Renewing professionalism in dental education: overcoming the market environment.

The most important mission of dental education is development of student professionalism. It is only within the context of professionalism that specialized knowledge and technical expertise find meaning. Altruism, integrity, caring, community focus, and commitment to excellence are attributes of professionalism. Its backbone is the obligation of service to people before service to self--a social contract. Professionalism can and should be acquired by targeted interventions, not as an assumed by-product of dental education. Top-down, rule-based professionalism is contrasted with its experience-based, mentor-mediated, socially driven counterpart. Moral principles are inherent in professional development and the professional way of life. Unfortunately, American society, including higher education, glorifies a market mentality centered on expansion and profit. Through formal and hidden curricula, dental schools send mixed messages to students about the importance of professionalism. Institutional consensus on professionalism should be developed among faculty, administration, and students through passionate advocacy and careful analysis of dentistry's moral convictions. The consensus message should communicate to stakeholders that morality and ethics "really count." Maximum student exposure to faculty exemplars, substantial service-learning experiences, and portfolio use are likely to enhance professionalism, which should be measured for every student, every semester, along with faculty and institutional assessment. Research reveals a significant relationship between levels of student moral reasoning and measures of clinical performance and shows that moral reasoning ability can be enhanced in dental students. Valid and reliable surveys exist to assess student moral reasoning. Documented student unprofessional behavior is a predictor of future state professional board disciplinary action against practitioners, along with low admissions test scores and course failures in the first two professional school years. ADEA Policy Statements recognize the importance of professionalism in student development. From day 1 of dental school, faculty and students should have no doubt as to what constitutes acceptable and unacceptable behavior in academic and clinical settings. With education and experience, dental students and dentists are likely to elevate their standards of professionalism.