Perspectives of Dental Students at Kerman University of Medical Sciences on the Application of Justice and Ethics in Educational ProgramsABSTRACT
Objective: To explore how dental students at Kerman University of Medical Sciences perceive the implementation of ethical standards and principles of justice within their dental education curriculum.
Material and Methods: This descriptive-analytical cross-sectional study investigated the views of 207 dental students (113 females and 94 males; mean age 22.94 ± 2.45 years, range 18-33) from the first to sixth year of the general dentistry program, with participants normally distributed across each academic year. Data were collected using two previously validated questionnaires with closed-ended questions that evaluate educational programs based on ethical (28 items) and justice (32 items) criteria. Data were analyzed using one-sample t-tests, one-way ANOVA, and Pearson's correlation with SPSS software version 22 (p < 0.05).
Results: Students' perspectives on adherence to justice were moderate, while their views on ethical adherence were significantly above average in the dental education curriculum (p < 0.05). No significant differences were found by gender or age; however, basic sciences students had significantly different views on justice than clinical students (p = 0.04). A significant positive correlation was found between justice and ethics scores (p = 0.01).
Conclusion: Dental students perceived moderate adherence to justice and above-average adherence to ethics in their curriculum. Higher justice scores were associated with higher ethics scores.
Keywords:
Ethics, Professional; Ethics, Medical; Social Justice; Education; Dental; Curriculum.
Introduction
The primary goal of medical education is to cultivate a workforce that delivers care with respect for human dignity [1]. Realizing this aim requires the continuous evaluation and revision of university curricula [2,3] and the adoption of a justice-oriented framework. Justice in education - understood as fair interactions, equitable performance, and unbiased treatment - enhances students’ sense of self-worth and promotes positive civic and academic behaviors [4,5]. Conversely, perceptions of injustice foster doubt, anxiety, and disengagement, undermining both individual and collective self-esteem and impeding learning [6,7].
Alongside justice, the integration of professional ethics is indispensable. In dentistry - and health care more broadly - clinical competence alone is insufficient to guarantee quality care; ethical principles such as beneficence, non-maleficence, respect for autonomy, and justice must inform every decision [8,9]. Consequently, ethics education in dental curricula should be continuous and experiential rather than episodic [10]. Embedding case-based reflection on ethical dilemmas throughout the program prepares students to navigate the complex moral challenges they will inevitably face in practice.
Empirical evidence supports this integrated approach. Students exposed to structured ethics courses demonstrate significant gains in knowledge, attitudes, and practical skills [11]. In contrast, dental students at various training levels recognize professional ethics as a cornerstone of effective practice and cite religious and spiritual values as key motivators [8]. Moreover, familiarizing both faculty and learners with formal ethics guidelines improves work processes and outcomes across medical and pharmacy education [12].
Justice and ethics are thus complementary pillars of medical education: justice ensures equal learning opportunities and fair treatment, fostering academic engagement, while ethics underpins the delivery of responsible, patient-centered care. To assess how these principles manifest in our own institution, this study examines dental students’ perceptions of justice and ethics in the curriculum at Kerman University of Medical Sciences.
Material and Methods
Study Design and Ethical Aspects
This study employed a cross-sectional, descriptive-analytical design to investigate dental students' perspectives on adherence to justice and ethics in their dental education curriculum at Kerman University of Medical Sciences. The study was conducted in the academic year 2021-2022 (corresponding to the Iranian calendar year 1400) and received ethical approval from the Ethics Committee of Kerman University of Medical Sciences (IR.KMU.REC.1400.260). Participation was voluntary, and students could withdraw at any stage of the research.
