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Cimino RT, Streiner SC, Burkey DD, Young MF, Bassett L, Reed JB. Comparing First-Year Engineering Student Conceptions of Ethical Decision-Making to Performance on Standardized Assessments of Ethical Reasoning. SCIENCE AND ENGINEERING ETHICS 2024; 30:23. [PMID: 38833046 PMCID: PMC11150177 DOI: 10.1007/s11948-024-00488-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 05/11/2024] [Indexed: 06/06/2024]
Abstract
The Defining Issues Test 2 (DIT-2) and Engineering Ethical Reasoning Instrument (EERI) are designed to measure ethical reasoning of general (DIT-2) and engineering-student (EERI) populations. These tools-and the DIT-2 especially-have gained wide usage for assessing the ethical reasoning of undergraduate students. This paper reports on a research study in which the ethical reasoning of first-year undergraduate engineering students at multiple universities was assessed with both of these tools. In addition to these two instruments, students were also asked to create personal concept maps of the phrase "ethical decision-making." It was hypothesized that students whose instrument scores reflected more postconventional levels of moral development and more sophisticated ethical reasoning skills would likewise have richer, more detailed concept maps of ethical decision-making, reflecting their deeper levels of understanding of this topic and the complex of related concepts. In fact, there was no significant correlation between the instrument scores and concept map scoring, suggesting that the way first-year students conceptualize ethical decision making does not predict the way they behave when performing scenario-based ethical reasoning (perhaps more situated). This disparity indicates a need to more precisely quantify engineering ethical reasoning and decision making, if we wish to inform assessment outcomes using the results of such quantitative analyses.
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Affiliation(s)
- Richard T Cimino
- Otto H. York Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, NJ, USA.
| | - Scott C Streiner
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel D Burkey
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT, USA
| | - Michael F Young
- Learning Sciences Program, Neag School of Education, The University of Connecticut, Storrs, CT, USA
| | - Landon Bassett
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT, USA
| | - Joshua B Reed
- Department of Experiential Engineering Education, Rowan University, Glassboro, NJ, USA
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Lusk P, Ark T, Crowe R, Monson V, Altshuler L, Harnik V, Buckvar-Keltz L, Poag M, Belluomini P, Kalet A. Measuring the development of a medical professional identity through medical school. MEDICAL TEACHER 2024; 46:665-671. [PMID: 37917985 DOI: 10.1080/0142159x.2023.2273218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
PURPOSE The Professional Identity Essay (PIE) is a theory and evidence-based Medical Professional Identity Formation (MPIF) measure. We describe trajectories of PIE-measured MPIF over a 4-year US medical school curriculum. METHODS Students write PIEs at medical school orientation, clinical clerkships orientation, and post-advanced (near graduation) clerkship. A trained evaluator assigns an overall stage score to narrative responses to nine PIE prompts (inter-rater ICC 0.83, 95% CI [0.57 - 0.96], intra-rater ICC 0.85). Distribution of PIE stage scores across time points were analyzed in the aggregate and individual students were classified as Increase, Stable (no score change) or Decrease based on the trajectories of PIE stage scores over time. RESULTS 202 students completed 592 PIEs from 2018-2023. There was a significant change in the proportion of PIEs in stages over time (X2 84.40, p < 0.001), 47% (n = 95) students were categorized in the Increase trajectory, 45.5% (n = 92) as Stable and 7.4% (n = 15) as Decrease. Older age and time-predicted stage scores change within trajectories (p < 0.05). CONCLUSIONS Medical students' PIE stage scores increase over time with three distinctive trajectories. Further study is needed to explore the utility of this method for formative assessment, program evaluation, and MPIF research.
