The Issue The issues to be resolved in this proceeding concern whether the Petitioner is entitled to received a passing score on the June 2001 Dental Licensure Examination.
Findings Of Fact The Petitioner sat for the Dental Licensure Examination of June 2001. He failed to pass the clinical section of that examination and thus became an unsuccessful candidate for licensure. The June 2001 Dental Licensure Examination (Examination) consists of two parts, a clinical portion and a law and rules section. The clinical portion consists of nine procedures. The Petitioner challenged four of the nine procedures. The Department selects three examiners to independently grade each candidate's performance. The average of the three examiners' independent scores for each procedure produces the overall grade for that procedure under the Department's scoring methodology. The average grade for each procedure is then weighted pursuant to the requirements of Rule 64B5-2.013, Florida Administrative Code, which produces the overall score for the entire clinical examination. The Department allows for three examiner scores, rather than only one examiner scoring each procedure, because it provides a more reliable indication of the candidate's competency and a more accurate score. Each examiner must be a licensed dentist for a minimum of five years before becoming an examiner and must have no complaints or disciplinary actions recorded against his license. The examiners have no contact with the candidate and therefore have no knowledge of the identity of the person whose examination they are grading. Each examiner must attend and successfully complete a standardization session or course as well. This is designed to train each examiner to use the same internal grading criteria. In standardization, the examiners are taught specific grading criteria, which instruct them on how to evaluate the work of candidates. The examiners are accorded identity numbers for use in the examination and grading process. The examiners who graded the Petitioner's examination were examiners numbered 364, 083, 316, 366, 117, and 299. All of them successfully completed the above-described standardization session or course. The Petitioner contested the score he received on the Class II composite restoration procedure. He claims that the Department's instructions, as to the use of a dye material in the amalgam material used to fill a tooth, conflicted with the manufacturer's instructions, that is, the manufacturer of the restoration amalgam material and/or dye material. The Class II composite restoration procedure of the examination is a procedure involving the candidates' ability to fill an opening inside a tooth with a composite resin material which produces a "tooth colored" filling. This procedure also involves replacing a portion of the tooth. Based on the examiners' comments and grades, as well as the testimony of Dr. Charles Ross, the Petitioner failed to properly perform this procedure. The Respondent's expert witnesses Dr. Charles Ross, a licensed dentist practicing for 32 years, as well as Marsha Carnes, a psychometrician employed by the Department, explained that due to security reasons and fairness considerations, all candidates were instructed to place the dye material in the composite. All candidates thus had to contend with the use of the dye material and none was exempted from it. Dr. Ross has had over 12 years' experience working with the Dental Licensure Examination and has examined well over 1000 dental candidates. He established that, as to the manufacturer's instructions, candidates are not graded on a specific name brand material. Candidates are graded on their technique and how well they perform the required criteria. Therefore the manufacturer's instructions are not considered for grading purposes because no two manufacturers, or the materials they produce, are the same. Dr. Ross also established that the dye did not hamper the Petitioner's ability to perform this procedure. In fact, the Petitioner received a passing grade of 3.33 on the Class II composite restoration procedure. The Petitioner's Exhibit One does not support the Petitioner's argument that "the Department contravened the manufacturer's instructions as to the use of dye material." On the contrary, the Petitioner agreed that there are numerous manufacturers of dye material and how they use their materials varies from one manufacturer to another. The Petitioner contested the score he received on the Class II Amalgam preparation procedure claiming that since only one of the three examiners found caries (decay) in his preparation and the other two examiners did not