J Islamabad Med Dental Coll 2022 247 Open Access Perception of Ethics and Professionalism Teaching among Dental Professionals at a Teaching Hospital in Karachi Rubab Jawed1, Ruqayyah Quresh Hashmi2, Hafsa Usman3, Mehtab4, Saba Sabir5. 1Assistant professor, Baqai Dental College, Karachi, Pakistan. 2Registrar, Baqai Dental College, Karachi, Pakistan. 3,4,5House Officer, Baqai Dental College, Karachi, Pakistan. A B S T R A C T Background: Health care professionals come across many ethically difficult situations in their clinical practices and community; the students should be equipped with skills to resolve ethical and professional issues. Methodology: A cross-sectional study was conducted at Baqai dental college, Karachi. All the faculty members and house officers of the dental teaching hospital were included in the study. The tool used for the data collection was a structured questionnaire, for drawing views of the participants on professionalism and ethics teaching. The survey instrument evaluated two domains; attitudes 25 items, and goals 19 items on ethics and professionalism education. Data were recorded and analyzed in SPSS 24. To compare the responses of both the groups, that is, the house officers and the faculty member’s independent t-test was applied to compare the mean scores. A p-value of ≤ 0.05 was considered significant. Results: The questionnaire was circulated to a total of 157 participants (75 faculty members and 82 house officers) with a 100% response rate. The faculty members and the house officers showed a positive attitude regarding ethics, professionalism, and teachings. The participants agreed with the goals that can be achieved by incorporating professionalism and medical ethics in education. The participant strongly affirmed the learning and teaching of professionalism (4.06 ± 0.989). Conclusion: The realization of the need to teach ethics and professionalism by dental professionals is the first step to bringing change in their daily clinical practice and interpersonal qualities. Keywords: Ethics, Professionalism, “Education, Medical”, “Personality development”, “Social Desirability”. Authors’ Contribution: 1Conception; Literature research; manuscript design and drafting; 2,3 Critical analysis and manuscript review; ,4,5Data analysis; Manuscript Editing. Correspondence: Rubab Javed Email: rubab13@baqai.edu.pk Article info: Received: December 18, 2020 Accepted: December 9, 2022 Cite this article.Jawed R, Hashmi R Q ,Usman H, Mehtab, Sabir S. Perception Of Ethics And Professionalism Teaching Among Dental Professionals At a Teaching Hospital. J Islamabad Med Dental Coll. 2022;11(4): 247-255. Funding Source: Nil Conflict of Interest: Nil DOI: https://doi.org/10.35787/jimdc.v11i4.645 I n t r o d u c t i o n Ethical values, conduct, it’s practice and it’s understanding is essential for any professional including doctors. The teachings of ethics are the instructions about the role of values in the relationship of a doctor with patients, colleagues, other providers, and society.1-3 Healthcare professionals come across many ethically difficult situations in their clinical practices and community home healthcare services.4 The ethical standards remain the same, though the underlying ethical standards of different professions may differ.5 The principles of medical ethics in terms of patient treatment are not emphasized and therefore have a diminished role in the medical and dental student's O R I G I N A L A R T I C L E J Islamabad Med Dental Coll 2022 248 mind.6 The use of superior knowledge, skill, and judgment, which coincides with both good conduct and character for the benefit of another, without considering self-interest is Professionalism. There are two broad categories of the curricula of ethics and professionalism, first, the students should be equipped with skills to resolve ethical or professional issues, and second, virtuous health professionals should be produced through character building.7 In the dental setting to achieve proper ethical conduct, the patient first should be treated as an individual, and the patient's needs and wants should be kept on priority.8 Principles of medical ethics have been greatly refined and revolutionized in the western world, focusing on the concepts of autonomy, beneficence, non-maleficence, justice, informed consent, disclosure, and confidentiality.6 The health care settings have changed in recent years and all health professionals face ethical challenges in health care that put them at risk of ethical conflict, therefore a study was conducted in Nepal in a nursing institute regarding the need assessment for teaching ethics.9 In a qualitative study conducted in Karnataka, India the ethical challenges encountered were taking informed consent, excessive treatment, maintaining confidentiality, competence of dentist, expensive