Although education at all levels faces financial constraints ranging in severity from routine to critical, dental education faces particular challenges given its relatively high costs and specialized needs. For most schools, financial health will not be achieved through a single grand solution. Rather, some combination of more modest and difficult steps Will be necessary. Schools will need to develop better cost and revenue data if they are to design steps that match their particular problems and characteristics and minimize potential harm to their educational, research, and patient care missions.

Accreditation and Licensure

Accreditation and licensure are components of a broad social strategy to ensure the quality of dental care by protecting the public from poorly trained, incompetent, or unethical dental practitioners. They also account for much of the tension between dental schools and the profession. The dental community has taken important actions to improve licensure and accreditation processes, but further work is needed.

The accreditation process remains too focused on process and too inhospitable to educational innovation. The committee believes that the process tolerates some inferior educational programs, although data to document this are not publicly accessible. Accreditation reform should focus on dental schools with significant deficiencies and reduce the administrative burden on other schools. Improved methods of assessing educational outcomes are as central to achieving accreditation reform as they are to improving predoctoral education, entry-level licensure, and assessment of continued competency. Thus, cooperation and coordination among responsible organizations in each of these arenas should be established to avoid conflicting strategies and costly duplication of effort.

The major deficiencies of dental licensure are concentrated in a few areas: the use of live patients in clinical licensure examinations; variations in the content and relevance of clinical examinations; unreasonable barriers to the movement of dentists and dental hygienists across state lines; practice acts that unreasonably restrict the use of appropriately trained allied dental personnel; and inadequate means of assessing competency after initial licensure. The committee concluded that it is neither practical nor necessary to construct new national systems for licensure and accreditation. A uniform national clinical examination (one that does



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