comment on having seen caries, that this is an example of inconsistent grading. The Petitioner acknowledged that he still had caries in his preparation when he completed a "monitor to examiner note." In this note, which is permitted under the examination procedures, the Petitioner requested to "extend his preparation beyond ideal" in order to clear away remaining decay. He presented this note to the monitor of the examination who then, without revealing the candidate's identity, gave the note to the examiner for approval or disapproval. The monitor to examiner notes are used by a candidate to convey a message to the examiner through the monitor. The monitor, who is also a licensed dentist, does not render any grading. The monitor acts merely as a "messenger" between the candidate and the examiner, who must not know each other's identity. Although the monitor agreed with the Petitioner that decay remained, the monitor disagreed that the Petitioner needed to "extend his preparation beyond ideal." The monitor indicated his agreement by circling his identification number (318) and his disagreement by not circling his identification number. In other words, he agreed that decay was present but disagreed that the Petitioner needed to extend his preparation or the size or configuration of the "box" where the filling would ultimately be placed. The patient amalgam preparation procedure of the examination is a procedure that requires candidates to completely remove a caries lesion or decay from a section of tooth. Based on the examiners' comments and grades and the testimony of Dr. Ross and Dr. Jeffrey Metcalf, the Petitioner did not properly perform this procedure. Dr. Metcalf stated that he gave the Petitioner a grade of "1" for the patient amalgam preparation procedure because the Petitioner's "proximal box" had a very thin wall of enamel or severe undermining. This thin wall, according to Dr. Metcalf, will eventually crack and fracture upon pressure as the patient chews food or grinds his or her teeth. Although Dr. Metcalf saw the Petitioner's monitor note regarding decay, it had very little effect on how he graded the Petitioner. Dr. Ross established that the Petitioner had removed too much or more than enough dentin from the tooth on the Class II amalgam preparation procedure. The presence of adequate dentin is critical to provide a foundation or support for the enamel. Enamel must be attached to dentin, the bulkiest portion of the tooth, otherwise, the enamel will fracture. Concerning the caries, Dr. Ross established that caries may start out large and then the candidate removes caries until it appears as the size of a small dot. Upon Examiner 117's discovery of the caries, while simultaneously using the explorer (probe or pick) to "feel" for the caries, his instrument could have removed the small portion of the carious lesion remaining. Depending on the order in which each examiner graded the Petitioner on this procedure (not of record) it is possible that the next two examiners did not see the caries, if the first examiner through his probing with the tool had removed the caries by removing the discolored area it consisted of. Moreover, Dr. Ross established that even if Examiner 117 was not the first examiner to grade the preparation, the other examiners may have focused on other specific areas of the Petitioner's preparation and simply may not have detected the caries. This is not an unusual occurrence among examiners. Thus the fact that two of them did not record seeing the caries does not mean that they were not present. The psychometrician, Marsha Carnes, testifying as an expert in that area for the Department, explained that based on the monitor sheet, Examiner 117 specifically requested the Petitioner to "deepen the axial gingival line angle of the proximal box." In other words, Examiner 117, through the monitor, requested the Petitioner to remove the decay. The Petitioner acknowledged that he had caries by generating the monitor note in which he requested the authorization to "extend his preparation" in order to remove the caries. Both Dr. Ross and Ms. Carnes explained that examiners commonly "bubble-in" different comments for the same procedure. This is not unusual and is sometimes beneficial to the candidate. Further, when examiners grade an examination they grade holistically. In other words, they do not deduct points for different comments. Instead, examiners consider the model or the patient as a whole and render a grade based on what they learned in their standardization training. When three examiners observe the same model or patient procedure, it is expected that three people will render