Dentistry at The University of Queensland Dental School (UQDS) is a five-year degree with 60 students per year from a wide range of ethnic, religious, cultural, and socio-economic backgrounds. They vary in age although most are eighteen. Their patient contact commences in Year 1 with assisting, and concludes in final year with a full immersion at community health clinics. There are nine discipline streams within the degree and ethics and law are within Community Oral Health and Professional Development.

Development of dental ethics and law curriculum

Until the mid 1990’s, UQDS ethics and law was delivered as loosely structured lectures by speakers, professional associations and indemnity insurers. Although assessed, students felt it was perfunctory and did not research deeply. A total restructure of teaching ethics, law and professionalism was undertaken with help from the School of Philosophy. Our priorities when designing the new course were:

Teach ethics and/or law in all years and as part of all subjects

It is important to both teach ethics and involve students in its application. We have partly reached this goal. At the moment a formal component of ethics and law is taught in all five years. Because the same two people do most of the teaching, there is a collective memory of cases, students, problems that can achieve vertical integration. Professionalism only attracts a minimal attention in other subjects. Plans are in progress for professional conduct to be an integral and assessable part of every subject. The model in Year 5 has been successful and is discussed later.

Adequate time to teach the knowledge base for law and ethics

This required tenacity to set in place and watchfulness to prevent erosion. It is important to have concentrated ethics teaching, independent of other courses, to reinforce the scholarship that informs this field. Students with an affinity for this subject see a reflection in their grades. In Year 3, students have a semester of ethics lectures and in Year 4 they have a large block for law. Whilst small group seminars have not been possible because of lack of timetable space, a compromise was reached with two-hour lectures (rather than 45 minutes). This enables a mixture of didactic lectures and discussion groups.

Creating student interest and peer support

The cases and examples used in teaching are based on the premise that the hardest ethical dilemmas are those which are closest to home, and these are the ones that teach us most. We use cases that students can identify with personally at each stage of their education. These are gathered from prior students’ reflective journals. Wherever possible, the cases retain the student’s own words. Whist discussions start with the abstract, they frequently focus on a genuine and current issue and real solutions are sought. By guiding the discussions back to basic principles and problem solving, the students gain confidence in the techniques. Later in the course, students move into peer groups culminating in a total peer support approach to learning, assessment and discipline in Year 5.

Timing of ethics and law within the degree

The teaching of ethics and law follows a vertically integrated structured involving 50-55 hours of class contact over five years. Assessment occurs in each year by assignment, examination or both. The largest module of ethics teaching is 13 weeks and of law is 18 weeks. The decision to teach ethics before law was an intentional one. Law and ethics often overlap each other and yet health law can differ between countries. In Year 3 students examine the fundamentals of professional ethics including literature reviews, without the distraction of regional legal differences. However, before graduation students must know the local laws thoroughly. This is undertaken in Year 4.

In all written work in Community Oral Health and Professional Development subjects regardless of topic, appropriate ethical or legal deliberation is required. Professional behavior is monitored in all clinical components of the degree. However, it would be true to say that in clinical subjects, feedback is generated mostly when infringements occur (and marks are deducted).

Progression of Ethics and Law throughout the degree

Years 1 & 2

The emphasis in early years is on the ethical decision-making process and reflective learning. Teaching and assessment are a small part within a larger course. The examination question is based on a multi-faceted case requiring deliberation.

In Year 1, students are introduced to the profession of dentistry and are given an overview of bioethical principles. The class exercises focus on autonomy, veracity, rights and obligations. Discussion topics practice the decision-making ‘5-Step Model’ and include:

In Year 2, the focus expands to include consent, confidentiality and privacy in preparation for closer patient contact. Examples include:

Year 3

In Year 3 dental ethics is a self-contained module with two hours of lectures and seminars over 13 weeks. During Year 3 students investigate the knowledge base informing dental ethics. They keep a reflective journal, prepare an individual assignment with a literature review, work on a joint project and sit for a one-hour examination.

A variety of methods are used to deliver the ethics module. Didactic and interactive lecture techniques are used for some topics.  Case based analysis and small group problem solving are used for other topics.  Many students have formed personal study groups and they are forced out of this comfort zone during some of the small group sessions to be exposed to alternative views.  Two or three cases are presented in the two-hour lecture depending on familiarity or complexity, preparation time, and topics may flow into the next week with take-home tasks.

In Year 3, dilemma encountered by final year students on their clinical placement are used as examples, and examples from dentists in general practice are introduced.  During this year, the following lecture topics are covered: Ethical Foundations; Autonomy; Consent; Confidentiality; Deception; Equity and Justice; Professional and Client; Professional Associations & Codes; Professional Dissent; Altruism; Business Ethics; Professional Dilemma.

Year 4

Year 4 incorporates a full-year course in Community Dentistry. Health law, epidemiology and public health are some of the modules that contain lectures on ethics and law. This course also rounds off professional ethics by inviting experts to lecture on specific topics such as culture, disability, child abuse and volunteering. Students continue with their reflective journal. Research ethics is assessed using an application to a Research Ethics Committee and the law module is assessed by a written examination. In Year 4, health law is a major component and lectures include:

The examination requires the students to apply the legal and ethical reasoning skills that they have acquired throughout the course to a number of hypothetical situations. Two examples follow:

Year 5

In Year 5 students undertake two placements of 17 weeks in public health clinics. Two to four students become members of each clinic team treating patients from lower socio-economic districts for both emergency and comprehensive dental care. They return to the dental school for three teaching weeks during which a variety of speakers including those from professional associations and indemnity insurers give lectures. The assessment for final year is a non-graded ‘pass-fail’ and has four components: supervisor reports, case reports, record of professional development, oral examination. The supervisors provide two reports on student’s clinical progress each semester (using excellent, good, adequate and fail for each item). The professional development component of this clinical report contains the following details:

Students write four case reports exemplifying difficulties they experienced in ethics, law or professionalism whilst on placement. The cases must be experienced by or observed by the student. The case reports are peer assessed and the peer reviewers are assessed on their feedback. Peer groups are used in developing and assessing each student’s professional development plan for the year. The final oral examination with a panel of four is held in the last week of the year and includes legal and ethical questions. If during the year any student performs in an unprofessional manner, a peer review committee is convened. This has only been used twice since 2005.

Outcome of the course

The University of Queensland undertakes a regular survey of all students to determine, among other things, their level of social sensitivity. This measure has increased greatly for dentistry students over the past ten years. Also, in the evaluations of courses conducted within dentistry, students indicate that the ethics and law components of their study are intellectually stimulating and challenging.

The authors have observed changes in student reactions and behavior to legally and ethically challenging situations. Students appear to be more confident in open discussions with their peers and with the authors. Their communication style is more professional and thoughtful than in the past. They seek clarification of their own solutions, having already applied the framework of ethical problem solving. This is in contrast to previous students who would arrive with a problem for others to solve. Students are also more likely to discuss and solve problems collectively and openly rather than individually and privately.

About the Authors

Dr. Suzette A.T. Porter was Discipline Leader of Community Oral Health, Ethics and Professional Development at The University of Queensland, for nineteen years. She is currently the Director Oral Health Clinical Education & Training in Queensland Health, Australia
Dr. Tonia S. Girdis has been a lecturer at The University of Queensland School of Dentistry for ten years teaching both dentistry and oral health students. She is also a dentist in private practice.

Correspondence

The authors can be reached at t.girdis@uq.edu.au

Citation

Porter, S. A. T. & Girdis, T. S. (2009). Teaching dental ethics and law at the University of Queensland. Bulletin of the International Dental Ethics and Law Society 9(2), 19-26.