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Affiliation(s)
- P Lusk
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA
| | - T Ark
- The Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee,WI, USA
| | - R Crowe
- Office of Medical Education, New York University Long Island School of Medicine, New York, NY, USA
| | - V Monson
- The Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee,WI, USA
| | - L Altshuler
- New York University Grossman School of Medicine, New York, NY, USA
| | - V Harnik
- New York University Grossman School of Medicine, New York, NY, USA
| | - L Buckvar-Keltz
- New York University Grossman School of Medicine, New York, NY, USA
| | - M Poag
- New York University Grossman School of Medicine, New York, NY, USA
| | - P Belluomini
- New York University Grossman School of Medicine, New York, NY, USA
| | - A Kalet
- The Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee,WI, USA
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Barry ES, Durning SJ, Schreiber-Gregory D, Grunberg NE, Yarnell AM, Dong T. Undergraduate Medical Education Leader Performance Predicts Postgraduate Military Leader Performance. Mil Med 2023; 188:87-93. [PMID: 37201490 DOI: 10.1093/milmed/usac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Developing physicians as leaders has gained attention across the United States. Undergraduate medical education (UME) and graduate medical education (GME) leader development programs have increased. During postgraduate years (PGY), graduates bring their leadership education to the bedside; however, associations between leader performance in medical school and GME is largely unknown. It is important to find experiences that can assess leader performance that may be useful to predict future performance. The purpose of this study was to determine if (1) there is a correlation between leader performance during the fourth year of medical school versus leader performance in PGY1 and 3, and (2) leader performance during the fourth year of medical school is associated with military leadership performance in PGY1 and 3s while taking previous academic performance markers into account. METHODS This study examined overall leader performance of learners (classes of 2016-2018) during the fourth year of medical school and their graduate leader performance post-medical school. Leader performance was assessed by faculty during a medical field practicum (UME leader performance) and graduate leader performance was assessed by program directors at the end of PGY1 (N = 297; 58.3%) and 3 (N = 142; 28.1%). Pearson correlation analysis examined relationships among UME leader performance and between the PGY leader performance items. In addition, stepwise multiple linear regression analyses were conducted to examine the relationship between leader performance at the end of medical school with military leadership performance in PGY1 and 3, while taking into account the academic performance markers. RESULTS Pearson correlation analyses revealed that the UME leader performance was correlated with 3 of 10 variables at PGY1, and was correlated at PGY3 with 10 out of 10 variables. Results of the stepwise multiple linear regression analysis indicated that leader performance during the fourth year of medical school explained an additional 3.5% of the variance of PGY1 leader performance after controlling for the previous academic performance markers (MCAT total score, USMLE Step 1 score and Step 2 CK score). In contrast, leader performance during the fourth year of medical school alone accounted for an additional 10.9% of the variance of PGY3 leader performance above and beyond the set of academic performance markers. Overall, UME leader performance has more predictive power in PGY leader performance than the MCAT or USMLE Step exams. CONCLUSIONS The findings of this study indicate that a positive relationship exists between leader performance at the end of medical school and leader performance in PGY1 and 3 years of residency. These correlations were stronger in PGY3 compared to PGY1. During PGY1, learners may be more focused on being a physician and an effective team member compared to PGY3 where they have a deeper understanding of their roles and responsibilities and can take on more leadership roles. Additionally, this study also found that MCAT and USMLE Step exams performance was not predictive of PGY1 or PGY3 leader performance. These findings provide evidence of the power of continued leader development in UME and beyond.
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Affiliation(s)
- Erin S Barry
- Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Steven J Durning
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Deanna Schreiber-Gregory
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Neil E Grunberg
- Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Angela M Yarnell
- Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Ting Dong
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
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Miranda-Rodríguez RA, Leenen I, Han H, Palafox-Palafox G, García-Rodríguez G. Moral reasoning and moral competence as predictors of cooperative behavior in a social dilemma. Sci Rep 2023; 13:3724. [PMID: 36878921 PMCID: PMC9987402 DOI: 10.1038/s41598-023-30314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
The level of moral development may be crucial to understand behavior when people have to choose between prioritizing individual gains or pursuing general social benefits. This study evaluated whether two different psychological constructs, moral reasoning and moral competence, are associated with cooperative behavior in the context of the prisoner's dilemma game, a two-person social dilemma where individuals choose between cooperation or defection. One hundred and eighty-nine Mexican university students completed the Defining Issues Test (DIT-2; measuring moral reasoning) and the Moral Competence Test (MCT) and played an online version of the prisoner's dilemma game, once against each participant in a group of 6-10 players. Our results indicate that cooperative behavior is strongly affected by the outcomes in previous rounds: Except when both participants cooperated, the probability of cooperation with other participants in subsequent rounds decreased. Both the DIT-2 and MCT independently moderated this effect of previous experiences, particularly in the case of sucker-outcomes. Individuals with high scores on both tests were not affected when in previous rounds the other player defected while they cooperated. Our findings suggest that more sophisticated moral reasoning and moral competence promote the maintenance of cooperative behaviors despite facing adverse situations.