grades for different reasons. Further, if they render a grade of "2," "1," or "0" for the patient procedures, examiners are required to go a step further by completing a grade documentation sheet. Although the Petitioner's main focus on the Class II amalgam preparation led to lengthy testimony and argument on the caries issue, caries did not unilaterally determine the overall grade. The Petitioner's overall grade is a combination of all of the individual grades he received for all nine clinical procedures. Moreover, the "0" grade was not the only failing grade the Petitioner received on the Class II amalgam preparation. The Petitioner also received a grade of "1" from Examiner 366 for the same procedure. The Petitioner also contested the score he received on the preparation for a three-unit, fixed, partial denture procedure, claiming that he could not find the undercut as indicated by one of the examiner's comments. The preparation for a three-unit, fixed, partial denture procedure of the examination is a procedure that involves the candidate's ability to provide preparation of two teeth in order to replace a missing tooth with a fixed bridge. Based on the examiners' comments and grades and the testimony of Dr. Ross, the Petitioner failed to properly perform this procedure. Dr. Ross established that the Petitioner's work on this procedure resulted in one tooth, the cuspid, being slightly tilted away from the bicuspid. It is impossible to place a bridge on an improper preparation. Dr. Ross further stated that the Petitioner had a problem with this procedure because of the Petitioner's undercut. The undercut indicated that the Petitioner's preparation was not properly aligned to accept a bridge. Additionally, the Department's expert psychometrician witness, Ms. Carnes, explained that it is common for examiners to give identical grades, yet write down different comments on the same procedure. That does not mean an examiner has made a mistake. While they use the same grading criteria, examiners occasionally see different errors. The Petitioner has contested the score he received on the Endodontic procedure as well. An Endodontic procedure also known as a "root canal," involves removal of infected nerve tissue and blood vessels and pulp from a tooth. The candidate is required to access the canal and pulp tissue from the outside. He must then remove the affected nerve and cleanse the canal. Finally, the canal must be sealed to prevent recurring bacteria inside the tooth. In consideration of the examiners' comments and grades and the expert testimony of Dr. Ross, the Respondent has established that the Petitioner did not properly perform that procedure. Dr. Ross opined that the Petitioner failed to properly fill the canal. The Petitioner's access to the canal was not straight. Instead the Petitioner's access to the canal removed too much of the tooth on one side which resulted in weakening the structure of the tooth. This would cause the tooth to eventually fracture. Additionally, the Petitioner's gutta percha material (rubber-like material) was improperly left inside the chamber reamed out in the tooth in the root canal and nerve removal process. When a core is placed inside that chamber the gutta percha material left under it in the chamber can flex or move, which will force the core to move when the patient applies pressure, as, for instance, by chewing. Finally, the Petitioner failed to adequately seal the apical end of the root canal at the apex of the canal space or a maximum of one millimeter above the apex. The Department allows for a "re-grade" process. The purpose of the regrading process is to give all candidates who request a re-grade another chance at passing the examination. In other words the Department thus seeks to determine whether any grades rendered were inconsistent or inaccurate. The Department selects the top three examiners, who had the highest reliability from that examination, to participate in the re-grading process. The Department's post-standardization statistics of the examiners' performance indicated that the Petitioner's examiners graded reliably. The post-standardization statistics indicate the examiners' performance on grading of models during standardization. Additionally, the Department calculates post- examination statistics, which are as follows for the examiners who graded the Petitioner's challenged procedures: Examiners Accuracy Index & Rating #364 93.1 Very Good #083 95.7 Excellent #316 97.0 Excellent #366 (Metcalf) 94.0 Very Good #117 90.4 Good #299 89.5 Watch All the examiner's reliability was significantly above the minimum acceptable accuracy index of 85.0.
