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The American Dental Education Association (ADEA) is committed to developing and sustaining institutional environments within the allied, predoctoral and postdoctoral dental education community that foster academic integrity and professionalism. 

The ADEA Task Force on Professionalism in Dental Education was charged by the ADEA Board of Directors with the development of a Statement on Professionalism for the dental education community. All seven ADEA Councils endorsed this effort and were represented on the Task Force. Through its work, the Task Force sought to identify and clarify those personal and institutional values and behaviors that support academic integrity and professionalism in dental education and that are aligned with the existing values and codes of the dental, allied dental and higher education professions.

The Task Force intends for this Statement on Professionalism to help define the expectations for professional behavior in dental education institutions, including the values and behaviors that should guide students as they enter the dental and allied professions, and faculty and administrators as they continuously improve their educational programs.

The Task Force acknowledges and respects that each dental education institution has its own unique culture, institutional values, principles and processes, and in some cases, codes of conduct for community members. The ADEA Statement on Professionalism is not intended to replace or supersede these codes. Rather, it is intended to serve as a touchstone upon which the entire dental education community can build a shared understanding and definition of professionalism. We invite our colleagues, individual and institutional, to use this statement to develop their own codes of professionalism.

The Task Force also recommends that advisory opinions be developed to provide “real-life applications” of these values and that best practices in developing and advancing a culture of professionalism within dental education be documented and disseminated. It is our belief that through these illustrative stories, the concept of professionalism will be more easily understood and applied by individuals and institutions.

The Task Force hopes that this Statement on Professionalism stimulates broad discussions about professional behavior in dental education, provides guidance for individual and institutional behavior within dental education, and in so doing, supports professionalism across the continuum of dental education and practice.
 
VALUES DEFINING PROFESSIONALISM IN DENTAL EDUCATION

The Task Force identified and developed the following six values-based statements defining professionalism in dental education:

A discussion of each of these values follows and includes a more full definition of each value and a description of the behaviors that enactment of the value requires and to which all members of the dental education community can aspire.

In developing the ADEA Statement on Professionalism, the Task Force sought to align the Statement with existing codes of ethics and conduct within the allied, pre-doctoral and post-doctoral dental communities.  To illustrate the continuity of these values between the dental education community and the practicing community, the discussion of each value includes a reference to the ethical principles espoused by the American Dental Association (ADA Principles of Ethics and Code of Professional Conduct) and the American Student Dental Association (ASDA Student Code of Ethics), and the values expressed in the American Dental Hygienists’ Association (ADHA Code of Ethics for Dental Hygienists). 

Finally, examples of how the value applies to different constituencies within the dental education community are provided. 

DETAILED DEFINITIONS OF THE SIX VALUES

Competence: acquiring and maintaining the high level of special knowledge, technical ability and professional behavior necessary for the practice of dentistry and for effective functioning in the dental education environment.

Expanded Definition: Encompasses the concept of knowing dentistry – having acquired the unique knowledge, skills, and abilities required for effective practice of dentistry; encompasses the concept of knowledge about how people learn, skills for effective pedagogy – including developing curriculum and assessments; also encompasses the knowledge of ethical principles and professional values (2); life-long commitment to maintain skills and knowledge; modeling appropriate values as both an educator and dental professional; developing ability to communicate effectively with patients, peers, colleagues, and other professionals; recognizing the limits of one’s own knowledge and skills – knowing when to refer; recognizing and acting upon the need for collaboration with peers, colleagues, allied professionals, and other health professionals; includes recognizing the need for new knowledge - supporting biomedical, behavioral, clinical, and educational research, and engaging in evidence-based practice.

Alignment with:

• ADA Principles of Ethics: beneficence and nonmaleficence
• ADHA Code for Dental Hygienists: beneficence and nonmaleficence
• ASDA Student Code of Ethics: nonmaleficence and beneficence

Examples:

