The use of virtual patient scenarios as a vehicle for teaching professionalism

OBJECTIVES

This study aimed to measure students' perceptions of virtual patient scenarios (VPs) for developing ethical reasoning skills and to explore features in VP design that are necessary to promote professionalism.

METHODS

Sixty-five dental students participated in learning sessions that involved collaborative practice with five VPs (four high fidelity and one low fidelity), followed by reflection sessions. Students' perceptions towards the use of VPs in developing ethical reasoning skills were assessed using a questionnaire that involved 10 closed and three open-ended questions.

RESULTS

High-fidelity VPs were perceived as significantly better for developing ethical reasoning skills than low-fidelity VPs. Analyses of answers to open-ended questions revealed two new features that are specific for VPs intended for teaching professionalism, which are VP dramatic structure and how it should end.

CONCLUSION

VPs intended for teaching professionalism need to have high fidelity, follow a specific dramatic structure and should include multiple plausible endings. The use of VPs as part of a collaborative activity that is followed by a reflection session is perceived as an effective tool for the development of ethical reasoning skills in dental education.

Reflections on the encouragement of altruism in dental education

Dental ethics and professionalism are often relegated to being taught on the coat-tails of other disciplines, if they are taught at all. The assumption that students develop professionalism as a by-product of other learned competencies in dentistry is well documented to be false, and yet, little has been done in many institutions to deal with this. This article seeks to propose that altruism should be championed in dental education and that traditional learning through the preaching of professional codes is not the appropriate way to achieve this. The environment of dental schools needs to be challenged and reformed so that altruism is promoted. If we fail to address declines in altruism in the dental profession, then damage to the professional status of dentistry is inevitable and the ability to fulfil the profession's social contract with society will be inhibited.

A review of teaching ethics in the dental curriculum: challenges and future developments

This study considers the role and status of the teaching of ethics on the dental undergraduate curriculum. The study reviews current developments in the delivery of dental ethics education and in particular focuses on the development of new pedagogies and curricula content. The study then critically considers the consequences of a squeezed curricula and the consequent reliance on professional regulation as shorthand for the ethical development of students. The study concludes that, although great strides have been made in improving the teaching of ethics in dental education, further dialogue is needed to better include patient views and develop a more theoretically robust approach to self-reflection.

The Role of Self- and Peer Assessment in Dental Students' Reflective Practice Using Standardized Patient Encounters

The aim of this study was to gain insight into the nature of the role played by self- and peer assessment in the development of dental students' reflective practice skills and the value gained through structured encounters with standardized patients. Four standardized patient encounters in an objective structured clinical exam (OSCE) format served as a learning experience for students to demonstrate decision making and communication skills in complex scenarios regarding issues of ethics. Self- and peer assessment and peer-to-peer discourse were used to enhance student reflection. A sample of 16 peer pairs was randomly selected from the population of 108 fourth-year students who participated in the 2014 Clinical Dental Ethics OSCE. Data were collected from self- and peer assessment forms. Five overall performance themes (personal affect, verbal communication, professional demeanor, relationship-building, and patient management) and three student learning themes (application and knowledge, ways to change, and impressed with peer/increased confidence in self) were identified. The results showed that peer assessment ratings were consistently higher than those in the self-assessments, but overall the students deemed both their peers' and their own decision making and communication skills to be quite good. These students rated their experience with the OSCE and self- and peer assessments as positive, appreciating the importance of reflection and learning from their peers. These results provide support for the continued formative use of standardized patient OSCEs and self- and peer assessment to help students develop skills in decision making, communication, professionalism, and reflection.

Conversation Salons: A Flexible Format for Open Discourse in Dental Education

A series of conversation salons was created at the University of Minnesota School of Dentistry as an innovative format with the objective of engaging students, faculty, staff, and practitioners in discussion to promote reflection. The aim of this study was to explore the nature of students' abilities in the salons to connect experiences through reflection and apply what they learned to practice. Reflective essays (written during the summer and fall semesters of 2014) from 108 fourth-year dental students (all members of the Class of 2015) were read and assessed for the nature of reflection, number of connections, references to the past, applications to the future, and use of examples. For analysis, the theoretical works of Schön and Mezirow provided a useful framework. Overall, the results showed that the participants found the salon experience to be positive, and student participation was strong. When asked about learning, the most frequent responses were topic-related. At this stage of dental education, the students were largely focused on their future practice and found it easier to connect to an imagined future than a past experience. In terms of student abilities to reflect, the majority were skilled at simple reflection, based on these essays since only 18% were non-reflective and 15% showed strong critical reflection skills. The open and respectful environment of the salons enabled discussion and promoted reflection. These results suggest that more opportunities for collegial conversations and instruction in reflective practice earlier in the dental curriculum may be beneficial.