dental care, rigorous training of dentist, lack of knowledge, practice of defensive medicine and development of new technologies.10 Several studies have shown that teaching medical ethics assists in producing morally grounded and principled health professionals.11 According to the beneficence (do good) principle of ethics the dentist must promote the patient welfare and therefore the most important aspect of this is the timely and competent delivery of dental care within the bounds of clinical circumstances presented by the patient with due consideration being given to the needs, desires and values of the patient.12 The teaching of ethics and professionalism may help improve the dental professionals, in dealing with the ethical dilemmas; they face in clinics and hospitals and help manage them accordingly. The teaching of ethics and professionalism has not been a significant part of the dental curriculum. With increasing emphasis on interprofessional health management and patient safety, it is important to know the perception of dental professionals regarding ethics and professionalism. This study will help in making decisions to include these in the curriculum which will ultimately help in the production of better dental professionals in the future. M e t h o d o l o g y A cross-sectional study was conducted at Baqai dental college, Karachi. The study was conducted during 6 months period from July – December 2019. All the faculty members and house officers were included in the study. Census type of sampling was used only those faculty members and house officers were excluded from the sample who were on leave for more than 15 days. The total number of participants included in the study was 157 out of these 75 were faculty members and 82 were house officers. A pre-structured, validated questionnaire drawing opinions on ethics and professionalism education was spread among the participants. The questionnaire consists of two domains regarding professionalism and ethics education, the domains include attitudes (25 items), and goals(11 items).13 A Likert-type scale, ranging from 1 ‘strongly disagree’ to 5 ‘strongly agree’ was used to rate the items of the questionnaire. Informed written consent was obtained from all the participants. The ethical review board of Baqai dental college granted ethical approval for the study. Data was entered and analyzed through SPSS version 22.14 The mean and standard deviations (SD) of each item were calculated and the P-value was obtained by applying an Independent t-test to find the difference between the two groups i.e. faculty and house officers regarding the attitudes and goals of medical ethics and professionalism. J Islamabad Med Dental Coll 2022 249 R e s u l t s The survey was distributed to a total of 157 participants (75 faculty members and 82 house officers), eighty-three male and seventy-four female participants. All completed the survey (100% response rate). Table 1 illustrates the attitude of faculty members and house officers towards ethics and professionalism it included 25 statements to rate from ‘1’ strongly agree to ‘5’ strongly disagree. Mean ± SD, 4.06 ± 0.989 for the response regarding professionalism can be taught and learned indicates that participants agree with it and they disagree with the fact that ethics cannot be taught and learned. Table I: Overall and Comparison of Faculty and house Officer’s Attitude towards Ethics and its teaching SNO Questions Overall Faculty House Officers P-value Mean SD Mean SD Mean SD 1 Professionalism can be taught and learned 4.02 0.97 3.91 1.042 4.11 .889 0.190 2 Ethics CANNOT be learned or taught 2.24 1.13 2.19 1.036 2.29 1.222 0.560 3 The medical school curriculum ought to formally teach ethics 3.9 0.98 3.92 .912 3.87 1.039 0.730 4 By the time students arrive at residency, attitudes and values have already been defined 3.59 1.05 3.51 1.107 3.67 1.019 0.335 5 NO right and wrong responses to ethical dilemmas questions 2.90 1.04 3.01 1.033 2.78 1.006 0.155 6 Ethics is a discipline with its own procedures, writings, terms, and ideas. 3.83 0.89 3.63 .802 3.99 .923 0.10 7 Family, culture and religion all influences one’s attitudes and values. 4.03 0.93 3.88 .944 4.22 .930 0.025 8 Values and attitudes should NOT be the main focus of medical education for undergraduate level. 