Ethical dilemmas and financial burdens faced by clinical dental students in a 'quota-driven' curriculum

Unprofessional behaviour, cheating or falsifying of information by undergraduate dental students is a serious problem, and may be a predictor of future professional board disciplinary actions against practitioners. In quota-driven curricula students have to complete a minimum number of procedures, many of which require laboratory services. In order to achieve this some students at the University of Limpopo had begun bribing technicians to complete their work preferentially, or to do part of it for them. A final-year dental student carried out an independent investigation to establish the extent of the problem so that school authorities could be alerted and requested to curb this practice. Anonymous questionnaires were given to all the clinical-year dental students, who were asked to answer as honestly as possible. Results showed that almost half of the 4th-year students (47%) and double that of 5th-years (86%) had paid technicians for special favours and services. Payment methods and amounts ranged from gifts to actual monetary reimbursement. Ninety-three per cent of students reported additional financial burdens owing to their having paid for patient treatment, transport costs, telephone calls or food, or for the actual prosthesis. Ethics courses are part of most dental curricula, but have no standard, universally accepted outline or structure. Bribery was investigated by a student who had experienced it as a problem himself, highlighting the point that students will be more engaged in ethics education when it addresses issues directly relevant to them. Faculties should therefore design dental ethics curricula that are practical and relevant to students' experiences, and ensure these courses begin early in the dental education and span its entire duration. Faculties should also support and encourage consistent professional conduct in undergraduate students which they will hopefully continue to practise in their future professional lives as dentists.