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   CONTENT AND SCORING

Manikin Procedures - 100 Points

Content Format
  1. Primary Molar Pulpotomy Procedure (#A)
  2. Primary Molar Stainless Steel Crown Placement (#J)
  3. Primary Molar Stainless Steel Crown Preparation (#L)
  4. Primary Molar Class II Composite Restoration (#T)
- Performed on a Manikin
- Time: 6 hours
 

Restorative Procedures - 100 Points 

Content Format

Class II Amalgam Preparation

Class II Amalgam Finished Restoration

                      OR

Class II Composite Preparation

Class II Composite Finished Restoration

                      OR

Class II Composite Slot Preparation 

Class II Composite Slot Finished Restoration

                    AND
 
Class III Composite Preparation 

Class III Composite Finished Restoration 

- Performed on a Patient
- Time: 6 hours
 

SCORING SYSTEM 
The examination scoring system was developed in consultation with three different measurement specialists; the scoring system is criterion-based and was developed using an analytical model. The examination is conjunctive in that its content is divided into separate Parts containing related skill sets and competence must be demonstrated in each one of the Parts. A compensatory scoring system is used within each Part to compute the final score for each Part, as explained below.

Only State Boards of Dentistry are legally authorized to determine standards of competence for licensure in their respective jurisdictions. However, in developing the examination, CRDTS has recommended a score of 75 to be a demonstration of sufficient competence; and participating State Boards of Dentistry have agreed to accept that standard. In order to achieve “CRDTS status” and be eligible for licensure in a participating state, candidates must achieve a score of 75 or more in each Part of the examination.
 
SCORING SYSTEM FOR MANIKIN AND PATIENT-BASED RESTORATIVE PROCEDURES 
CRDTS and other testing agencies have worked together on a national level to draft and refine the performance criteria for each procedure in this examination. For the majority of those criteria, gradations of competence are described across a 4-level rating scale. Those criteria appear in this manual and are the basis of the scoring system. Those four rating levels may be generally described as follows:
 
SATISFACTORY
The treatment is of good to excellent quality, demonstrating competence in clinical judgment, knowledge and skill. The treatment adheres to accepted mechanical and physiological principles permitting the restoration of the tooth to normal health, form and function.
MINIMALLY ACCEPTABLE
The treatment is of acceptable quality, demonstrating competence in clinical judgment, knowledge and skill to be acceptable; however, slight deviations from the mechanical and physiological principles of the satisfactory level exist which do not damage the patient nor significantly shorten the expected life of the restoration.
MARGINALLY SUBSTANDARD
The treatment is of poor quality, demonstrating a significant degree of incompetence in clinical judgment, knowledge or skill of the mechanical and physiological principles of restorative dentistry, which if left unmodified, will cause damage to the patient or substantially shorten the life of the restoration.
CRITICALLY DEFICIENT
The treatment is of unacceptable quality, demonstrating critical areas of incompetence in clinical judgment, knowledge or skill of the mechanical and physiological principles of restorative dentistry. The tooth must be temporized, or the treatment plan must be altered and additional care provided in order to sustain the function of the tooth and the patient’s oral health and well-being.
 
A rating is assigned for each criterion in every procedure by three different examiners evaluating independently. Based on the level at which a criterion is rated by at least two of the three examiners, points may be awarded to the candidate. In any instance that none of the three examiners’ ratings are in agreement, the median score is assigned. However, if any criterion is assigned a rating of critically deficient by two or more of the examiners, no points are awarded for that procedure or for the Examination Part, even though other criteria within that procedure may have been rated as satisfactory. A description of and the number of criteria that are evaluated for the procedures in each of those Parts appears below:
 
MANIKIN EXAMINATION - 100 Points
The manikin-based examination consists of the following:

   Primary Molar Pulpotomy Procedure (#A)                                5 Criteria

Primary Molar Stainless Steel Crown Placement (# J)              7 Criteria

Primary Molar Stainless Steel Crown Preparation (#L)           10 Criteria

Primary Molar Class II Amalgam Restoration (#T)                  8 Criteria

 
RESTORATIVE EXAMINATION - 100 Points
The patient-based Restorative Clinical Examination consists of four procedures as specified below:
 
            Class II Amalgam Preparation                                                 12 Criteria

            Class II Amalgam Finished Restoration                                    8 Criteria*

                                  OR

           Class II Composite Preparation                                                11 Criteria

           Class II Composite Finished Restoration                                   8 Criteria*

                                      OR

          Class II Composite Slot Preparation                                           9 Criteria

          Class II Composite Slot Finished Restoration                            8 Criteria*

                                   AND
 
          Class III Composite Preparation                                                 7 Criteria

          Class III Composite Finished Restoration                                  9 Criteria*

