The Integrated National Board Dental Examination (INBDE) - David M Waldschmidt, Ph.D.
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
The Integrated National Board Dental Examination (INBDE) David M Waldschmidt, Ph.D. Director, JCNDE and Director, ADA Department of Testing Services April 7, 2021
Overview • Background • The Domain of Dentistry • Core Facts • Results Reporting • Resources and Item Development • Standard Setting • Additional Information and Other Relevant Examinations • Q&A © 2020 Joint Commission on National Dental Examinations, All Rights Reserved 2
How did the INBDE come about? • A convergence of factors led to the INBDE, which was designed to better serve communities of interest by: – Improving test content to make it more appropriate and relevant to the practice of dentistry and contemporary dental education – Improving processes and candidates’ experiences in taking the examination – Better assisting regulatory agencies • Examination content trends and the movement toward integrated content and clinical relevance also were considered. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 3
How did the INBDE come about? • In 2009, the JCNDE appointed a Committee for an Integrated Examination (CIE) to develop and validate a new examination instrument for dentistry that integrates the biomedical, behavioral, and clinical sciences to assess entry level competency in dental practice, to supplant NBDE Part I and Part II. • The Integrated National Board Dental Examination (INBDE) retains the same fundamental purpose as NBDE Part I and Part II – to assist state boards of dentistry in determining qualifications of dentists who seek licensure to practice in the U.S. • The INBDE was designed from the ground up to focus on clinical relevance, within the JCNDE’s “Domain of Dentistry” • The INBDE has relied heavily on subject matter input to inform development, with measurement/psychometric guidance provided by the Department of Testing Services (DTS) • Development and implementation of the INBDE has been an historical undertaking for the JCNDE. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 4
What content is assessed by the INBDE? • The Joint Commission has established 56 “clinical content areas” that represent the tasks entry-level general dentists must be able to perform to practice safely. These content areas are classified into three sections: 1) Diagnosis and Treatment Planning 2) Oral Health Management 3) Practice and Profession • The JCNDE also adapted 10 Foundation Knowledge Areas from medicine, to represent the knowledge, skills, and abilities necessary to perform the aforementioned tasks. • The tasks and foundation knowledge areas together form the “Domain of Dentistry” which represents the basis for INBDE content © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 5
56 Clinical Content Areas © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 6
56 Clinical Content Areas © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 7
56 Clinical Content Areas © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 8
Content Area Percentages © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 9
INBDE Content Specifications INBDE Content by Foundation Knowledge Area # Foundation Knowledge Area Percent Molecular, biochemical, cellular, and systems-level 1 development, structure and function 12.2% Physics and chemistry to explain normal biology and 2 pathobiology 6.8% Physics and chemistry to explain the characteristics and use of 3 technologies and materials 8.0% Principles of genetic, congenital and developmental diseases 4 and conditions and their clinical features to understand patient 10.6% risk Cellular and molecular bases of immune and non-immune host 5 defense mechanisms 9.0% 6 General and disease-specific pathology to assess patient risk 11.8% 7 Biology of microorganisms in physiology and pathology 10.6% 8 Pharmacology 10.6% 9 Behavioral sciences, ethics, and jurisprudence 10.6% 10 Research methodology and analysis, and informatics tools 9.8% © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 10
INBDE Implementation and NBDE Discontinuation Extended through Dec 31, 2020 due to COVID-19 © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 11
INBDE Core Facts • Administration: The INBDE contains 500 questions and requires 1½ days to administer – Administrations occur at Prometric professional testing centers located throughout the US and Canada – *** NEW *** Administrations can occur on non-consecutive days, with the second day of testing occurring within 7 days of the candidate’s first day of testing. – Dental examination fees for 2021 are as follows: • INBDE $750 • NBDE Part II $530 • DLOSCE $800* – Examination regulations are strictly enforced, with corresponding penalties for rule violations (e.g., mandatory wait periods) – Irregularity handling and appeal procedures are described in the INBDE candidate guide, and mirror those present for other examinations of the JCNDE (e.g., NBDE Part II) * Approved by the JCNDE in October 2020, in light of continuing challenges faced by students due to COVID-19 © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 12
INBDE Administration Schedule © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 13
Retest Policy* • Under the JCNDE’s 5 Years/5 Attempts Eligibility Rule, candidates must pass the examination within a) five years of their first attempt or b) five examination attempts, whichever comes first. Subsequent to the fifth year or fifth attempt, candidates may test once every 12 months after their most recent examination attempt. * See INBDE Candidate Guide © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 14