EDUCATING THE DEVELOPING DENTAL STUDENT IN ETHICS AND PROFESSIONALISM

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.

Social Media in the Dental School Environment, Part B: Curricular Considerations

The goal of this article is to describe the broad curricular constructs surrounding teaching and learning about social media in dental education. This analysis takes into account timing, development, and assessment of the knowledge, skills, attitudes, and behaviors needed to effectively use social media tools as a contemporary dentist. Three developmental stages in a student's path to becoming a competent professional are described: from undergraduate to dental student, from the classroom and preclinical simulation laboratory to the clinical setting, and from dental student to licensed practitioner. Considerations for developing the dental curriculum and suggestions for effective instruction at each stage are offered. In all three stages in the future dentist's evolution, faculty members need to educate students about appropriate professional uses of social media. Faculty members should provide instruction on the beneficial aspects of this communication medium and help students recognize the potential pitfalls associated with its use. The authors provide guidelines for customizing instruction to complement each stage of development, recognizing that careful timing is not only important for optimal learning but can prevent inappropriate use of social media as students are introduced to novel situations.

Health professions ethics rubric: validation of reliability in an interprofessional health ethics course

The aim of this study was to validate a health professions ethics rubric by an interprofessional team. The rubric was used by two pharmacy and two dental faculty members to score ethics cases submitted by 16 teams comprised of 80 pharmacy and 50 dental students. A debriefing session for each case was moderated by a non-rater faculty member to arrive at a consensus score for the cases. Interrater reliability was calculated for the four raters and the debriefing scores as well as the four raters without the debriefing scores. The overall interrater correlations were in the range of 0.790 to 0.906 for the four raters. Issues ranged from 0.320 to 0.758. Principles ranged from 0.610 to 0.838. Options ranged from 0.655 to 0.843. Analysis ranged from 0.667 to 0.918. Solution ranged from 0.739 to 0.886. With the inclusion of the consensus scores, the interrater correlations were even higher. The best correlations were for the overall score and solution components of the rubric. With further edits in the rubric and enhanced training by faculty raters and changes in the ethics learning session, the revised rubric could be evaluated again for grading. Further training for faculty using the rubric for grading student cases should enhance its reliability. Demonstrating to students the ethical decision making process using the rubric should enhance the validation process.

Moral Communities and Moral Leadership

The American College of Dentists is embarking on a multiyear project to improve ethics in dentistry. Early indications are that the focus will be on actual moral behavior rather than theory, that we will include organizations as ethical units, and that we will focus on building moral leadership. There is little evidence that the "telling individuals how to behave" approach to ethics is having the hoped-for effect. As a profession, dentistry is based on shared trust. The public level of trust in practitioners is acceptable, but could be improved, and will need to be strengthened to reduce the risk of increasing regulation. While feedback from the way dentists and patients view ethics is generally reassuring, dentists are often at odds with patients and their colleagues over how the profesion manages itself. Individuals are an inconsistent mix of good and bad behavior, and it may be more helpful to make small improvements in the habits of all dentists than to try to take a few certifiably dishonest ones off the street. A computer simulation model of dentistry as a moral community suggests that the profession will always have the proportion of bad actors it will tolerate, that moral leadership is a difficult posture to maintain, that massive interventions to correct imbalances through education or other means will be wasted unless the system as a whole is modified, and that most dentists see no compelling benefit in changing the ethical climate of the profession because they are doing just fine. Considering organiza-tions as loci of moral behavior reveals questionable practices that otherwise remain undetected, including moral distress, fragmentation, fictitious dentists, moral fading, decoupling, responsibility shifting, and moral priming. What is most needed is not phillosophy or principles, but moral leadership.

Domestic violence education for UK and Ireland undergraduate dental students: a five-year perspective

The purpose of this cross-sectional study was to ascertain whether undergraduate dental students in the United Kingdom and Ireland are receiving formal teaching on recognizing and managing domestic violence (DV) as part of their curricula. A questionnaire was sent to all dental schools in the UK and Ireland in 2007 and again in 2012, requesting information on whether the subject was taught, by which specialty it was taught, and whether schools felt it was important to include in the curriculum. In 2007, twelve of the fifteen dental schools completed and returned the questionnaire, for a response rate of 80 percent; in 2012, eleven of the sixteen dental schools responded, for a response rate of 69 percent. The main findings were that, in 2007, 50 percent of the responding schools were providing teaching about DV and the majority of this teaching was delivered by oral surgery and pediatric dentistry departments. In 2012, only 45 percent of the responding schools were teaching DV, with 60 percent of this teaching being delivered by pediatric dentists. This study's findings suggest that DV is an undertaught area in UK and Irish undergraduate dental curricula. Some schools recognized the importance of DV teaching; however, they have been unable to implement it because of a full curriculum and lack of appropriately trained staff amongst other reasons.

