our code of ethics
In the April 2 edition of the ADA news, Dr. Maitland discusses issues of ethics in and out of dental school. The ethics issues present within dental schools is very evident, but difficult to address. The one problem that I can relate to is the concern of clinical competence.
How is this a question of ethics? Consider a third year dental students first patient. If the amount of preclinical time is insufficient, the student will be unprepared to perform at an acceptable level, putting his/her patient [and the general population] at risk. If this student is allowed to continue in the clinic at this level, without mention, they may not be aware of the degree of clinical deficiency. Then, at the end of four years, they are surprised when they don't pass their boards.
Part of the problem is that we have many instructors, and each may only see a small piece of each students work. If a student has done poorly on a daily project or competency, it may be passed off as a bad day, and no single instructor may see just how many "bad days" this student has had. Not wanting to come down too hard, faculty allow this performance to continue by giving passing grades. I understand that operative procedures [crown preps/composite preps/provisionals] are graded subjectively, but students have a right to honest criticism. When it is time for the student to enter clinic they face an even steeper learning curve, and if their abilities aren't at an acceptable level then something needs to be done.
Quality assurance is why we have an independent party administer board exams, and also why it will be near impossible to realize a curriculum integrated format for our clinical boards [but that is another entry]. What can be done [in my most humble opinion] is to establish a pre-clinic preceptor program that mirrors what is in the clinic. One or two faculty assigned to 10-15 students, who are responisble for all pre-clinic grading for those students during the first and second years of dental school. The consistancy of grading the same students' work allows the preceptor to monitor the growth of the students, and address problems as they arise. It also makes one or two people responsible for the clinical competence [or lack thereof] of those students.
No system is perfect. I am thankful that my education has been very clinically oriented, and I am proud of the level my classmates and I have achieved. I am also pretty confident that we are all ready to begin seeing patients. However, if a student is clearly not ready, is it ethical for a school to advance him/her to enter the clinic?
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