Political Pressures in the Life of Ethicists: Opportunities for Professional Moral Development.

This symposium highlights the political conflicts, clashing views, ethically problematic laws and regulations and competing pressures that ethicists encounter in professional practice. Viewed through the lens of Rest's Four Component Model of Morality, the stories illustrate the capacities required for effective professional practice: Are ethicists sensitive to the full range of ethical issues? Are they equipped to reason through complex situations in a principled manner? Do they have a strong ethical and professional identity? Do they have the perseverance, character, and implementation abilities needed to translate their convictions into action? The stories also reveal unsettled problems with respect to the role and responsibilities of the ethicist in contemporary society.

An evidence-based guide for ethics instruction.

Drawing from multiple sources of evidence, this paper updates previous descriptions (IOM, 2002) of measurement strategies and teaching techniques to promote four theoretically derived abilities thought to be necessary conditions for the responsible conduct of research. Data from three samples (exemplary professionals, professionals disciplined by a licensing board, and graduates who completed an ethics program designed to promote the four interrelated abilities) suggest that development of a moral identity that is consistent with the norms and values of a profession is the driving force that gives rise to ethical sensitivity, ethical reasoning, and ethical implementation. Evidence from the cited studies supports the usefulness of the theoretical model to (a) deconstruct summary judgments about character and see them as abilities that can be assessed and developed; (b) guide the design assessments that are sensitive to the effects of interventions; and (c) augment previous IOM recommendations for the development of meaningful learning activities.

Gender difference in ethical abilities of dental students.

Walker's comprehensive review of claims of gender difference and gender bias in moral cognition concluded 1) that gender explains a negligible amount of the variability in moral reasoning development, 2) that accumulated evidence does not support claims of gender polarity in moral orientations (i.e., an ethic of care and an ethic of justice), and 3) that future research should focus on the range of psychological processes that engender moral maturity. This study examined whether male and female predoctoral dental students who completed an ethics curriculum grounded in Rest's comprehensive model of moral functioning differed on measures of four capacities: moral sensitivity, moral reasoning, moral motivation, and moral implementation. From archival data at the University of Minnesota School of Dentistry, data on sixty females and sixty males were randomly selected from five cohorts (n=386) who completed an ethics curriculum and outcome measures of the four capacities between 1996 and 2000. Gender differences were not apparent for a measure of moral sensitivity, but were evident for one of the moral reasoning indices, for the responsibility dimension of moral motivation, and for the measure of moral implementation. Implications are drawn for future research and for professional ethics education.

The status of ethics teaching and learning in U.S. dental schools.

The purpose of this study was to gather and analyze information about the status of ethics teaching and learning in U.S. dental schools and to recommend a curriculum development and research agenda for professional ethics in dental education. A survey to collect this information was developed by the authors and administered by the American Society for Dental Ethics. The results suggest that dental schools have adopted many of the recommendations for curricular content and learning strategies proposed in the 1989 American Association of Dental Schools (now American Dental Education Association) Curriculum Guidelines on Ethics and Professionalism in Dentistry. The survey was sent to the individual who directs the ethics curriculum at the fifty-six U.S. dental schools that had a full complement of enrolled predoctoral classes as of January 2008. All fifty-six schools responded to the survey. The data suggest that, in general, little time is devoted to ethics instruction in the formal curriculum. The mean number of contact hours of ethics instruction is 26.5 hours, which represents about 0.5 percent of the mean clock hours of instruction for dental education programs reported in the most recent American Dental Association survey of dental education. While the amount of time devoted to ethics instruction appears not to have changed much over the past thirty years, what has changed are what qualifies as ethics instruction, the pedagogies used, and the development and availability of norm-referenced learning outcomes assessments, which are currently used by a number of schools. We found that dental schools address a substantial list of topics in their ethics instruction and that there is general agreement as to the appropriateness of the topics and the ethics competencies that need to be developed and assessed. This study also identified the respondents' perceptions of unmet needs in ethics education. Four general themes emerged: the need for ethics to be more fully integrated across the curriculum, including carryover into the clinical years; the need to assess and ensure competence; the need for faculty development; and the need for more attention to method of instruction. Recommendations based on the study findings are offered for a curriculum development and research agenda for professional ethics in dental education.

