Journal of the American College of Dentists

Students’ Views on Ethics
28
The first approach is basically similar
to an option we give patients when
presenting a treatment plan to them: “do
nothing.” That is, allowing students to
simply hit “rock bottom” if they should
experience an ethical breach. After all,
this is professional school and there
should be a certain level of trust between
students and faculty, right? The scenario
may play out as follows. Imagine yourself
in this position. The sweat is gathering on
your forehead as you struggle to finish
the final exam in pharmacology. The
paper next to you is practically begging
to be cited on your own page. Following
the glance that lasted two seconds too
long, you’re out in the hallway being
marched up to the dean’s office. As a
result, a very definitive decision is made
to suspend you from dental school.
Following this decision, it is the hope
that you, the perpetrator, will realize the
errors of your ways and change your
behavior in the future and that this
abrupt response will serve as a deterrent
to other students who might be tempted
to cheat. However, since past behavior
is the best predictor of future behavior,
will this really work or will you simply
just get better at cheating?
Is this really an appropriate approach
to fostering professional development?
It is extremely reactionary in nature.
Allowing students to flounder along
without ethical guidance until they “do
something stupid” and then punishing
them may deter others from doing the
same thing but this punitive approach is
in itself unprofessional. Faculty, who
should be mentors become policemen,
lying in wait to catch possible cheaters.
Also, the Commission on Dental Accreditation
(CODA) expects dental schools to
have a formal curriculum in ethics.
Although there need to be repercussions
for academic dishonesty, “scaring people
straight” is not an appropriate way to
promote professionalism and teach selfregulation
of the profession.
Another approach to teaching professional
development is one that I have
seen over and over again throughout my
educational career. The reason for its
prevalence is its simple approach and
ease of implementation. I am speaking
of the case-based method in which
different vignettes are presented, options
are given, and the correct choice is
revealed to the learners. It is my opinion,
however, that this is not the best way to
teach ethics and professionalism at this
point in our careers, for the following
reasons. First of all, each ethical situation
is different and has nuances that differentiate
it from anything previously
encountered. What works as the “right
decision” in one scenario may not work
in another very similar one with a small
difference. In the case-based approach
it is more practical to teach underlying
principles rather than “situations and
solutions.” Even then, this model has its
limitations. Many students will agree to
a given conclusion just because they
know it is what the instructor wants to
hear. For example, it is easy to know
that cheating on a test is wrong but it is
a lot more difficult to actually turn in a
classmate you know is cheating or to
resist the temptation yourself. Students
find creative ways to justify unethical
behavior if it involves them or their close
friends directly! The challenge is to get
students to not only recognize what ought
to be done in a particular situation but,
when it comes down to it, to actually
have the guts to “just do it.”
Student Ethical Responsibility
I believe the most effective way to teach
ethical problem solving in dental education
should take a different approach.
This approach involves much more
peer interaction and discussion. Students
listen to each other and share a common
bond and consciousness through the
dental school experience. On the other
hand, through a diverse student body,
we all bring different things to the
table. If the ethical didactic foundation
is in place, students can intelligently
approach an ethical dilemma with a
group of peers and come to a rational
conclusion with an understanding of
why the answer is what it is.
Using a small-group format, dilemmas
can be considered and debated within
the ethical framework outlined in
class. Students may have more candid
discussions among their peers about
issues, not having faculty listening in
on the conversation. Another benefit of
ethical discussion is that it gives people
an opportunity to poke holes in our
arguments. Other people’s perspectives
often bring light to our own biases and
errors in thought. In seeing the errors
in our own thought processes, the
principles that we believe in can be
applied more objectively and honestly.
Students who are comfortable with their
ideals yet able to see any situation more
objectively will be able to navigate a
dicey dilemma and come out completely
honest to the convictions that guide
their everyday behavior.
So the question still remains: are
things already set? It is my firm belief
that anyone, at any time, can start brand
new. Professional development is an
ongoing process throughout not only
dental school, but our entire careers.
New starts do not come, however, without
breaking down held ideals in favor
of new paradigms. If we are willing to
take the time and do the hard work of
listening to each other and learning
from our common experiences as well
as our diversity, we can ensure that
the principles of autonomy, beneficence,
justice, nonmaleficence, and veracity will
be upheld every day and that students
will gain an understanding of why these
principles are intrinsically valuable to a
profession well practiced. ■
2011 Volume 78, Number 4