The circumstances surrounding the recent controversy involving thirteen Dalhousie dental students should serve as an important wake-up call about the importance of comprehensive ethics education, and ensuring that the ideals of professionalism are understood in the early phase of academic training for all health care practitioners. By now the story of thirteen male dental students, who shared a blog that contained hateful and violent sexual references about female colleagues is common knowledge. It is reported that their Facebook page contained remarks about voting for “which female student they’d rather have “hate” sex with”, as well as how a penis is “the tool used to wean and convert lesbians and virgins into useful, productive members of society”.1 These thirteen students will soon graduate as dentists. Perhaps it will be necessary for them to fulfill conditional requirements for licensing. In a story that appeared in the Toronto Star, Mr. Fefergrad, the registrar of the Royal College of Dental Surgeons of Ontario, was reported to have requested the names of the thirteen Dalhousie students. “The conduct is deplorable”, he stated. “We have one responsibility, and that is to look after the public interest.”2
From a pedagogic perspective, dental educators must be asking themselves why it is that students so close to graduating demonstrated a lack of appreciation for the ethical and professional obligations for which they will be held accountable as licensed health care providers. Is the Dalhousie situation to be seen merely as the moral misadventure of thirteen male university students? Or, do these troubling circumstances indicate a need to re-assess ethics education in dental school, to examine how the ideals of the profession are being conveyed to students throughout their training?
Like other health professions, the future of dentistry as an essential and respected health profession will depend upon “the continuous development of principled leaders and moral leadership”.3 Such principled leadership is not only essential to preserving the integrity of dental education but also of supporting ethics and professionalism in clinical practice. Following graduation dentists must be prepared to assume leadership roles as well as the clinical duties for which they were trained. Dentists are the clinical leads or “head of the team” in work settings where they practice alongside other self-regulated health professionals like hygienists, who must adhere to their own professional standards for conduct. Dentists supervise chairside assistants, as well as manage administrative staff, most of whom are women. How well prepared are dental students to assume these leadership roles and what values will ultimately inform them as leaders in these work settings?
Values based leadership (also known as ethical leadership) is used to describe organizational leaders whose core values or ethical principles are fundamental to the way they interpret and execute their leadership role.4 In health care settings, value based leaders can positively influence the moral climate of the work setting.5,6 Such leadership is instrumental in preserving clinical integrity and in modelling for respectful communication, enhanced team functioning and quality care. Challenging values, disruptive or disrespectful behaviours within clinical settings have been found to compromise both quality of care and patient safety.7 In this regard, the behaviour of the thirteen Dalhousie students not only demonstrated poor moral judgement as individuals and as a collegial group, but also a collective lack of appreciation for the ethical obligations they hold as future health care professionals, care team leaders within clinical work settings.
To date critiques of the Dalhousie situation have highlighted societal influences like “deeply-rooted misogynistic attitudes that still persist at the heart of society today”.8 Much of the debate has centered on what would constitute a fair process of investigation, reconstructive justice and/or ultimate consequence for students involved in the offensive remarks made about female classmates on social media. From an ethics perspective, it is the choices that were made, the egregious behaviour that revealed a serious breach of professional obligations contained in dentistry’s code of ethics through their collective mistreatment of colleagues. With thirteen students engaged in unprofessional behaviour at such a late stage in their educational program, one must ask how and why such key ethical and professional obligations were not known, misunderstood, or collectively ignored. The answers to this question could be pivotal in shaping the future role of ethics education in dental programs.
If dental programs across Canada need to examine anything in the wake of this troubling situation, it is the extent to which their programs not only provide excellent clinical training, but also the skills and knowledge to support ethical reasoning and professionalism from day one.
The following are key areas of ethical concern for educators and schools of dentistry in the wake of the Dalhousie controversy.
Does the dental program provide a transformative experience for students that not only imparts relevant knowledge and excellent clinical skills, but also promotes the development of moral reasoning as health care professionals? Do students sufficiently understand inherent conflicts of interests, likely ethical challenges they will face in clinical practice? Does their program of study help them to develop the skills and ethics knowledge needed to address these matters in daily clinical practice?
Are students guided in their development of leadership skills, interpersonal communication skills and sensitivity about important issues like gender equality and culture within multi-disciplinary clinical settings?
Are students sufficiently aware of the values and obligations associated with professionalism from the time of their admission into dental school? What are dental faculty members modelling for dental students with regards to professional demeanor and values? Are students aware of the impact that disruptive and disrespectful behaviours can have in both the educational and clinical setting?
Do students have opportunities to develop their skills of ethical reasoning and ethical decision-making which are necessary in effectively addressing unethical or problematic behaviour in the educational and/or clinical work setting?
Are existing mechanisms, policies and procedures sufficient to ensure fairness and justice when dental students or faculty are believed to be acting unethically? Are these mechanisms, procedures or resources clearly understood and accessible to dental students who may witness unprofessional behaviour, or be the target of abuse by a colleague or faculty?
Trust in Canadian health care is dependent upon the level at which the various health professions are held accountable and the extent to which they are transparent about professional and practice standards. Ontario Health Minister, Dr. Eric Hoskins, is charting “a new course “for health care in Canada with “transformation and transparency” as his two top priorities. He is targeting unprofessional practices of regulated health professionals, ordering self-regulating colleges to engage in greater disclosure, to ensure there is greater accountability.9 In the wake of the allegations made about the thirteen Dalhousie dental students, and in this climate of greater accountability and transparency in health care, how well dental students understand and appreciate their ethical and professional obligations becomes more important than less.
Karen Faith is a Bioethics consultant, university lecturer, speaker and writer who lives in Toronto. Her areas of interest include ethics education for health care provid
ers, women’s health issues as well as the role of values based leadership in sustaining ethical work environments. www.karenfaith.com
References:
1. Wente, M. Dalhousie’s dental hysteria. Globe and Mail. Jan.6, 2015.
2. Edwards, P. Ontario dental watchdog demands names of Dalhousie students in Facebook scandal. Toronto Star. Jan. 5, 2015.
3. Souba, W. The Inward Journey of Leadership. Journal of Surgical Research, 2006,131:159-167.
4. Faith, K. The role of values-based leadership in sustaining a culture of caring. Healthcare Management Forum, 2013 26:6-10.
5. Rathert C, FlemingDA. Hospital ethical climate and teamwork in acute care: the moderating role of leaders. Health Care Manage Rev. 2008;33:323-331.
6. Schein E. Organizational Culture and Leadership. San Francisco, CA: Jossey-Bass; 1992.
7. The Joint Commission. Sentinel event alert: behaviors that undermine a culture of safety. (http://www.jointcommission.org/sentinel_event_alert_issue_40_behaviors_that_undermine_a_culture_of_safety/)
8. Bensimon C. Dalhousie Dentistry Story: A Case for Proportionality, Professionalism, and the Promotion of Moral Character. BioethiqueOnline 2015, 4/1 (http://bioethiqueonline.ca?4?1)
9. Cohn, M. Why our health ministry is following doctor’s orders: Cohn. Toronto Star. Jan. 31, 2015.