                   * 1 category split into 2 for clarity; scored as 1 criteria

 To compute the score for each individual procedure, the number of points the candidate has earned for each criterion is totaled, divided by the maximum number of possible points for that procedure and the results are multiplied by 100. This computation converts scores for each procedure to a basis of 100 points. Any penalties that may have been assessed during the treatment process are deducted after the total score for the Examination Part has been converted to a basis of 100 points.
If no critical deficiency has been confirmed by the examiners, the total score for each portion of the examination is computed by adding the number of points that the candidate has earned across all procedures in that Part, and that sum is divided by the number of possible points for all procedures in that Part. If a critical deficiency has been confirmed by the examiners, an automatic failure is recorded for both the procedure and the Examination Part.
Although there are two Parts that are scored separately for restorative clinical skills, within each Part a compensatory system is used to compute the final score for that Part, as long as there is no critical deficiency. For both exam parts, the computed score for each procedure is not averaged, but instead is numerically weighted by the ratio of its number of scorable criteria to the total number of scorable criteria in the Part. For example, the Class III Composite Preparation has a total of 7 scorable criteria which represents 28 possible points out of the total of 136 possible points for the Restorative Procedures. If the candidate earned 130 out of 136 possible points for the four Restorative procedures, their final score would be 95.58 points. If any penalties were assessed, the points would be deducted as percentage points from the final score.
 
PENALTY DEDUCTIONS
Throughout the examination, not only clinical performance will be evaluated, but also the candidate’s professional demeanor will be evaluated by Clinic Floor Examiners. A number of consi¬derations will weigh in determining the candidate's final grades and penalties may be assessed for violation of examination standards, as defined within this manual, or for certain procedural errors as described below:
Any of the following may result in a deduction of points from the score of the entire examination Part or dismissal from the exam in any of the clinical procedures:
  1. Violation of universal precautions or infection control; gross asepsis; operating area is grossly unclean, unsanitary or offensive in appearance; failure to dispose of potentially infectious material and clean the operatory after individual examinations
  2. Poor Professional Demeanor--unkempt, unclean, or unprofessional appearance; inconside¬rate or uncooperative with other candidates, examiners or testing site personnel
  3. Poor Patient Management--disregard for patient welfare or comfort; inadequate anesthesia
  4. Improper management of significant history or pathosis
  5. Inappropriate request for extension or modification
  6. Unsatisfactory completion of required modifications
  7. Improper Operator/Patient/Manikin position
  8. Improper record keeping
  9. Improper treatment selection

    Restorative Treatment Section Penalty Points
    1. Penalty points are assessed for Treatment Selections that do not meet the described criteria
    2. 5 penalty points for 1st rejection on either procedure
    3. No additional penalty points deducted for subsequent rejections but an acceptable Treatment Selection must be submitted within the allotted time 
  10. Improper liner placement
  11. Inadequate isolation - The isolation dam is inappropriately applied, torn and/or leaking, resulting in debris, saliva, and/or hemorrhagic leakage in the preparation, rendering the prearation unsuitable for evaluation or the subsequent manipulation of the restorative material.
  12. Administration of anesthesia before approval of Medical History by Clinic Floor examiners
  13. Corroborated errors for Treatment Management criteria on all Restorative Procedures

The following infractions will result in a loss of all points for the entire examination part:
  1. Temporization or failure to complete a finished restoration
  2. Violation of Examination Standards, Rules or Guidelines
  3. Treatment of teeth or surfaces other than those approved or assigned by examiners
  4. Gross damage to an adjacent tooth
  5. Failure to recognize an exposure
  6. Unavoidable mechanical exposure which is poorly managed or irreparable
  7. Unjustified or irreparable mechanical exposure
  8. Critical Lack of Diagnostic/Clinical Judgment Skills – This penalty would be applied when the prognosis of the treatment and.lor the patient's well-being is seriously jeopardized. Examples include but are not limited to: 
    1. Inability to differentiate between caries and a pulpal exposure
    2. Inability to carry out instructions for modifications that any competent practitioner should be able to complete
    3. Failure to recognize the need for a critical alteration of hte preparation beyond the assigned surfaces, such as a fracture of defect that must be eliminated by the extension of the preparation.
The penalties or deficiencies listed above do not imply limitations, since obviously some pro¬ce¬dures will be classified as unsatisfactory for other reasons, or for a combination of several deficiencies. Corroborated errors for the treatment management criteria for each Restorative procedure – Manikin and Patient-based will be deducted as penalty points. If any restorative procedure is unacceptable for completion during the examination, any preparations must be temporized, the patient must be adequately informed of any deficiencies, and a "Follow-up Form" must be completed.
 
Professional Conduct – All substantiated evidence of falsification or intentional misrepresentation of application requirements, collusion, dishonesty, or use of unwarranted assistance during the course of the examination shall automatically result in failure of the entire examination by any candidate.
In addition, there will be no refund of examination fees and that candidate cannot apply for re-examination for one full year from the time of the infraction. Any of the following will result in failure of the entire examination:
  • Falsification or intentional misrepresentation of application requirements
  • Cheating (Candidate will be dismissed immediately);
  • Any candidate demonstrating complete disregard for the oral structures, welfare of the patient and/or complete lack of skill and dexterity to perform the required clinical procedures.
  • Misappropriation of equipment (theft);
  • Receiving unwarranted assistance;
  • Alteration of examination records and/or radiographs
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