1. For students: Learning dentistry is a top priority.  Develop the habits and practices of lifelong learning, including self-assessment skills; Accept and respond to fair negative feedback about your performance – recognize when you need to learn; Learn and practice effective communication skills; Know the limits of your knowledge and skills and practice within them; Learn when and how to refer.
2. For faculty: Engage in lifelong learning and evaluate and enhance your abilities in this area; Model continuous professional development, in dentistry and pedagogy. Model effective interactions with patients, colleagues, and students: Accept and respond to fair negative feedback about your performance – recognize when you need to learn; Know the limits of your skills and practice within them; Model how and when to refer; Acknowledge and act on the need for collaboration.
3. For researchers: Generate new knowledge; Engage in lifelong learning and evaluate and enhance your abilities in this area; Model continuous professional development. Model effective interactions with patients, colleagues, and students: Accept and respond to fair negative feedback about your performance – recognize when you need to learn.
4. For institutions/administrators: Set high standards; Learn and practice effective self-assessment skills; Accept and respond to fair negative feedback – recognize the need for institutional learning and address it; Acknowledge and act on the need for collaboration. Support the learning needs of all members of the institution and encourage them to pursue lifelong learning.

Fairness: demonstrating consistency and even-handedness in dealings with others.

Expanded Definition: Encompasses considerations of how to best distribute benefits and burdens; to each an equal share, to each according to need, to each according to effort, to each according to contribution, to each according to merit (4) are some of the possible considerations; encompasses evenhandedness and consistency; includes setting process standards, striving for just consideration for all parties, ensuring consistency in application of process (following the rules) while recognizing that different outcomes are possible, transparency of process, calibration; consistent, reliable, and unbiased  evaluation systems; commitment to work for access to oral healthcare services for underserved populations.

Alignment with:

• ADA Principles of Ethics: justice, beneficence, nonmaleficence
• ADHA Code for Dental Hygienists: justice and fairness, beneficence, nonmaleficence
• ASDA Student Code of Ethics: justice, nonmaleficence and beneficence

Examples:

1. For students: Follow institutional rules and regulations; Promote equal access to learning materials for all students and equal access to care for the public.
2. For faculty: Use appropriate assessment and evaluation methods for students;  View situations from multiple perspectives, especially those that require evaluation; Provide balanced feedback to students, colleagues, and the institution; Use evidence-based practices; Promote equal access to oral health care.
3. For researchers: Set high standards for the conduct of research and use unbiased processes to assess research outcomes; Generate the data to support evidence-based practice and education.
4. For administrators/institutions: Set high standards and ensure fair, unbiased assessment and evaluation processes for all members of the institution including applicants to educational programs; Insure that institutional policies and procedures are unbiased and applied consistently; Insure transparency of process.  

Integrity: being honest and demonstrating congruence between one’s values, words, and actions.

Expanded definition:  concept of wholeness and unity (1); congruence between word and deed; representing one’s knowledge, skills, abilities, and accomplishments honestly and truthfully; devotion to honesty and truthfulness, keeping one’s word, meeting commitments; dedication to finding truth, including honesty with oneself; willingness to lead an examined life; willingness to engage in self-assessment and self-reflection; willingness to acknowledge mistakes; commitment to developing moral insight (1) and moral reasoning skills; recognizing when words, actions or intentions are in conflict with one’s values and conscience (3) and the willingness to take corrective action; dedication and commitment to excellence – requires more than just meeting minimum standards – making a continual conscientious effort to exceed ordinary expectations (2); encompasses fortitude, the willingness to suffer personal discomfort/inconvenience/harm for the sake of a moral good (1).

Alignment with:

• ADA Principles of Ethics: beneficence, nonmaleficence, and veracity
• ADHA Code for Dental Hygienists: beneficence, nonmaleficence, and veracity
• ASDA Student Code of Ethics: nonmaleficence and beneficence, dental student conduct

Examples:

1. For students: Strive for personal excellence.  Take examinations honestly.  Make entries in patient’s records honestly.
2. For faculty: Strive for personal excellence in teaching as well as in practice and/or research.  Represent your knowledge honestly.
3. For researchers: Strive for personal excellence.  Report research outcomes honestly.
4. For administrators/institutions: Strive for personal and institutional excellence. Use appropriate outcomes measures and acknowledge openly when improvements need to be made. Ensure institutional systems and structures are honest, open, respectful, and don’t create undo conflicts.

Responsibility: being accountable for one’s actions and recognizing and acting upon the special obligations to others that one assumes in joining a profession.

