Many dental students from my era found the education process to be both challenging and trying. A certain level of animosity by the faculty, in conjunction with a “figure it out — we had to” attitude existed. Students needed to survive and endure to join the dental “family” of practitioners. A culture of “us versus them” sometimes crept into our years of school. As graduation became more certain, we were suddenly introduced to ethical considerations for practice by some of those same instructors. It occasionally felt like they had put on an entirely different, less combative mindset. The ethical lessons felt more like an afterthought from someone on a team we were not quite sure we belonged to.
One of the many positive changes in dental education at the University of Minnesota School of Dentistry is an ethics component in the curriculum that engages students from their freshman year. Karin Quick, D.D.S., Ph.D. has taught ethics to the dental students since 2007. Class discussion and topics have included:
• Botox and dermafillers and scope of practice
• Bartering for services and the doctor/patient relationship
• Barriers to care
• Boundary issues
• Marketing and professionalism
• Social media
• Family violence
• Belief systems
• Conflicts of interest
Dr. Quick explains, “I see the process of ethics education as a dynamic one for me and the students.”
Ethics Curriculum at the School of Dentistry
According to Dr. Quick, a dental, dental hygiene, and dental therapy student’s experience with ethics and professionalism begins on day one. She says, “Each class writes its own class code of ethics. Beginning last year, I became involved in this activity. At the Orientation Program for incoming students, I introduce the idea of writing a class code, and members from the previous year’s entering classes are there to present the student perspective. Working together, the classes create and approve their codes. This activity culminates with a White Coat Ceremony, where students take an oath affirming their intentions to act in the best interest of the patient, practice with integrity, and uphold the ethical standards of the profession.” First year students in all programs also take part in an interprofessional course (FIPCCFoundations in Interprofessional Communication and Collaboration) with students from all six Academic Health Center programs (medicine, nursing, pharmacy, dentistry, veterinary medicine, and public health), plus Allied Health. Dr. Quick adds, “Previously the White Coat Ceremony was held at the conclusion of the preclinical year(s) as a rite of passage to mark the students’ transition into patient care experiences. In 2007, the School began a new tradition of holding the ceremony for all students during the first year to underscore the importance of professionalism that starts from day one — the first day of dental education.”
Years Three and Four
There are two courses in clinical dental ethics for third and fourth year students. (Dental hygiene and dental therapy students have their own ethics course, directed through the division of dental hygiene). The course for third year dental students is a series of five two-hour workshops. Students are assigned to one of six small groups of 16 to 20 participants. These workshops focuses on the five principles of the American Dental Association Code of Ethics and Professional Conduct. Discussions are open and use clinical case scenarios. The students have both individual written assignments and a group project as the final.
During the summer between the third and fourth year of dental school, students take a clinical dental ethics Objective Structured Clinical Exam (OSCE). All new fourth-year dental students participate — as both clinician and observer — with a standardized patient in challenging clinical situations with elements relevant to ethics and professionalism. Sessions are videotaped, and there is immediate feedback from the standardized patient and a small group debriefing of both scenarios. In the fall, volunteers from the American College of Dentists and the International College of entists review the students’ performance as captured by digital video and provide one-on-one feedback.
A second course for the fourth year students is a series of three two-hour workshops. Students are assigned again to one of six small groups of 16 to 20 participants. The format is similar to the course from the third year. The first workshop revisits professionalism and reviews the code of ethics the students wrote in the first year. Workshop II focuses on doctor/patient relations, and Workshop III looks at doctor/doctor relationships, everyday practice ethics, and transitions. Student assignments are self-reflective, and include an interview with a dental professional about ethical challenges.
Clearly, the University of Minnesota School of Dentistry is on the right track. Ethics is not an add-on or distraction from their academic program. Student participation and ownership of their ethical standards create a culture of ethics for the school. Working through issues with other allied professionals and members of the practicing community reinforces these standards. We all represent our profession wherever we are and in every stage of our career. Minnesota’s dental school training in ethics better prepares graduates for that responsibility, helping them get “off on the right foot”.
*Dr. Kurkowski is Chair of the Minnesota Dental Association Committee on Ethics,Constitution and Bylaws. He is a general dentist in private practice in Saint Paul, Minnesota. Email is firstname.lastname@example.org.