A case of collegial communication and a patient who does not pay.

Four individuals who teach ethics in dental schools comment on a case in which negative financial information is revealed by one dentist when transferring records of a potential patient to another dentist. All commentators find varying degrees of ethical problem with disclosing such information. Professional codes discourage this practice. All commentators stress the importance of the potential new dentist developing a relationship based on professional standards, with the greatest emphasis placed on the patient's health needs. Several of the commentators discuss positive ways of conducting a patient interview, including specific useful language.

Authorship and publication practices in the social sciences: historical reflections on current practices.

An historical review of authorship definitions and publication practices that are embedded in directions to authors and in the codes of ethics in the fields of psychology, sociology, and education illuminates reasonable agreement and consistency across the fields with regard to (a) originality of the work submitted, (b) data sharing, (c) human participants' protection, and (d) conflict of interest disclosure. However, the role of the professional association in addressing violations of research or publication practices varies among these fields. Psychology and sociology provide active oversight with sanction authority. In education, the association assumes a more limited role: to develop and communicate standards to evoke voluntary compliance. With respect to authorship credit, each association's standards focus on criteria for inclusion as an author, other than on the author's ability to defend and willingness to take responsibility for the entire work. Discussions across a broad range of research disciplines beyond the social sciences would likely be beneficial. Whether improved standards will reduce either misattribution or perceptions of inappropriate attribution of credit within social science disciplines will likely depend on how well authorship issues are addressed in responsible conduct of research education (RCR), in research practice, and in each association's ongoing efforts to influence normative practice by specifying and clarifying best practices.

Enhancing professionalism using ethics education as part of a dental licensure board's disciplinary action. Part 2. Evidence of the process.

Pretest scores were analyzed for 41 professionals referred for ethics assessment by a dental licensing board. Two were exempt from instruction based on pretest performance on five well-validated measures; 38 completed an individualized course designed to remediate deficiencies in ethical abilities. Statistically significant change (effect sizes ranging from .55 to 5.0) was observed for ethical sensitivity (DEST scores), moral reasoning (DIT scores), and role concept (essays and PROI scores). Analysis of the relationships between ability deficiencies and disciplinary actions supports the explanatory power of Rest's Four Component Model of Morality. Of particular interest is the way the model helped referred professionals deconstruct summary judgments about character and see them as capacities that can be further developed. The performance-based assessments, especially the DEST, were particularly useful in identifying shortcomings in ethical implementation. Referred practitioners highly valued the emphasis on ethical implementation, suggesting the importance of addressing what to do and say in ethically challenging cases. Finally, the required self-assessments of learning confirm the value of the process for professional renewal (i.e., a renewed commitment to professional ideals) and of enhanced abilities not only to reason about moral problems, but to implement actions.

Enhancing professionalism using ethics education as part of a dental licensure board's disciplinary action. Part 1. An evidence-based process.

This paper describes a process and procedures for interacting with individuals who have violated the rules of professional conduct and includes descriptions of each of the assessment measures used to conduct a baseline assessment of four ethical capacities that are necessary conditions for reflective, ethical practice. The process and assessment methods are theoretically grounded in Rest's Four Component Model of Morality--a model that asserts that moral failing can result in a deficiency in any one of four abilities or capacities that are necessary for ethical behavior. Following descriptions of five well-validated assessment strategies, a synopsis of an educational intervention is presented.

Hugo A. Owens: dentist, civil rights leader, politician.

For 44 years Dr. Hugo A. Owens was a distinguished practitioner and community leader in Portsmouth, Virginia. Besides his affinity to for dentistry, he was driven by two other passions: politics and civil rights. In 1970 he was one of the first African-Americans elected to the Portsmouth City Council. He was reelected for the next term and appointed Vice Mayor, a position he held for eight years. His political successes were preceded by his activities as a civil rights leader, which began in 1950 and lasted through the 1960s. In a remarkable series of negotiations and litigations, Dr. Owens was the prime mover in the desegregation of the City of Portsmouth. In all three 'careers, Dr. Owens used dentistry as a home base for the expression of his activist philosophy of providing help for others when they were unable to do things for themselves.

