accreditation process as well as in critiques of the dental schools themselves. The argument is that if accreditation were ensuring a basic level of quality overall, failure rates should be lower in general and no school should see half or more of its licensure applicants failing regional clinical examinations. This argument assumes the validity and reliability of the licensure examinations, which are questioned later in this chapter.

Of the 54 dental schools, 53 are accredited without qualification. As noted earlier, detailed accreditation results are not published. Committee members—based on their own involvement in the process—seconded complaints made during site visits and other meetings that substandard programs were allowed to continue despite identified (but not public) deficiencies that are both serious and persistent. The CDA does not encourage closure of schools that do not improve, arguing that such a strategy would be "contrary to the spirit of accreditation" (CDA, 1993b, p. 5). This position is consistent with the commission's mission statement and with the models of continuous quality improvement now widely endorsed (if not successfully applied) in U.S. industry and health care. Such a position is, arguably, inconsistent with enforcing a minimum standard of quality to protect students and the public generally, a process that may require more decisive action for institutions with persistent problems.

Cost and Benefit

Overall, critics of the current accreditation process argue that its costs in time, money, and aggravation are excessive for its positive results. The aggravation factor is highlighted colorfully in the remark that "we will not make it into the 21st Century without killing each other off unless ... we find the correct manner to re-look at accreditation" (Formicola, 1993, p. 214). The cost of the process is indicated by an estimate from the dental school of the University of Maryland that the direct and indirect costs of its 1981 site visit exceeded $200,000 (Linthicum and Moreland, 1981).

The Commission on Dental Accreditation recognizes that the accreditation process makes heavy demands on institutions, and this committee commends its efforts to streamline the process and reduce its costs. The organization hopes to increase the use of electronic data transfer to collect information more quickly and inexpensively. The commission also is helping to develop materials that individual schools can use in assessing student competency and outcomes.

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