Blending public health into dental education: A.T. Still university's D.M.D./M.P.H. program

As dental education across the United States undergoes growth and change in an effort to improve access to dental care, one dental school, the Arizona School of Dentistry & Oral Health, established in 2003, designed its initial curriculum with innovation in mind. One of those innovations was the introduction of an online certificate in public health that can be used as the foundation for a Master's in Public Health (M.P.H.) degree with a dental emphasis, which students may complete concurrent with their dental education. This article discusses the educational intersection between dentistry and public health and describes how this dental school uses an online public health curriculum to accomplish this integration. It also presents the potential advantages and disadvantages of obtaining the M.P.H. degree concurrent with the dental school training.

Teaching culturally sensitive care to dental students: a multidisciplinary approach

Dental schools must prepare future dentists to deliver culturally sensitive care to diverse patient populations, but there is little agreement on how best to teach these skills to students. This article examines this question by exploring the historical and theoretical foundations of this area of education in dentistry, analyzes what is needed for students to learn to provide culturally sensitive care in a dental setting, and identifies the discipline-specific skills students must master to develop this competence. The problems associated with single-discipline, lecture-based approaches to teaching culturally sensitive care are outlined, and the advantages of an interdisciplinary, patient-centered, skills-based approach to teaching culturally sensitive care are described. The authors advocate for an approach to teaching culturally sensitive care that builds upon learning in the behavioral sciences, ethics, and public health. Component skills and perspectives offered by each of these curriculum areas are identified, and their contributions to the teaching of culturally sensitive care are described. Finally, the need to consider the timing of this instruction in the dental curriculum is examined, along with instructional advantages associated with an approach that is shared by faculty across the curriculum.

Dental ethics and emotional intelligence

Dental ethics is often taught, viewed, and conducted as an intell enterprise, uninformed by other noncognitive factors. Emotional intelligence (EQ) is defined distinguished from the cognitive intelligence measured by Intelligence Quotient (IQ). This essay recommends more inclusion of emotional, noncognitive input to the ethical decision process in dental education and dental practice.

An assessment of faculty and dental student decision-making in ethics

This study reports and compares dental student and dental faculty scores to national norms for the Defining Issues Test 2, a measure of ethical decision-making competency. The findings showed that dental students and faculty tend to make decisions that promote self-interest, paralleling the ethical orientation of business professionals. Differences associated with gender, language, and norms from previous studies were observed. The findings underscore the importance of raising dental faculty and student awareness of their own ethical decision-making approaches. More importantly, the findings highlight the need to ensure that dental faculty have both the knowledge and skills to train dental students about the central role that ethical decision-making must play in patient care.

Development of undergraduate gerodontology courses in Austria, Switzerland, and Germany from 2004 to 2009

The growing number of individuals over the age of sixty-five with specific dental needs requires increased teaching efforts to adequately prepare predoctoral dental students. The study assessed whether such increases in undergraduate gerodontology teaching in German-speaking countries between 2004 and 2009 occurred. Questionnaires were mailed in 2004 and 2009 to all deans (n=37) and all department heads (n=140) of Austrian, Swiss, and German dental schools. Results show that gerodontology is still mostly included in traditional core subjects but that specific lecture series and practical teaching have increased. These cover a broad variety of subjects including geriatric medicine, gerontopsychiatry, nursing care, pharmacology, and public health. The number of departments with dedicated staff for gerodontology, research activities, and mean number of publications has increased. Barriers to the further integration of the subject include its continued exclusion from final examinations in Austria and Germany. Guidelines of the European College of Gerodontology (2009), which aim to prepare students to provide dental treatment to seniors by teaching theoretical knowledge, practical skills, patient management techniques, and the ethical foundation of gerodontology, need to be implemented. Continued professional education of faculty in all departments, intensified cooperation between universities, and the presence of faculty specializing in gerodontology are suggested.

Development of ethical practices and social responsibility in dental education at the university of Chile: student and faculty perceptions

BACKGROUND

The authors argue that dental curricula in Latin America are noted for providing highly technical and individualistic training that may fail to address society's problems or instil in the dentist the idea that he/she has a social responsibility to contribute to his/her community.