Study Population and Sampling
The study population consisted of all dental students from the first to sixth year enrolled at Kerman University of Medical Sciences. Participants were recruited through simple random sampling, with the researcher attending each year's lectures to distribute the questionnaires and collecting them upon completion. The study population included all 480 dental students enrolled at Kerman University of Medical Sciences, of whom 207 participated, yielding a response rate of 43.1%. The participants were distributed across six entry years as follows: 46 (22.2%) in 2015, 34 (16.4%) in 2016, 44 (21.3%) in 2017, 21 (10.1%) in 2018, 42 (20.3%) in 2019, and 20 (9.7%) in 2020. This distribution was standard across the entry years. Inclusion criteria required current enrollment in the dental program, while students whose grade-point average remained below the established normative threshold over multiple consecutive semesters were excluded. The sampling method ensured that students from each academic year were included, although the representation varied slightly due to differences in cohort sizes.
Data Collection
Data were collected using two previously validated questionnaires designed to evaluate educational programs based on ethical and justice criteria [3]. The justice questionnaire contained 32 items, and the ethics questionnaire contained 28 items, both with closed-ended yes/no response options. Each questionnaire was scored such that higher scores indicated greater perceived adherence to justice (range: 0-32) and ethics (range: 0-28), respectively. The questionnaires were distributed to participants, and responses were collected anonymously. The reliability of the questionnaires was established by Ghavi et al. [3], with high Kappa coefficients and Cronbach's alpha values.
Statistical Analysis
Data were analyzed using SPSS software version 22. A one-sample t-test was used to compare the mean scores of justices and ethics against hypothetical benchmarks of 16 and 14, respectively, to determine whether students' perceptions differed significantly from these standards. One-way analysis of variance (ANOVA) was then applied to assess mean score differences across gender, year of entry, and educational level (basic sciences vs. clinical students). Pearson's correlation analysis was conducted to examine the relationship between justice and ethics questionnaire scores. For all statistical tests, a p-value of less than 0.05 was considered statistically significant.
Results
Of the 220 distributed questionnaires, 207 were collected (response rate: 94.1%). The mean age of participants was 22.94 ± 2.45 years (range: 18-33), with 113 female students (54.6%) and 94 male students (45.4%). The number of participants varied by entry year, with the highest proportion in 2015 (46 students, 22.2%) and the lowest in 2020 (20 students, 9.7%). Demographic characteristics are presented in Table 1.
Descriptive statistics for students’ perspectives on justice and ethics in the dental education curriculum are shown in Table 2. The mean justice score was 16.30 ± 7.41 (range: 1-32), and the mean ethics score was 16.51 ± 7.15 (range: 0-28). One-sample t-test analyses comparing the mean justice score to the hypothetical average of 16 (midpoint of the 0-32 scale) showed no statistically significant difference (p = 0.556), indicating that students’ perceptions of justice were at a moderate level. In contrast, the mean ethics score was significantly higher than the hypothetical average of 14 (midpoint of the 0-28 scale) (p < 0.001), suggesting that students perceived ethical adherence to be above average.
Descriptive statistics of students’ perspectives on justice and ethics in the dental education curriculum.
The highest mean score for justice items was for “It pays attention to human rights” (0.72 ± 0.031), while the lowest was for “It emphasizes developing leadership skills in students”, “It focuses on acquiring research abilities in the field of social justice”, and “Attention to student participation in providing services to the community” (0.28 ± 0.031) (Table 3).
For ethics, the highest mean scores were for “The ethics curriculum addresses confidentiality regarding patient matters” (0.78 ± 0.029) and “It considers independent decision-making and the necessity of patient consent” (0.74 ± 0.031), while the lowest was for “Integration of specialized courses with relevant ethical content” (0.39 ± 0.034) (Table 4).
Pearson’s correlation analysis revealed a significant positive relationship between justice and ethics scores (r = 0.45, p < 0.001), indicating that higher justice scores were associated with higher ethics scores. No significant differences were found in justice or ethics scores based on gender (p = 0.70 for justice, p = 0.11 for ethics) (Table 5).
The relationship between students' views on ethics and justice in the educational program by gender.
