Great thread.
1. A national board exam is definitely needed rather than these regional exams. I have heard that WREB is preparing to join ADEX, which would pretty much make a national board exam. I'm not sure if this is true or not, but it is needed. Also, there should be more means of licensing through a residency. As far as specialties go, we need to figure out a better way than having a 50 year old oral surgeon taking the ADEX in order to practice OS in Florida. A good example for us is Canada. They have on written board over 2 days (I think some sort of practical is involved). That's it. Are Canadian dentists any less competent than us? (Yeah, insert Canada joke here, but in all honesty think about it.) Also, in Canada, I believe specialists are not required to take the national dental board. They're only required to take their specialty exams. WHAT A CONCEPT!!! Who thought of that? Yeah, sad but true, but Canadians are ahead of us.
2. The issue of live patients on these exams is something I simply don't understand. It is unethical for many reasons. How many of us are saving the "ideal" lesion for a period of time just so we can use it on the board exam? Is it ethical to wait that long? Now, put yourself in your patient's place. Imagine if you knew all the stress the student is under while undergoing these boards. Would you sit for these boards? One more point regarding this: Is it ethical to put on a rubber dam for 2 hours on a patient when it usually takes 30 minutes for a filling and restoration? Someone earlier asked about the ADA's stance on this. I dug up this article for you:
http://www.jdentaled.org/content/66/5/605.long
I think we're the only profession that uses live patients to get licensed (maybe some cosmetology licenses need it too, but I don't know).
3. Now when it comes to the exam itself. It is completely based on case selection and having luck finding the ideal lesions. More importantly having the patient actually show up on that day is the most significant factor. As a result, a good portion of the exam is based on luck. That is not a good way to have an exam. In order to truly have a standardized exam, I believe that this exam should be done on a typodont. Everyone would have the same tooth so it is comparable. I'm not saying get rid of the Endo and Prosth on the typodont for NERB. I think that is fair. So why not do the rest on a typodont?
Additionally, on the NERB, if you fail either restorative portion (class 2 or class 3), you must retake both the class 2 and class 3. Does failing a class 2 mean you are incompetent in restoring a class 3 you already successfully completed? Same is true vice versa.
Another problem I have is the retake. Let's say you fail the class 2 (pulp exposure or you get instructions to temporize). You still have 3 hours left on the exam. Why can't you just bring in another patient and do it again? Isn't that the same thing you'll be doing on the retake anyway (trying again on another patient)? Oh yeah, I forgot, they would be losing out on $900 on a retake. If that was me, I'd pay the $900 on the spot and try to retake it the same day. But we all know that option doesn't exist.
Why is it that if the patient no shows on you, it is your fault? I know someone who not only had his patient no show, but also his back up patient no show. If you didn't submit anything for the exam, why are you being forced to pay another $900 for a retake? Shouldn't the retake be free since you technically didn't take the exam?
4. I'm sure the state boards are somehow benefiting from these exams. This is probably a large reason why they are still around. When the ADA recommends they should be phased out just like the article above says, and they're still around, it makes you wonder. We all know this is more about money than anything else. This is especially true considering most regional boards are private entities, not associated with the ADA. Basically, dental schools are accredited, but we can't agree that these students can do a Class 2 of Class 3 on a live patient. I really hope that part of this accreditation process is ensuring dental students are able to complete those procedures.
Sorry this is a long post, but I saw this topic and wanted to jump on.