Acquisition of deontological principles through game technologies

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Professional thinking of the physicians of any specialty including dentists incorporates an extremely important notion of duty (duteous), and the basic principle of deontology is the conscious subordination of private interests to the interests of society. The object of medical ethics is medical morality, which is a system of norms and rules of behavior of the doctor, his rational and high-human behavior in achieving the most effective results in preventing diseases, in healing and recovery of the patient. The essence of medical morality is determined not only by the personal individual qualities of the doctor, the level of his professionalism, responsibility to the case, but also by the totality of social conditions, status, position in society, the conditions of his work, the development of science. Internal rules include the relationship of health workers to work, based on mutual respect, discipline, subordination, friendliness, a sense of collegiality, clear performance of their professional duties. Most physicians are guided in their daily activities by delivering disinterested medical assistance to the people who need it. However, some medical professionals see the patient as a direct or indirect source of their earnings; in this case some non-standard moral and ethical relationships based on the so-called human factor may arise between a doctor and a patient in the dental office. Currently, the effective development of dentistry is possible only if the experts adhere to ethical and deontological principles and rules. The basic ethical principles of professional activity of a dentist are fixed in the ethical code, developed by the Stomatological Association of Russia. They reflect the specifics of the interaction of the dentist and patient, as well as the society as a whole, regulate the relations between colleagues, maintain the professional level of interpersonal interaction, which undoubtedly contributes to the strengthening of trust in therapeutic and preventive measures. For the physicians of all specialties including dentists it is general medical training, modern methods of prevention, diagnosis, treatment, knowledge of deontological principles that are directly related to the fulfilment of their professional duty. The nature of the physician-patient relationship that is established during their first contacts is extremely important for the treatment outcome which involves taking into account the patient’s personality characteristics. A physician should analyze all his actions and conduct, be self-critical, bear responsibility for his actions, and have professional medical observation. The physician when in contact with a patient must pay attention to his appearance, facial expression, notice and detect changes in his condition. To make an accurate diagnosis a doctor should use all the achievements of medical science and technology assessing their effectiveness but treating them as addition to and not instead of direct communication with a patient [1, p. 1618]. The physician-patient relationship is now becoming increasingly important. However, the introduction of bioethics principles into practical dentistry is difficult. The emerging competition among dentists as well as patient’s increasing role in the treatment process show the need for the dentists’ professional growth not only as highly skilled specialists. An ever greater number of patients want to participate in the decision making process concerning their health, in choosing a treatment method. This involves the physicians’ increased competence in the tactics of building a dialogue with a patient. Most often, the physician-patient relationship is built on the basis of the doctor’s personal qualities. Scientific approach is now being developed to build a dialogue between a physician, a patient and his relatives. The most acceptable model of physician-patient communication is based on the equality of all parties. The patient can synthesize information and identify priorities for himself and the physician should help him in that. This model of relationships is being further developed in the patient’s informed consent for the diagnostic procedures and therapeutic manipulations to be carried out. What are the reasons for the modern doctors’ low competence in establishing a proper physician-patient dialogue? Among them, one can note the detachment from the practice of medical ethics and deontology. A physician should know the deontological principles of his behavior, be able to resolve and prevent conflict situations. However, the physicians’ knowledge in this area is superficial; therefore there is a need for the medical students’ education to include extended courses of medical psychology and bioethics which are necessary in conditions of fee-for-service medical care. The most important condition for a physician to enter professional activities is to train him as a harmonious, comprehensively developed personality [2, с. 161]. 52 The urgent task of students’ professional education is the development of independent evaluation and selection of information received. Active and interactive teaching methods in the form of role-playing games are used in the educational process. The application of active teaching methods is one of the important means of training a competitive person. The purpose of role-playing games is to develop skills and capacities to play diverse formal and informal social roles in real life by modeling the real conditions of professional activities [3, p. 200]. When playing the game, the basic principles should be the compliance with ethics and deontology, the doctor’s and patient’s legal provisions. All educational games fall into three categories: direct didactic impact when the teacher himself is in the game; mediated didactic impact when the teacher acts as an observer; mixed didactic impact when the teacher acts as a facilitator, expert or consultant. Regardless of the type, all role-playing games have common rules: developing a game goal, game rules, defining a subject material, method guidelines, preparing a game plan and roles distribution [2, p. 23-24]. The purpose of the research: to study the impact of s role-playing game on the development and assimilation of deontological principles. Materials and methods: To accomplish this goal, a study was conducted which involved the students from the dentistry department of Volgograd State Medical University who studied the discipline of Therapeutic Dentistry. Before the start of role-playing games to assimilate the principles of bioethics and deontology, the test was conducted to identify the knowledge baseline in this area. After the game, the teacher determined the level of the material learned and professional skills acquired on this subject, and a control test was also conducted. Research results o and their discussion: During a role-playing game the students show their knowledge in the discipline of Therapeutic Dentistry. Particular attention is paid to the students’ ability to conduct a dialogue with a patient, to draw a diagnostic hypothesis through information search, the students’ capacity fir teamwork. Incoming testing revealed the knowledge baseline on deontological principles (correct responses - 48%). After the role-playing game and discussion of the basic deontological principles of physician-patient and physician-nurse relationships, the level of knowledge was much higher. The degree of the material mastered was estimated at 79% of correct responses. If one pays attention to the bioethical education of students during classes the process of student-patient relationship changes at the end of the cycle. The students conduct a dialogue with a patient, pay due attention to the medical history, explain the need for specific procedures and manipulations, discuss the financial issue of providing fee-based services, explain what services can be provided in the framework of Compulsory Health Insurance. The factors that affect the quality of patient treatment were specified in the course of a role-playing game. This was necessary in order to have a clearer vision of a dentistpatient relationship in outpatient settings. Conclusion: During a role-playing game, the students' knowledge of specific problems is exhibited, professional skills are consolidated, their creative abilities and capacities are revealed to find solutions in various situations. The research results showed the effectiveness of the use of gaming technology in the teaching process.

About the authors

I. V. Starikova

Volgograd State Medical University

Email: radyshevskaya@mail.ru
Candidate of Medical Science, assistant of the Department of Therapeutic Stomatology Volgograd

N. V. Piterskaya

Volgograd State Medical University

Email: piterskij.k@yandex.ru
Candidate of Medical Science, аssistant of the Department of Therapeutic Stomatology Volgograd

T. N Radyshevskaya

Volgograd State Medical University

Email: radyshevskaya@mail.ru
Candidate of Medical Science, аssistant of the Department of Therapeutic Stomatology Volgograd

N. F Alyoshina

Volgograd State Medical University

Email: alyoshinanf@yandex.ru
Candidate of Medical Science, аssistant of the Department of Therapeutic Stomatology Volgograd

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