INBDE Results Reporting • Candidate Results: INBDE results are reported as Pass/Fail – Candidates who pass simply receive notification they have passed. – For remediation purposes, candidates who fail are provided with information concerning their performance in the following areas: • Foundation Knowledge Areas (10) • Clinical Content Sections (3) • School Results: Candidate pass/fail status is reported to dental schools through the DTS Hub. Monthly and annual school reports are available through the DTS Hub. – 2020 INBDE Annual Profile Reports for dental programs will be available in the DTS Hub by mid-April 2021 • State Board Results. Candidate pass/fail status is reported to state boards through the DTS Hub – The DTS Hub indicates whether a candidate has met or not met the National Board Dental Examination cognitive skills requirements for dentistry (i.e., no distinction will be made among Part I, Part II, or the INBDE) © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 15
INBDE – Report for Failing Candidates © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 16
INBDE – Report for Failing Candidates © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 17
INBDE – Monthly School Performance Report © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 18
INBDE – Monthly School Performance Report © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 19
INBDE – Annual School Performance Report © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 20
INBDE Resources • The JCNDE website contains a number of useful INBDE-related resources http://ada.org/inbde Resources Related to Examination Content – Foundation Knowledge for the General Dentist – INBDE Test Specifications – INBDE Domain of Dentistry – INBDE Practice Questions – INBDE Item Development Guide – INBDE Technical Report Resources Related to Policy and Timelines – Formal Notice of INBDE Implementation and NBDE Discontinuation • INBDE implementation timeline • Retest policy • Eligibility • Administration © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 21
INBDE Resources – Foundation Knowledge Areas https://www.ada.org/en/jcnde/inbde/test-preparation © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 22
INBDE Item Development • Interested in understanding how INBDE items are written? See the INBDE Item Development Guide! • The INBDE item development guide was drafted to facilitate item development. • This guide is available online (ada.org/inbde) • INBDE Test Construction Team (TCT) members are asked to write clinically relevant, integrated items capable of providing insight as to whether a candidate has the cognitive skills necessary to safely practice entry-level dentistry. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 23
Guiding Principles in INBDE item development • Examination purpose drives all development decisions. • Focus on clinical relevance. • Promote the clinical relevance of the biomedical sciences by placing foundation knowledge areas within the context of clinical content areas. • Increased focus on the general dentist in item writing. • Standardized presentation format and conventions for presenting information. • Direct and concise wording that focuses examinees on the concept tested as opposed to language/item wording. • Increased accuracy, validity, and fairness/sensitivity through a thorough, multi-faceted item development and review process that capitalizes on the unique expertise of the individuals involved. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 24
INBDE Patient Box: Patient Section Patient Section Patient Female, 28 years old. • This section presents patient Chief Complaint demographic characteristics “I haven’t been able to open my mouth Description for two days.” (gender, age, and potentially ethnicity). Background and/or Patient History • Male or Female, x years old. Three days prior, left mandibular third Presentation • Ethnicity may be included if molar extraction. Format relevant. Current Findings Example • Female, 28 years old. Maximum opening is 10 mm © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 25
INBDE Patient Box: Chief Complaint Section Patient Section Chief Complaint Female, 28 years old. • This section presents the chief Chief Complaint Description complaint as described by the “I haven’t been able to open my mouth for two days.” patient or a guardian. • If quoted directly from the Background and/or Patient History patient, enclose the statement Presentation Three days prior, left mandibular third Format in quotation marks and voice molar extraction. the statement in the first person. Current Findings • “I’ve been unable to open my Maximum opening is 10 mm Example mouth for two days.” © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 26
INBDE Patient Box: Background/Patient History Patient Section Background/Patient History Female, 28 years old. • This section presents Chief Complaint background information such “I haven’t been able to open my mouth as history of dental diagnosis for two days.” Description and treatment, medical conditions, allergies, social history, etc. Background and/or Patient History Three days prior, left mandibular third molar extraction. • The information is assumed to Presentation Format be factual and provided by the treating dentist. Current Findings Maximum opening is 10 mm • Three days prior, left Example mandibular third molar extraction. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 27
