by the CDRAF Multi-Stakeholder Working Group which agreed that the passing standard for the Clinical Skills component is the absolute minimum required of a dentist entering practice in Canada. It was also determined that a dentist entering practice should be able to perform the seven basic clinical procedures at a minimally competent level on the same day. Therefore, there will be no change to the policies for repeating the Clinical Skills component. If a candidate receives a failing grade on one or more clinical requirements, they must repeat the entire Clinical Skills component.

The passing standard for the Situational Judgement component

The situational judgment component has five blueprint categories. There are two stations for each blueprint category for a total of 10 stations. To pass, candidates must pass six of the 10 stations and pass at least one station per blueprint category. Through the consultation and review process with the CDRAF Multi-Stakeholder Working Group and NDEB Committees, it was confirmed that each of the five blueprint categories (domains of competence): communication and collaboration, patient-centered care, health promotion, professionalism, and practice and information management represent a critically important area for patient care in Canada. It was also confirmed that a dentist entering practice should be required to demonstrate competence in each of the five blueprint categories; therefore, candidates must pass at least one station in each of the five domains.

The inclusion of amalgam restorations in the Clinical Skills component

Candidates taking the NDECC questioned the relevance of the Class II Amalgam Restoration Requirement of the Clinical Skills component and raised concerns about the materials provided to complete the amalgam restoration. An environmental scan of the Canadian Faculties of Dentistry curriculum indicates that restorations are still taught in all Canadian dental schools, and there is evidence that amalgam is the material of choice in specific high-risk populations in Canada. Therefore, it was determined that amalgam will continue to be tested in the Clinical Skills component. The NDEB will continue to monitor the use of amalgam in Canada and adjust the NDECC requirements as needed.

Concerning the extent of the amalgam restoration requirement, the review confirmed that a restoration with a cusp reconstruction (MODBL) is more challenging than an MOD restoration. As a result, the NDEB has balanced the assessment teeth provided to candidates based on level of difficulty. Difficulty of the requirements will continue to be monitored and adjusted as appropriate.

As part of the review, candidates’ comments regarding materials provided for the amalgam restoration were considered. Following a review of the comments, in April 2023, extended carving time amalgam (ECT) was introduced as part of the materials provided to candidates. Candidates now have access to regular set and ECT amalgam in the NDECC clinic.