Issues and Debates

The criticisms of dental school accreditation are both substantive and procedural (see, for example, AADS, 1993c; Hutchison, 1993; Pew Health Professions Commission, 1993; ten Pas, 1993). In the committee's survey, a majority of dental school deans expressed concern that government regulatory agencies or other outside forces were influencing the accreditation process or affecting the independence of the CDA. In addition, 14 disagreed and 12 were neutral on the statement that the current process helps ensure entry-level competency. Ten deans did not agree that candidates for state licensure should be graduates of accredited programs.

Accreditation has been such a significant concern to dental educators that the AADS has planned a major study of accreditation (House of Delegates Resolution 24-93-H). Nonetheless, as critical as dental educators have been of aspects of the accreditation process, it is important to note that the AADS itself has conceded that "if one were to start over to design an accrediting body for dental education, . . the basic features of that accrediting body . . . might not be all that dissimilar from what exists currently" (AADS, 1993c, p. 27). Even a purely internal program of quality assurance and improvement would make many similar demands on schools for information, analysis, and faculty participation.

The Commission on Dental Accreditation has, in recent years, made numerous changes in its processes and standards. It has, for example, shifted the accreditation cycle from ten to seven years. The organization has been recognized for its efforts by USDOE, particularly in the area of calibrating its processes, committees, and consultants.

Effectiveness and Quality

A major issue in the debate about accreditation is the lack of evidence that it is effective in identifying substandard schools or improving educational quality and, concomitantly, that it protects students from deficient education or the public from deficient dental care. The problem of evidence has at least two parts: (1) linking educational programs to outcomes, in particular, competency of graduates, and (2) identifying educational processes, methods, or structures (e.g., faculty organization, data systems, accounting procedures) that are desirable in and of themselves.

The high rates of failure on regional examinations, cited below in the discussion of licensure, are invoked in critiques of the



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