J Korean Acad Oral Health.  2025 Mar;49(1):40-47. 10.11149/jkaoh.2025.49.1.40.

An evaluation of the effectiveness of discussion and debate learning in a dental hygiene ethics class: a case study focusing on changes in moral sensitivity and judgment

Affiliations
  • 1Department of Dental Hygiene, College of Health Science and Genome-based BioIT Convergence Institute, SunMoon University, Asan, Korea
  • 2Department of Preventive and Social Dentistry, College of Dentistry, Kyung Hee University, Seoul, Korea

Abstract


Objectives
Moral sensitivity and moral judgment are key factors influencing ethical decision-making in the clinical practice of dental hygienists. This study utilized a dilemma discussion in a dental hygiene ethics class to assess changes in the moral sensitivity and moral judgment of students and to examine the implications of these changes.
Methods
The study included 46 sophomore students from the Department of Dental Hygiene who were enrolled in a dental hygiene ethics course during the second semester of 2021. The class employed the dilemma discussion method in the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model-based Development Beyond Learning (DBL) dental hygiene ethics curriculum. This approach aimed to help dental hygienists develop professional ethics and make sound ethical judgments. To evaluate the degree of change in moral perception before and after the dilemma discussion class, a predesigned questionnaire was administered twice—once in the first week and again in the 15th week of the course.
Results
Moral sensitivity increased following the dental hygiene ethics course. Although moral judgement did no show a statistically significant change, students demonstrated a noticeable shift toward deeper consideration in their ethical reasoning.
Conclusions
Dental hygiene programs should explore diverse instructional designs and activities to foster ethical competencies. This study provides insights that may contribute to improving the ethical thinking skills of future dental hygienists.

Keyword

Debate; Dental; Discussion; Ethic; Learning

Figure

  • Fig. 1 A semester class operation based on the DBL.

  • Fig. 2 The eight learning process for dilemma discussion based on DBL.


