THEORETICAL FOUNDATIONS OF ETHICS AND QUALITY IN DENTAL CARE

Being a part of healthcare, modern dentistry is somewhere in between scientific and technological innovations and humanistic values. In this regard, both high technical and ethical competences that regulate behavior of a doctor in relation to patients, colleagues and entire society are essential. Ethical standards and criteria of medical aid quality are interrelated as they supplement one another and form the foundation of a dentist’s professional activity [1].

The fundamental ethical standards in medicine rest upon classical philosophical systems; they are also codified in international documents such as the Helsinki Declaration and local codes of ethics for medical professionals. They determine professional behavior especially when clinical cases present ambiguity or ethical dilemmas [2].

Certain quality measures in the field of oral health care show the extent of compliance of the provided services to established standards and expectations of patients. According to international and national standards, medical care quality in dentistry concerns the following:

1. an expert’s technical competence, which is an ability to carry out diagnostic and therapeutic interventions while being highly professional and accurate;
2. procedural safety, which is prevention of medical errors, compliance with aseptic and antiseptic standards and a decreased risk of complications;
3. therapy effectiveness occurring when the expected therapeutic results were achieved as per clinical protocols;
4. availability and timely provision of care when care can be provided to patients with minimal inconvenience and whenever they need it;
5. patient-centered interaction including respectful attitude, clear communication, taking into consideration preferences and needs of patients;
6. ethical standards including respect for patient rights, confidentiality, informed consent, and honest communication.

Thus, quality criteria cover not only clinical and technical aspects, but also personality-oriented and ethical components. That is why it is difficult to teach quality standards as students should have a comprehensive understanding consisting both of professional skills and moral standards. In case the ethical component is lacking, trust-based relations between a doctor and a patient cannot be achieved. However, the relations are essential for effective treatment outcomes. Ethical behavior minimizes conflicts and legal issues improving the image of a medical institution [3].

Within the educational process, the relations are perceived through pedagogical tasks of developing both professional and ethical competencies among students. Thus, following quality standards while ignoring ethical considerations will lead to routine performance of procedures without proper understanding of their importance for a patient and the entire society.

Ethical education of medical professionals is a well-established practice, which is currently complemented by new methods and approaches that take into account dynamics and complexity of modern clinical cases, ethical dilemmas and social responsibility [4].

PECULIARITIES OF TEACHING QUALITY STANDARDS TAKING INTO ACCOUNT ETHICAL ASPECTS

Teaching quality standards of dental care without ignoring ethical aspects is a complex and multifaceted process that requires integration of theoretical knowledge and practical skills, as well as formation of professional values among students. The goal of the teaching process is not only to transfer technical competencies, but also to raise responsibility, respect for patients, and the ability to make better moral decisions in clinical practice among future specialists [5].

To integrate ethical principles into education, it is necessary to start from a well-structured educational program that includes mandatory academic subjects in medical ethics, bioethics, and legal health issues. Interdisciplinary modules acquire importance in addition to theoretical courses. So, some of the modules such as Organization of Healthcare and Quality Ethics, where clinical standards and professional ethics in dentistry are discussed in detail, can serve as an example [3, 5].

Effective educational methods include as follows:

1. lectures and seminars on ethical and quality standards. Theoretical classes serve as a foundation for understanding key concepts, generally accepted codes of ethics, as well as regulations governing medical activities;
2. clinical case studies. Analysis of specific clinical situations helps students to understand how quality standards of dental care are combined with ethical dilemmas. This approach is used to develop critical thinking and evaluate actions from the point of view of professional ethics;
3. role-playing games and simulations — these methods create real-life conditions in which students can practice communication skills with patients and colleagues and make ethically informed decisions in difficult situations;
4. debates and discussions. Discussion of controversial issues in medical ethics promotes a deep understanding of problems and develops the ability to defend positions in a reasoned manner, while taking into account the rights and interests of all stakeholders;
5. reflection and writing. Keeping diaries or writing essays on ethics fosters self-reflection and enhances understanding of ethical principles ин students.