INBDE Patient Box: Current Findings Section Patient Section Current Findings Female, 28 years old. • This section presents information collected by dental Chief Complaint Description professionals during the “I haven’t been able to open my mouth for two days.” current visit. • Can include information such as height and weight, vital Background and/or Patient History Presentation signs, results of diagnostic Three days prior, left mandibular third Format tests, and a general molar extraction. assessment of the patient condition. • Facial edema Current Findings • Lymphadenopathy Maximum opening is 10 mm • Extensive apical radiolucency Example associated with tooth 6 • Temp. 100.3° • Blood glucose 240 mg/dL • BP 150/93 © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 28
Case-Based Item Sets and Standalone Items • Approximately 70% of INBDE items contain a patient box; these include “Standalone Items” and items that are part of “Case-Based Item Sets.” • A “Case-Based Item Set” consists of two or more items that reference a common set of stimulus materials (e.g., a patient box and an image). INBDE item sets typically involve 2 to 5 items. • Case-Based Item Sets make up 40% of the INBDE. • Standalone items make up the remaining 60% of INBDE content • Standalone items are written to be clinically relevant and integrated; they can contain patient boxes and images. • If a question involves a patient, the question will include a Patient Box. However, item writers are discouraged from including a patient or patient box where doing so would simply add unnecessary verbiage to an item that is already clinically relevant. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 29
INBDE Sample Questions • The JCNDE has provided 43 sample questions written by JCNDE Test Construction Teams for communities of interest (https://www.ada.org/en/jcnde/inbde/test-preparation) • These questions were provided to help familiarize candidates with how INBDE questions are presented and formatted. • The JCNDE does not currently have plans to increase the number of sample questions. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 30
Guiding Principles in INBDE item development (continued) • The Just Qualified Candidate (JQC) is a hypothetical examinee whose knowledge, skills, and abilities (KSAs) represent the lowest level that would still be considered acceptable to pass the INBDE. More specifically: • The JQC is a candidate, currently pursuing an accredited dental education program in dentistry, who possesses the minimally acceptable level of knowledge, cognitive skills, and ability in the biomedical, dental, clinical dental, and behavioral sciences—including the areas of professional ethics and patient management—that is necessary for the safe, entry-level general practice of dentistry. • The INBDE is intended to differentiate the JQC from those who fall below that skill level. This is the focal purpose of the INBDE. • The INBDE is NOT intended to differentiate stellar students from average students. • Items should avoid focusing on trivia and esoteric bits of knowledge. • Items should reflect clinically relevant situations that a practicing dentist would encounter. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 31
Relationship between INBDE and NBDE Candidate performance on the 2017-2018 INBDE Field Test was positively correlated with performance on NBDE Parts I and II Correlation Between INBDE Field Test and NBDE Performance (N = 1,180 participants) Observed Disattenuated Correlation Correlation NBDE Part I .58 .65 NBDE Part II .74 .84 Note. Disattenuated correlations were estimated using the following reliability coefficients: Field Test=.87; NBDE Part I=.94; NBDE Part II=.91 © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 32
INBDE Standard Setting • The standard for each examination is criterion-referenced (not norm- based) and determined through a process called “standard setting.” • INBDE standard setting activities were facilitated in February 2020 by Dr. Gregory Cizek, a nationally recognized expert in standard setting who has authored several books on the subject. • The standard setting panel consisted of 10 subject matter experts. • Panel members were selected to be broadly representative and aligned with the purpose of the examination: – Practitioners – Dental school faculty – Joint Commission members – Members of dental boards – Dental school deans and associate deans (NBDE) – Current and former JCNDE Test Construction Team members – Geographically representative © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 33
Standard Setting Panelist Feedback • Participants were thoroughly trained and underwent a multi-stage exercise. • At the conclusion of all activities, participants’ evaluations of all aspects of the process were uniformly strong and supportive, with each panelist indicating that they supported the final group-recommended performance standard. – Panelist feedback on the last item of the final evaluative questionnaire: Survey Item Number and Statement Mean Rating 14. Overall, I support the final group-recommended cut score as fairly representing the appropriate performance standard for the 4.89 INBDE. Key: Values are on a five-point scale, ranging from 1=Strongly Disagree to 5=Strongly Agree; NR = no response. One panelist did not answer evaluation question 14, so the mean rating is based on responses from nine of the ten panelists. • The panel’s recommendation was approved by the JCNDE in June 2020 and implemented in August 2020. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 34
