Member Contributions
Dental Education: An Ethical Conduct System
Manfred Seidemann, B.S.Ph., D.D.S., M.I.C.D.,
International President, I.C.D.,
Head of Pre-Clinical Operative Dentistry, Universidad de Chile College of Dentistry
Jose J. Matas, D.D.S., F.I.C.D.,
Treasurer, Section IV, I.C.D.,
Immediate Past Dean, Universidad de Chile College of Dentistry
Human behavior is influenced by innumerable factors that are generally genetic, familial, cultural, ethnic, educational, emotional, authoritarian and legalistic in nature. Any or a combination of these elements may affect or determine a person's conduct. Essentially, each person is different and responds in a unique way. Therefore, the mentioned factors may hamper harmony, co-existence and, eventually, positive group activity. People are essentially good;1 consequently, erroneous acts can be corrected.
Education plays a fundamental role in the social development of human beings. As a group activity it is subject to the influence of the previously mentioned factors. As a result, academicians and students, at any educational level, must be aware of and understand their significance, since every society has its own established norms for life and conduct. Ultimately, people must adjust their behavior accordingly, regardless of personal background or education. In short, society dictates rules of conduct to bring about and maintain harmony, orderliness, and acceptable behavior. The same applies to Learning Institutions, including Dental Schools.
Dental education curriculums encompass extremely demanding academic, psychomotor and clinical teaching-learning tasks. Dental Schools should perform their challenging mission in an ethical environment. This is especially important because students, in their quest to satisfy the high academic standards, might relax their ethical observances. Consequently, learning activities should only be conducted in morally inclined environments. Obviously, the most elevated ethical values must predominate in health-related teaching institutions.
The above observations suggest that an Ethical Conduct System should be implemented to guide Dental Schools' activities. This would require the creation of a special Ethical System Committee. The members should be outstanding and irreproachable academicians. The chairman should be a high-ranking and well-respected professor. Initially, the committee would be formed by no less than five individuals, including the chairman. It would not be advisable for faculty administrative authorities to belong to the Ethical Conduct System Committee. From the outset, its members would prepare themselves for the assignment by studying pertinent literature and attending relevant courses, as well as conferences and seminars. The most important prerequisites for committee membership are honesty, absolute observance of the accepted rules of life, common sense, and a willingness to participate. The committee's activities, as well as its members' training, would start simultaneously. Training would be a never-ending process. It should be kept in mind that there are few academicians specialized in the field of ethics.
One of the objectives of an Ethical System Committee would be to receive and analyze, in a confidential manner, any conflictive situations involving students and academicians, as well as auxiliary and administrative personnel. The Committee would be an autonomous body, acting with the utmost discretion. Any member of the mentioned groups would have ready access to the Committee. When deemed necessary, the Committee could solicit advice from specialists. It is essential that it enjoys the full confidence and respect of the student body and faculty. It is also fundamental that the Ethical Conduct System be functional solely through its virtues, efficacy, and prestige.
To make the Dental School population more aware of the importance of an Ethical System of Life, the Committee would conduct Seminars on diverse related subjects, such as ethics, trustworthiness and community life. Specialists from various fields would be invited to lecture and share experiences; for instance, clergymen, teachers, philosophers, psychologists, sociologists, dentists and physicians. Publications on the subject would be encouraged. Praiseworthy occurrences and situations would be publicized. Students, faculty and administrative personnel would be expected to attend all Ethical Conduct System-related activities. The program would not include formal ethics courses.
The Ethical Conduct System would in no way be conceived as a vigilantes, dilation or inquisitional regime. It could never be that way. Quite to the contrary, it would be a practical system supporting ethical living, proper habits and self-respect. It would strive to strengthen self-esteem as well as self-analysis, and to help each person bring out his or her best. It would be a model inspiring the continual optimization of quality human relations, promoting tolerance and trust. In addition, it would seek to stimulate the exchange of opinions, ideas and knowledge. It would be a tool to reinforce self-analysis, since it would emphasize the simple axiom, "It is much more difficult to judge oneself than to judge others"2. The System would apply the wise and timeless concept, "What is hateful to you, do not do to your neighbor"3. Another of the System's objectives would be to encourage "Honor Systems". For instance, the evaluation of written tests could always be anonymous; written and practical tests could be held without supervision.
Dignity can be lost only once. For better or worse, each person is followed by a reputation. The central idea of the Ethical Conduct System Committee is to look after and ensure full compliance with the established Code of Conduct, or "observance of good manners". Whenever the Ethical System is violated, the Committee would be convened. The Ethics Committee would have the authority to summon whomever it deems necessary to obtain an impartial view of the reported incident. The goal of the Committee would be to discreetly reestablish order and harmony. Its mere existence would help to prevent inadequate or unethical conduct among the members of a Dental School body. Problems involving only teachers would be analyzed without the presence of students, in the event that a student was a Committee member.
The Ethical Conduct System's first practical action would be the preparation and dissemination of a "Self-Evaluation Questionnaire." The questions would be prepared with the assistance of teachers and students. The purpose of the self-evaluation would be to objectify the program's theoretical concepts. It would explicitly include instances in which students might fail to be ethical. This could be with classmates, teachers, the university, auxiliary personnel, patients, society, or themselves. Each student would privately analyze the questions and answer the test. This self-evaluation is not to be considered a psychological analysis. It should serve only as a means for reflection and, as an instrument, to achieve self-improvement.
