Predictors of success on the Dental Assisting National Board exam.

Dental assisting is on the threshold of becoming one of the most challenging professions of the 21st Century. Employment is expected to grow much faster than the average for all occupations through the year 2012. In fact, dental assisting is expected to be one of the fastest growing occupations through the year 2012. (1)

The profession of dental assisting is growing in two parallel fashions. The profession is growing in size because of the increasing demand for dental assistants and in depth due to the increased skilled functions dentists are delegating to assistants. The annual number of projected graduating dentists is about half that of the dentists who are retiring. (2) Advances in technology and changes in reimbursement systems have created a competitive atmosphere in dentistry. Dentists are expected to hire more dental assistants to perform more tasks so the dentists can devote their time to more profitable procedures. In addition, numerous job openings will arise due to the need to replace assistants who transfer to other occupations, retire, or leave the labor force for other reasons. (3)

To meet the demands of dental care in the year 2020 dentists must increase their productivity. A dentist's productivity is dependent on their use of technology and the assistance of dental auxiliaries. The routine tasks delegated to dental assistants have become increasingly more complex. Today's dental assistants spend an equivalent amount of time performing intraoral functions as they do assisting the dentist. In addition to performing more intricate procedures it is federally mandated that all dental personnel with occupational exposure to bloodborne pathogens have annual OSHA training.

The complexity of the job of dental assisting has kept up with the demands of dentistry; however, professional credentialing has fallen short. Currently there is no national mandatory education or credentialing requirements for dental assistants. About 30 states require dental assistants to take and pass a written and/or clinical test to expose radiographs. (4) Dental assisting as a profession needs to organize and prepare for the changes brought by the evolution of dentistry. As educators, we have an obligation to prepare tomorrow's professionals for tomorrow's world. (5) Supporting national standards and credentialing for the practice of dental assisting will enhance the growth of the profession by defining its standards. Educators can endeavor to direct the profession of dental assisting from the groundwork up.

A mechanism exists for dental assistants to become certified by the Dental Assisting National Board (DANB). The board is available nationally to graduates of ADA-accredited dental assisting programs and DANB-approved programs or through designated work experience. The American Dental Association (ADA) passed a resolution in 1980 that recognizes DANB as the certification board for dental assisting. DANB submits an annual review to the ADA Council on Dental Education and Licensure (CDEL). The DANB mission is "to promote the public good by providing credentialing services to the dental community."

In allied health professions, success in a discipline is often displayed by the credentials a person has earned by graduating from a program or successfully passing a state or national licensure examination. These measures of success are frequently required by law to be publicly displayed to protect the interest of the consumer. The success of an academic health-related program is often measured by the success rate of passing national examinations.

It is the authors' feeling that a graduate of an accredited dental assisting program should be able to take and pass the DANB exam. DANB certification is value added to the graduate and the credibility of the program. The intrinsic worth of taking the entire exam and becoming a CDA (Certified Dental Assistant), is a costly and intangible value that must be taught to students.

Incentive to sit for the board is generated by the need to pass the Radiation Health and Safety (RHS) portion to fulfill a state requirement to expose radiographs. At this time, students who have been encouraged to take all three will often take all three components. Those who take and fail sections of the board generally do not return to sit for the failed components unless one is the required RHS. If the other sections are not mandatory, students are not likely to retake the board due to the cost of taking the board, the inconvenience of traveling a distance of up to 50 miles to a testing site and the lack of consequences for the failing score. As time progresses and the graduate is more removed from the academic setting, the chances of having interest in the certification diminishes.

The intent of this project was to determine the best predictor of a student's success on the DANB exam. The subject's grade point average, mock board scores, SAT/ACT and college entrance exams were compared.

Literature Review

To date there has been no published research on the predictability of dental assistants passing the DANB. Clarke (6) studied predictor variables for dental assistants to successfully complete the dental assisting program. He determined that high school performance and final GPA were a better predictor of success as measured by graduation status than SAT/ACT test scores, age or prior college. Dental Hygiene is the most closely related discipline that has examined the dental hygiene student's performance on the Dental Hygiene National Board Examination, DHNBE. Edenfield and Hansen (7) examined the relationship between early course average, interim course average and a mock dental hygiene board and the passing rate on the National Board Dental Hygiene Examination. Their findings implied that success on the DHNBE can be estimated by the early course work and the mock board examinations scores. It is recommended that this information be used for early intervention of at-risk students. Dadian et al. (8) found that the use of a mock board for dental hygiene students more accurately identified students who were not at risk rather than identifying those at risk. More importantly their findings emphasize that failure on a mock board does not guarantee failure on the DHNBE.

Miller (9) examined whether the two admissions criteria, Scholastic Aptitude Test (SAT) and high school class ranking could be used to predict a student's success on the American Registry of Radiologic Technologists Examination (ARRT). This study indicated a highly significant correlation between these variables and passing ARRT performance. Students in the upper 25 percent of their high school rank had a 100 percent passing rate on the ARRT and those who had a combined SAT of 800 or greater passed the registry exam.

