The Examination Process Evolves
In 1953, with the election of its 34th president, Dwight David Eisenhower, the country entered a period of remarkable calm. Families moved to the suburbs, women transformed themselves from the well-muscled Rosie the Riveter of WWII to a more demur “kinder und kuchen” image, and the tranquilizer Miltown was introduced in 1955 for those who couldn’t make the transition to either the suburbs or the kitchen. For all sorts of reasons, the country entered a period of mellowness.
But not the ABP, which continued its evolution with a wide range of changes throughout the decade. Many focused on the examination process itself: According to a report written by Dr. Maynard Hine, in 1952 the Board determined that the order of examinations would be case reports, accompanied by color photographs, due February 1; written examination to be taken the same month; and oral examination.
In its February 1953 meeting, the Board decided on implementing a practical examination for those candidates whose case reports were accepted and who had passed the written portion. As Dr. Harold J. Leonard, secretary of the board at the time, explained in the Journal of Periodontology, “It has ...become apparent to the Board that the eight case reports plus the written examination and the oral interview and examination before the Board are not enough to screen out those who are mentally agile but manually and technically unfit. The ‘heavy handed that butcher their patients,’ or those so slow as to require twenty or more hours to do the work of three, may not be detected by these tests.” 1
The first clinical examination was held June 25-26 that year at Indiana University School of Dentistry, where Dr. Hine was dean. An all-day written examination was also instituted that year. The Board hoped that the practical exam would test the candidate’s technical proficiency and treatment of patients. It was decided to conduct the oral interview and examination at the same time, thereby eliminated the need for candidates to have yet another meeting with the Board.
Certifying exams were held at Indiana University and patients for the practical component came from the clinic of the University’s dental school. This was actually a two-day process: on the first day the candidate would thoroughly clean the patient’s teeth and on day two the actually surgery would be performed. While some on the Board expressed mixed feelings about the practical exam because of the circumstances under which it was performed, these concerns were overridden by the greater concern that candidates demonstrate their hands-on skills.
Logistically, taking the exam was no easy task for candidates. During the 50s and into the 60s there were few practicing periodontists and most were flooded with patients. Taking time away from their practice to prepare and then actually go through the examination process was extremely difficult for most periodontists.
In matters of periodontal education, a two-year postgraduate educational requirement was adopted at the insistence of the Council of Dental Education of ADA, which wanted to make dental education more similar to that of medical specialties. The ABP was not so enthusiastic about the move, feeling that educational facilities were insufficiently developed to accommodate candidates. At the time six dental schools offered a two-year postgraduate or graduate course in periodontology and several others were known to be giving one-year courses that would soon develop into two-year programs.
“There were few post graduate programs in the 1950s,” says Dr. Robert Reeves. “Most periodontists learned the process through preceptorships.”
Nonetheless, in the fall of 1951 it was decided that persons who submitted applications for the boards after December 31, 1952, must have at least two academic years postgraduate periodontal education and three years of practice devoted primarily to periodontics.
In September 1953 the number of required case reports was also changed, lowered from eight to five (there seems to be no written record of when the number of case reports was increased from three to eight). It was also decided that the examination process would include case reports, written examination, clinical examination, and oral examination.
The demands on the Board were heavy. Noted Dr. H.J. Leonard in an article in the Journal of Periodontology: “The receipt of approximately one hundred and twenty applications between October 1 and January 1, meant the sending out of over a thousand letters to references, etc. in that time. The labor of evaluating educational qualifications for the number is also extremely heavy. Twenty-eight sets of case reports (eight each) have come in by Feb. 1. Each case report required two hours of study, on average, a total of four hundred forty-eight hours.” 2
Travel expenses continued to be a concern and placed pressure on the Board’s treasury. In the fall of 1952 the board increased fees for examinations to $200 and for re-examination of any step, $25.