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J Dent Educ. 70(10): 1076-1080 2006
© 2006 American Dental Education Association
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Milieu in Dental School and Practice

Competencies for the Beginning Dental Practitioner in Canada: A Validity Survey

Jack D. Gerrow, D.D.S., M.S., M.Ed.; H. Joseph Murphy, Ed.D.; Marcia A. Boyd, D.D.S., M.A., L.H.D. (Hon)

Key words: competencies, validation survey, dental curriculum, accreditation, certification examinations

Submitted for publication 05/02/06; accepted 07/26/06


   Abstract
Top
 Abstract
Literature review
 Method
 Results
 Discussion
 Conclusion
 References
 
As part of the recommended review of the national competencies for beginning general dentists in Canada, a validation survey was distributed to 731 dentists. The survey asked participants to supply demographic information and rate each of the forty-six competencies on a 5-point Likert scale. The response rate was 43.1 percent (315 total usable responses). Self-reported demographic data was used to create respondent subgroups. The participants rated all of the competencies quite high with thirty-six of the forty-six receiving rankings averaging 4.0 or higher on the 5-point scale. No competency received a ranking averaging lower than 3.0. Competencies rated as most important by the entire sample were also rated as most important by all respondent subgroups. The results of this validation survey provide evidence of content validity and reinforce the value of a national competency document that can serve as a reference for curriculum management, program accreditation, and development of certification examinations.

In 1993, the National Dental Examining Board of Canada (NDEB) was charged with the responsibility of developing and implementing a certification examination process for graduates of accredited Canadian dental programs.1 It was agreed that the first step in the development process would be the identification of competencies required for initial licensure as a general dentist in Canada. These competencies were needed to establish a comprehensive certification examination blueprint. The NDEB invited the Association of Canadian Faculties of Dentistry (ACFD/AFDC), the Commission on Dental Accreditation of Canada (CDAC), and the Canadian Dental Association’s Council on Education (CDA Council) to participate in a national initiative to establish competencies for a beginning dental practitioner in Canada. This process described previously2 resulted in the acceptance of a set of competencies that has been used by the NDEB to develop national certification examinations, by the ACFD/AFDC for curriculum planning, and by the CDAC for accreditation purposes. The forty-six competencies contained in the national competency document were numbered but not in a hierarchical manner.

Participants in the 1993 process recommended that the competencies be reviewed and revised periodically. As a result, in 2002, the NDEB initiated a review process of the competency document. As the first step in that review, a survey was conducted to validate the competencies by determining their importance to general dental practice.


   Literature Review
Top
 Abstract
 Literature review
Method
 Results
 Discussion
 Conclusion
 References
 
The development and validation of competency systems for dental education have become integral to the work of organized academic dentistry. Glassman and Chambers3 stated that repeated iterations of goal and standard setting, design of experiences, and appraisal are required to move dental education institutions to become true learning organizations. Shugars et al.4 surveyed dentists’ attitudes toward competencies for dental health care professionals. Their feedback confirmed many of the skills, attitudes, and behaviors incorporated in dental education programs and also suggested areas for curriculum reform. Weintraub5 described a process whereby several stakeholder groups were surveyed, leading to the development of competencies for specialists in dental public health. Prescott et al.6 conducted a comprehensive validation of competencies for dentistry students in Scotland, using a combination of surveys and focus groups. Their work led to the production of a validated competency document designed to allow a high degree of standardization of training throughout the country.

At the University of Texas Health Sciences Center at San Antonio (UTHSCSA), Glass et al.7 involved a wide range of stakeholders in their curriculum review. The stakeholders—which included faculty, students, alumni, and outside consultants—re-evaluated the UTHSCSA competencies to ensure that they were contemporary and that the methods to assess them were valid and reliable. Zachazewski et al.8 described the process and results of a reevaluation of competencies of the American Board of Physical Therapy Specialists and emphasized that competency and examination processes are constantly evolving.

