Start at the Beginning

Brian Shue, DDS, CDE

Students face many ethical dilemmas while in dental school. In a national survey, the ethics educators at each school were asked to list these concerns. Out of the 49 responses received, the most common ethical matter was cheating on written tests (mentioned 25 times), followed by pressure for clinical productivity/ requirements (14), a wide range of differing treatment plans from clinical faculty (eight) and a lack of civility and/or professionalism (eight). Other responses included one-time licensure exams, respect for patients, quality of students, substance abuse and educational debt.[1]

Today’s promising dental students must have strong ethical values to ensure the success of our profession in the future. It’s clear they know their professional duty. In 2020, the American Dental Education Association (ADEA) asked dental school seniors for their opinion on this statement: “I understand the ethical and professional values that are expected of the profession.” An overwhelming 98% either strongly agreed or agreed (total of 2,427) and only 42 strongly disagreed or disagreed.[2] Although that is reassuring, understanding expectations can be quite different than doing the right thing.

Dental schools are required to teach ethics. An ADEA survey of dental students in 2017 found “seniors’ perceptions of time devoted to ethics education” were seen as: appropriate 85.8%, excessive 11.1% and inadequate 2.7% (4,809 responses). The statistics were about the same for 2016 and 2015. So not all students look at the subject of ethics the same way. Providing a mandatory course to an ethically challenged individual doesn’t necessarily change that person’s actions or even moral character.

It is necessary to strengthen ethics right from the beginning. And ethics need to be present in the first place. There are students who want to do the right thing.

It is necessary to strengthen ethics right from the beginning. And ethics need to be present in the first place. There are students who want to do the right thing. Those are the students who need to be encouraged to continue to make the right decisions, beyond didactic courses, in their future decision-making.

In 2007, several dental students and a dental hygiene student from the Herman Ostrow School of Dentistry at USC had that exact thought. They independently went to their ethics professor, Alvin Rosenblum, DDS, to express their concerns. As a result, the students created a studentcentered organization to develop professionalism, with Dr. Rosenblum acting as an advisor. It did not replace the judicial functions of the school’s existing ethics committee. More than 100 students, faculty and staff attended the club’s first event. They also created a startup kit for other dental students across the country to establish similar clubs.

This developed into the nationwide Professionalism and Ethics Association in Dentistry (SPEA). Its mission is to “promote and support students’ lifelong commitment to ethical behavior in order to benefit the patients they serve and to further the dental profession.”

SPEA’s objective is to “act as a support system for students in strengthening their personal and professional ethics values.” It aims to meet its mission by providing resources. It allows for ethics communication and promotes awareness of ethics. It also aims to collaborate with dental leadership. All dental students are invited to join; no membership dues are required. The organization now has 35 active chapters and 568 members across the United States and Canada.

SPEA will hold its eleventh annual session this fall. It’s a “weekend of personal development, distinguished guest speakers, professionalism and ethics workshops as well as collaborating and connecting with fellow passionate SPEA members across the country,” according to its website at speadental. org. National SPEA Executive Chair Becca Long (USC class of 2022) said SPEA’s biggest accomplishment this year was a collaboration with the American College of Dentists to create a master list of SPEA chapters, student representatives and ACD mentor contacts for its website.

Local activities occur throughout the year too. For example, the chapter at USC just collaborated with the Student National Dental Association during Black History Month to co-host faculty guests who discussed real-life situations with ethical dilemmas. More than 150 participants attended this Zoom event. This chapter also recently held small discussion groups with first-year students. Long said, “We are able to talk with them about why ethics are important and how it can affect your decisions from day one in dental school.”

We are encouraged to reach out, collaborate and support the school SPEA chapters. Go to the website and click on “ACD/SPEA Collaboration” to get contact information. You will find active chapters in California at the schools of dentistry of UCLA, UCSF, USC and Pacific Dugoni. Help nurture professionalism in our dental school students. Dr. Rosenblum recommends that we can become volunteer faculty members at our schools of dentistry and be positive influences.

It is commendable that SPEA members, who may make up a minority of the total student body of each of their respective dental schools, outwardly express their belief in strong professionalism and ethics. Such individuals make up the future leaders of our profession. Think about the impact they will make. Who would you want to lead our profession at the component level? State level? National level? Strong ethical leadership determines the direction our dental organizations will take. It should be dependent on those who we believe will have the best interests of our profession on their minds and in their actions.

As dentists, practicing ethically has a profound impact in the public realm. Just look at the annual Gallup Poll’s question that asks “how would you rate the honesty and ethical standards” of a list of professionals. The results are quite frank. Car salespeople and members of Congress almost always score at the bottom. Conversely, nurses almost always rank at the top with physicians a distant second. Dentists are not always included in the revolving list of job categories, but when they are, you can find us barely in the top five of the health professions. Is that good enough? In the last Gallup Poll to include dentists, which was in 2016, only 59% of those polled ranked the ethics of dentists as “very high” or “high.” Conversely, that means 41% believed our standards are “average” or “low/very low.” That is troubling.

We all need to consider strengthening the public’s continued trust in our profession. Support the Student Professionalism and Ethics Association in dentistry. It will foster a great foundation for our dental students and also hold our profession to a higher standard. n

REFERENCES

1. Chambers DW. Survey of Dental Ethics Education: 2018. J Am Coll Dent 2020;87(1):48–55. 2. Istrate EC, et al. Dentists of tomorrow 2020: An analysis of the results of the 2020 ADEA survey of U.S. dental school seniors summary report. ADEA Education Research Series. March 2021. The Journal welcomes letters