The mean justice score was significantly higher among basic sciences students (17.91 ± 7.13) compared to clinical students (15.61 ± 7.45, p = 0.04), whereas no significant difference was observed for ethics scores (p = 0.434). Analysis based on year of entry showed that students’ perspectives on justice and ethics did not significantly differ across different years of entry (p = 0.224 for justice, p = 0.686 for ethics) (Table 6).
Mean scores of students’ perspectives on justice and ethics in dental education by academic level and year of university admission.
Discussion
It is well established that increased education does not necessarily lead to improved learning or behavioral change. Instead, emphasizing values such as ethics and justice in the curriculum fosters introspection, a deeper understanding of values, and behavioral transformation [13,14]. This is particularly critical for dental students, who will face complex ethical decisions in their professional careers [3].
This study evaluated dental students' perspectives on the integration of ethics and justice into their curriculum at Kerman University of Medical Sciences. In this context, "average" refers to the midpoint of the questionnaire scales: 16 for justice (0-32) and 14 for ethics (0-28). The mean justice score was not significantly different from 16 (p=0.556), indicating a moderate level of perceived justice. In contrast, the mean ethics score was well above 14 (p<0.001), suggesting strong ethical adherence in the curriculum. Our finding of moderate justice aligns with Yaghini et al. [15], who identified educational injustice as a challenge in the dental curriculum at Isfahan University of Medical Sciences. Similarly, Chen et al. [16] found that social justice was often overlooked in dental education, supporting the need for enhanced justice-focused content. Social justice remains underexplored in higher education, particularly in Iran, due to limited educational content and teaching approaches [17]. Fostering professional values, such as justice, requires ongoing education for educators and students [18,19].
The above-average ethics score is consistent with Al-Zain et al. [8], who reported that dental students view professional ethics as fundamental to dental practice. Students highly valued ethical indicators such as patient confidentiality, honesty, and informed consent, but found ethics education grounded in student experiences or integrated with specialized courses less familiar. This echoes Fawzi [20], who noted that students at Ain Shams University found ethics complex, particularly regarding confidentiality and informed consent. Campbell et al. [21] further highlighted a “too little, too late” model in ethics education, emphasizing the role of student perspectives and culture.
A significant finding was that preclinical students (n=62) reported a higher justice perspective (mean=17.91 ± 7.13) than clinical students (n=145, mean=15.61 ± 7.45, p=0.04). This may reflect preclinical students' limited patient contact, which can foster an idealized view of justice. Jagsi and Lehman [22] found that ethical principles were not upheld for clinical students in over 38% of cases, possibly due to deficiencies in ethics education, which may contribute to our observed difference. The smaller preclinical sample size may have reduced statistical power; however, the independent-samples t-test is robust for unequal sample sizes when variances are similar (SD=7.13 vs. 7.45). Thus, the difference is likely reliable, though future studies with larger samples could provide further validation.
A strong positive correlation between justice and ethics scores (r=0.45, p<0.001) indicates that students who perceive higher justice also perceive greater ethical adherence. This is supported by Hlaing et al. [23], who found that health students applied justice and ethical principles in ethical reasoning. Sajadi et al. [24] further noted that high ethical skills enhance clinical performance, underscoring the interconnectedness of these values. Experts agree that while clinical skills are essential, quality dental care requires professional ethics, making ethics education as critical as clinical training [8,10]. Ethical principles - integrity, beneficence, autonomy, and justice - guide clinical decisions [9].
Limitations include challenges in tracking participants during the COVID-19 pandemic, limited comparable studies in Iranian dental schools, and the smaller preclinical sample size, which may have affected statistical power. Despite this, significant findings suggest robust effects. Future research with larger, balanced samples and updated curricula could further explore these perspectives.
To address gaps, we suggest innovative strategies such as problem-based learning and ethics workshops. Assessment methods such as case studies and reflective journals can assess ethical understanding. Continuous, reflective assessment is crucial for fostering ethical and fair educational practices.
