An Overhaul of the Dental Equivalency Process in Canada

Example of NDEB dental equivalency OSCE exam

On October 29, 2021, the National Dental Examining Board of Canada (NDEB) released further changes to the Canadian dental equivalency process. This article has been updated to reflect those changes.

In 2021, the National Dental Examining Board of Canada (NDEB) announced significant changes to the Canadian dental equivalency process, impacting internationally-trained dentists across the country. 

The question many dentists going through the equivalency process are asking is: “how will these changes affect me?” Our Chief Learning Officer, Dr. Marwan Al Rayes, has conducted a number of webinars sharing our understanding of what has been announced. Here is a breakdown of the upcoming changes and what we know so far.

As part of its five-year strategic plan, the NDEB committed to reviewing the existing equivalency process in Canada. This review analyzed the blueprints for each of its three examinations in the equivalency processthe Assessment of Fundamental Knowledge (AFK), the Assessment of Clinical Judgment (ACJ), and the Assessment of Clinical Skills (ACS) now the National Dental Examination of Clinical Competence™ (NDECC™) and identified vital modifications and positive adjustments to evaluate international dental graduates. The changes are part of a multiple-step “Reduce, Change, and Develop” strategy in their Vision 2022: The Future of the NDEB Equivalency Process proposal.

So, what are these changes, and how will they affect each exam? 


An infographic that goes from 1-3 to visually list the NDEB changes for Vision 2022


The Assessment of Fundamental Knowledge (AFK): 

Currently, the AFK exam consists of 300 multiple-choice questions, which tests candidates’ core and basic knowledge of dentistry. Beginning in the August 2021 exam, AFK will now consist of 200 questions under the “Reduce” pillar offering a more comfortable examination experience while still maintaining substantial authenticity and validity for students. The assessment will continue to be administered electronically. 


The Assessment of Clinical Judgement (ACJ): 

As part of their “Change” strategy, the second development is the NDEB’s update on sequence and eligibility. As it stands, candidates who are successful in the AFK exam can attempt the ACJ and ACS simultaneously or in the order of their choosing. Starting in 2022, however, eligibility for the assessments will become sequential, and the completion of the ACJ exam will become a prerequisite to undergo the ACS. In other words, once examinees take and pass the AFK, they will only become eligible to take the ACJ. When they complete the ACJ examination process, they may then, and only then, attempt the ACS. This change comes from the standard procedure of practising dentists who consistently apply their clinical judgement before entering into treatment. Therefore, candidates must first demonstrate the appropriate knowledge and decision-making acumen needed to perform dental procedures on patients that very well may be irreversible. 


The Assessment of Clinical Skills (ACS) now will be the National Dental Examination of Clinical Competence™ (NDECC™): 

Finally, several modifications to both the existing structure, overall format, and content of the ACS exam in the “Develop” initiative account for the most consequential changes as this exam will now become the National Dental Examination of Clinical Competence™ (NDECC™). The big difference is the introduction of OSCE-style stations for dental procedures, in addition to the traditional psychomotor skills analysis on simulated patients (manikins) in a clinical setting. These contemporary stations will mimic a pharmacy setting and test participants’ ability to interact with patients on conversations surrounding diagnosis, treatment planning, and informed consent. The NDECC™ will also be split into two components over two days.

The NDEB expects the new components and requirements to take effect in June 2022, and these changes will allow for a better analysis of a candidate’s knowledge, skills, and abilities (KSAs).

At Prep Doctors, we will be offering an NDECC™ Clinical Skills course to better prepare trainees for the modified examination. Once the NDEB formally releases its updated blueprint, we will make the necessary modifications to the class. 

Additionally, the current ACS structure comprises 12 project requirements. Presently, participants can fail one of the 12 requirements and still be successful. As with the AFK and ACJ, candidates can attempt the ACS a maximum of three times. In the updated “Develop” strategy,  participants will be able to take the NDECC™ exam an unlimited number of times within a five-year period, but they must pass all requirements. 

The NDEB has also announced they have begun the construction of an in-house NDECC™ testing facility in Ottawa, Ontario. The development of this centre will offer ample opportunity for the NDEB to administer the modified NDECC™ examination in a controlled environment throughout the year, reducing scheduling conflicts and clearing the backlog of candidates. This will also promote a less stressful yet more consistent testing environment. 


Are these changes a good thing?

Overall, these changes are definitely a step in the right direction. They help foster a more fair and honest assessment of internationally-trained dentists on their path to dental licensure in Canada. 

At Prep Doctors, we have already begun adapting our curriculum to the upcoming changes. We are committed to making sure our trainees are the best prepared to clear this challenging process — now and in the future.


For more details, please direct specific questions about Vision 2022 directly to the NDEB. Don’t forget to sign up for our dental equivalency newsletter for our future breakdowns of equivalency-related announcements and Prep Doctors’ course updates.  

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