The Buffalo Model Joseph E Gambacorta DDS Assistant

The Buffalo Model Joseph E. Gambacorta, DDS Assistant Dean for Clinical Affairs University at Buffalo School of Dental Medicine

Background � In 2012 applications for licensure decreased in New York State and NYSDA forms PGY 1 Task Force. � November 2014 first planning session at UB with CDCA & NYSDA.

PGY 1 Task Force Pilot Exam � To assure that patient care is protected. Care on patients of record in a normal course of treatment. � Integrated exam to be offered continuously throughout the D 3 and D 4 year. �

Establishing a Process � PGY 1 Task Force Report used as a basis to formulate exam model. � Advisory Group formed UB Clinical Staff D 3/D 4 Group Directors Student Leadership CDCA NYSDA

Curriculum Integrated Format - CIF In 2007 ADA House defined CIF as: � Treatment performed on patients of record with sequenced treatment plan. � Exam assessment integrated into dental school curriculum. � Multiple exams scheduled during the academic year.

The Buffalo Model Is a modification of the traditional licensure exam format which enables the focus of the exam to shift from the candidate to the patient.

Exam Modifications � Faculty & Curriculum integration � Patient eligibility restricted � Multiple � Exam exam dates available part of normal clinic day

Faculty/Curriculum Integration � � CDCA faculty calibration session Revised faculty role includes: Prior to Exam - lesion/case approval Exam Day - competency assessment - documentation - supervise definitive treatment

Patient Eligibility Treatment MUST be rendered on patients of record as part of an appropriately sequenced treatment plan.

Exam Schedule � Six exams were scheduled every 3 weeks January – May. � Manikin Exam – one session � Retakes offered at all exams. � Eligible candidates were allowed to register with only two sections of the clinical exam approved.

Normal Clinic Day Seamless integration of the exam was achieved as a result of: � Control in populating exam � UB faculty, staff and student support � Available clinic space � Flexibility of CDCA � CDCA and UB faculty interaction on the clinic floor.

Intended Consequence The Buffalo Model is the Curriculum Integrated Format in action.

Orientation Before each exam UB and CDCA held a joint orientation session to: � Schedule exam patients into database. � Review parameters of ADEX exam. � Discuss faculty role. � Outline documentation requirements.

Exam Day � CDCA established a Buffalo exam team. � UB staff coordinate clinical activities. � Prescheduled clinical assignments continue uninterrupted. � Continuous interaction between Examiners and UB faculty/staff. � Definitive treatment model established.

Results � Case Approval � Competency � Class Exams of 2015 Results � WREB/ADEX Comparison

Case Approval RESTORATIVE PERIODONTICS EXAM DATE ACCEPTED REJECTED JANUARY 20 15 0 9 0 FEBRUARY 10 31 0 14 0 MARCH 24 40 2 16 0 APRIL 14 37 0 23 1 MAY 12 10 0 5 0 98. 5% of the restorative lesions and periodontal cases pre-approved by UB faculty were accepted by CDCA examiners.

Competency Exams EXAM DATE Total D 4’s Total OPER Total PERIO UB PASS UB FAIL ADEX PASS ADEX FAIL JANUARY 20 9 8 4 8 4 FEBRUARY 10 17 9 3 12 0 MARCH 24 25 11 2 13 0 APRIL 14 27 8 7 15 0 78 26 16 46 6 48 4 TOTAL - NO COMPENCIES OFFERED DURING MAY 12 th EXAM. - NO FAILURES IN PERIO. - TWO CANDIDATES PASSED ADEX BUT NOT UB COMPETENCY. - COMPETENCY OPTION WELL UTILIZED BY STUDENTS.

Class of 2015 Results EXAM DATE # D 4 s 2 -SECTION REGISTRATION 3 -SECTION REGISTRATION TOTAL PASS TOTAL FAIL JANUARY 20 9 3 6 5 4 FEBRUARY 10 17 4 11 17 0 MARCH 24 25 10 10 23 2 MARCH 28 61 N/A 49 12 APRIL 14 27 8 10 24 3 MAY 11 11 N/A 11 0 MAY 12 9 3 0 8 1 66. 6% of UB candidates passed the ADEX exam on their first attempt.

WREB/ADEX EXAM # D 4 s RESTOR. PERIO. ENDO. WREB 39 9 9 7 ADEX 61 9 9 9 � Nine candidates challenged both exams. � Only first attempts were considered. � Prosthodontic manikin only part of ADEX. � Student comments most important result in this comparison.

Student Perspective � Presence of faculty helped establish trust between students and examiners. � No need to search for “ideal” lesions. � Flexible scheduling reduced the stress of “all or nothing weekend exam”. � No extracted teeth to mount and radiographs to take. � It felt like a regular day at school.

UB Next Steps � Establish faculty, da, and runner coverage schedule. � Pre-exam chart review. � Treatment plan submitted as part of patient intake. � Move manikin exam to fall semester. � Certify D 3 candidates to challenge at the end of the spring semester.

Next Steps Nationally � Educate the dental community – 2016 ADEA Annual Session – seminars/publications � Pilot The Buffalo Model at other dental schools – CDCA survey. � Standardization of the process to facilitate ease in implementation.

Thank You � Dr. Michael Glick � UB faculty, staff and students � CDCA examiners and staff � ADEX � NYSDA – PGY 1 Task Force � Mr. Michael Zeder � Dr. David Perkins � Dr. Guy Shampaine

questions