Conclusion
Dental students at Kerman University of Medical Sciences perceive adherence to justice in their curriculum as moderate, while their perception of ethical adherence is above average. Preclinical students reported a significantly more positive perspective on justice than clinical students, possibly due to their lack of patient interaction. A strong positive correlation between justice and ethics scores suggests that students who perceive greater justice also perceive stronger ethical standards. These findings underscore the need for curriculum revisions to enhance justice and ethics education, particularly in clinical settings. Future research with larger, balanced samples and updated curricula could further explore these perspectives and inform educational improvements.
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Financial Support
This study was supported by the Research and Technology Deputy and the Student Research Committee of Kerman University of Medical Sciences, and we sincerely thank them.
Data Availability
The data used to support the findings of this study can be made available upon request to the corresponding author.
References
- [1] Khaghanizade M, Maleki H, Abbasi M, Abbaspour A. Pattern of medical ethics curriculum with Islamic approach. Educ Strateg Med Sci 2013; 6(1):1-6. [In Persian].
- [2] Ahmed YA, Alneel S. Analyzing the curriculum of the faculty of medicine, University of Gezira using Harden’s 10 questions framework. J Adv Med Educ Prof 2017; 5(2):60-66.
- [3] Ghavi A, Valizadeh L, Zamanzadeh V, Kianian T. Designing and validating novel scales for the evaluation of curriculum in terms of ethics and justice. Iran J Med Educ 2019; 19(60):554-564. [In Persian].
-
[4] Stovall D. Against the politics of desperation: Educational justice, critical race theory, and Chicago school reform. Crit Stud Educ 2013; 54(1):33-43. https://doi.org/10.1080/17508487.2013.739192
» https://doi.org/10.1080/17508487.2013.739192 -
[5] Afrazandeh SS, Mirzaei T, Pouraboli B, Sabzevari S. Educational justice and educational citizenship behavior from perspective of nursing students. J Med Ethics 2016; 10(35):117-140. https://doi.org/10.21859/mej-1035117 [In Persian].
» https://doi.org/10.21859/mej-1035117 - [6] Sanagoo A, Nomali M, Jouybari L. Explanation of educational equity among medical sciences students: Evaluation of medical sciences students opinions and experiences. Future Med Educ J 2011; 4(3):39-44. [In Persian].
-
[7] Lind EA, Van den Bos K. When fairness works: Toward a general theory of uncertainty management. Res Organ Behav 2002; 24:181-223. https://doi.org/10.1016/S0191-3085(02)24006-X
» https://doi.org/10.1016/S0191-3085(02)24006-X - [8] Al-Zain SA, Al-Sadhan S, Ahmedani MS. Perception of BDS students and fresh graduates about significance of professional ethics in dentistry. J Pak Med Assoc 2014; 64(2):118-123.
- [9] Ozar DT, Sokol DJ, Patthoff DE. Dental ethics at chairside: Professional obligations and practical applications. 3rd edition. Washington, D.C: Georgetown University Press; 2018.
- [10] Brondani MA, Rossoff LP. The “hot seat” experience: A multifaceted approach to the teaching of ethics in a dental curriculum. J Dent Educ 2010; 74(11):1220-1229.
-
[11] Shrestha C, Shrestha A, Joshi J, Karki S, Acharya S, Joshi S. Does teaching medical ethics ensure good knowledge, attitude, and reported practice? An ethical vignette-based cross-sectional survey among doctors in a tertiary teaching hospital in Nepal. BMC Med Ethics 2021; 22(1):109. https://doi.org/10.1186/s12910-021-00676-6
» https://doi.org/10.1186/s12910-021-00676-6 -
[12] Sadeghimahalli F, Ghahrani N, Khaleghzadeh-Ahangar H. Evaluation of professor's professional teaching ethics from the perspective of basic medical students at Babol University of Medical Sciences. Educ Develop Judishapur 2023; 13(4):593-603. https://doi.org/10.22118/edc.2022.338077.2073 [In Persian].