INBDE Results • Over 1,000 candidates have attempted the INBDE since its release in August 2020. • INBDE candidate performance information will be shared in the INBDE technical report (released subsequent to the report’s approval during the JCNDE’s meeting in 2021). • At present there are a small number of CODA accredited dental programs whose candidates are taking the examination in large numbers, but the number of programs is rising. • Preliminary data indicates that candidates educated by CODA- accredited dental programs are performing very well on the INBDE • Preliminary data indicates that candidates educated by programs not accredited by CODA are failing in larger numbers, as compared to those from CODA accredited programs (similar to what is seen for NBDE Part II) © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 35
Feedback from INBDE Field Test Participants What insights would you like to share with students who might be anxious to take this new examination? “The INBDE is more clinically applicable than NBDE part I, while integrating some of the same required knowledge. There was a lot of tested information that new graduates simply should know in order to be good clinicians.” “It’s not radically different than previous exams and not any harder.” “If you have paid attention and have studied to the best of your abilities for all the exams throughout dental school, you will not have a problem with this exam. Dental school prepares you for it.” “The exam is case-based so it is very similar to the cases that you currently see in clinic.” “It is much more clinically focused than the previous format.” © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 36
Feedback from INBDE Field Test Participants What insights would you like to share with dental programs and faculty members who are working to prepare their students to take the INBDE? “Teach with a case-based model and help your students to learn the basics of how to take care of their patients and they'll be fine!” “Focus more on clinical questions and how basic science is used in clinical dentistry.” “They need to teach basic sciences while incorporating clinical scenarios in order to prepare the students.” “Prepare the students for the majority of the exam to be case based, including many health conditions and their associated pharmacology.” “Please try to relate the basic sciences to real-life clinical situations.” © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 37
Targeted Questions from Candidates When should students take the INBDE? – Dental Programs: When your dental dean indicates you are ready. – Dental Boards: As close to the time of licensure as possible. What periodontal classification system is used on the INBDE? – American Academy of Periodontology Classifications (2017) Will I be able to “zoom in” on radiographs? – Unfortunately not at this time. – We are working with Prometric concerning this capability. Do candidates feel DLOSCE content is clinically relevant and integrated? – Survey feedback from live administrations indicates that the vast majority of candidates (approx. 90%) feel that DLOSCE content is clinically relevant. – Over 90% of candidates indicated that the questions required them to integrate their biomedical and discipline-based knowledge with their clinical training. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 38
Targeted Questions from Candidates What is the best way to find a testing appointment? How difficult is it find an appointment? – Make your appointment as far in advance of your desired testing date as possible. – Appointments can be limited due to smaller-sized test centers. – At present DTS staff are not hearing that candidates are having significant difficulties scheduling appointments. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 39
Targeted Questions from Candidates How can I best prepare to take the INBDE? – The JCNDE does not provide specific recommendations concerning examination preparation courses. – The INBDE is a clinically relevant examination. Review material related to the foundation knowledge areas and clinical content areas. Study the material and textbooks you were provided by your dental education program. – Candidates who completed the INBDE indicated the following were most helpful to them in their preparations: • Reviewing course textbooks and/or class notes • Reviewing flash cards • Participating in an online review course • Completing a practice test – Current data suggest that candidate endorsement of the following is predictive of performance on the INBDE: • Met with school faculty and/or staff to create a study plan © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 40
Targeted Questions from Faculty How should my course change in light of the INBDE? – First and foremost: Academic deans should be consulted on all decisions concerning course objectives – The “Foundation Knowledge for the General Dentist” document referenced previously provides examples of disciplines (e.g., biochemistry) that are relevant to each of the INBDE’s ten foundation knowledge areas Does the INBDE measure critical thinking? – Yes! The foundational knowledge areas and clinical content areas provide a platform for measuring dental critical thinking skills. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 41
Summary • The INBDE focuses on clinical relevance and is supported by strong validity evidence • INBDE development has relied heavily on input from dental subject matter experts, with measurement/psychometric guidance provided by the Department of Testing Services (DTS) • Dental programs and students are currently transitioning to the INBDE, and must do so before the NBDE Part II is no longer available. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 42
Additional Information and Other Relevant Examinations: COVID-19