OBJECTIVES

This study's main objectives were to determine whether the curriculum and the faculty teaching practices of the School of Dentistry at the University of Chile contribute to its students' commitment to ethical and social responsibility.

METHODS

This was a qualitative study that investigated the perceptions of sixteen subjects (eight students and eight faculty members). Data were collected in thorough deep interviews. The interview process model conceptualised and organised the information into sets of dimensions and categories. The dimensions studied were ethical commitment and social responsibility. The categories assessed within ethical commitment were honesty, tolerance, responsibility and respect. In the social responsibility dimension, the categories were solidarity, teamwork and concern for and communication with the patient. Analysis of the textual data was performed using a method of content analysis based upon constructed qualitative matrices.

RESULTS

Our results show that students and scholars alike realise that ethical commitment and a sense of social responsibility are not promoted in the curriculum. They do, however, recognise the importance of these qualities in dental practitioners.

CONCLUSIONS

These results indicate that the current curriculum and teaching practices used in our School of Dentistry need to be reviewed and that programmes promoting professionals' commitment to their role in society need to be implemented.

Why stories matter. Applying principles of narrative medicine to health care ethics

Narrative medicine seeks to improve clinical effectiveness through narrative training in reading and writing. Stories give meaning to experience and encourage communication between doctors and patients by honoring the basic human need to recognize and be recognized. Learning how to receive and tell stories, practiced through close reading, group discussion, and written response, may also facilitate ethical reflection and inquiry.

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.

Teaching social responsibility through community service-learning in predoctoral dental education

Social responsibility refers to one's sense of duty to the society in which he or she lives. The Professionalism and Community Service (PACS) dental module at the University of British Columbia is based upon community service-learning and helps dental students to understand the challenges faced by vulnerable segments of the population as they actively reflect on experiences gathered from didactic and experiential activities. This article aims to illustrate the extent to which PACS has fostered awareness of social responsibility through the British Columbia Ministry of Education's Performance Standards Framework for Social Responsibility. Reflections were gathered from students in all four years of the D.M.D. program and were analyzed thematically in three categories of the framework: Contribution to the Classroom and Community, Value of Diversity in the Community, and Exercise of Responsibilities. The constant comparison analysis of the reflective qualitative data revealed that the students directly or indirectly addressed these three categories in their reflections as they synthesized their understanding of community issues and their collaborative roles as socially responsible members of the dental profession. Follow-up studies are needed to explore the impact of community-based dental education upon students' perceptions and understanding of social responsibility and professionalism regarding underserved communities.

Can patients help teach professionalism and empathy to dental students? Adding patient videos to a lecture course

A key aspect of predoctoral dental education involves ethics/professionalism and interpersonal communications. Empathy is an integral aspect of both. This study at the Schulich School of Medicine and Dentistry, University of Western Ontario, examined predoctoral students' perspectives to determine the impact of new educational methodologies designed to integrate patients' voices into a patient management lecture course. Videos of patients describing their dental experiences were added along with classroom discussion and students' reflective journals on the topics raised. Early results indicate that students perceived this innovation enhanced the teaching of professionalism, raised their awareness of the importance of empathy, and was a well-received addition to the course.

Program design considerations for leadership training for dental and dental hygiene students

Since leadership is an essential part of the oral health professions, oral health educators can play an essential role in establishing a culture of leadership and in mentoring students to prepare them for future leadership roles within the profession. However, leadership training for oral health professionals is a relatively new concept and is frequently not found within dental and dental hygiene curricula. The purpose of this article is to propose several models for leadership training that are specific to the oral health professions. The authors hope that providing an overview of leadership programs in academic dental institutions will encourage all U.S. and Canadian dental schools to begin developing a culture that promotes leadership development.

Towards a specific approach to education in dental ethics: a proposal for organising the topics of biomedical ethics for dental education

Understanding dental ethics as a field separate from its much better known counterpart, medical ethics, is a relatively new, but necessary approach in bioethics. This need is particularly felt in dental education and establishing a curriculum specifically for dental ethics is a challenging task. Although certain topics such as informed consent and patient rights can be considered to be of equal importance in both fields, a number of ethical issues in dental practice are only remotely-if at all-relevant for medical practice. Therefore, any sound approach to education in dental ethics has to recognise the unique aspects of dental practice in order to meet the needs of dental students and prepare them for the ethical challenges they may face during their professional practice. With this goal in mind, this paper examines the approach of the authors to dental ethics education and proposes a system to organise the topics of biomedical ethics for dental education. While the authors' perspective is based on their experience in Turkey, the proposed system of classification is not a rigid one; it is open to interpretation in other contexts with different social, cultural and professional expectations. Therefore, the paper also aims to inspire discussion on the development of an ideal dental ethics curriculum at an international level.