Reference

References

1. Valera L, Castilla JC. 2019; Global changes: Ethics, politics and environment in the contemporary technological world. Springer Nature. 46:9–16. DOI: 10.1007/978-3-030-29443-4.
2. Lee MJ, Kim DK, Hwang SJ, Oh SH. 2018; Elderly welfare system and role of dental hygienists in Korea and Japan. J Dent Hyg Sci. 18:172–181. DOI: 10.17135/jdhs.2018.18.3.172.
Article
3. American dental hygienists association. Professional roles of an RDH [Internet]. Available from: https://www.adha.org/becomeahygienist/degree-options/dental-hygiene-programs/professional-roles-of-an-rdh/. cited 2022 June 03.
4. Korean dental hygienists association, introduction of dental hygienist. 1 [Internet]. Available from: https://www.kdha.or.kr/introduce/dentalhygienist.aspx#introduce. cited 2022 June 03.
5. Cruess SR, Cruess RL, Steinert Y. 2019; Supporting the development of a professional identity: general principles. Med teach. 41:641–649. DOI: 10.1080/0142159X.2018.1536260. PMID: 30739517.
Article
6. Yang EM, Park SJ, Kim HJ. 2015; The experience of medical conflict and the educational needs of dental hygienists. J Dent Hyg Sci. 15:361–368. DOI: 10.17135/jdhs.2015.15.3.361.
Article
7. Yun NN, Lee MJ, Sung MK. 2017; Analysis of the perception degree on dental medical accident and dispute experience, psychological status and preventive education according to clinical career of dental hygienist. J Korean Acad Dent Adm. 5:13–21.
8. Korea health personnel licensing examination institute, a study on the application of medical ethics in the national examination of health care personnel [Internet]. Available from: http://rnd.kuksiwon.or.kr/last/lastList.do?MENU_ID=C-01-01. cited 2022 June 03.
9. Duley SI, Fitzpatrick PG, Zornosa X, Lambert CA, Mitchell A. 2009; Dental hygiene students' attitudes toward ethical dilemmas in practice. J Dent Educ. 73:345–357. DOI: 10.1002/j.0022-0337.2009.73.3.tb04707.x. PMID: 19289724.
Article
10. Jung JH, Kim MA, Kim HJ. 2022; A study on ethical values and professionalism of dental hygienists. J Korea Converg Soc. 13:357–364.
11. [cited 2022 June 25]. Available from: http://rnd.kuksiwon.or.kr/last/lastList.do?MENU_ID=C-01-01. cited 2022 June 25.
12. Kacerik MG, Prajer RG, Conrad C. 2006; Ethics instruction in the dental hygiene curriculum. J Dent Hyg. 80:9.
13. Choi IS, Yoon BY. 2014; New challenges for korean medical education: enhancing students' abilities to deal with uncertain ill-defined problems. Korean Med Educ Rev. 16:111–118. DOI: 10.17496/kmer.2014.16.3.111.
Article
14. Hong SH. 2009; Application to the dilemma discussion program: ethics and character education for medical students. Korean Medical Education Review. 11:3–14. DOI: 10.17496/KMER.2009.11.2.3.
Article
15. Kim YJ, Lee SH, Yoo HH. 2017; Analysis of students' reflective journals on medical communication role plays. Korean Med Educ Rev. 19:169–174. DOI: 10.17496/kmer.2017.19.3.169.
Article
16. Xue H, Yuan H, Li G, Liu J, Zhang X. 2021; Comparison of team-based learning vs. lecture-based teaching with small group discussion in a master's degree in nursing education course. Nurse Educ Today. 105:105043. DOI: 10.1016/j.nedt.2021.105043. PMID: 34247012.
Article
17. Burgess A, Roberts C, Ayton T, Mellis C. 2018; Implementation of modified team-based learning within a problem based learning medical curriculum: a focus group study. BMC Med Educ. 18:1–7. DOI: 10.1186/s12909-018-1172-8. PMID: 29631579. PMCID: PMC5892039.
Article
18. Thompson CC. 2019; Advancing critical thinking through learning issues in problem-based learning. Med Sci Educ. 29:149–156. DOI: 10.1007/s40670-018-00649-2. PMID: 34457462. PMCID: PMC8368909.
Article
19. Lee SH, Kim SH. 2017; Effects of a debate on nursing students' critical thinking disposition, ethical value and moral judgment in nursing ethics education. J Korean Data Anal Soc. 19:2263–2276. DOI: 10.37727/jkdas.2017.19.4.2263.
Article
20. Kim WJ. 2018. Development and effect of nursing ethics education program based on academic debates for undergraduate nursing students. [dissertation]. Ajou University;Suwon: [Korean].
21. Hwang Sl, Kwon BK, Koo YM, Kim OJ, Moon YL, Hong SH. 1998; Study on the development of medical ethics education program. Korean J Med Ethics. 1:59–69. DOI: 10.35301/ksme.1998.1.1.59.
Article
22. Kim JY, Choi SH, Han SH, Jun G, Kim DS, Love M, et al. 2000; The implementation of the moral education program in a medical school using dilemma discussion. Korean Med Educ Rev. 12:53–63. DOI: 10.3946/kjme.2000.12.1.53.
Article
23. Hong SH. 2000; Effects of dilemma discussion on the moral development of medical students. J Moral Educ. 12:227–253. DOI: 10.17715/jme.2000.11.12.2.227.
Article
24. Lee MA. 2009; The efficacy of ethics education on the moral judgment of nursing students. Korean J Med Ethics. 12:177–188. DOI: 10.35301/ksme.2009.12.2.177.
Article
25. Bang SY. 2020; The effects of ethics education on nursing students' professional self concept, ethical dilemma and ethical decision making confidence. J Korea Acad-Ind Coop Soc. 21:568–576.
26. Choi YK, Kim EJ. 2022; A case study on the evaluation of discussion and debate learning effectiveness in a dental hygiene ethics class. Eur J Dent Educ. 26:223–231. DOI: 10.1111/eje.12690. PMID: 33977601.
Article
27. Lützén K, Nordström G, Evertzon M. 1995; Moral sensitivity in nursing practice. Scand J Caring Sci. 9:131–138. DOI: 10.1111/j.1471-6712.1995.tb00403.x. PMID: 7569517.
Article
28. Jo HK, Kim SA. 2017; Moral sensitivity, empathy and perceived ethical climate of psychiatric nurses working in the national mental hospitals. J Korean Acad Psychiatr Ment Health Nurs. 26:204–215. DOI: 10.12934/jkpmhn.2017.26.2.204.
Article
29. Rest JR. 1992. Development in judging moral issues. Minnesota:U of Minnesota Press.
30. Moon YL, Kim MK, Lee JH, Won HJ. 2008; Development of moral reasoning in Korea: a thirteen-year comparison. Korean J Educ Psychol. 22:281–299.
31. Lee SM, Kang BW, Kim CH. 2010; Dental hygienist's ethical dilemma. J Dent Hyg Sci. 10:259–264.
32. Lohiya S. 2013; Domestic violence dilemma in the dental clinic. J Am Coll Dent. 80:9–11.
33. Jordan J. 2007; Taking the first step toward a moral action: A review of moral sensitivity measurement across domains. J Genet Psychol. 168:323–359. DOI: 10.3200/GNTP.168.3.323-360. PMID: 18200892.
Article
34. Kim YS, Kang SW, Ahn JA. 2013; Moral sensitivity relating to the application of the code of ethics. Nurs Ethics. 20:470–478. DOI: 10.1177/0969733012455563. PMID: 23166142.
Article
35. Cruess RL, Cruess SR, Steinert Y. 2016. Teaching medical professionalism: supporting the development of a professional identity. Cambridge University Press;Cambridge: DOI: 10.1017/CBO9781316178485.
36. Kim IJ, Sung NJ, Jung KH, Bae GR. 2005; Park KU, Kim JP, et al. Effect of the medical ethics education evaluated by DIT test. Korean Soc Med Ethics. 8:95–104. DOI: 10.35301/ksme.2005.8.2.95.
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