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Review of the Equivalency Process for Graduates from Non-Accredited Dental Programs

Dr. James Richardson

Vision 2022: The Future of the NDEB Equivalency Process

In 2019, the National Dental Examining Board of Canada (NDEB), as part of its five-year strategic plan, committed to undertake an evaluation of the existing Equivalency Process for graduates of non-accredited dental programs. This review was intended to identify strengths and potential areas for modifications in the evaluation of international dental graduates who are seeking licensure in Canada.

The NDEB previously examined the blueprint for the Equivalency Process in 2016 after completing a national study to identify and measure the knowledge, skills, and abilities (KSAs) required for entry to dental practice in Canada. Using the results of this analysis, NDEB examiners reviewed the blueprints for each of the examinations in the Equivalency Process; the Assessment of Fundamental Knowledge (AFK), the Assessment of Clinical Skills (ACS), and the Assessment of Clinical Judgment (ACJ) and recommended a series of changes the Board.

Over the last year, the NDEB has considered these recommendations, the 2019 evaluation for the Equivalency Process, and consulted with many of its stakeholders. The result is a multi-stage plan to modify the Equivalency Process while preserving the fairness, validity and reliability of its examinations.

The first step relates to the total number of questions on the AFK. The AFK is currently a 300 question multiple-choice examination. After thorough investigation, independent psychometric consultants have recommended that the number of questions on the examination could be reduced while still maintaining strong validity and reliability. Therefore, beginning in 2021 the AFK will be comprised of 200 questions. The examination will continue to be administered electronically.

The second step is an update to eligibility for the examinations in the Equivalency Process. Currently, examinees who are successful in the AFK are then eligible to take both the ACJ and the ACS at the same time or in the order of their choosing. Beginning in 2022, the eligibility will become sequential. Participants who successfully complete the AFK will first be eligible to take the ACJ. Once successful in the ACJ, examinees will be eligible to sit the ACS. This change is being made to align the testing with the principle that individuals must demonstrate that they have clinical judgement prior to performing technical skills on patients, especially irreversible dental procedures.

The third step involves the ACS. Currently, the ACS can be taken a maximum of three times. Examinees can fail one of 12 requirements and still pass the examination. In the updated Equivalency Process model, an examinee will be able to take the new ACS an unlimited number of times. However, they will not be permitted to fail any requirements. This is a significant change from the existing structure. The new ACS will introduce new requirements that will test skills required for general practitioner dentists. The NDEB expects this new ACS to be in place in 2022.

The NDEB will spend the coming months updating its By-laws and developing the processes for applying the new eligibility criteria.

Finally, the NDEB is excited to announce that it is beginning the construction of an in-house ACS testing facility in Ottawa, Ontario. The development of the NDEB ACS facility will have many benefits. Primarily it will allow the NDEB to administer the new ACS in a controlled purpose-built testing environment on a regular basis throughout the year, reducing scheduling bottlenecks while increasing capacity for this examination. For examinees, it provides greater scheduling flexibility, a consistent testing experience, and an overall lower stress environment. The NDEB is projecting to open the facility in time to offer the new ACS in 2022.

The NDEB has garnered significant support for the Equivalency Process changes from its stakeholders and is confident these changes will continue its ability to conduct fair, valid, and reliable assessments of competence for beginning dental practitioners in Canada.

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team

Full Conversation (13.48")


  1. NK March 31, 2021

    Thank you for sharing!

  2. Suha Babiker April 3, 2021

    Thanks for sharing. I have a suggestion regarding the proposed new ACS to make it more representative of what is expected from Canadian dentist skillwise. Let a number of Canadian schools graduates sit for the ACS and see how they do. Maybe choose a fresh graduate, a dentist who graduated years ago and maybe a specialist. This will be like a small study to see if this assessment produces dentists who are equal to graduates of accredited programs. Who knows maybe the ACS is too strict or maybe it is lacking in some aspects. This will be a good gauge that might help fine tune the ACS and all the other assessmens as a matter of fact.
    Thanks again.

    1. Richa Mehra April 8, 2021

      That’s a great and smart thought. I think this should be taken into consideration asap.

  3. Kalal Derhami April 9, 2021

    Speaking as an NDEB qualified dentist, I believe strongly that Canada needs to have well-qualified foreign-trained dentists to work in Canada. What I cannot understand is why we are over flooding the urban markets with more dentists when there are numerous dental clinics on every corner of our big cities and there are debilitating shortages of support staff in every sector of our industry, such as assistants, receptionists, and hygienists. Wouldn’t it serve our membership better if our organizations spent their time and effort on finding ways to increase support staff rather than making the situation worse for the ones that are already practicing? wouldn’t it serve our membership and our smaller hard-to-reach communities better if the foreign-trained dentists are mandated to initially work in communities that lack dental services? and wouldn’t it serve the foreign-trained dentists better if for those who are willing to work in remote towns a more reasonable path for certification is designed?


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