Expanded Definition: Encompasses the concepts of obligation, duties, and accountability; requires an appreciation of the fiduciary relationship (a special relationship of trust) between dentists and patients and the profession and society. Accountability requires fulfilling the implied contract governing the patient-dentist relationship as well as the profession’s relationship to society (2).  It includes standard setting and management of conflicts of interest/commitment (2) as well as meeting one’s commitments and being dependable. It requires striking a morally defensible balance between self-interest (1) and the interest of those who place their trust in us, our patients and society. It requires keeping one’s skills and knowledge current and a commitment to lifelong learning. It requires embracing and engaging in self-regulation of the profession, including peer review and protecting from harm those who place their trust in us.  

Alignment with:

• ADA Principles of Ethics: beneficence and nonmaleficence
• ADHA Code for Dental Hygienists: beneficence and nonmaleficence
• ASDA Student Code of Ethics: nonmaleficence and beneficence

Examples:

1. For students: Meet commitments.  Complete assignments on time.  Make your learning in dental school a top priority.  Acknowledge and correct errors.  Report misconduct and participate in peer review.  
2. For faculty:  Continuously improve as a teacher.  Stay current.  Set high standards.  Show up on time and be available to students when assigned to teach. Meet commitments.  Acknowledge and correct errors.  Report and manage conflicts of interest/commitment.  Ensure that all patient care provided is in the best interest of the patient.  Ensure that patient care provided is appropriate and complete.  Protect students, patients, and society from harm.  Report misconduct and participate in peer review. 
3. For researchers:  Know and practice the rules and regulations for the responsible conduct of research.  Stay current.  Meet commitments.  Report and manage conflicts of interest/commitment.  Report scientific misconduct and participate in peer review.      
4. For administrators/institutions: Continuously improve as administrators.  Use appropriate institutional outcomes assessments and continuously improve institutional systems and processes.  Acknowledge and correct errors.  Report misconduct and support institutional peer review systems.   

Respect: honoring the worth of others.

Expanded Definition: Encompasses acknowledgment of the autonomy and worth of the individual human being and his/her belief and value system (2); personal commitment to honor the rights and choices of individuals regarding themselves and their oral healthcare; for patients requires confidentiality, privacy, and informed consent (2) – derives from our fiduciary relationship with patients; also accorded to colleagues in dentistry and other health professions, students and other learners, institutions, systems, and processes (2).  Includes valuing the contributions of others, interprofessional respect (other healthcare providers) and intraprofessional respect (allied healthcare providers); acknowledging the different ways students learn and appreciating developmental levels/differences among learners; includes temperance – maintaining vigilance about protecting persons from inappropriate over- or undertreatment and/or abandonment (1)  - and tolerance.

Alignment with:

• ADA Principles of Ethics: autonomy, beneficence and nonmaleficence
• ADHA Code for Dental Hygienists: individual autonomy and respect for human beings, beneficence and nonmaleficence
• ASDA Student Code of Ethics: patient autonomy and nonmaleficence and beneficence

Examples:

1. For students: Develop a nuanced understanding of the rights and values of patients; Protect patients from harm; Support patient autonomy; Be mindful of patients’ time and ensure timeliness in the continuity of patient care; Keep confidences; Accept and embrace cultural diversity; Learn cross-cultural communication skills; Accept and embrace differences; Acknowledge and support the contributions of peers and faculty.
2. For faculty: Model valuing others and their rights – particularly those of patients; Protect patients from harm; Support patient autonomy; Accept and embrace diversity and difference; Model effective cross-cultural communication skills; Acknowledge and support the work and contribution of colleagues; Accept, understand and address the developmental needs of learners.
3. For researchers: Protect human research subjects from harm; Protect patient autonomy; Accept, understand and address the developmental needs of learners; Acknowledge and support the work and contributions of colleagues.
4. For administrators/institutions: Recognize and support the rights and values of all members of the institution; Acknowledge the value of all members of the institution; Accept and embrace cultural diversity and individual difference; model effective cross-cultural communication skills;  Support patient autonomy, protect patients from harm and safeguard privacy; Protect vulnerable populations; Create and sustain healthy learning environments; Insure fair institutional processes.

Service-mindedness: acting for the benefit of others, particularly for the good of those the profession serves, and approaching those served with compassion.

