Chapter
2
Ethics in Dental School
Good times become good memories. Bad times become good lessons.
Why did you choose to go to dental school? What made dentistry so compelling that you would take 4 years of your life and dedicate it to becoming a member of our profession. For myself, the answer to this inquiry lies in the story behind the Figure 2.1.
Figure 2.1 A child embraces the author after her dental work was completed on a dental mission trip to Nicaragua.
It was a hot morning on the final day of a weeklong dental outreach trip during my junior year of dental school when I saw the young lady pictured walking across the playground. I had met her 5 days before when she entered our clinic unwilling to smile and having a tough time speaking due to the condition of her dentition. She had never been to a dentist, and a toothbrush was the last item on her parent’s minds as they had a tough enough time putting food on the table. After 4 days, and 4 quadrants of dentistry, the whimpers I heard and the cringes I saw as she spoke initially turned into smiles and her into a jubilant girl beaming with stories to tell. As she approached me on the other side of the playground, she motioned for me to kneel down. As soon as I did, she hugged me and thanked me for taking away her pain. The picture was taken at that instant by a fellow student, but what it doesn’t show was the tear in my eye and the smile on my face as that moment confirmed the reason that I had entered into the profession of dentistry. I wanted to be a part of something that could change people’s lives for the better, all while providing a good living for my family.
My hope is that you entered into the profession for similar reasons.
This chapter is going to discuss the ethics and professionalism dilemmas encountered at the various stages of dental school as well as suggest activities and best practices to aid you in becoming a successful practitioner on graduation.
Patient-Focused Education
Unlike any other time in your previous education, every principle taught and class attended will focus and hone your skills on becoming a competent dentist with the ability to properly treat and care for your fellow human beings. Unprofessional and unethical behaviors during this portion of your education can have a direct effect on the patients you will treat. If you miss a class, cheat on an assignment, turn in work that may not be yours, and so forth, you will miss valuable information and possibly fail to learn specific skill sets that you will need in the future to properly care for your patients. It is imperative that from this point forward, you maintain the patient as your primary focus and not participate in activities that can affect your ability to properly treat them in the future.
Exercise 1
Take a few quite minutes to reflect on and write down why you joined the dental profession and what goals you have as a dental student. Then, picture yourself years from now at your graduation and heading off into private practice or into advanced training. What kind of dentist do you want to be? How did you arrive there? And what are you goals from that point forward? Write these thoughts down as well on the same document.
Now keep this document somewhere safe, yet accessible, and review it each year as you advance to the next year of training to ensure you are heading down the correct path and remind yourself of your altruistic goals and reasons for becoming a dentist.
*Exercise to be completed during first month of dental school or within the first month of reading this chapter.
Impropriety within Dental Education
Cheating and acts of academic dishonesty have plagued all levels of education across the globe for many years. A survey of 43,000 high school students conducted in 2010 by the Josephson Institute found that 59% admitted to cheating within the past year, with 34% doing it twice or more.1 A study by Bowers (as cited in McCabe et al.) in 1964 found that 75% of college students cheated.2 Thirty years later, the study was repeated by McCabe et al.2 and found a modest increase from that number. While US News & World Report revealed the most saddening statistic when it reported that 84% of college students believe that they need to cheat to get ahead in the world today.3
With dentistry being thought of as 1 of the 10 most trusted professions in the United States,4 one might suppose that academic dishonesty and unethical acts within dental education would be much less severe. A 2007 study by Andrews et al. found that indeed behaviors of impropriety continue into dental education. Of the 1153 dental students surveyed, 74.7% admitted to cheating on tests or examinations and 68.4% on preclinical examinations or assignments.5 The old cliché that states, “When you cheat, you are only hurting yourself,” does not hold true in our profession, because in the end, you are cheating the patients you will serve and the community in which you will work.
Didactic Training
Each school of dentistry goes about instructing students didactically in different ways. Some use traditional methods of lecture and testing, while others use small group sessions known as problem-based learning, while others send their dental students to complete their didactic training with their fellow medical students at varying schools of medicine. Regardless of how you receive this training, the principles of remaining academically honest and steering clear of academic dishonesty remain the same.
One of the negative byproducts of our ever-progressing technological world is that cheating becomes much easier to take part in and much more difficult for instructors to detect. Upon entering any academic institution, the prevalence of students using smart phones, iPads or other tablets, and apps that allow recording, taking pictures, retrieving information from others computers and devices, sharing of information instantly, and so on, has increased drastically in recent years. For that reason, it is crucial that we as students self-govern to insure impropriety within our schools ceases.
The genesis of the cheating dilemma has been cited as being due to competition for grades, large class sizes, an unwillingness to turn fellow students in, cynicism against the school, among others.6,7 That said, I feel two major reasons stand out above the rest: a student’s desire to remain on a level playing field when they see others cheat and the lack of punishment for cheating as decided by faculty and administration.
Within dental education, there is much competition. With the competition to get into specialty programs, graduate practice residencies, get better jobs, gain more patients, find perfect lesions for clinical exams, and so on, there will inevitably be one or two students who are tempted to gain an advantage that is outside of the guidelines. The behavior of this small minority greatly affects the majority who normally wouldn’t take part in these actions. Andrews et al. reported that “Students stated they were motivated to cheat because ‘everyone does it.’ If their peers cheat, students felt they were placed at a disadvantage by not cheating.”5 In that sense, cheating is contagious to fellow students. The contagiousness of cheating does not only affect fellow students but also degrades the person committing the act. Each time an individual cheats and gains an unfair advantage, he or she becomes desensitized to the act, making it that much easier to commit subsequent acts of impropriety in the future.8 If you combine an increasing number of students who feel they must cheat to remain at an equal playing field, with the degradation of the individual, you end up with an institution whose decaying moral values will inevitably hurt the profession as a whole.
In the study by Koerber et al.,9 a dental student stated that “Peers from my school and others agree that when a student was caught for cheating and disciplined by only a ‘slap on the wrist,’ more and more individuals began cheating.” This is a hidden curriculum within education that must be stopped. Another student in the study by Andrews et al. recommended that institutions “Actually follow the enforcements that are listed in the handbook for students caught cheating. Come down hard on cheaters; we had 10 accounts against the same student in writing and signed … nothing happened.”5 The school’s fear for legal action from those who are expelled, the time intensive nature of dismissing a student, as well as the risk of losing popularity among students have been stated by academic deans as reasons that cheating has not been punished.6
So as a student what is your roll in this? First, you must ensure that you as an individual are taking responsibility for your education and are maintaining your own academic integrity. Second, you should encourage your classmates to hold to the same values. If you see someone starting down the wrong path, pull him or her aside and speak with them. If you see something egregious that cannot be remedied with simply discussion with that individual, it is your responsibility to discuss this with the faculty or administration.
Preclinical Training
The preclinical courses you will undertake to develop the hand skills, knowledge, and techniques necessary to practice on a live patient are some of the most valuable you will take as a dental student. As such, it is paramount to your success as a future practitioner that you do not cut any corners during this time.
Impropriety in these courses can be similar to those discussed in the previous section as you will be asked to study many concepts and didactic information that will be put to practical use. It is also seen in the actual hands on assignments you will be given. Students have been found paying for dental labs or other students to complete their work, exchanging laboratory work with other students after the first students work had been graded, forging faculty signatures, and so on.5
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