Recommendation Having considered the foregoing Findings of Fact, Conclusions of Law, the evidence of record, the candor and demeanor of the witnesses, and the pleadings and arguments of the parties, it is, therefore, RECOMMENDED that a Final Order be entered by the Board of Dentistry dismissing the Petitioner's challenge to the grades assigned him for the June 2001 Dental Licensure Examination. DONE AND ENTERED this 6th day of June, 2002, in Tallahassee, Leon County, Florida. P. MICHAEL RUFF Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with Clerk of the Division of Administrative Hearings this 6th day of June, 2002. COPIES FURNISHED: Kristian L. Koszeghy 1731 Beacon Street Apartment 1103 Brookline, Massachusetts 02445 Cherry A. Shaw, Esquire Department of Health 4052 Bald Cypress Way Bin A02 Tallahassee, Florida 32399-1703 William H. Buckhalt, Executive Director Department of Health 4052 Bald Cypress Way, Bin C06 Tallahassee, Florida 32399-1701 R. S. Power, Agency Clerk Department of Health 4052 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701
Findings Of Fact Petitioner took the podiatry licensure examination administered by the Respondent in July, 1989, receiving a grade of 70.5%, with 254 correct answers. A score of 75%, with 270 correct answers, is required to pass the examination for licensure. This podiatry examination was developed by the Bureau of Examination Services in conjunction with consultants who served as "item writers", and Florida licensed podiatrists. Five Florida licensed podiatrists selected items written by the various consultants from a bank of questions available for the 1989 examination. Competent substantial evidence was not introduced on behalf of the Petitioner to establish that the examination was in any way flawed in its preparation or method of selecting the actual questions used on this exam. The Petitioner testified that as many as thirty questions in the examination booklet which she received at the exam site had misspellings. The actual question booklets used for the July, 1989, exam were introduced in evidence, but the Petitioner failed to establish, by competent substantial evidence, that there were any significant misspellings in these booklets which would in any way impair the fairness or validity of the examination results. There is a lack of competent substantial evidence in the record to establish that the grades which the Petitioner received on the July, 1989, podiatry licensure examination were incorrect, unfair, or invalid, or that the examination was administered in an arbitrary or capricious manner. The Petitioner totally failed to introduce any evidence which would establish that there were material misspellings in the examination booklets which would impair the validity of the grading results.
Recommendation Based upon the foregoing, it is recommended that Respondent enter a Final Order dismissing the Petitioner's challenge to the grades she received on the July, 1989, podiatry licensure examination. RECOMMENDED this 7th day of May, 1991 in Tallahassee, Florida. DONALD D. CONN Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 Filed with the Clerk of the Division of Administrative Hearings this 7th day of May, 1991. APPENDIX TO RECOMMENDED ORDER, CASE NO. 90-2802 Despite waiting an additional seven days until April 25, 1991, as requested by counsel for the Petitioner in his letter filed on April 19, 1991, no proposed recommended order was filed on behalf of the Petitioner. Rulings on the Respondent's Proposed Findings of Fact: Adopted in Finding 1. Adopted in Findings 2 and 3. Adopted in Finding 3. COPIES FURNISHED: Melvyn G. Greenspahn, Esquire 3550 Biscayne Boulevard Suite 404 Miami, FL 33137 Vytas J. Urba, Esquire Northwood Centre, Suite 60 1940 North Monroe Street Tallahassee, FL 32399-0792 Jack McRay, Esquire Northwood Centre 1940 North Monroe Street Tallahassee, FL 32399-0792 Patricia Guilford Executive Director Board of Podiatry 1940 North Monroe Street Tallahassee, FL 32399-0792
Findings Of Fact Petitioner took the podiatry licensure examination administered by the Respondent in July, 1989, receiving a grade of 61.3%, with 221 correct answers. A score of 75%, with 270 correct answers, is required to pass the examination for licensure. This podiatry examination was developed by the Bureau of Examination Services in conjunction with consultants who served as "item writers", and Florida licensed podiatrists. Five Florida licensed podiatrists selected items written by the various consultants from a bank of questions available for the 1989 examination. Competent substantial evidence was not introduced on behalf of the Petitioner to establish that the examination was in any way flawed in its preparation or method of selecting the actual questions used on this exam. The Petitioner testified that several questions were misspelled in the examination booklet which he received at the exam site. The actual question booklets used for the July, 1989, exam were introduced in evidence, but the Petitioner failed to establish, by competent substantial evidence, that there were any significant misspellings in these booklets which would in any way impair the fairness or validity of the examination results. It is also asserted by the Petitioner that he was given insufficient time to review his examination in order to identify problems in the grading of the examination, and that the review room was cramped and noisy. The review session was conducted on October 24, 1989, and the Petitioner attended. The review session began at 8:30 a.m. and concluded at 1:00 p.m. on that date, and was conducted in the Respondent's office in Tallahassee, Florida. The Petitioner actually began his review at 8:35 a.m., and completed the review and left the review room at 12:52 p.m. Thus, the Petitioner has failed to establish, by competent substantial evidence, that he lacked sufficient time to complete his review, and has also failed to prove by competent substantial evidence that conditions in the review room deprived him of an opportunity to conduct a meaningful review of his exam. There is a lack of competent substantial evidence in the record to establish that the grades which the Petitioner received on the July, 1989, podiatry licensure examination were incorrect, unfair, or invalid, or that the examination, and subsequent review session, were administered in an arbitrary or capricious manner.
