Review process and perspective

Reviews of the ABO’s written and clinical examinations are ongoing processes. Historically, significant changes to the examinations followed extensive evaluation and research over many years, and included input from key orthodontic leaders. The current decision for change followed the same path. It began with significant input from those attending the 2016 ABO Educators’ Symposium, which highlighted challenges to the examination structure based on the changing environment.

Feedback from the ABO’s certification survey in March 2017 produced additional support for change in the certification process. The survey showed that the overwhelming majority of orthodontists believe that ABO certification is a designation that all orthodontists graduating from a specialty program accredited by the Commission on Dental Accreditation (CODA) should strive to obtain. The survey also indicated that there are unwarranted barriers in the current certification process. Length of residency programs, increases in corporate and dental support organization work environments, and testing based on treated patients were a few of the barriers that were stated.

The ABO elected to research and observe other dental and medical specialty boards to ensure adherence to best practices. Currently, the clinical examinations of 4 of the American Dental Association’s recognized dental specialty boards are completely scenario-based (American Board of Oral and Maxillofacial Pathology, American Board of Oral and Maxillofacial Surgery, American Board of Pediatric Dentistry, and American Board of Periodontology). Also, the orthodontics oral examination of the Royal College of Dentists of Canada is entirely scenario-based. The majority of the American Board of Medical Specialties’ member boards also offer scenario-based certification examinations.

The Board’s extensive evaluations, combined with research of best practices, support the decision that a new design is needed to give an examination that is fair, valid, and reliable, while increasing accessibility. To facilitate the development of a new examination design, the ABO contracted with Castle Worldwide (Castle), a certification and licensure testing company with 30 years of experience in the science of psychometrics and training development. Castle facilitated a practice-analysis study, which began by defining the core proficiencies required of a successful orthodontist. The ABO and its consultants used the CODA Curriculum Standards and the American Association of Orthodontists (AAO) Clinical Practice Guidelines for Orthodontics and Dentofacial Orthopedics as the foundations in defining key skills and abilities.

The practice analysis provided the primary basis for defining the content domains or categories, as well as the proficiencies, that should be covered by the ABO Clinical Examination. These domains and proficiencies were then validated in August 2017 by key stakeholders with a survey of board-certified orthodontists, members of the AAO, residents, and educators. Once these were validated, Castle made recommendations for the best methods and best practices that could be used to evaluate each identified core proficiency. This exhaustive study resulted in the recommendation to move toward a scenario-based clinical examination.

During the most recent ABO Educators’ Symposium (November 2017), over half (54%) of the survey respondents supported an immediate change to a scenario-based examination. Only 10% did not support a complete scenario examination. The remainder supported a slow transition to a scenario-based examination or a combination of cases and scenarios. This finding provided further impetus for the ABO to implement a change to a scenario-based examination.

The ABO believes that in today’s climate a shift is needed to develop an examination that facilitates participation by all, while creating a measure of proficiency and expertise that most specialists should aspire to attain. The change to a scenario-based clinical examination structure is significant; the Board must look to current board-certified orthodontists for their support as it transitions to this new format. The new process will not result in an easier examination. Standards will not be lowered. The new process offers an improved testing method that will be fair, valid, and reliable for the specialty of orthodontics while increasing accessibility and complementing residency curricula.