JCNDE Response to COVID-19 – The JCNDE and DTS are pursuing solutions that address pressing needs while maintaining high psychometric standards (validity, reliability), in recognition of the importance of these testing programs – In the initial 3 months of the crisis, DTS engaged in 6,000 live chats to assist candidates (in 3 months handled typical chat volume for 4 years) – In 60 days Prometric experienced over 450,000 candidate displacements, the number they typically experience in 7 years – Implementation of the Dental Licensure Objective Structured Clinical Examination (DLOSCE) is fast-tracked – Introduction of short-form-NBDHE in mid-July 2020, with accompanying rollout to thousands of Pearson VUE test centers – Delayed discontinuation of NBDE Part I (until Dec 31, 2020) for all qualified candidates – Expanded eligibility periods for candidates (through Dec 31, 2020) – All test construction team meetings are currently being held remotely – Integrated National Board Dental Examination (INBDE) successfully launched on schedule © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 44
DTS COVID-19 Update Document – Posted and updated regularly: www.ada.org/jcnde © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 45
The Dental Licensure Objective Structured Clinical Examination (DLOSCE)
Join us for a DLOSCE webinar! Wednesday, April 14, 12:00pm (CST) Registration: ada.org/dlosce JCNDE Speakers: K. “Ragu” Ragunanthan, DDS, MS, Chair David M. Waldschmidt, Ph.D., Director © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 47
How do the DLOSCE and INBDE differ? “Domain of Dentistry” (INBDE) DLOSCE Content Domain. Clinical content directly applicable to chairside treatment. Also represents overlap between INBDE and DLOSCE. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 48
How do the DLOSCE and INBDE differ? The DLOSCE and the Integrated National Board Dental Examination (INBDE) both assess clinical skills (e.g., diagnosis and treatment planning, oral health management). However, key differences also exist: • The DLOSCE is focused exclusively on the clinical tasks a dentist performs while providing direct, chair-side treatment to patients. • Micro-judgments, errors and knowledge of success criteria, narrow focus • The INBDE focuses on cognitive skills. • The biomedical underpinnings of clinical decisions, broader focus that includes the “why” • Practice and profession considerations, evidence based dentistry, being good consumers of research, patient oral health care education © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 49
How do the DLOSCE and INBDE differ? • Examples of how the INBDE and DLOSCE conceptually differ: INBDE Example Corresponding DLOSCE Example Understand basic principles of pharmacokinetics and Review patient information and write an appropriate pharmacodynamics for major classes of drugs and prescription. over-the-counter products to guide safe and effective treatment. Understand local and central mechanisms of pain Identify the final needle position (point of insertion, modulation. angulation, and depth) immediately prior to injection that will best accomplish complete local anesthesia for a given procedure. Understand dental material properties, biocompatibility, Identify one or more flaws present in a metal-ceramic and performance, and the interaction among these in restoration. working with oral structures in health and disease. Understand the principles and logic of epidemiology No corresponding DLOSCE example. Epidemiology and the analysis of statistical data in the evaluation of and statistics are not covered on the DLOSCE. oral disease risk, etiology, and prognosis. © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 50
DLOSCE 3-Dimensional Models © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 51
Correlations with Important Outcomes The DLOSCE and Performance in 3rd Year Dental Courses1 Updated information as of March 2, 2021. Not yet published in DLOSCE Technical Manual. 1 The third-year courses covered the following areas: Oral Pathology, Oral Surgery, Pediatric Dentistry, Prosthodontics, Endodontics, Orthodontics, Medical Emergencies, Management of Medically Compromised Patients, Health Promotion, and Dental Practice Operations. The partially disattenuated correlations were estimated assuming a reliability coefficient of .66 for the letter of commendation (LOC) sum scores. The fully disattenuated correlations were estimated assuming reliability coefficients of .66 for the LOC sum scores and .83 for the DLOSCE scores. *p < .05 © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 52
The ADA’s Advanced Dental Admission Test (ADAT)
Join us for an ADAT webinar! Wednesday, May 5, 12:00pm (CST) Registration: ada.org/dlosce Department of Testing Services (DTS) Speakers: Matthew Grady, Ph.D., Senior Manager of Development Nicholas B. Hussong, MA, Manager, Test Administration © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 54
The ADA’s Advanced Dental Admission Test The Advanced Dental Admission Test (ADAT) is used by advanced dental education programs to inform admission decisions. The ADAT is overseen by the ADA’s Council on Dental Education and Licensure (not the JCNDE). Quantitative results are presented for the following scales: Overall; Biomedical Sciences; Clinical Sciences; and Data, Research Interpretation, & Evidence Based Dentistry. ADAT Overall Scale Frequency Distribution (2016-2020); N = 1,922 © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 55
Questions? © 2020 Joint Commission on National Dental Examinations. All Rights Reserved. 56
Thank you! David M Waldschmidt, Ph.D. waldschmidtd@ada.org
You can also read