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Affiliation(s)
| | - Iwin Leenen
- Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | - Hyemin Han
- Educational Psychology Program, University of Alabama, Tuscaloosa, USA, Alabama, 35487
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Isaac S, Kotluk N, Tormey R. Educating Engineering Students to Address Bias and Discrimination Within Their Project Teams. SCIENCE AND ENGINEERING ETHICS 2023; 29:6. [PMID: 36749523 PMCID: PMC9903283 DOI: 10.1007/s11948-022-00426-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 12/14/2022] [Indexed: 06/18/2023]
Abstract
What training should engineering students receive to enable them to contribute to reducing bias, discrimination and the persistent lack of diversity in engineering? Collaboration is central to professional engineering work and, consequently, teamwork and group projects are increasingly present in engineering curricula. However, the influence of unconscious bias on interactions within teams can negatively affect women and underrepresented groups and is now recognised as an important engineering ethics issue. This paper describes a workshop designed to enable engineering students to work equitably in diverse teams. Key features of the workshop include (1) the emotionally safe, empowering and warm environment created, (2) the creation of opportunities for students to discuss and apply the issues raised to their own engineering projects, and (3) the opportunities to practice the use of both proactive and reactive strategies to address bias and discrimination in teams. The evaluation of the workshop suggests that engineering students regarded both onsite and online formats as providing useful skills that they intended to apply in practice. Follow-up evaluations suggest that the workshop leads to behavioural change, especially the use of proactive teamwork strategies intended to reduce the impact of unconscious bias.
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Affiliation(s)
- Siara Isaac
- École Polytechnique Fédérale de Lausanne (EPFL), Centre for Learning Sciences/Teaching Support Centre, 1015 Lausanne, Switzerland
| | - Nihat Kotluk
- École Polytechnique Fédérale de Lausanne (EPFL), Centre for Learning Sciences/Teaching Support Centre, 1015 Lausanne, Switzerland
| | - Roland Tormey
- École Polytechnique Fédérale de Lausanne (EPFL), Centre for Learning Sciences/Teaching Support Centre, 1015 Lausanne, Switzerland
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Ignatowicz A, Slowther AM, Bassford C, Griffiths F, Johnson S, Rees K. Evaluating interventions to improve ethical decision making in clinical practice: a review of the literature and reflections on the challenges posed. JOURNAL OF MEDICAL ETHICS 2023; 49:136-142. [PMID: 35241628 DOI: 10.1136/medethics-2021-107966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
Since the 1980s, there has been an increasing acknowledgement of the importance of recognising the ethical dimension of clinical decision-making. Medical professional regulatory authorities in some countries now include ethical knowledge and practice in their required competencies for undergraduate and post graduate medical training. Educational interventions and clinical ethics support services have been developed to support and improve ethical decision making in clinical practice, but research evaluating the effectiveness of these interventions has been limited. We undertook a systematic review of the published literature on measures or models of evaluation used to assess the impact of interventions to improve ethical decision making in clinical care. We identified a range of measures to evaluate educational interventions, and one tool used to evaluate a clinical ethics support intervention. Most measures did not evaluate the key impact of interest, that is the quality of ethical decision making in real-world clinical practice. We describe the results of our review and reflect on the challenges of assessing ethical decision making in clinical practice that face both developers of educational and support interventions and the regulatory organisations that set and assess competency standards.