The majority of related literature on predictive validity studies in allied health care has been done in the area on nursing education. Most of these studies have focused on grade point average and a second dependent variable that demonstrated predictive validity for graduates passing the National Council Licensure Examination (NCLEX).

The dependent variable used with grade point average has been: overall grade point average, Whitley, Chadwick; (10) grade point average and science classes, Crane, Wright, Michael (11) and Glick, McClelland, Yang; (12,13) grade point average and nursing theory courses, Yocum, Scherubel, (14) Payne, Duffey, (15) Froman, Owen, (16) and Heupel; (17) grade point average and early course work, Jenks, Selekman, Pohlman, Becker; (18) and grade point average at the end of the junior year, Mills, Sampel, Pohlman, Becket (19) and Jenks, Selekman, Boss, Paquet. (20)

Other studies looked at language and grade point average: Washington, Perke; (21) the use of a review course, Siktberg, Dillard; (22) pre-entrance scores on standardized tests, McKinney, Small, O'Dell, Coonrod; (23) race and the National League of Nursing achievement test (NLN), Horns, O'Sullivan, Gorman; (24) and self-predictive scores and anxiety, Poorman, Martin. (25)

Method and Results

The intent of this project was to determine what was the best predictor of a student's success on the DANB exam. The participants included 23 students from the 2002 and 2003 classes of the Indiana University South Bend Dental Assisting Program. Candidate predictors were the subjects' cumulative GPA, mock board scores, SAT or ACT scores or college entrance exams. Because of missing data, the SAT and/or ACT scores were not used in the analyses.

A mock board examination was administered the first week of class of the spring semester. This was the student's second and final semester. The mock board examination was modeled in length and content to imitate the DANB. The original purpose of the mock board examination was to prepare the students for the DANB exam by giving them a test that was similar in content, length, and time. The scores were used to motivate the students to study, point out areas of weakness and provide the basis for review sessions for the board.

In the spring of both years the students took the DANB exam. Two students from the class of 2002 took the exam via computer rather than pencil and paper. Students' mock board scores and cumulative GPA in dental assisting were compared to the final DANB scores to determine which was the best predictor for success on the national board.

Because the sample size was small, the exploratory analyses started by looking at the simple correlations among the variables collected. The means, standard deviations, and correlations are presented in Table 1. There are moderate correlations between each of the mock board examination scores and the respective DANB scores.

Regression analyses were used to create prediction equations for each of the three DANB scores. Because the mock board examination used is not widely available, we will not present the unstandardized regression equations. Both GPA and the matching mock board were significant predictors of the ICE portion of the DANB. Only GPA was a significant predictor of the RHS portion of the exam; the matching mock board was not significant. Only GPA was a significant predictor of the GC portion of the exam; the matching mock board was not significant. Thus, for our three regression equations, GPA was a significant predictor of all of the DANB subscores; the matching mock board examination was only a significant predictor for one of the DANB subscores, the ICE subscore. We believe that it is very possible that with a larger sample size that all three mock board examinations scores would be significant predictors of the matching DANB subscores.

Discussion

Dental assisting is regarded as a profession; it has professional standards, However, the professional standards are not nationally enforced. Educators have the opportunity to impact the values of the profession from the bottom up by preparing and encouraging dental assisting students to take the DANB exam.

This study sought to determine the best predictor of success. The two variables examined were the students' GPA in the dental assisting program and the mock board. The findings demonstrated that students' GPA was the best predictor of success on DANB for the General Chairside and Radiation Health and Safety sections, and the mock board was the best predictor for the section on Infection Control. General Chairside dental assisting and Radiology are the two primary areas of skills required for a dental assistant. Students are motivated to do well in these courses because failure would interrupt their progression in the curriculum. Students' GPA in these more structured and rigorous classes was a predictor for success on the exam. At the time of the mock board, the students were just beginning their clinical rotations and application of chairside and radiology skills. Plausibly, the knowledge without the application made the mock board a poor predictor of the final results. Infection control is integrated into the entire curriculum and all clinical and lab skills. This interdisciplinary approach to infection control gives students an early opportunity to learn and apply these concepts. This may account for the mock board scores having greater predictive value on the DANB scores.

The use of a dental assisting mock board can identify areas that students are weak in, and serve as a motivator for students to study. The students taking the dental assisting mock board found the experience helpful because it strengthened their ability to sit for a long test and re-enforced their test taking skills.

Graduates of a dental assisting program, who have worked hard with focused aspirations, are highly motivated and well-prepared candidates to take the DANB exam and enjoy the benefits of being a Certified Dental Assistant.