Using case studies in education is one of the most effective ways to engage students in real professional tasks. Dentists constantly come across the situations when quality of care overlaps with ethical aspects [6]. The examples are provided below:

1. a need to make a decision to continue or terminate treatment of a patient whose consent is questionable;
2. conflict of interest that can arise when a patient’s financial capabilities do not align with optimal treatment recommendations;
3. cases of informed consent that consider cultural and personal characteristics;
4. disclosure of confidential information to anyone who can prevent harm;
5. resolution of conflicts regarding therapeutic tactics among medical personnel.

Analysis of each case shows which quality standards are applicable under specific conditions and how ethical standards shape behavior of doctors. Regular practice broadens horizons of students making them flexible and ethically mature [7].

Mentoring plays a crucial role in promoting professional ethics and enhancing the quality of care. Experienced teachers and clinicians are perceived by students both as a source of knowledge and as role models. Examples of mentoring are as follows:

1. ethically correct communication with patients;
2. consultation and support when cases are complex;
3. joint participation in clinical operations following quality standards and professional ethics.

Practice-oriented training, including internship in dental clinics, consolidates theoretical knowledge in practice. In real conditions, students work with patients, face real ethical dilemmas, and learn to make decisions using their knowledge and internal professional beliefs [1, 7].

In addition, modern educational technologies use remote simulators and online platforms to model clinical and ethical situations, which expands the possibilities for acquiring and practicing skills before starting independent medical practice.

ETHICAL CHALLENGES IN TEACHING QUALITY STANDARDS

Teaching dental students about quality standards of care, taking into account ethical aspects, is associated with a number of significant challenges and problems that may hamper development of the necessary professional and moral responsibility among future specialists. Successful overcoming of these difficulties requires a conscious approach from teachers and systematic work from the Department of Healthcare Organization.

Preparing students to resolve ethical conflicts that inevitably arise in real clinical practice relates to one of the most difficult aspects. In dentistry, these conflicts are often about choosing between the interests of the patient, economic constraints and professional standards [8].

Examples include as follows:

1. Contradictions between the desired high quality of treatment and finances of the patient. Thus, students often doubt whether they should offer expensive methods to obtain optimal results or recommend more affordable but less effective options;
2. Informed consent issues as patients often have poor understanding of their treatments and associated risks. Thus, a doctor should not only provide all the details but also respect the patient’s autonomy when making decisions;
3. Conflicts of interest as sometimes financial incentives from suppliers can influence prescribing behaviors of doctors, potentially leading to unnecessary procedures and violations to ethical standards;
4. Information disclosure involves balancing patient confidentiality with the need to protect the patient or society (for example, when identifying potentially dangerous diseases).

In the educational process, it is essential for future specialists to see the conflicts and understand how the conflicts should be resolved by finding the reasons and consequences hereof.

Developing a proper attitude to quality standards among students is also a complicated task. Students sometimes perceive the standards as a bureaucracy, which reduces their motivation to follow them closely [9, 10].

The reasons for the attitude are as follows:

1. inability to understand the real importance of standards for safe and effective treatment;
2. no personal experience in dealing with ethical issues and consequences of non-compliance with standards;
3. impact of academic workload and desire to complete the program quickly, which leads to formal fulfillment of requirements without deep engagement.

Teachers should provide conditions that will help students understand the value of standards, see how they influence treatment quality and safety through practical examples and real stories.

Being a structural unit of an educational organization, the Department of Public Health and Healthcare plays a crucial role in integrating ethical components into the dental training program. The department doesn’t only give theoretical knowledge; it also forms an educational environment, which is beneficial to professional and ethical competencies [2, 5].

The principal activities of the department are as follows:

1. development and updating training programs with ethical topics and quality standards;
2. training of mentoring teachers who can effectively deal with ethical dilemmas, support students and help them develop their moral values;
3. control and assessment of knowledge and skills related to ethics and quality, as the assessment system should include not only testing, but also qualitative methods such as decision analysis in business games, essays, and oral interviews;
4. creating opportunities for practical application of knowledge through clinical bases and internships, such as transfer of experience in real interaction with patients in ethically difficult situations;
5. conducting scientific research and seminars on ethical education development to identify best practices and introduce innovations.