» https://doi.org/10.22118/edc.2022.338077.2073 - [13] Bertolami CN. Why our ethics curricula don't work. J Dent Educ 2004; 68(4):414-425.
- [14] Lovas JG, Lovas DA, Lovas PM. Mindfulness and professionalism in dentistry. J Dent Educ 2008; 72(9):998-1009.
-
[15] Yaghini J, Faghihi A, Yamani N, Daryazadeh S. Challenges in implementing the general dentistry curriculum in the viewpoint of the students: A qualitative study. J Mashhad Dent Sch 2018; 42(4):356-369. https://doi.org/10.22038/jmds.2018.11994
» https://doi.org/10.22038/jmds.2018.11994 -
[16] Chen V, Foster Page L, McMillan J, Lyons K, Gibson B. Measuring the attitudes of dental students towards social accountability following dental education-qualitative findings. Med Teach 2016; 38(6):599-606. https://doi.org/10.3109/0142159X.2015.1060303
» https://doi.org/10.3109/0142159X.2015.1060303 -
[17] Habibzadeh H, Jasemi M, Hosseinzadegan F. Social justice in health system; a neglected component of academic nursing education: A qualitative study. BMC Nurs 2021; 20(1):16. https://doi.org/10.1186/s12912-021-00534-1
» https://doi.org/10.1186/s12912-021-00534-1 - [18] Parvan K, Hosseini F, Zamanzadeh V. Professional values from nursing students’ perspective in Tabriz University of Medical Sciences: A pilot study. Iran J Nurs 2012; 25(76):28-41.
-
[19] Parandeh A, Khaghanizade M, Mohammadi E, Nouri JM. Factors influencing development of professional values among nursing students and instructors: a systematic review. Glob J Health Sci 2014; 7(2):284-293. https://doi.org/10.5539/gjhs.v7n2p284
» https://doi.org/10.5539/gjhs.v7n2p284 -
[20] Fawzi MM. Medical ethics educational improvement, is it needed or not?! Survey for the assessment of the needed form, methods and topics of medical ethics teaching course amongst the final years medical students Faculty of Medicine Ain Shams University (ASU), Cairo, Egypt 2010. J Forensic Leg Med 2011; 18(5):204-207. https://doi.org/10.1016/j.jflm.2011.02.012
» https://doi.org/10.1016/j.jflm.2011.02.012 -
[21] Campbell AV, Chin J, Voo T-C. How can we know that ethics education produces ethical doctors? Med Teach 2007; 29(5):431-436. https://doi.org/10.1080/01421590701504077
» https://doi.org/10.1080/01421590701504077 -
[22] Jagsi R, Lehmann LS. The ethics of medical education. BMJ 2004; 329(7461):332-334. https://doi.org/10.1136/bmj.329.7461.332
» https://doi.org/10.1136/bmj.329.7461.332 -
[23] Hlaing PH, Hasswan A, Salmanpour V, Shorbagi S, AlMahmoud T, Jirjees FJ, et al. Health professions students’ approaches towards practice-driven ethical dilemmas; A case-based qualitative study. BMC Med Educ 2023; 23(1):307. https://doi.org/10.1186/s12909-023-04089-4
» https://doi.org/10.1186/s12909-023-04089-4 -
[24] Sajadi FS, Torabi-Parizi M, Aftabi R, Khosravi S. Assessing moral skills in general and post-graduate dental students in the Southeast of Iran: A cross-sectional study. Pesqui Bras Odontopediatria Clin Integr 2022; 22:e210194. https://doi.org/10.1590/pboci.2022.080
» https://doi.org/10.1590/pboci.2022.080
Edited by
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Academic Editor:
Ana Maria Gondim Valença