Recommendation Based upon the foregoing, it is recommended that Respondent enter a Final Order dismissing the Petitioner's challenge to the grades he received on the July, 1989, podiatry licensure examination. RECOMMENDED this 7th day of May, 1991 in Tallahassee, Florida. DONALD D. CONN Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 Filed with the Clerk of the Division of Administrative Hearings this 7th day of May, 1991. APPENDIX TO RECOMMENDED ORDER, CASE NO. 90-2799 Despite waiting an additional seven days until April 25, 1991, as requested by counsel for the Petitioner in his letter filed on April 19, 1991, no proposed recommended order was filed on behalf of the Petitioner. Rulings on the Respondent's Proposed Findings of Fact: Adopted in Finding 1. Adopted in Findings 2 and 3. Adopted in Finding 3. COPIES FURNISHED: Melvyn G. Greenspahn, Esquire 3550 Biscayne Boulevard Suite 404 Miami, FL 33137 Vytas J. Urba, Esquire Northwood Centre, Suite 60 1940 North Monroe Street Tallahassee, FL 32399-0792 Jack McRay, Esquire Northwood Centre 1940 North Monroe Street Tallahassee, FL 32399-0792 Patricia Guilford Executive Director Board of Podiatry 1940 North Monroe Street Tallahassee, FL 32399-0792
Findings Of Fact Petitioner took the podiatry licensure examination administered by the Respondent in July, 1989, receiving a grade of 66.9%, with 241 correct answers. A score of 75%, with 270 correct answers, is required to pass the examination for licensure. This podiatry examination was developed by the Bureau of Examination Services in conjunction with consultants who served as "item writers", and Florida licensed podiatrists. Five Florida licensed podiatrists selected items written by the various consultants from a bank of questions available for the 1989 examination. Competent substantial evidence was not introduced on behalf of the Petitioner to establish that the examination was in any way flawed in its preparation or method of selecting the actual questions used on this exam. There is a lack of competent substantial evidence in the record to establish that the grades which the Petitioner received on the July, 1989, podiatry licensure examination were incorrect, unfair, or invalid, or that the examination, and subsequent review session, were administered in an arbitrary or capricious manner.
Recommendation Based upon the foregoing, it is recommended that Respondent enter a Final Order dismissing the Petitioner's challenge to the grades he received on the July, 1989, podiatry licensure examination. RECOMMENDED this 7th day of May, 1991 in Tallahassee, Florida. DONALD D. CONN Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 Filed with the Clerk of the Division of Administrative Hearings this 7th day of May, 1991. APPENDIX TO RECOMMENDED ORDER, CASE NO. 90-2803 Despite waiting an additional seven days until April 25, 1991, as requested by counsel for the Petitioner in his letter filed on April 19, 1991, no proposed recommended order was filed on behalf of the Petitioner. Rulings on the Respondent's Proposed Findings of Fact: Adopted in Finding 1. Adopted in Findings 2 and 3. COPIES FURNISHED: Melvyn G. Greenspahn, Esquire 3550 Biscayne Boulevard Suite 404 Miami, FL 33137 Vytas J. Urba, Esquire Northwood Centre, Suite 60 1940 North Monroe Street Tallahassee, FL 32399-0792 Jack McRay, Esquire Northwood Centre 1940 North Monroe Street Tallahassee, FL 32399-0792 Patricia Guilford Executive Director Board of Podiatry 1940 North Monroe Street Tallahassee, FL 32399-0792
