Virtues in Competency-Based Assessment Frameworks: A Text Analysis.

Introduction: Official documentation of specialty training provides comprehensive and elaborate criteria to assess residents. These criteria are commonly described in terms of competency roles and entrustable professional activities (EPA's), but they may also implicitly encompass virtues. Virtues are desirable personal qualities that enable a person, in this case, a medical specialist, to make and act on the right decisions. We articulate these virtues and explore the resulting implied ideal of a medical professional. Method: We applied a two-staged virtue ethical content analysis to analyze documents, specific to the Dutch training program of the Ear, Nose, and Throat (ENT) specialty. First, we identified explicit references to virtues. Next, we articulated implicit virtues through interpretation. The results were categorized into cardinal, intellectual, moral, and professional virtues. Results: Thirty virtues were identified in the ENT- training program. Amongst them, practical wisdom, temperance, and commitment. Furthermore, integrity, curiosity, flexibility, attentiveness, trustworthiness and calmness are often implicitly assumed. Notable findings are the emphasis on efficiency and effectiveness. Together, these virtues depict an ideal of a future medical specialist. Conclusion: Our findings suggest that competency-frameworks and EPA's implicitly appeal to virtues and articulate a specific ideal surgeon. Explicit attention for virtue development and discussion of the role and relevance of implied ideal professionals in terms of virtues could further improve specialty training.

Wish-fulfilling medicine and wish-fulfilling dentistry.

OBJECTIVES: to explain the practice of wish-fulfilling medicine and how it relates to dentistry. SOURCES: Relevant papers, and reports from authoritative institutions were identified in Pubmed and Google Scholar. RESULTS: Wish-fulfilling medicine refers to services provided by professionals using medical methods in a medical setting to address non-medical wishes of patients. Care-providers, medical industries, and health-insurance companies also contribute to wish-fulfilling in medicine and dentistry. Various concepts of health and illness compounded by blurred borders between health and illness offer an unstable foundation for wish-fulfilling medicine, and growing demands for these services where healthcare resources are limited can displace medically necessary treatments. Moreover, treatments without a medical or a dental necessity, can be harmful and bear the risk of futile or excessive treatments not in patients' long-term interest. Examples in dentistry are found in the field of cosmetic interventions, prosthodontics and orthodontics, where perceptions of small 'deviations' from normality prompt wishes or recommendations for intervention. Ethically, wish-fulfilling services confront the principles of the common morality if the autonomy of a patient is compromised, beneficence is unclear, harm is foreseeable, or distributive justice is compromised. Wish-fulfilling dental treatment can be restricted by legislation if it conflicts with safe, effective and efficient care, or if it interferes with patient's real needs or undermines established professional standards. CONCLUSIONS: The general understanding of wish-fulfilling medicine including its ethical and legal themes is relevant to dentistry. CLINICAL RELEVANCE: Ethical considerations and legislation can guide a dentist to reflect critically on clinical decisions regarding wish-fulfilling dentistry.