Faculty Bibliography

PURPOSE/OBJECTIVE:The ultimatum bargaining game has been devised by economists to measure fairness and generosity during negotiations. This study sought to adapt the game to classroom application with the intent of (a) determining whether the known outcomes would be replicated given modifications needed to make the game suitable as an educational tool and (b) sharing the resulting self-appraisal with students themselves. METHODS:A total of 452 first-year dental students participated in this adaptation as part of a classroom exercise. Students, identified as donors, were allocated an imaginary stake of $100 and asked to share some amount of it with a recipient classmate by making a nonnegotiable, one-time offer. If the offer is accepted, the donor student retains any residual amount. If the offer is rejected, neither the donor nor recipient receives anything. The question being tested is whether student fairness and/or generosity change when the preferred donor status is assigned at random versus on the basis of an earned property entitlement represented here by a higher-class rank. RESULTS AND CONCLUSION/CONCLUSIONS:When status as Group A donors was established at random, the majority of students offered their fictitious Group B counterpart the fairest possible amount of $50 (70.4% in 2020 and 61% in 2018). However, when students were told that their status as Group A donors would be established based on their ranking in the upper half of the class, the percentage offering the fairest amount declined to 49.5% in 2020 and to 51.8% in 2018. This outcome was available for immediate disclosure to students during the classroom session; it was consistent with results previously reported for the ultimatum bargaining game; and it showed that when a property entitlement is perceived as having been earned (manifested by a higher-class rank), fairness and generosity decline.

PURPOSE/OBJECTIVES/OBJECTIVE:The Knobe effect refers to a measurable tendency among people to believe that undesirable side effects are brought about intentionally while desirable side effects are brought about unintentionally. People blame decision-makers for bad outcomes but do not credit them for good outcomes. The purpose of this study was to determine if the same is true for dental students and whether, as health care practitioners, students might mistakenly expect a benefit-of-the-doubt entitlement for themselves that the public is unwilling to bestow when an outcome is bad. METHODS:Over three years, roughly 500 first-year dental students were posed two previously published standardized Knobe cases requiring a yes/no response. The survey was conducted as part of a classroom exercise with aggregated responses recorded digitally, anonymously, in real time. RESULTS:The Knobe phenomenon was confirmed among dental students but the effect was muted in comparison to that of the public. Dental students aligned with the general public in declining credit for a good outcome but not in attributing blame for a bad outcome. Overall, dental students' negative responses exceeded their positive responses for both questions-confirming the Knobe effect but also revealing that dental students were less willing to take a stance by positively assigning either praise or blame. CONCLUSION/CONCLUSIONS:Using an in-class survey instrument to demonstrate the Knobe effect among dental students may be one way of making more concrete an unjustified benefit-of-the-doubt entitlement these future professionals may otherwise expect for themselves.

If it is not a naive expectation for dentists who have been beneficiaries of public generosity to share their good fortune with the public that made it possible, there may be a rational basis for enhancing the role of dental education in improving access to oral health care by promoting-but not requiring-a voluntary service commitment after graduation commensurate with the magnitude of the subsidy received. Such an approach would be in accordance with the Institute of Medicine's report Improving Access to Oral Health Care for Vulnerable and Underserved Populations, but without the governmental coercion explicit in the report. A sustainable alternative proposal is made here, offering both greater options to students in the financing of their dental education and greater obligations for those students who accept state subsidies: providing tuition discounts for students of state-supported dental schools based not on past residency status but rather on a future commitment to public service. This arrangement could be good public policy that might also help to create a culture in which dental students are given authentic options as part of a profession-wide ideology of public service. The result could well contribute to improved oral health care for the underserved.