Lawrence Garetto, PhD Indiana University

Lawrence Garetto, PhDIndiana University

Kelly Horvath, Dental Student, Indiana University

Zahid Ahmed, Dental Student,University of Michigan

Responsibility for professionalism How is professional conduct reviewed at your

school? Are students involved in this professional

process? If so, is it a student peer-review system or is

there a joint review panel of students and faculty?

What are the pros and cons of each system?

Professional independence (self-regulation) is a privilege, not a right

Dependent on the public's belief that professionals are trustworthy

To remain trustworthy, professionals must meet the obligations expected by society

A foundation of professionalism should be a part of all levels of medical/dental education

Cruess and Cruess, BMJ 1997;315:1674-1677

Professional independence cannot be assured without competent self-regulation

As long as practitioners judged inadequate by their colleagues are dealt with by the profession, the trust that the patient places in the profession can be maintained.

Irvine, BMJ 1997;314:1540JVM Welie, JCDA 2004; 70(8):675-8

Individual Collective

Case–control study showing disciplinary action

among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school.

Students with the strongest association were those who were described as “irresponsible” or as having diminished ability to improve their behavior (self-awareness or capacity).

Missing immunizations/evaluations, and self-assessment inaccuracy were significantly correlated with unprofessional behavior in the clinical years

Papadakis et al. NEJM 2005; 353:2673-82

Peer review is essential to professional independence

We can do better in identifying problems before graduation and subsequent licensure.

YET What is effective peer review? Where and how do we educate our students

to do effective peer review?

Data indicates that peer feedback is a powerful motivator for improvement

Societally-expected professional activity

Both a judicial process and an educational process

Different strategies exist to accomplish the goal of student involvement

Peter G. Dominick, Richard R. Reilly and Jack W. Mcgourty, The Effects of Peer Feedback on Team Member Behavior, Group Organization Management 1997; 22; 508

Kelly HorvathPresident, Student Professional Conduct Committee, Indiana University School of Dentistry

Zahid AhmedVice-Chair, Honor System Review CommitteeUniversity of Michigan School of Dentistry

Student Professional Conduct Committee

Why a Student ProfessionalConduct Committee?

Students involved in self-governing, alignment with the ADA Code of Professional Conduct

Ethical obligations are part of the self-regulation process

2

The Student ProfessionalConduct Committee

Comprised solely of a Peer Review Board:

-3 students from each DDS class

-2 from each dental hygiene class

-1 from dental assisting class

One faculty member advisor

3

Faculty StudentsAdministration

Judicial Advisory

Recommendation

4

Six Values of Professionalism*

* ADEA House of Delegates Statement 2009

5

Our Recommendations

Possible Recommendations by the SPCC:1. Dismiss the Case

2. Decide the Course of Action-Mediation

-Permanent letter in SPCC File

3. Forward the case to the PCC

-Expulsion

-Suspension

-Any change in academic standing

-Permanent Letter in Student File

6

Recommendations* to PCC

Recommendations occur after interviews, witness accounts, and formal discussion

…Do we feel the actions demonstrated are UNPROFESSIONAL?

Uphold the Code of Professional Conduct

A. AdvisoryReformation

CounselB. Judicial

Recommendations Forward to the PCC

7

* ALL RECOMMENDATIONS are based on the individual case. The goal is reform.

Benefits of a StudentProfessional Conduct Committee

Able to uncover facts and information quickly Diversity of the group of student professionals

makes decisions that are well-thought through on every angle

Clinical professionals have our own culture and language…“Is it something we would do?”

Focus on reform - recommendations from peers is more powerful

Process is easy to understand, students know the system

8

Challenges for the Student Professional Conduct Committee

Committee members are required to be dedicated (challenges of balancing time and schedules)

New members each year, getting members up to speed on the process takes time and commitment

Cases can be sent back or a different decision can be reached by the PCC

9

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y

The Honor System Policy University of Michigan School of Dentistry

Zahid AhmedClass of 2010

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y

The Honor Pledge

“…to have established the highest concepts of honor and personal integrity, and to maintain these concepts during matriculation in the School and, following graduation, as a dentist or dental hygienist.”

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y

Structure & Process

Formal Complaint

Investigation

Informal Hearing (Review Committee)

Student Appeal Formal Hearing(Executive Committee)

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y

Strengths and Weaknesses

Reporting a violation Peer monitoring and review Ethical standards Responsibility and integrity Role of faculty and students Faculty & Student involvement

during the hearing process

U N I V E R S I T Y O F M I C H I G A N S C H O O L O F D E N T I S T R Y

Thank you

Leadership demonstrated by moral ethical actions has a strong impact on ethical behavior by a group

Failure of leaders to respond to unethical actions/events desensitizes the professional community and results in increased likelihood of unethical acts

By your actions, YOU have the ability to influence and set a tone for your own professional communities

Ethical tone extends beyond individual communities

Dan Ariely, Behavioral Economist, Duke Univ.

How can we improve the function of our professional responsibility for peer review?

◦ Is there a need to implement differently?◦ Is there a need for leadership?◦ Is there a need to educated differently?

Professional Practice of Dentistry◦ Specialized Knowledge◦ Specialized Skills◦ Professional Behavior

Just as dental school prepares students for the clinical practice of dentistry, it needs to prepare students to practice the professionalism responsibilities

Student participation in peer review during dental school is an important educational component

Peer Review (Professional self-regulation)

◦ Conventional: A process done TO someone Criticism/regulatory action in the face of perceived

incompetent or unethical actions

vs.

◦ Ideal: A process done FOR someone Routine supportive critique (+/-) about performance

and actions

Cain, Sci Engineer Ethics, 1999; 5:531-40