The Journal of the American College of Dentists最新文献

James Rest proposed a model of moral behavior with four components: sensitivity, reasoning, character, and courage (or action). Research has shown that moral character is a complex construct. Multiple moral self-concepts exist within each individual, and different context predispose various of these to become dominant in different settings. Moral priming is the practice of manipulating the environment to favor the use of appropriate moral self-concepts. A study is reported, demonstrating that dentists can be primed to express more moral views based entirely on context. The observed effect of priming was large. The ACD Rule for Moral Identity states that when there is conflict between professionalism and economic or other self-interests, professionalism takes precedence.

Almost 20 years ago dental education, including ancillary and residency training, made a fundamental shift to a competency model. Competency is the level of knowledge, skills, and values needed to begin independent practice. This replaced the older emphasis on process. It had formerly been assumed that if a student was exposed to good teaching for a set period of time, he or she must be ready for practice. The responsibility has been shifted from schools needing to demonstrate that they have done the traditional things well to requiring that they demonstrate that every graduate is in fact capable of independent performance as a dentist. This paper describes the nature of competency in predoctoral dental education and introduces some of the most common assessment methods schools use to ensure that each graduate is competent.

Dentistry usually concerns itself with managing the scope of practice relationships with areas historically performed by dentists as solo practitioners. Many trends in health care-such as electronic records, Big Data, consolidated reimbursement systems, effective but expensive technology, the economies of group practice-are now overwhelming the boundaries of tasks performed in isolation. The Commission on Dental Accreditation has added a standard that dental education programs must prepare professionals to function in these new environments.

Ethics education has been a required part of accreditation standards for dental and dental hygiene programs since the 19lJs. The dominant approach uses a combination of lectures and small, case-based seminars to teach ethical principles and provide practice in decision-making procedures to reason through dilemmas where there are several "right" ways to act. Detail is provided about three such programs.

This presentation is an interim report on the American College of Dentists Gies Ethics Project. Following the example of William Gies, our work has been grounded in empirical studies, with progress on the first 11 projects summarized here. The following general patterns are beginning to emerge: (a) the traditional model of individual dentists guided by abstract principles seems to exhibit some inadequacies; (b) ethical cases suggest that patients and dentists hold common views or what should be done and why in some areas but they diverge in others; (c) dentists place high value on technical excellence and income and relatively less on ethics and oral health outcomes; (d) ethics education in dental schools has not achieved the status of a discipline and is showing signs of receiving less attention than in recent years; (e) focus groups of both patients and dentists are concerned that private standards that differ across dentists as to what constitutes appropriate care are eroding trust in the profession, both among dentists and between dentists and patients; (f) recent economic trends highlight growing fragmentation within the profession; (g) practice is losing its direct relationship with patients as it becomes more commercial; (h) dentists are confused about their role in self-regulation and thus compromising public trust; (i) dentists seem to be willing to tolerate a significant number of their colleagues cutting corners; (j) educating individual dentists about ethical theory is unlikely to be effective in bringing about needed professional behavior. Based on this preliminary evidence, it may very well be the case that the ACD Gies Ethics Projects makes recommendations such as the following: (a) improving the ethical tone of the profession will require changes at the organizational as well as the individual level; (b) standards may be more effective if shared among dentists and with the public;

The literature is equivocal: dentists are either as susceptible to substance abuse or somewhat more susceptible than the general public. Most of us have suspected at one time that a colleague was troubled by excessive alcohol consumption or prescription pain medications. We often sit on the sidelines, waiting for an ideal opportunity to help, wary about offering unsolicited advice or invading the privacy of a colleague. When the problem is confronted and intervention begins, we hold our breath, yearning for a healthy outcome but dreading the worst. This brief memoir describes the first author's real-life attempts to support a colleague (with the help of a psychologist, the second author) at various intersections of treatment. The moral challenge of professional confrontation is explored. Suggestions on how to intervene with friends, colleagues, and loved ones are offered.