Clinical licensure exams: the unruly gatekeepers.

A dental student approaching graduation reflects on concerns over initial licensure examinations. Among the issues that have been recognized but remain unaddressed are ethical treatment of live patients, unfair treatment of candidates, excellent reliability among examiners on any single case but poor consistency across testing, lack of validity, and no evidence of protecting the public. The licensure system would be improved by paying attention to issues of mobility and continued competence.