The Self-evaluation Questionnaire should be kept as simple as possible. Its purpose would be to provide the student body with a tool to assist discernment, calibrate actions and attitudes, and to recall the moral teachings of home. The questions should be objective and reflect present-day realities. The students must periodically repeat, during their stay in dental school, the self-evaluation and its subsequent analysis. This would enable them to perform a comparative study of themselves, and to observe improvements or regressions. In addition, it would allow them to detect areas of behavior that might require special attention or professional help.
One of the purposes of an Ethical Conduct System in a School of Dentistry is to effectively show and place trust in the student body. Through it, the students will learn to have confidence in themselves. This, in turn, will encourage them to develop their "own professional responsibility,"5 and also stimulate their pursuit of the ideal of "being, instead of appearing to be"4. Another goal of the System is to assist young people in strengthening their character by showing the perils of envy and arrogance. The former leaves harmful aftereffects and the latter produces dangerous reactions. The viability of an Ethical Conduct System depends on the students' motivation, professionalism and seriousness, as well as the faculty's commitment, enthusiasm and generosity.
In conclusion: The spirit of an "Ethical Conduct System Committee" Program is the prevention of moral misdeeds, not the denunciation of wrongful actions. It is aimed at preventing violations of trust and academic fraud. The System teaches professionals to conduct themselves in ways that will enable them to always be beyond criticism. It emphasizes that morality is not relative, but absolute; also, that what is legal is not necessarily ethical6. Its intent is to foster and support a continuous Preventative Ethics Program, to promote trust. To implement the Ethical Behavior Plan, students, faculty and administrative personnel must be invited to tenaciously and energetically collaborate on a road built on trust, honor, tolerance and respect. This program would be equivalent to an Ethical System of Life.
References
1. Seidemann, Theodor. Personal communication. Valparaiso 1947
2. Saint-Exupery A de. The Little Prince. New York: Hartcourt, Brace & World
1943; 39.
3. Hillel the Elder. Tractate Shabbat. Babylonian Talmud 32 A.C.; 31-A.
4. Johnson, D E.: Personal communication. Fort Lauderdale.18 February 2002.
5. Seidemann, B A.: Personal communication. Santiago. 12 February 2002.
6. Howard WW. Health professionals are not merchants. AGD Impact. 1993;
21, 11: (Editorial).
SELF- EVALUATION QUESTIONNAIRE
- Do I have all of the required or necessary instruments?
- What do I do when I do not have an instrument or material to perform a particular task?
- Have I ever "borrowed something and not returned it?"
- Have I ever falsified information?
- What do I do when I have a dirty instrument?
- What do I do with an instrument when it falls on the floor while I am attending a patient?
- What do I do when I come across an abandoned instrument or object?
- Have I ever thought of trying to "slip some money" to the person who prints the tests or exams?
- Have I ever copied during a test or exam?
- Have I ever "helped" others during a test or exam?
- What do I do when I don't know something?
- Have I ever performed a portion of some work knowing that it was not well done?
- Have I ever treated some dental work as finished when I knew it was not really performed properly?
- Am I willing to redo a treatment when I consider that I have not done it properly?
- Do I choose that which is best for the patient?
- Do I choose that which is easiest for me?
- Am I discrete?
- Am I a friendly person?
- How do I treat my patients?
- How do I behave with my colleagues?
- Do I pay attention to what patients tell me?
- Do I take the time necessary to properly treat my patients?
- Do I take the time that is necessary to give my local anesthesias?
- Have I ever lied to my parents or guardians regarding my grades?
- Have I ever offered improper solutions for my problem(s)?
- Do I arrive late to my classes or office? Why?
- Do I arrive late to my social engagements? Why?
- Do I normally greet others?
- Do I normally thank others?
- Do I apologize when I make a mistake?
- Do I correct my mistakes?
- Am I in the habit of lying?
- Do I like to gossip?
- How do I react to criticism?
- Do I say, "Please," whenever I ask for something?
- How is my vocabulary?
- How is my handwriting?
- How is my spelling?
- How is my writing ability?
- How is my personal hygiene?
- Do I actively participate in group work?
- Have I made offensive or suggestive remarks to teachers or students of the opposite gender?
- Have I ever been the object of offensive or suggestive remarks from teachers or students of the opposite gender?
- When I have turned in work for evaluation, have I ever not been the true author?
- Have I made dishonest suggestions?
- How do I react in uncomfortable work situations with my patients?
- Do I "redo" restorations that are serviceable?
- Do I perform clinical treatments that are not really necessary?
- Does personal profit influence my therapeutic decisions?
- Do I offer commissions or other economic benefits to colleagues who refer patients to me?
- What is my attitude when I am late delivering (finishing) some work?
- Am I satisfied with the quality of my work?
- Am I satisfied with the development of my clinical skills?
- Am I satisfied with my behavior?
- Do I take sufficient time to help my colleagues?
- Do I sign class or course attendance sheets on behalf of other persons?
- Do I share my experience?
- Do I share my knowledge?
- Do I request help when I don't know something?
- Do I respect my teachers?
- Do I practice what I preach?
- Do I like what I study?
- Do I keep my knowledge up to date?
- Does the success of my colleagues bother me?
- Do I pretend to be something that I am not?
This questionnaire can be modified or completed with the help of academicians, students and dentists.