In the United States, Kramer and Neumann9 conducted a validation study examining the relationship between Part II of the National Board Dental Examinations and the judgments of practicing dentists. In Canada, competency statements have been utilized by Gerrow et al.10–13 as a reference tool in determining the composition of National Board examinations and in validating these national examinations. Dagenais et al.14 suggested that faculties of dentistry in Canada use the "competencies of beginning dentists" as benchmarks against which their D.D.S./D.M.D. curricula offerings can be measured.

While practice analysis serves as a major source of evidence supporting inferences from the scores on licensure examinations in dentistry, Raymond15 argues that there is little consensus regarding suitable methods for conducting job analyses and translating the results into test plans. LaDuca16 has proposed an alternative validation strategy for professional licensure tests that is based on professions theory. The theory proposes that the profession define its social characteristics, its cognitive knowledge base, and the relationship between the two. No empirical studies applying this schema have been reported.

The literature therefore reinforces the need to periodically revalidate competency statements as the profession evolves. The study was initiated by the NDEB to validate the existing competency statements, originally created in 1993, for beginning dental practitioners in Canada and to provide a resource for revising and updating the competencies.


   Method
Top
 Abstract
 Literature review
 Method
Results
 Discussion
 Conclusion
 References
 
Surveys were mailed/delivered to 731 Canadian dentists representing several professional groups: 150 were randomly selected from individuals who had graduated from accredited dental education programs between 1995 and 1997; ninety were randomly selected from graduates of nonaccredited programs who successfully completed the NDEB examinations during the same years; 300 were randomly selected from all licensed dentists in Canada; 169 were NDEB examiners; twelve were NDEB board members; and ten were deans of the dental schools in Canada.

The intent of selecting participants based on these professional groups was to ensure that the opinions of newly licensed dentists (both accredited and nonaccredited graduates) were well represented as the competencies were written for "beginning" dentists. The inclusion of a group with considerable experience working with the competencies (examiners, deans, and board members) was to ensure that the opinions of these experienced individuals were represented. The 300 randomly selected licensed dentists were included to provide input from the dental community at large. To ensure that all participants were confident of the anonymity of the process, no identification was placed on the response forms, but self-reported answers to demographic questions were included to identify subgroups of respondents.

Each participant was asked to provide demographic information (including gender, age, geographic location, years in practice, specialty status, and academic affiliation) and to rate, on a 5-point Likert scale (1=Not Important to 5=Extremely Important), the importance of each of the forty-six competencies for the beginning dental practitioner in Canada. Responses were entered into a computerized database, and the resulting data were analyzed for the group as a whole and for the subgroups using SPSSX.


   Results
Top
 Abstract
 Literature review
 Method
 Results
Discussion
 Conclusion
 References
 
Participation
Useable responses were received from 315 participants, representing 43.1 percent of those surveyed. As stated in the method, in order to ensure anonymity, no identifiers were placed on the response forms, so the response rates from the identified professional groups are not directly available. The self-reported demographic information was used to infer response rates from the various groups.

Respondent subgroups based on self-reported demographic information were gender, age, years in practice, geographic location, specialty status, and academic affiliation. Males outnumbered females three to one among the respondents. Approximately one-third of respondents were age forty and below, one-third were in their forties, and one-third were over fifty. One-half had been practicing fewer than twenty years; the other half, more than twenty years. Geographically, participants were distributed across the country as follows: Atlantic Canada (15 percent), Quebec (18 percent), Ontario (31 percent), and Western Canada (36 percent). Approximately 76 percent of respondents identified themselves as full-time practitioners. Sixteen percent of respondents identified themselves as specialists, and 30 percent were faculty members (one-half full-time and one-half part-time).

Assuming that the younger practitioners came from the recently certified groups and that the full-time practitioners came from the non-academic groups, the responses to the demographic questions regarding age, years in practice, specialty status, and academic affiliation support the likelihood that no identified professional group was over- or underrepresented in the sample due to a large variation in response rate. The geographic distribution is representative of the actual dentist population distribution in Canada.