2.44 1.14 2.55 1.166 2.32 1.076 0.201 J Islamabad Med Dental Coll 2022 250 9 Should possess professionalism 4.31 0.83 4.29 .897 4.35 .791 0.655 10 Selection of residents should NOT include assessment of professionalism 2.56 1.18 2.60 1.294 2.54 1.102 0.741 11 Assessment of professionalism should NOT be used in the selection of residents 3.87 0.83 3.91 .825 3.87 .857 0.762 12 Ethical conflicts are common in the everyday practice of medicine 3.82 0.97 3.87 .977 3.76 .963 0.477 13 Training in ethics does NOT help medical students deal with ethical conflicts 2.29 1.14 2.29 1.194 2.29 1.105 0.997 14 At various stages of their training, students deal with a variety of ethical dilemmas 3.85 0.88 3.91 .975 3.80 .808 0.476 15 Medical training fosters unethical behavior 2.83 1.03 3.03 1.127 2.67 .944 0.033 16 Medical training fosters professionalism 3.32 0.88 3.32 .961 3.37 .868 0.754 17 Medical training fosters cynicism 3.11 0.92 3.12 .972 3.09 .849 0.812 18 Students receive sufficient instructions in handling potential ethical issues 3.15 1.03 2.93 1.004 3.34 1.021 0.013 19 Medical education should pay attention to attitudes, values and ethical dilemmas to avoid 3.75 0.86 3.68 .961 3.80 .777 0.370 J Islamabad Med Dental Coll 2022 251 developing cynicism 20 It is crucial that medical students and residents take an oath or make commitment to support the principles of their profession 3.90 1.07 3.81 1.205 4.00 .956 0.282 21 Psychiatrists must abide by a different set of ethical guidelines than physicians 3.41 1.09 3.48 1.131 3.37 1.083 0.519 22 Psychiatrists are subject to a more stringent set of ethical rules than other doctors 3.40 1.05 3.53 .963 3.28 1.125 0.134 23 Physicians are more ethical than the general public 3.39 1.04 3.27 .963 3.51 1.114 0.143 24 Most faculty doctors treat students with integrity 3.32 1.09 3.23 1.008 3.41 1.165 0.283 25 Most faculty doctors treat patients with ethics 3.56 0.99 3.40 1.013 3.71 .962 0.053 Table II: IDEAS ABOUT THE GOAL OF EDUCATION IN PROFESSIONAL AND MEDICAL ETHICS. SNo Question Overall Faculty House officer P-value Mean SD Mean SD Mean SD 1 To become better people 4.23 0.823 4.05 .914 4.39 .698 0.010 2 To better recognize ethical issues 4.08 0.859 3.88 .915 4.26 .767 0.006 3 To cultivate interpersonal abilities necessary for addressing ethical disputes 4.03 0.920 3.95 .943 4.10 .897 0.306 J Islamabad Med Dental Coll 2022 252 4 To acquire a working knowledge of social science, philosophy, religion, and law as they apply to clinical care 3.97 0.869 3.93 .859 4.01 .882 0.572 5 To improve patient care and clinical decision making 4.20 0.866 4.16 .823 4.23 .907 0.606 6 To avoid being negative and detached when speaking with patients 4.06 0.798 4.13 .704 4.00 .875 0.297 7 To more cearly define values-driven (irrational; Biased by personal interests)decisions 3.75 0.875 3.79 .874 3.72 .879 0.632 8 To lessen the possibility a doctor may later commit a legal mistake 3.71 0.934 3.79 .843 3.65 1.011 0.349 9 To lower the possibility that a medical liability will be incurred by a doctort during practice 4.24 4.630 4.87 6.593 3.67 .944 0.106 10 To reduce the likelihood that a physician may make an ethical error in the future 3.88 0.950 3.91 .947 3.85 .957 0.728 11 To acquire the skills necessary to not only treat but also heal our patients 4.03 1.025 3.85 1.159 4.18 .862 0.044 Table 2 displays the participant’s ideas about the goal of education in professional and medical ethics. They strongly agree that education in professional and medical ethics can bring up better professionals and; a better understanding of the ethical issues and ultimately that will help in improving patient care and clinical decision making. D i s c u s s i o n The present study provides an overview of the perception of dental professionals towards ethics and professionalism teaching at a dental teaching hospital in Karachi. The ethical issues faced by dentists in today's society have become more J Islamabad Med Dental Coll 2022 253 complex and seems to arise more often than those faced by dentist in the past. Given the current direction of health and dental care, the holistic approach to patient care and safety in regard to interprofessional collaboration and teamwork has become a significant part of training and practice. Oral physicians have become an integral part of a medical team to provide treatment and rehabilitation to patients.15 Working as a part of a team requires strong work ethics and an understanding of the code of conduct. Hence, it was necessary to inquire about the readiness of dental students and faculty for teaching and practice. The results of this study affirm positive attitudes towards ethics education by the faculty members and the house officers. The results of the present study are in line with the other studies examining medical students, attitudes towards the subject of ethics, and identifying the need for its teaching.16 The similarity is most probably due to the same problems faced in clinical and hospital setups by all the health professionals and knowledge to tackle these ethical problems is important for the health professionals. In the present study majority of the participants agreed that teaching and learning professionalism and ethics can be carried out, they affirm that a physician should possess professionalism, they want that students should be evaluated by assessing professionalism