Table 1: Means, Standard Deviations, and Correlations Among
Variables in Study.

              gpa      ice2     icedanb    rhs2

gpa           --
ice2         0.36       --
icedanb      0.604     0.716      --
rhs2         0.419     0.494     0.42       --
rhsdanb      0.565     0.657     0.645     0.473
gc2          0.427     0.339     0.414     0.732
gcdanb       0.668     0.537     0.611     0.601
               *         *         *         *
Mean         2.94      76.05    464.48     66.17
Standard      0.5      8.49      42.34     14.96
Deviation
N             23        20        23        23

            rhsdanb     gc2     gcdanb

gpa
ice2
icedanb
rhs2
rhsdanb       --
gc2          0.391      --
gcdanb       0.639     0.52       --
               *         *         *
Mean        455.65     72.96    423.65
Standard     52.08     10.77     47.31
Deviation
N             23        23        23

References

(1.) Bureau of Labor Statistics, U.S. Dept of Labor, Occupational outlook handbook, 2004-05 Ed, Dental Assistants on the internet at http://www.bls.gov/oco/ocos163.htm.

(2.) Future of dentistry--executive summary. Chicago: American Dental Association, Health Policy Resources Center; 2002.

(3.) Ibid. 1

(4.) Survey of legal provisions for delegating intraoral functions to chairside assistants and dental hygienists. Chicago: American Dental Association, Draft 2002.

(5.) Rettie LL. The future of allied health in higher education: where does it belong. J Dent Edu 1993;57(8):623-5.

(6.) Clarke RG. Predicting the success of dental assisting students. Dent Assist 1984;53(6):17-20.

(7.) Edenfield SM, Hansen JR. Relationships among dental hygiene course grades, a mock board dental hygiene examination and the national dental hygiene examination. J Dent Hyg 2000;74(11):124-9.

(8.) Dadian T, Guerink MA, Olney C, Littlefield J. The effectiveness of a mock board experience in coaching students for the dental hygiene national board examination. J Dent Edu 2002;66 (5):643-8.

(9.) Miller AC. Indicators of potential success among radiography students. Radiol Technol 1993;64(3):373-6.

(10.) Whitley MP, Chadwick PL. Baccalaureate education and NCLEX: the causes of success. J Nurs Edu 1986; 25(3):94-101.

(11.) Crane P, Wright CR, Michael WB. School-related variables as predictors of achievement on National Council Licensure Examination (NCLEX-RN) for a sample of 418 students enrolled in a diploma nursing program. Edu & Psychol Measure 1987;47:1055-69.

(12.) Glick OJ, McClelland E, Yang JC. NCLEX-RN: predicting the performance of graduates of an integrated baccalaureate nursing program. J Profes Nurs 1986;2(2):98-103.

(13.) McClelland E, Yang JC, Glick OJ. A statewide study of academic variables affecting performance of baccalaureate nursing graduates on licensure examination. J Profes Nurs 1992;8(6):342-50.

(14.) Yocom CJ, Scherubel JC. Selected pre-admission and academic correlates of success on state board examinations. J Nurs Edu 1985;24(6): 244-9.

(15.) Payne MA, Duffey MA. An investigation of the predictability of NCLEX scores of BSN graduates using academic predictors. J Profes Nuts 1986 2(5):326-32.

(16.) Froman RD, Owen SV. Predicting performance on the National Council Licensure Examination. West J Nurs Res 1989; 11(3):334-6.

(17.) Huepel, CA. Model for intervention and predicting success on the national council licensure examination for registered nurses. J Profes Nurs 1989;10:112-7.

(18.) Jenks J, Selekman J, Bross T, Paquet M. Success in NCLEX-RN: identifying predictors and optimal timing for intervention. J Nurs Edu 1989; 28(3):112-8.

(19.) Mills AC, Sampel ME, Pohlman VC, Becker AM. The odds for success on NCLEX-RN by nurse candidates from a four-year baccalaureate nursing program. J Nurs Edu 1992;31(9):403-8.

(20.) Jenks J, Selekman J, Bross T, Paquet M. Success in NCLEX-RN: Identifying predictors and optimal timing for intervention. J Nurs Edu 1989;28(3):112-8

(21.) Washington LJ, Perkel L. NCLEX-RN strategies for success: a private university's experience. ABNF J 2001;12(1):12-6.

(22.) Siktberg LL, Dillard NL. Assisting at-risk students in preparing for NCLEX-RN. Nurs Edu 2001; 26(3): 150-2.

(23.) McKinney J, Small S, O'Dell N, Coonrod BA. Identification of predictors of success for the NCLEX and students at risk for NCLEX failure in a baccalaureate nursing program. J Profes Nurs 1988;4(1):55-9.

(24.) Horns PN, O'Sullivan P, Goodman R. The use of progressive indicators as predictors of NCLEX-RN success and performance of BSN graduates. J Nurs Edu 1991;30(1):9-14.

(25.) Poorman SG, Martin EJ. The role of nonacademic variables in passing the National Council Licensure Examination. J Profes Nurs 1991; 7(1): 25-32.

Barbara MacMillan, CDA, RDH, MS, is an Assistant Professor in Dental Education at Indiana University South Bend.

Frank Fujita, Ph.D., is an Associate Professor/Program Director in Psychology at Indiana University South Bend.