Factor analysis as a tool for survey analysis using a professional role orientation inventory as an example.

BACKGROUND AND PURPOSE: The purpose of this article is to illustrate how confirmatory factor analysis can be used to extend and clarify a researcher's insight into a survey instrument beyond that afforded through the typical exploratory factor analytic approach. The authors use as an example a survey instrument developed to measure individual differences in professional role orientation among physical therapists, the Professional Role Orientation Inventory for Physical Therapists (PROI-PT). SAMPLE: Five hundred three physical therapists responded to a mail survey instrument that was sent to a random sample of 2,000 American Physical Therapy Association members. METHODS: An adapted version of the Professional Role Orientation Inventory, a 40-item Likert-scale instrument developed to assess professional role orientation on 4 dimensions (authority, responsibility, agency, and autonomy), was used. Exploratory and confirmatory factor analyses were used to examine the factorial validity of the PROI-PT. RESULTS: Exploratory factor analysis served as a starting point for examining the factor structure of the instrument. Confirmatory factor analysis then was used to test the hypothesized factor structure and to suggest refinements to the PROI-PT that would improve a psychometric property (internal consistency). DISCUSSION AND CONCLUSION: Although further refinement of the PROI-PT is needed, an instrument that yields valid and reliable measurements of individual differences in professionalism among physical therapists could further our understanding of the psychosocial aspects of physical therapist practice. Exploratory and confirmatory factor analyses can be used by researchers who study various psychosocial constructs in physical therapy.

Organized dentistry as an agent for helping others: the leadership of Donna J. Rumberger.

Dr Donna Rumberger graduated from New York University College of Dentistry in 1980 and has practiced dentistry in Manhattan ever since. Even before her graduation, she was active in organized dentistry, always viewing it as a conduit for helping other people. Working with the American Association of Women Dentists, she was cofounder of the Smiles for Success Foundation, a program started in New York City that helps women advance from welfare into the workforce with restored, healthy smiles. That program now has expanded to 14 other cities. Working with organized dentistry in New York City, she has been instrumental in initiating and running the Skate Safe program, which provides mouthguards and oral home care education for inner city children in Harlem. In addition, she has worked with the dentistry merit badge program for the Boy Scouts of America Jamborees, helped coalesce women's dental organizations in New York City, and led her dental society to collaborate with Columbia University in a program to improve access to dental care. As further evidence of her ability to get things done, she also has served as president of the American Association of Women Dentists, the Midtown Dental Society, and the New York County Dental Society--one of the largest dental societies in the country.

Serving the poorest of the poor: the story of Jeremiah J. Lowney.

Since 1966, Dr Jerry Lowney has practiced orthodontics in Norwich, Connecticut, where he has been active in both community and professional organizations, including the University of Connecticut Board of Trustees and the Board of Governors for Higher Education. Since his first volunteer trip to Haiti in the mid-1980s, during which he provided dental services for the poor, he has returned to that country at least three times each year. Over time the nature of his activities has changed. Through grant writing, personal influence, liaison with a religious order, a huge investment of time, successful fundraising, the seizing of every opportunity, and the expenditure of large amounts of his own money, he has created a multimillion-dollar general health facility in one of the poorest areas in Haiti. Besides dental treatment, the scope of his activities has ranged from creating centers for high-risk pregnancy and malnutrition to the hiring of physicians, the training of local nurse practitioners, and an Adopt-a-Family program run by his wife, Virginia. His actions have been influenced by Virginia's caring attitudes and by his conviction that much is expected from those who have received life's bounties.

The defining issues test and the four component model: contributions to professional education.

This article reviews studies examining the effect of professional education on ethical development. Most studies limit assessment to the measurement of moral judgement, observing that moral judgement plateaus during professional school unless an ethics intervention is present. Whereas interventions influence the shift to postconventional reasoning (the DIT P score), a more illuminating picture of change may emerge if researchers examined DIT profiles. More importantly, limiting assessment to measures of moral judgement ignores important aspects of moral functioning suggested by the Four Components Model. Assessment methods have been validated for sensitivity, role concept and ethical implementation that could be adapted to provide individuals in a particular profession with a more complete picture of abilities needed for real-life professional practice.