in them, and they assented that medical training promotes ethical and professional behavior and most of the faculty act ethically towards students and patients, these results are in line with the results of a study conducted by Tahra Al Mahmouda in the United Arab Emirates,13 in few other studies also show that participants agree towards the subject of ethics and its need of teaching.16-18. The positive attitude toward ethics and professionalism teaching is due to the increased awareness regarding the importance of ethics teaching and learning among health professionals, which will eventually help all health professionals including dentists to be successful in their practical life. During the training period in dentistry it is very important that along with the technical competence, future dentists should be trained to take care of the ethical values of the patient. The need to perform and validate their clinical training causes the students to concentrate more on their objectives rather than the patient's needs.19 The present study indicated the interest of dental professionals in ethics and professionalism teaching to produce better doctors, having a better understanding of the ethical issues, and how to deal with them. These results are consistent with the previous surveys that valued the teachings of ethics and professionalism. In a national survey conducted in the US, the medical students reported that to be a good doctor it is important to have good character and endorsed the idea that all medical educators should teach students ethics. Few studies support character-based medical education, that is, the patient is interested in getting treatment from a physician who exhibits good behavior and positive character.5 The compassion of the dental professionals undergoes gradual erosion, whereas successful traineeship slowly gives way to cynicism, a certain psychological detachment, and a vision of the patient as an object of study.19 In our study, the participants agree that medical training fosters unethical behavior, professionalism, and cynicism. These results are parallel with the results of other studies that met similar criticism among medical students. It has been observed that attempts to inculcate professionalism among students may not have the desired impact due to the surrounding work environment. Unprofessional behavior among faculty and trainers led to cynicism among students. The reason behind this was found to be a lack of effort in faculty development and accountability in these areas.7 A study conducted by Siddiqui in Lahore Pakistan highlighted that, both the teachers and the students are too occupied in covering the J Islamabad Med Dental Coll 2022 254 cognitive knowledge that they are unable to spare time to practice the necessary skills, behavior, and attitude in Pakistan.20 The present study shows no statistically significant difference in perception toward medical ethics and professionalism teaching between faculty and house officers. Whereas a study conducted in a private institute in southern India revealed differences in knowledge, attitude, and behavior among the postgraduates, staff, and house surgeons. This difference is mainly because medical ethics and professionalism is taught as a part of the curriculum in postgraduate studies.21 Ethics education is gradually being recognized by dentists as a solution for many of the challenges faced in the dental profession. In the present study, the faculty and house officers both agree that ethics teaching is an important aspect of training dentists to maintain the standards of their profession. It is also essential to ensure continued patient confidence in dentistry. This education needs to start early, be reinforced continually throughout students' graduate training, and continue after they embark upon their professional career. Barry and Anant Bhan in their research paper emphasize on the quality of teaching in Dental colleges and also highlighted that teaching professionalism should be an integral part of the curriculum.22 The results of a study conducted in dental schools of Sudan are also in line with the present study reporting positive perception of students both in private and public schools towards ethics teaching23 C o n c l u s i o n The realization of the need to teach ethics and professionalism by dental professionals is the first step to bringing change in their daily clinical practice and interpersonal qualities. R e f e r e n c e s 1. Miles SH, Lane LW, Bickel J, Walker RM, Cassel CKJAm. Medical ethics education: coming of age. 1989. 2. Auf AI, Awadalla H, Ahmed ME, Ahmed MHJJoPH, Emergency. Perception, barriers, and practice of research among teaching staff at five Sudanese medical faculties. 2018;2(22):1-8. 3. Bashir A, McTaggart IJJJoTUMS. 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