Report #8 Q4 2016

ACD Gies Ethics Project

Report #8 Q4 2016

David W. Chambers

Preliminary Summary of Status of Dental Ethics Education

Eighty-five percent of US dental schools have responded to a written survey, supplemented in many cases by phone conversations, regarding how ethics in taught in our dental schools.

Unlike previous surveys that tapped hours, content, and methods (see Lantz, Bebeau, and Zarkowski on Google Scholar), the ACD effort has focused on the background and interests of the people in charge and the school context.  An open-ended format has been used.  Some generalizations appear to be emerging.

Less attention is being devoted to teaching ethics in dental schools than was previously the case.  Over 90% of schools had stand-alone ethics course in 1998, 80% in 2010, and so far about 75% today.  Further, the number of hours is declining from an average of 26 six years ago to about 20 now.  All of these numbers are likely to be slight over-estimates because the courses are typically identified as “Ethics and Professionalism” or “Practice and Jurisprudence” and very likely contain other material besides ethics.

The trend is toward “blended” curricular streams running from prematricualtion and ceremonies such as White Coat through the four years, including clinical orientation, practice management, cultural competency, treatment planning, interprofessional education, personal growth, critical thinking and research, and community service.  Four of five schools reported having such a curriculum thread or theme six years ago; virtually 100% of those responding today say that ethics is an integral part of the total dental education.  It is more common today to say that ethics is mentioned in other courses.

I am enthusiastic about making organizations ethical to create a context that promotes the right behavior of individuals.  But I am also cautious here.  Whatever is everywhere and everyone’s responsibility tends eventually to be difficult to detect and something we assumed someone else had covered.  The most typical form of evaluation in schools in now having students reflect on their experiences.  The most common challenge worrying ethics educators is the erosion of what they teach in the face of clinical requirements.  (The most troublesome ethical issue in practice is said, as an extension, to be the tension between producing billable procedures and treating patients the right way.)  No schools have yet reported judging the impact of their ethics programs using practice performance of their graduates.

Further holding me back from open optimism about the trend to regard ethics as “the way we do things around here” were some of the outlier responses.  Although the average percent time respondents devoted to ethics was 12%, several put down 100% (one bragged 155%).  The rationale was that since they were ethical all the time in what they did professionally, thus they were teaching ethics all the time.  A similar logic was observed with respect to course content.  One response listed 52 hours of lecture on ethics, another reported 123.  I worry that breadth is masking shallow depth.

My thought at the moment is that our commitment to teaching ethics as a discipline or body of terms and rules is waning and being covered over by convenient generalizations.  At the very least there is fragmentation about what it means to talk ethics or behave morally.

The ACD Gies Ethics Project is coming at just the right time if we can steer the conversation productively toward answering these questions.



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