Quantitative Data
Collectively, the participants rated all of the competencies quite high, with thirty-six of forty-six receiving ratings averaging 4.0 or higher on the 5-point scale. The top ten rated competencies are listed in Table 1Go.


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  		Table 1. The top ten competencies listed in order from the highest
 
Only ten competencies failed to attain an average score of 4.0 on the 5-point scale. These ten lower-rated competencies are listed in Table 2Go.


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  		Table 2. The bottom ten competencies listed in order from the lowest
 
As expected, the top ten rated competencies for the entire sample were repeated for many of the subgroups. Competencies #2 (identify chief complaint), #5 (conduct clinical exams), #18 (infection control), #22 (local anesthesia), and #43 (recognize own limitations) are included in the top ten for all subgroups, while #23 (drug use) and #26 (dental emergencies) are in the top ten for all subgroups except older practitioners and Ontario practitioners, respectively.

Similarly, competencies rated in the bottom ten are also largely shared by all subgroups. For example, competencies #7 (taking radiographs), #30 (manage trauma), #36 (assess dietary intake and oral hygiene status), #38 (manage growth/developmental abnormalities), and #39 (neglect and abuse issues) are rated in the bottom ten by all subgroups, while #44 (evaluate the literature) is in the bottom ten for all subgroups except for the specialist subgroup. It is important to note that, despite being rated in the bottom ten, all of the competencies have quite high ratings, with the lowest having a mean score of 3.26 on a 5-point scale.


   Discussion
Top
 Abstract
 Literature review
 Method
 Results
 Discussion
Conclusion
 References
 
The response rate of 43 percent is typical for this type of mailed survey. The decision made to not place an identifier for membership in one of the identified professional groups did limit the information available for the analysis of response rates for each group. This decision was made because there was a concern that the response rate from newly graduated/certified dentists would be adversely affected if an identifier was placed on the response sheet.

The self-reported demographic data involving the age distribution and experience in practice (one-third were age forty and below, one-third were in their forties, and one-third were over fifty; one-half had been practicing fewer than twenty years, and the other half, more than twenty years) of the respondents indicates that the response rates from the different groups were consistent. The academic affiliation, specialty status, and full-time practitioner responses (approximately 76 percent identified themselves as full-time practitioners, 16 percent as specialists, and 30 percent faculty members, divided equally between half- and full-time) also indicate that the response rates were relatively consistent and that no group was over- or underrepresentated due to variation in response rate. In addition, the respondent subgroups based on self-reported demographic data were of sufficient size.

Overall, the forty-six competency statements were rated quite high on the 5-point scale with only ten having a rating of below 4.0. Competency #38 (managing growth and developmental abnormalities) received the lowest score of 3.26. No competency scored below the chance mean of 3.0. Therefore, all competencies can be considered to be integral to the practice of general dentistry in Canada.

It is comforting to see that the highest rated competencies were shared by the vast majority of the subgroups. Similarly, the competencies rated lowest by the entire sample tend to be rated low by the various subgroups. Perhaps the most disturbing finding is that all groups, except the specialists, rated competency #44 (evaluation of the literature) in the bottom ten grouping. This may be a red flag for the evidence-based component of the dental curriculum.

Although all of the competencies were rated quite high, the results of this survey did provide a rank order of competencies by perceived importance. The rank order was a valuable resource document for a national workshop that was tasked with revising the competencies.

Future competency validation studies may wish to place identifiers on the response sheets in order to assess response rates. In addition, an open-ended comments section would encourage respondents to make suggestions for new competencies.


   Conclusion
Top
 Abstract
 Literature review
 Method
 Results
 Discussion
 Conclusion
References
 
All forty-six competencies contained in the national competency document were rated high in importance. There was a general agreement in the ranking of the competencies by various subgroups.