Expanded Definition: encompasses beneficence: the obligation to benefit others or to seek their good (3) as well as the primacy of the needs of the patient and/or society - those who place their trust in us; patient needs, not self-interest, should guide the actions of dentists; also includes compassion and empathy; providing compassionate care requires a sincere concern for and interest in humanity and a strong desire to relieve the suffering of others (1); empathic care requires the ability to understand and appreciate another person’s perspectives without losing sight of one’s professional role and responsibilities (1).  Compassion and empathy also extend to one’s peers and co-workers.  The expectation that dentists serve patients and society is based on the autonomy granted to the profession by society.  The orientation to service also extends to one’s peers and to the profession.  Commitment of dentists to serve the profession is required in order for the profession to maintain its autonomy.  The orientation to service also extends to encouraging and helping others learn, including patients, peers, and/or students.  Dental schools are also expected to serve the oral health needs of society, not only by educating dentists, but also by being collaborators in solutions to problems of access to care.

Alignment with:

• ADA Principles of Ethics: beneficence and justice
• ADHA Code for Dental Hygienists: beneficence, justice and fairness
• ASDA Student Code of Ethics: nonmaleficence and beneficence and justice

Examples:

1. For students: Contribute to and support the learning needs of peers and the dental profession; Recognize and act on the primacy of the well-being and the oral health needs of patients and/or society in all actions; Provide compassionate care; Support the values of the profession; Volunteer to work for the benefit of patients, society, colleagues and the profession to improve the oral health of the public.
2. For faculty: Model a sincere concern for students, patients, peers and humanity in your interactions with all; Volunteer to work for the benefit of patients, society, colleagues and the profession to improve the oral health of the public; Model recognition of the primacy of the needs of the patient and/or society in the oral health care setting and at the same time, support the learning needs of students;  Contribute to and support the knowledge base of the profession to improve the oral health of the public.
3. For researchers: Generate new knowledge to improve the oral health of the public; Contribute to and support the learning needs of students, colleagues and the dental profession. Model the values of and serve to the dental profession and to relevant scientific/research associations; Volunteer to serve the public and the profession and engage in peer review.
4. Administrators/institutions: Recognize and act on opportunities to provide oral health care for underserved populations; Encourage and support all members of the institution in their service activities; Provide leadership in modeling service to the profession and the public.

APPENDIX ONE: ADEA CODE OF PROFESSIONALISM IN DENTAL EDUCATION TASK FORCE MEMBERSHIP

Task Force Chair
Dr. Richard Buchanan, Dean, University of Buffalo School of Dental Medicine

Representing the Council of Allied Program Directors
Dr. Susan Duley, Associate Professor of Dental Hygiene, Clayton State University

Representing the Corporate Council
Mr. Daniel Perkins, President, AEGIS Communications

Representing the Council of Deans
Dr. Cecile A. Feldman, Dean, University of Medicine and Dentistry of New Jersey

Representing the Council of Faculties
Dr. Kenneth R. Etzel, Associate Dean, University of Pittsburgh School of Dental Medicine

Representing the Council of Hospitals and Advanced Education Programs
Dr. Todd Thierer, University of Rochester Eastman, Department of Dentistry

Representing the Council of Sections
Dr. Judy Skelton, Associate Professor, University of Kentucky, Division of Dental Public Health

Representing the Council of Students
Mr. Matthew MacGinnis, dental student, University of Southern California

Representing ADA’s Council on Dental Education and Licensure
Dr. Frank Maggio, American Dental Association

Representing the ADA’s Council on Ethics, Bylaws and Judicial Affairs
Dr. David Boden, American Dental Association

Representing the Commission on Dental Accreditation
Dr. James R. Cole II

Representing the American Dental Student Association
Mr. Michael Meru, dental student, University of Southern California

At-Large Representatives
Dr. Marilyn Lantz, Associate Dean, University of Michigan School of Dentistry
Dr. Kathy Roth, ADA Immediate Past President



References:

1. Rule, JT, and Bebeau, MJ. 2005. Dentists Who Care: Inspiring Stories of Professional Commitment. Quintessence Publishing Co, Inc. Chicago, pp. 171-172.
2. Stern, DT. 2006. Measuring Medical Professionalism. Oxford University Press. New York, pp. 15 – 32.
3. American College of Dentists. Ethics – Core Values & Aspirational Code of Ethics (http://www.acd.org/acdethics1.htm).
4. Beauchamp, TL, and Childress, JF. 1989.  Principles of Biomedical Ethics, 3rd Edition, Oxford University Press, New York.