Responding to Ethical Lapses in Dental School

1. Responding to Ethical Lapses in Dental School Lawrence Garetto, PhD Indiana University Kelly Horvath, Dental Student, Indiana University Zahid Ahmed, Dental Student, University of Michigan

2. Focus of Presentation • Responsibility for professionalism • How is professional conduct reviewed at your school? • Are students involved in this professional process? • If so, is it a student peer-review system or is there a joint review panel of students and faculty? • What are the pros and cons of each system?

3. Professional Status • Professional independence (self-regulation) is a privilege, not a right • Dependent on the public's belief that professionals are trustworthy • To remain trustworthy, professionals must meet the obligations expected by society • A foundation of professionalism should be a part of all levels of medical/dental education Cruess and Cruess, BMJ 1997;315:1674-1677

4. Professional Independence • Professional independence cannot be assured without competent self-regulation • As long as practitioners judged inadequate by their colleagues are dealt with by the profession, the trust that the patient places in the profession can be maintained. Irvine, BMJ 1997;314:1540 JVM Welie, JCDA 2004; 70(8):675-8

5. Responsibility for Maintenance of the Profession? Individual Collective

6. Disciplinary Action by Medical Boards and Prior Behavior in Medical School • Case–control study showing disciplinary actionamong practicing physicians by medical boards was strongly associatedwith unprofessional behavior in medical school. • Students withthe strongest association were those who were described as “irresponsible”or as having diminished ability to improve their behavior (self-awareness or capacity). • Missing immunizations/evaluations, and self-assessment inaccuracy were significantly correlated with unprofessional behavior in the clinical years Papadakis et al. NEJM 2005; 353:2673-82

7. Evidence Indicates • Peer review is essential to professional independence • We can do better in identifying problems before graduation and subsequent licensure. YET • What is effective peer review? • Where and how do we educate our students to do effective peer review?

8. Student Participation in Peer Regulation • Data indicates that peer feedback is a powerful motivator for improvement • Societally-expected professional activity • Both a judicial process and an educational process • Different strategies exist to accomplish the goal of student involvement Peter G. Dominick, Richard R. Reilly and Jack W. Mcgourty, The Effects of Peer Feedback on Team Member Behavior, Group Organization Management 1997; 22; 508

9. Peer Judicial Examples fromIndiana and Michigan • Kelly Horvath President, Student Professional Conduct Committee, Indiana University School of Dentistry • Zahid Ahmed Vice-Chair, Honor System Review Committee University of Michigan School of Dentistry

10. Student Professional Conduct Committee

11. Why a Student ProfessionalConduct Committee? • Students involved in self-governing, alignment with the ADA Code of Professional Conduct • Ethical obligations are part of the self-regulation process 2

12. The Student ProfessionalConduct Committee • Comprised solely of a Peer Review Board: -3 students from each DDS class -2 from each dental hygiene class -1 from dental assisting class • One faculty member advisor 3

13. Faculty Students Administration Judicial Advisory Recommendation 4

14. Six Values of Professionalism* * ADEA House of Delegates Statement 2009 5

15. Our Recommendations • Possible Recommendations by the SPCC: 1. Dismiss the Case 2. Decide the Course of Action -Mediation -Permanent letter in SPCC File 3. Forward the case to the PCC -Expulsion -Suspension -Any change in academic standing -Permanent Letter in Student File 6

16. Recommendations* to PCC • Recommendations occur after interviews, witness accounts, and formal discussion …Do we feel the actions demonstrated are UNPROFESSIONAL? Uphold the Code of Professional Conduct A. Advisory Reformation Counsel B. Judicial Recommendations Forward to the PCC 7 • * ALL RECOMMENDATIONS are based on the individual case. The goal is reform.

17. Benefits of a StudentProfessional Conduct Committee • Able to uncover facts and information quickly • Diversity of the group of student professionals makes decisions that are well-thought through on every angle • Clinical professionals have our own culture and language…“Is it something we would do?” • Focus on reform - recommendations from peers is more powerful • Process is easy to understand, students know the system 8

18. Challenges for the Student Professional Conduct Committee • Committee members are required to be dedicated (challenges of balancing time and schedules) • New members each year, getting members up to speed on the process takes time and commitment • Cases can be sent back or a different decision can be reached by the PCC 9

19. The Honor System Policy University of Michigan School of Dentistry Zahid Ahmed Class of 2010

20. The Honor Pledge “…to have established the highest concepts of honor and personal integrity, and to maintain these concepts during matriculation in the School and, following graduation, as a dentist or dental hygienist.”

21. Structure & Process Formal Complaint Investigation Informal Hearing (Review Committee) Student Appeal Formal Hearing (Executive Committee)

22. Strengths and Weaknesses • Reporting a violation • Peer monitoring and review • Ethical standards • Responsibility and integrity • Role of faculty and students • Faculty & Student involvement during the hearing process

23. Thank you

24. Leadership and Followership • Leadership demonstrated by moral ethical actions has a strong impact on ethical behavior by a group • Failure of leaders to respond to unethical actions/events desensitizes the professional community and results in increased likelihood of unethical acts • By your actions, YOU have the ability to influence and set a tone for your own professional communities • Ethical tone extends beyond individual communities Dan Ariely, Behavioral Economist, Duke Univ.

25. Question • How can we improve the function of our professional responsibility for peer review? • Is there a need to implement differently? • Is there a need for leadership? • Is there a need to educated differently?

26. Conclusion • Professional Practice of Dentistry • Specialized Knowledge • Specialized Skills • Professional Behavior • Just as dental school prepares students for the clinical practice of dentistry, it needs to prepare students to practice the professionalism responsibilities • Student participation in peer review during dental school is an important educationalcomponent

28. My Colleague’s Keeper? • Peer Review (Professional self-regulation) • Conventional: A process done TO someone • Criticism/regulatory action in the face of perceived incompetent or unethical actions vs. • Ideal: A process done FOR someone • Routine supportive critique (+/-) about performance and actions Cain, Sci Engineer Ethics, 1999; 5:531-40