ADA subcommittee explores wide range of ethics initiatives

A number of comprehensive initiatives designed to bolster ethics and professionalism in dentistry have come into clearer focus since the Council on Dental Education and Licensure and Council on Ethics, Bylaws and Judicial Affairs appointed the Joint Subcommittee on Ethics and Integrity in Dental Education last year.

The subcommittee was put in place following the 2007 Symposium on Integrity and Ethics in Dental Education, which convened after a series of well-publicized allegations of cheating by dental students and graduates on graduation requirements, national board examinations and clinical licensure exams.

The subcommittee met April 26-27 at ADA Headquarters to discuss ongoing projects that address ethics and how the ADA might be able to assist with those projects. Representatives of stakeholder groups in attendance included the American College of Dentists, American Dental Education Association, American Association of Dental Examiners, American Student Dental Association, American Society for Dental Ethics, Joint Commission on National Dental Examinations and the Commission on Dental Accreditation.

“There are no simple or quick answers to the complex ethical issues facing students, dental schools and the entire profession,” said Dr. W. Scott Waugh, a CEBJA member and subcommittee co-chair. “Some of the integrity issues in education that have occurred are just the tip of the iceberg. There is a need for all of us as professionals to address principles of ethics in our own practices.”

“The profession is well aware that there are concerns with ethical conduct, and not just in dental education,” said Dr. Frank Maggio, CDEL chair. “It’s really become a societal issue. We recognize that as health care providers, dentists are held to higher standards than society as a whole. It’s something we take very seriously. Misconduct in education and practice just can’t occur.”

Many of the stakeholder groups have already implemented innovative approaches to furthering ethics and integrity, and the ADA has emerged as a facilitator of discussions to determine whether these activities could be part of an ADA initiative.

“Like other professions, dentistry has become increasingly aware of breaches in unethical behavior and is taking steps to address the problem,” said Dr. Stephen K. Young, CDEL member and subcommittee co-chair who also represented ADEA at last month’s meeting. He noted that ADA, ADEA and AADE have held ethics-related symposia in the last year.

“Coordination of activities among these groups is necessary to address the issue most effectively,” said Dr. Young.

At the April meeting, Dr. Young presented information on ADEA’s plans to develop a new Code of Professionalism in Dental Education, an action step that resulted from the November 2008 ADEA Council of Deans’ symposium. The Code will be presented to ADEA’s House of Delegates in 2009.

Dr. Marsha Pyle, chair of the Joint Commission on National Dental Examinations鈥攖he agency responsible for the development and administration of the National Board Dental Examinations (Part I, Part II and Dental Hygiene)鈥攑resented the subcommittee with a range of JCNDE activities that deal with exams, content and ethical behavior.

Some measures, such as having scores changed to pass/fail instead of competitive grading, were made to better reflect the intention of the exams.

“Pass/fail grading gives those sitting for exams less incentive to cheat to get the highest score,” said Dr. Pyle, the associate dean for education at Case Western Reserve University School of Dental Medicine. “The intention of the exam is to provide information for state boards of dentistry to use in evaluating candidates for licensure in dentistry and dental hygiene, rather than for other purposes of achievement.”

Dr. Hal Haering, a CDEL and subcommittee member, discussed an innovative program of the Florida Board of Dentistry at the April meeting.

In 2003, the dental board began inviting dental students to observe the board’s disciplinary hearings, which were regularly scheduled, open meetings of the dental board. State budget shortfalls have limited where the meetings are held these days, but the program has been valuable in showing dental students that accountability is not some abstract concept.

“Dental schools do a great job promoting ethical standards but sometimes students lose that when they get out and practice on their own,” said Dr. Haering, the former chair of the Florida Board of Dentistry. “Dentists practice without supervision and we want them to see that they will be held accountable for actions they take, especially in a group practice where they may be pressured by senior members to do things in a certain way. We have seen cases where there has been pressure on dentists to produce that is unethical. New graduates look at the senior members and think they’ve been doing this for 20 years so it must be OK, and it’s not.”

The Joint Subcommittee on Ethics and Integrity in Dental Education is expected to present a full report to the ADA House of Delegates this fall. Other projects and activities under consideration include:

• An ADA Code Preamble revision that incorporates a statement regarding student integrity and ethics. “The revision encompasses students from the educational setting through practice,” said Dr. Waugh. “We pondered the question, ‘When does one become a member of the profession?’ We believe the answer is when you are accepted into dental school. By including students in the Code, it indicates they are held to higher standards, and that the profession has high expectations of them as they complete the educational process.”
• The American College of Dentists and ADA are planning a collaborative ethics seminar to take place at annual session this fall.
• A proposal to CODA to strengthen accreditation standards relating to ethics and professionalism for predoctoral and advanced dental education programs.
• ASDA’s project to revise and strengthen its Student Code of Ethics.
• Development of a template student honor code to assist schools in implementing or revising codes in schools.
• Assisting the American College of Dentists in identifying and compiling existing ethics case studies and making that material available through an ethics clearinghouse.