Orthodontic programs incentivize board exam as the ‘gold standard’

The revised criterion allows new orthodontists to sit for the boards earlier in their careers, and many graduate programs and residents are taking advantage of this opportunity.

The ABO wants dental students who are considering becoming orthodontic specialists to make informed decisions. By soliciting orthodontic graduate programs across the country, the ABO has put together a survey of the strategies and practices many programs are offering to encourage students to take the boards.

“ABO certification establishes a format to allow graduates to objectively assess their clinical outcomes as well as provides a measuring gauge to assess future clinical outcomes as lifelong learners,” says Richard Kulbersh, DMD, MS, professor, chairman and program director at the University of Detroit, Michigan. “In addition, the ABO is the only orthodontic organization that has instituted a program for future recertification. And, I believe that future certification and recertification will be a requirement for all specialties in the near future.”

Here’s a sampling of some creative ways schools are encouraging their students:

At Louisiana State University, the Department of Orthodontics introduced the Pay It Forward Program in 2014. Through this program, the Dr. J.M. Chadha Orthodontic Educational Foundation, which is supported by alumni donations, reimburses recent LSU graduates for the fees associated with the Clinical Examination, which are presently $1,875.

“We only ask that they (the graduates) consider donating at least a like amount over their careers back to the foundation so that future graduates have the same opportunity,” Hector Maldonado, DDS, clinical associate professor of orthodontics, says.

The Pay It Forward Program is also designed to streamline the reimbursement process.

“Through the cooperation of the staff at the ABO, we even have an agreement where the ABO will bill the foundation for the exam fees automatically and not the registrant,” says Maldonado, who is the secretary-treasurer of the foundation.

When the foundation introduced the program, it extended the offer not only to the 2014 graduating class but also to the 2013 graduates, who were still eligible to take the clinical examination. This was good news for Merrell Irby, DDS, who graduated in 2013. Irby wanted to take the clinical examination immediately after graduation but could not afford the exam fees at that time. Later, when she had the financial means, the examination coincided with her wedding. She then registered for the September 2015 exam, her last opportunity to present residency cases. Soon after, the foundation informed her that she qualified for the Pay It Forward program, a welcome turn of events.

“All and all, it’s a great change,” says Irby. “I encourage [the residents] to go as soon as possible.”

During the exam, Irby presented six cases, all from residency. Looking back on the experience, Irby appreciates the steps faculty members took to prepare her for the examination. Every day, the LSU residents attend a seminar session to review cases, she said. Prior to graduation, the residents also participate in a mock board exam, where they now have to present three completed cases.

“We are hoping they can take these same cases and use them on the board exam,” says Maldonado, who also noted that if a recent graduate does not present all six of the required cases during the clinical examination, they can bank a minimum of three cases and submit the remainder of their cases to the ABO within 10 years.

Each graduating class has four residents, and, to date, three recent graduates have used the program. “Dr. J.M. Chadha, the founder of the department, and Dr. Paul Armbruster, the current chair, have always been adamant about pursuing board certification,” Maldonado says. “It’s the culture around the orthodontic department. We’re trying to make it as easy as possible. This new program encourages them to get it done before they get caught up in their lives post-graduation.”

At Arizona School of Dentistry & Oral Health, orthodontic residents in the postgraduate orthodontic program are encouraged to become board certified orthodontists shortly after graduation. The school sees the process of taking the exam as both an opportunity to objectively gauge skills as much as it is an occasion for personal self-reflection.

Last year, all five residents succeeded in achieving this distinction thanks to board certified full-time and part-time faculty members. “They are ‘in-house’ promoters of the certification process and do an excellent job of helping residents prepare their cases,” says John Grubb, DDS, an ABO past president, who is a part of the program’s adjunct faculty and is an invaluable resource for preparing residents for the clinical exam.

“Residency is the time for exposure to numerous materials, methods and philosophies, but there must be a filtering process to ensure that the techniques we teach are sound, evidence-based and not subject to individual bias,” says Jae Hyun Park, DMD, MSD, MS, PhD, diplomate, American Board of Orthodontics, professor and chair, Postgraduate Orthodontic Program, at the Arizona School of Dentistry & Oral Health.

“Many programs require that the written ABO exam be taken during residency, with some requiring a passing grade,” says Park. “The process of preparing board cases allows for self-reflection and a discussion of alternative treatment plans. This self-analysis helps residents to become better clinicians, which will likely be evidenced in the cases presented at recertification.”

Jacksonville University, Brooks Rehabilitation College of Healthcare Sciences, School of Orthodontics stresses the educational value of taking the board exam and bolsters that value with financial help to give all residents the opportunity to take the exam.

Toward the end of the JU orthodontics residency, the program offers financial and logistical support for all residents so they may finish at least six cases that meet the criteria of the ABO initial certification examination. The program also absorbs the written exam registration fee for all 15 residents each year. All new JU ABO-certified graduates are celebrated through a campus-wide press release and recognition on the school's alumni social media outlets.

“From early on, ABO certification is emphasized to our residents,” says Mark Alarbi, DDS, MS, CAGS, diplomate of ABO, associate dean and program director. “Thanks to the meticulous and dedicated effort of faculty and graduating residents to preselect the cases, the consistent support and validation of quality of records, weekly treatment progress seminars, and end of year audits and oral exams, the residents at JU have enjoyed a tremendous success in the past five years in acquiring the status of ABO diplomate through the initial certification process (ICE).”

Like many orthodontic graduate programs, Saint Louis University (SLU) offers a series of review sessions to go over the many topics on the ABO-provided reading list as well as special courses for additional support for students. SLU encourages students to take the board exam by reimbursing the cost of the Written Exam for those students who pass.

When asked about the value of taking the board, Rolf G. Behrents, DDS, MS, PhD, orthodontic program director of the Center for Advanced Dental Education, keeps it simple: “It monitors quality,” he said. “Like the Good Housekeeping Seal of Approval, it shows doctors have engaged in a personal quest to demonstrate the quality of the work they do.”

“We started a unique program at Seton Hill to enhance the ability of our residents to become ABO certified,” says Dan Rinchuse, DMD, MS, MDS, PhD, professor and program director of the graduate program in orthodontics at Seton Hill University for Orthodontics. “Our program is 30 months, but we developed an ‘ABO Case Completion Course,’ which is free for our new graduates that allows them to return as needed for eight more months to complete their resident board cases. So this gives them 38 months to work on board cases. This has been embraced by our residents.”

At University of Iowa, Tom Southard, MS, DDS, MS, professor and head of the Department of Orthodontics, says all orthodontic programs need a chairman who is passionate about the value of the board and dedicated faculty to accompany and instruct residents on how to master the exams. “I look upon the board as an educational experience,” he says.

The program makes certification optional, although close to 90 percent of residents opt in. Southard names two faculty, Steve Marshall, DDS, MS, and Clay Parks, DDS, MS, as instrumental in taking the lead to oversee the program’s residents through the certification process, including individual instruction in the identification of potential ABO-qualifying cases, preparatory exercises for the clinical and written exams, and a mock board exam.

“I’ve read that seventy percent of what you’re ever going to learn as an orthodontist you will learn during your residency. I think another ten percent of what you will ever learn you will learn while preparing for the board.”

(Source: The American Board of Orthodontics)