The results of this validation survey provide evidence of content validity and reinforce the value of a national competency document that can serve as a reference for curriculum management, program accreditation, and development of certification examinations. The results also provided a resource document for a stakeholders workshop that reviewed and revised the national competencies to reflect the competencies currently deemed to be essential to the general practice of dentistry in Canada.


   Footnotes
 
Dr. Gerrow is Professor and Chair, Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, and Executive Director and Registrar, National Dental Examining Board of Canada; Dr. Murphy is Associate Professor, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia; and Dr. Boyd is Professor Emerita, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, and Former Chief Written Examiner, National Dental Examining Board of Canada, Ottawa, Ontario, Canada. Direct correspondence and requests for reprints to Dr. Jack D. Gerrow, National Dental Examining Board of Canada, 100 Bronson Ave., Ottawa, Ontario, Canada K1R 6G8; 613-236-0947, ext. 224 phone; 613-236-8386 fax; jackg{at}ndeb.ca.


   REFERENCES
Top
 Abstract
 Literature review
 Method
 Results
 Discussion
 Conclusion
 References
 

  1. Boyd MA, Gerrow JD. Certification of competence: a national standard for dentistry in Canada. J Can Dent Assoc 1996; 62:928–30.
  2. Gerrow JD, Chambers DW, Henderson BJ, Boyd MA. Competencies for a beginning dental practitioner in Canada. J Can Dent Assoc 1998; 64:94–7.
  3. Glassman P, Chambers DW. Developing competency systems: a never-ending story. J Dent Educ 1998; 62(2):73–82.
  4. Shugars DA, Bader JD, O’Neil EH. Attitudes of dentists toward emerging competencies for health care practitioners. J Dent Educ 1992; 56(9):640–5.[Abstract]
  5. Weintraub JA. The development of competencies for specialists in dental public health. J Public Health Dent 1998; 58(Suppl 1):114–8.
  6. Prescott L, Hurst Y, Rennie JS. Comprehensive validation of competencies for dental vocational training and general professional training. Eur J Dent Educ 2003; 7(4):154–9.[Medline]
  7. Glass BJ, Dodge WW, MacDougall MJ, Kalkwarf KL. The UTHSCSA dental school in the new millennium. Tex Dent J 2000; 117(3):12–20.[Medline]
  8. Zachazewski JE, Felder CR, Knortz K, Thein L, Quillen WS. Competency revalidation study: a description of advanced clinical practice in sports physical therapy. J Orthop Sports Phys Ther 1994; 20(2):110–24.[Medline]
  9. Kramer GA, Neumann LM. Confirming the validity of Part II of the National Board Dental Examinations: a practice analysis. J Dent Educ 2003; 67:1286–98.[Abstract]
  10. Gerrow JD, Murphy HJ, Boyd MA, Scott DA. Concurrent validity of written and OSCE components of the Canadian dental certification examinations. J Dent Educ 2003; 67:896–901.[Abstract]
  11. Gerrow JD, Boyd MA, Scott DA, Boulais AP. Use of discriminant and regression analyses to modify a clinical certification board examination J Dent Educ 1999; 63:459–63.[Abstract]
  12. Gerrow JD, Boyd MA, Duquette P, Bentley KC. Results of the National Dental Examining Board of Canada written examination and implications for certification. J Dent Educ 1997; 61:921–7.[Abstract]
  13. Boyd MA, Gerrow JD, Chambers DW, Henderson BJ. Competencies for dental licensure in Canada. J Dent Educ 1996; 60:842–6.[Medline]
  14. Dagenais ME, Hawley ED, Lund JP. Assessing the effectiveness of a new curriculum: Part I. J Dent Educ 2003; 67:47–54.[Abstract]
  15. Raymond MR. Job analysis and the specification of content for licensure and certification examinations. Appl Meas Educ 2001; 14(4):369–415.
  16. LaDuca A. Validation of professional licensure examinations: professions theory, test design, and construct validity. Eval Health Prof 1994; 17(2):178–97.[Abstract/Free Full Text]



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