N. Sue Seale, DDS, MSD
Dallas, TX
QE Subcommittee Member, ABPD
Board certified: 1984


As one privileged to be involved in helping with the American Board of Pediatric Dentistry (ABPD) examination process, I had an interesting question recently. I was asked if I thought the whole exam had been “watered down” and had become too easy. The ABPD has undergone a remarkable metamorphosis over the past 30 years. Its purposes and processes have changed, and recalling some of the history of that change is an important part of answering the question.

The original certification process involved four distinctly different parts and took many years to complete. The first two parts, the written and oral exam, were fairly straightforward, and many pediatric dentists committed to take them. It was the last two parts, the four-case submission and the office visit, that stopped most from finishing. To challenge these two parts, one had to have been in practice long enough to have a developed office site and to gather the four cases with the required follow-up. All these cases needed “perfect” pretreatment and post-treatment radiographs. Following cases acceptance, the final part, the office visit, had to be scheduled within the year. Two examiners spent a half day in your office to observe you treat specified types of patients, read your records, and examine your office for all the required components. The dilemma came with the difficulty of standardization of those “required components” and “subjective assessment” of the acceptability of your records and patient treatment. Add to that the stress and vulnerability of subjecting ones self to such scrutiny, and it is no surprise the number of people who moved past the first two parts to become board certified was limited. 

The outcome was a small group of people who belonged to a fairly exclusive “club” who prided themselves in having made it through. It was accepted that many would fail, and in fact, the exam was expected to discriminate. There was a battlefield of casualties who did not finish certification, and ill will towards the process was common. The purpose of the exam at that time came across as certifying only those individuals who were the best, and the bar was high. No wonder those who passed were proud to be among the select! No wonder they may have developed the feeling that they were better.

Fast forward to the 21st century. Board certification is now required for pediatric dentists to be credentialed to treat children in the hospital, and having hospital privileges is part of how we define ourselves as a specialty. To have an examination process where only the “best” could pass, and where lack of standardization and subjectivity was unavoidably part of the process, would leave “casualties” unable to practice their profession properly. This could have been looked upon as “restraint of trade” and could even have left the ABPD open to legal challenges. 

Today the purpose of the certification process has to be to certify an individual as competent to practice their specialty, not to separate the best from the rest. It is expected that most new graduates will become board certified. It is the responsibility of the program directors to produce individuals who can challenge the ABPD with a successful outcome. It is the standard today that the certification process is routinely assessed for its validity and reliability. All of these things seem to be happening. The numbers are up from a few hundred in 2000 – to over 5,000 in 2016. The examination is now only two parts, a written and a clinical oral examination. A large number of pediatric dentists, both clinicians and academicians, participate in the process of writing and administering the examination. Every examination and all outcomes of both parts are routinely assessed by a psychometrician, and changes are made to ensure their validity to measure what they are intended to measure in a reliable manner.

So, in answer to the question posed to me, no I don’t think the process has gotten easier. I think it has gotten better – it has a better-defined and more contemporary purpose; it is a better and fairer process; it is valid and reliable; it reflects the efforts of a large, diverse group of talented individuals; approximately 85% of those who challenge it are successful. The vast majority of newly certified pediatric dentists take it and most pass. As one who “did it the old way” and feel like I “walked barefoot uphill in the snow”, I am thrilled to see the changes and honored to be part of the process.