THEMATIC ARTICLE

 

Jos VM Welie & Nicholas J Levering
Dental Ethics Education at the Creighton University School of Dentistry

 

Introduction

The Creighton University School of Dentistry has had a required course in dental ethics for at least 25 years, dating back to a decision reaching by the Academic Council of this Jesuit university that every degree program in the university should minimally include the equivalent of a 3 credit hours in ethics (that is, approximately 45 hours of formal education, usually offered as a single course lasting one semester). But over the years, the content and format of the dental ethics program has changed many times, in part to improve the course itself, in part to meet other curricular interests (such as overcrowding).

Credit Hours

Currently, this university-wide ethics requirement is met through a 2-credit course offered in the summer semester between the 3rd and final year of dental school (which is the focus of this article), and an additional 1-credit hour course offered in the 4th year (which focuses largely on practice management issues). A couple of additional lectures are given in other years, such as one on integrity in the first semester of the freshman year and one on justice in the junior year.

Location in the Curriculum

The evident advantage of the current location of the main 2-credit hour course is that the enrolled students have practical experience. The obvious disadvantage is that students practice dentistry – be it under faculty supervision – for a whole year (their 3rd year) without having had formal exposure to ethics. Although various organizations in American dentistry urge dental schools to admit students who have a strong background in the liberal arts, including therefore ethics, most of the Creighton students (as is probably true of most other American dental schools) have a strong undergraduate background in biology, chemistry and physics and are relatively weak in humanities. If they are allowed to practice clinical dentistry for a whole year without any formal ethics education, it is understandable that some students subsequently entering the ethics course do not really appreciate it (resulting in poor attendance of the lectures).

Topics

Whereas some topics in the main dental ethics course are of both ethical and legal relevance, such as informed consent, confidentiality, peer review, and advertising, most issues discussed are foremost ethical in nature. Our course covers more or less the standard topics for any dental ethics course, including:

Student Presentations

In order to boost student engagement in the course, for the past two years students have been required to prepare an in-class presentation. There are 18 of these in-class presentations.  Because of the class size (of approximately 86 students annually), students work on this assignment in small groups.  They are informed that the assigned topics are part of the required course contents and hence part of the exam, but will not be covered by the faculty instructors.  Thus, the students are truly the instructors for those topics. In order to make sure that the presentations are comprehensive and to the point, students are required to submit an early draft of their outline or PowerPoint to the course instructors. In addition to plenary presentations on topics such as “access to records”, “dating patients”, “treatment of family members”, “unethical dental research” and “dental spas”, there are also two in-class debates, moderated by the instructor, with two groups of students arguing against one another on “in-office confidentiality” and on “legislative proposals to reduce oral health disparities” respectively.

The Use of Mock Dental Records

The most successful component of the course is most certainly the case discussions in small groups, each led by a faculty member. Whereas such small group activities are common in health care ethics courses, our course takes a somewhat different approach in an attempt to boost student engagement. Instead of presenting students with one-page case descriptions, followed by free-floating discussion, we instruct the students that they are to behave as an ethics committee that must provide a properly argued recommendation. The students receive 7 mock dental records, each preceded by a letter from a dentist briefly introducing the issue he or she is struggling with and asking for advice. These records contain all the documents one can typically find in a dental record, and it is up to the students to find in these records all the ethically relevant facts.  The two students who are assigned the case to be discussed during one of the seven small group sessions must prepare for the meeting, lead the discussion, and write a consultative report back to the dentist requesting advice. This process has been described elsewhere in greater detail (Welie 1988). And although we have made some modifications to it to simplify the process, it has continued to be an effective tool ever since it was introduced more than a decade ago.

Administrator and Faculty Support

All too often, health care ethics education is seen by faculty members (and consequently by students as well) as a peripheral to the curriculum that should therefore be granted only minimal curricular time. As one of our former medical school deans once said, “ethics is not core and should be fun.” Fortunately, both the administration and the faculty of our School of Dentistry generally has been very supportive of our attempts at providing ethics instruction, as evidenced most tangibly by their willingness to serve as small group session leaders year after year. At the same time, dental ethics is certainly not a focus area of this school, as is evidenced by the lack of any other faculty members being members of IDEALS or ASDE, lack of a dental ethics committee (akin to a HEC), the poor attendance of ethics programs offered for faculty members, and the lack of any scholarly activities in the area of ethics by faculty members other than two course instructors of the main ethics course. Since most of the ethical formation of future dentists happens at the clinic floors (as opposed to the class rooms), this lack of formal engagement in ethics education and research is worrisome.

Assessment of the Effectiveness of the Course

Probably the greatest weakness of our dental ethics curriculum is the absence of reliable assessments of competencies gained. The annual surveys of the school’s alumni suggest that the graduates rank the amount of hours devoted to ethics education as satisfactory. But no other assessment data have been gathered. Although the course contains a variety of assignments, including a final competency exam, we have never pre-tested the students to get a better sense of their increase in knowledge and skills. Judging by the attendance in plenary sessions (attendance is not required during these sessions, whereas it is require during the small group discussions), in most years approximately a third of the class skips part or all of the lectures. The level of engagement of the attending students seems to differ by year without there being an obvious pattern.

References

1. Welie, Jos V.M.: “Doctor, I Really Need Whiter Teeth!” A Report on the Use of Deconstructed Cases in Dental Ethics Education. Medicine, Healthcare and Philosophy. 2,2 (1999) 195-203

About the Authors

Dr. Jos V.M. Welie is Professor of Medical and Dental Ethics at the Center for Health Policy and Ethics, Creighton University, Omaha, Nebraska, USA
Dr. Nicholas J Levering is an Associate Professor in the Department of Pediatric Dentistry, Creighton University School of Dentistry, Omaha, Nebraska, USA

Correspondence

The authors can be reached at: jwelie@creighton.edu or nicholaslevering@creighton.edu

Citation

Welie, J.V.M. & Levering, N.J. (2009). Dental Ethics Education at the Creighton University School of Dentistry . Bulletin of the International Dental Ethics and Law Society 9(2) 34-37.