Professional ethics and cynicism amongst Dutch dental students

BACKGROUND

Some 40 years ago, Morris and Sherlock concluded that dental students are very cynical about their future profession, and indeed become more cynical as they progress through dental school. Later studies continued to report cynicism among dental students, but some studies did not confirm the reported increase. However, any degree of cynicism among matriculating students and even more so among graduating students should be of grave concern to dental educators.

METHOD

This study used a survey modeled after the instrument used by Morris and Sherlock. First and fifth year students at one of the dental schools in The Netherlands were presented with 10 vignettes and asked to indicate how they themselves would respond, how practising dentists would respond and how any dentist should respond.

RESULTS

We did not find a rise in cynicism. However, we did find that both freshmen and graduating dental students in The Netherlands are rather cynical, as a group, about the ethics of their future profession. Even students who believe that the professional norms themselves are sound (as evidenced by their own willingness to abide by those norms) tend to believe that many practising dentists regularly violate those norms.

CONCLUSIONS

As was already reported some 40 years ago, dental students appear to harbour a widespread and persistent cynicism about the ethics of their future profession. The professionalism courses that are emerging in many dental schools around the world should take note of this challenging statistic.

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.

The journey beyond silos. Teaching and learning interprofessional ethics at UTHealth

Interprofessional education and ethics education are two educational programs that blend together well, and, moreover, they are a natural fit for teaching in an academic health science center. The purpose of this paper is to describe our recent journey of developing and implementing an interprofessional ethics curriculum across the six schools of UTHealth. We provide an overview of the goals of the Campus-wide Ethics Program, which is housed in the McGovern Center for Humanities and Ethics, and we highlight certain innovative developments that are the result of the collaborative work of faculty and administrators from all six schools of UTHealth. In addition, a brief synopsis of the specific didactic and clinical courses in which ethics is a significant component is outlined for both the dental and the dental hygiene curricula. Lastly, we describe some of the recent scholarly activities that are a product of this new program. We are excited about our evolving efforts and the potential benefits of weaving interprofessional ethics within our school and across our campus. This article tells the story of our journey beyond "the silos" that are common among academic health science centers.

Ethics and the 'seasons of my life' as a dental educator

Perhaps the first comprehensive ethics program in American dental schools was created in 1990 at the University of Kentucky by then dean David Nash. Nash recounts the emergence of his personal and professional interest in ethics using the structure of Daniel Levinson's book The Seasons of a Man's Life. Each season brings tasks of evolving and deepening ethical engagement. Being ethical is important; helping others to be so is special. Nash still teaches the course.

My journey in dental ethics

My ethics journal passed through these phases: personal inspiration by those I admire in the profession, struggle to incorporate their ideals in daily practice, working with like-minded colleagues, and formal education and exposure to broader and diverse interests. Now it is time to help others with their journeys.

Combining practice with ethics

As a dentist at the Mayo Clinic in Rochester, Minnesota, the author has found it easy and rewarding to combine specialty care in orofacial pain with ethics training for complex case management.

My life as a dentist and ethicist: an experiment in creative nonfiction

In a certain sense, we become the synthesis of our life experiences, and our professional identity is woven into a personal life story. A dentist with a PhD in Health Services Research and Policy who teaches clinical dentistry and ethics reflects on some of the moments that have combined to make her who she is.

Developing a Self-Scoring Comprehensive Instrument to Measure Rest's Four-Component Model of Moral Behavior: The Moral Skills Inventory

One of the most extensively studied constructs in dental education is the four-component model of moral behavior proposed by James Rest and the set of instruments for measuring it developed by Rest, Muriel Bebeau, and others. Although significant associations have been identified between the four components Rest proposed (called here Moral Sensitivity, Moral Reasoning, Moral Integrity, and Moral Courage) and dental ethics courses and practitioners with disciplined licenses, there is no single instrument that measures all four components, and existing single component instruments require professional scoring. This article describes the development and validation of a short, self-scoring instrument, the Moral Skills Inventory, that measures all four components. Evidence of face validity, test/retest reliability, and concurrent convergent and divergent predictive validity are demonstrated in three populations: dental students, clinical dental faculty members, and regents and officers of the American College of Dentists. Significant issues remain in developing the Rest four-component model for use in dental education and practice. Specifically, further construct validation research is needed to understand the nature of the components. In particular, it remains undetermined whether moral constructs are characteristics of individuals that drive behavior in specific situations or whether particular patterns of moral behavior learned and used in response to individual circumstances are summarized by researchers and then imputed to practitioners.