Transitioning Operative Dentistry Competencies to the Simulation Laboratory: Benefits and Challenges for Dental Students.

Dental education must continually adapt to changes in licensure, assessment expectations, patient care priorities, and institutional resources. At the University of Tennessee Health Sciences Center College of Dentistry, Class II and Class III operative dentistry competencies for D4 students were moved from the clinical setting to the simulation laboratory, where students complete standardized preparations and restorations on plastic teeth with simulated caries. This perspective uses that curricular change as a case example to analyze a broader assessment problem: how dental programs can improve standardization, fairness, and feasibility without narrowing the construct of clinical competence. Drawing on concepts of validity, reliability, authenticity, educational impact, and programmatic assessment, the manuscript argues that simulation-based competency assessment can produce defensible evidence of technical readiness but should not be interpreted as a complete measure of operative clinical competence. A hybrid model is proposed in which standardized simulation competencies are embedded within a broader system of patient-based clinical requirements, direct observation, faculty calibration, and outcomes monitoring. This approach preserves the benefits of simulation while maintaining the diagnostic reasoning, patient management, professional accountability, and adaptability required for real patient care.