Thus, the department should be a center where an ethical worldview and sustainable professional values are developed among students, producing a direct effect on quality and safety of dental care [11].

PRACTICAL RECOMMENDATIONS AND

METHODOLOGICAL APPROACHES

When dental students are taught quality standards and ethical aspects, up-to-date pedagogical methods aimed at transfer of knowledge and formation of professional competencies and values are essential. It is important to highlight existing recommendations and approaches that optimize the educational process and improve the quality of training for future specialists, as the educational process is organized through special modules that comprehensively combine knowledge on quality standards and ethics of dental care. The modules include as follows:

1. basic notions of medical ethics and law;
2. analysis of quality standard legal regulations;
3. practical classes where ethical dilemmas are solved using dentistry cases;
4. discussing real clinical cases with a focus on ethical and quality standards;
5. development of individual and group projects aimed at formalization of knowledge and skills.

Introduction of interdisciplinary topics leads to a deeper understanding of the relationship between quality and ethics, and creates the basis for holistic professional thinking [1, 6].

Practical methods used by students to simulate situations that reflect real-world practices are essential in shaping ethical awareness and responsible behavior.

Simulations allow to practice patient communication and decision-making skills in the face of uncertainty and ethical dilemmas without harming real patients. Modern simulators and virtual clinics are available in both face-to-face and remote formats. Role games help students understand different participants of the treatment process (the doctor, the patient, the administrator).

It encourages empathy, negotiation skills, and ethical leadership. Critical thinking is developed owing to case analysis and discussion. Group discussions help to identify different points of view, strengthen the ability to support own decisions with reasons based on ethical norms and quality standards [4, 8].

The educational process results should be assessed not only with traditional tests promoting complex development of professional qualities among students. The following assessment methods should be used:

1. case-oriented testing when both a correct response should be provided, and the ethical position should be explained;
2. portfolio of achievements including essays, reports on how ethical issues should be solved, self-analysis results and mentor’s feedback;
3. monitoring how students behave in clinics and discussing an ethical constituent of their actions;
4. feedback and reflection when students evaluate their own success and difficulties while applying knowledge in real-life scenarios;
5. regular and comprehensive monitoring makes it possible to adjust educational programs by strengthening weaknesses and developing positive practices.

To consolidate ethical skills and quality standards, learning should be continuous, which could be done through:

1. continuing professional development and participation in seminars on bioethics and quality management;
2. developing the mentoring culture and exchange of experience between teachers and clinicians;
3. introducing modern distance learning technologies that provide access to up-to-date information and interactive educational resources;
4. creating communities of practitioners and students where new challenges and best practices in quality and ethics are discussed.

This approach promotes professional growth at all stages of a dentist’s career and continuous improvement of care [2, 11].

CONCLUSION

The role of ethics in teaching dental care quality standards is fundamental and multifaceted. Future dentists should possess not only professional knowledge and technical skills, but also ethical awareness, responsible attitude towards the patient and respect for human rights, as it is a key factor of safe and successful clinical practice. Modern quality standards of dental care cannot exist without being integrated with moral principles, since it is ethics that guides the behavior of a doctor in difficult and ambiguous situations by enhancing effectiveness of treatment and improving the level of trust among patients.

The educational process at the Departments of Public Health and Healthcare should be based on an integrated approach that combines theoretical training, practical exercises using simulations and cases, active involvement of students in discussing ethical issues, as well as systematic mentoring. This approach promotes development of professional maturity, ability to analyze the consequences of their decisions and adhere to high quality standards in work.

However, there are certain challenges in modern education related to perception of standardized requirements, analysis of ethical conflicts and motivating students to in-depth learning. To overcome these problems, constant work from teachers and departments, introduction of innovative methods, monitoring training effectiveness and creation of a favorable educational environment are required.

Thus, effective training in ethical aspects of dental care quality does not only make training of specialists more effective, but also contributes to development of healthcare in general, ensuring safety, respect for patients’ rights and sustainable public trust in the profession of medicine.

The prospects for further research in this area are related to the search for new pedagogical formats, integration of interdisciplinary approaches, and assessing how ethical education produces a long-term impact on quality of dental care and professional culture of medical professionals.