Mr. Chairman, members of the committee, good afternoon. Bonjour. My name is Benoit Soucy. Thank you for inviting me to speak to you today about the licensure process used by Canadian dentistry.
On behalf of the Canadian Dental Association, I will present to you the work done by various components of dentistry to ensure the competency of dentists practising in Canada. Joining me is Robert Lees, the manager of registration at the Royal College of Dental Surgeons of Ontario. I look forward to his assistance and perspective during the question and answer period.
Dentistry is well known for its insistence on the importance of prevention and management of oral diseases. The “bias in favour of prevention” approach is reflected in the way we, as a profession, have approached licensure. To ensure the protection of Canadians seeking dental care, we have put in place a solid four-part process of education, accreditation, certification, and licensure, which guarantees that dentists entering practice in Canada have the training and skills that are needed to deliver safe and effective dental care.
Dental education is delivered at ten universities across Canada in a variety of programs that prepare dentists to meet all the needs of the Canadian population. To support their educational missions, all Canadian dental schools operate dental clinics and research centres, thereby combining in one facility what in medicine is delivered through the faculties of medicine and their academic health science centres.
The Commission on Dental Accreditation of Canada, or CDAC, is responsible for accrediting all Canadian dental and dental hygiene education programs, as well as some of the dental assisting programs. Accreditation is a lengthy, involved, and expensive process that requires regular site visits and considerable expertise. Accreditation provides verification of the quality of the education process.
Certification is the confirmation of the competency of individual applicants for licensure. It is done through the National Dental Examining Board of Canada. The NDEB has a system of examination that is fair and effective and that is recognized as one of the best worldwide.
The last step is licensure, which is the responsibility of the provincial and territorial dental regulatory authorities. All the provincial regulatory authorities for dentistry in Canada accept NDEB certification as the basis for licensure without further testing of qualifications. As a result, all Canadian dentists enjoy full interprovincial labour mobility.
One of the most remarkable features of this four-part process is the absence of any patient-based examination in the certification component. In many parts of the world, this type of examination, despite its many shortcomings, is still seen as essential for the verification of clinical competency. Canadian dentistry has been able to do away with this type of examination by requiring candidates for certification to be graduates of accredited programs and by relying on the confirmed quality of the in-curriculum evaluation.
To facilitate licensure of dentistry outside of Canada, the Commission on Dental Accreditation has been asked to establish mutual recognition agreements with counties that have accreditation systems that can be compared to ours. Graduates of dental programs in countries where MOUs exist are eligible to sit the same certification examination as graduates from accredited programs in Canada. Currently, MOUs have been signed with the United States and Australia, and agreements are being negotiated with New Zealand and Ireland.
While MOUs work well, the number of countries with whom they can be signed is relatively small, and alternative approaches are required to assess the competency of the majority of international applicants. While other occupations use credential assessment services for that purpose, the reality is that for dentistry this avenue is less than promising. Test cases were sent to credential assessment organizations with very disappointing results. Graduates of all test cases were deemed to be equivalent to Canadian grads, despite an enormous variation in the quality of their education. In fact, even graduates from schools with no clinical training at all were given passing marks.
To provide a working alternative, NDEB has been asked by the Canadian Dental Regulatory Authorities Federation to develop, with funding from the federal government, a process to verify the equivalence of dentists trained outside of Canada to graduates from accredited programs. The NDEB equivalency process is brand new and was used for the first time this year. It starts with a voluntary web-based self-assessment designed to allow potential immigrants to gauge their ability to become licensed in Canada before they are committed to moving here. Candidates who choose to seek licensure are assessed on their fundamental knowledge, clinical skills, and clinical judgment in a process that can be completed in less than a year.
Those who successfully complete the three assessments are judged equivalent to graduates from an accredited program and can get licensed in the same fashion. Candidates who fail to complete the equivalency program successfully can apply to a qualifying degree or degree completion program to become eligible to take the certification examination as graduates of an accredited program.
These two-year programs are offered in eight Canadian universities. From 2000 to 2010, they were the only avenue available to dentists from non-accredited programs who wanted to license in Canada. They are our best source of information on the level of preparedness of dentists moving to Canada and showed an immense variation, not only from country to country but in many cases from school to school within the country. Some foreign-trained dentists are essentially at the same level as their Canadian colleagues, while others simply do not even come close to making the grade, even missing some of the prerequisites to enter dental schools in Canada.
The variability is our biggest challenge and the reason a dental degree on its own cannot be taken as confirmation of competency. We either have to have formal knowledge of the educational process through accreditation or we need to test individual candidates in some way.
To wrap up, I would like to thank you again for listening to my remarks. This is a huge policy area and one that has clearly become a priority for this government. I applaud you for consulting with the many groups you will hear from during your hearings, and I encourage you to continue to consult with the Canadian Dental Association on a move forward basis.
We're available to answer any questions you may have.