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Affiliation(s)
| | | | - Christopher Bassford
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- University of Warwick, Warwick Medical School, Coventry, UK
| | | | | | - Karen Rees
- University of Warwick, Warwick Medical School, Coventry, UK
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Hijazeen RA, Aladul MI, Aiedeh K, Aleidi SM, Al-Masri QS. Assessment of Moral Development Among Undergraduate Pharmacy Students and Alumni. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:ajpe8659. [PMID: 34716133 PMCID: PMC10159402 DOI: 10.5688/ajpe8659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/18/2021] [Indexed: 05/06/2023]
Abstract
Objective. This study's principal aim was to assess the moral development of undergraduate pharmacy students and alumni at a university in Jordan.Methods. Using the Professional Ethics in Pharmacy (PEP) test, the moral reasoning of 512 pharmacy students and alumni was assessed in a cross-sectional design. The main assessment measure was the Principled Morality Score, which reflects an individual's level of moral judgment development and is given as a percentage, where higher values indicate greater moral development.Results. The response rate was 49%. The median Principled Morality Score was 16.7, with no significant differences observed across all five cohorts. No significant differences in median Principled Morality Scores were found between men and women (16.7 vs 20, respectively). Also, no significant differences in median Principled Morality scores were observed between students who had completed the ethics course versus those who had not completed the ethics course at the time of data collection (median Principled Morality Score 20 vs 16.7, respectively). No trends in median Principled Morality Scores were observed.Conclusion. In this study, the professional moral reasoning of prospective pharmacists was lower than expected. A further longitudinal study of the cohort, which attempts to correlate moral development with age, sex, education level, and moral education strategy, is warranted.
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Affiliation(s)
- Rima A Hijazeen
- The University of Jordan, Faculty of Pharmacy, Amman, Jordan
| | - Mohammed I Aladul
- University of Mosul, School of Pharmacy, Mosul, Iraq
- Ninevah University, Pharmacy College, Mosul, Iraq
| | - Khaled Aiedeh
- The University of Jordan, Faculty of Pharmacy, Amman, Jordan
| | | | - Qais S Al-Masri
- The University of Jordan, Faculty of Pharmacy, Amman, Jordan
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Individual and School Correlates of DIT-2 Scores Using a Multilevel Modeling and Data Mining Analysis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Moral reasoning was investigated with respect to individual characteristics (i.e., education level, political orientation and sex) and school-related (i.e., university/college) factors using multilevel modeling and data mining analysis. We used the multilevel modeling to detect school effects on moral reasoning as well as individual effects for 16,334 students representing 79 different higher education institutions across the U.S. The school-related factors, such as the racial composition, student–faculty ratio, average SAT score, institution type, institutions’ geographical region, frequencies of morally relevant words in college course catalog, college mission and value statements were collected through website searches. Data mining analysis was utilized to extract and calculate the frequencies of morally relevant words from the website content. There were significant effects for the individual characteristic of political orientation. Additionally, all school-related factors were significant. Only main effects were observed for some school-related factors (i.e., average SAT score, institution type, frequency of morally relevant words in mission statements, value statements and course catalogs). For other school-related factors (i.e., the region, student–faculty ratio and racial composition), main effects were also observed; however, these effects were particularly illuminating given their interactions with political orientation. Implications for educational communities are discussed.
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Jiang S, Liu RD, Ding Y, Jiang R, Fu X, Hong W. Why the Victims of Bullying Are More Likely to Avoid Involvement When Witnessing Bullying Situations: The Role of Bullying Sensitivity and Moral Disengagement. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP3062-NP3083. [PMID: 32762442 DOI: 10.1177/0886260520948142] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recent studies have suggested a link between bullying victimization and passive bystander behaviors, such as more outsider behaviors and fewer defender behaviors. However, little is known about the internal mechanism underpinning this relation. The present study aimed to examine the direct and indirect relationships between bullying victimization and two types of bystander behaviors (defender behavior and outsider behavior), considering the possible mediator role of bullying sensitivity and moral disengagement among Chinese adolescents. Participants were 435 primary school students aged from 11 to 13 years (M = 12.27, SD = 0.69) who completed measurements of bullying victimization, bullying sensitivity, moral disengagement, and bystander behaviors. The results of the total effect model indicated that bullying victimization was positively related to outsider behavior and negatively related to defender behavior. The results from the structural equation modelling (SEM) analysis showed that bullying sensitivity mediated the relationship between bullying victimization and defender behavior. The relationship between bullying victimization and outsider behavior was mediated by moral disengagement, as well as the multiple mediation of bullying sensitivity and moral disengagement. These results highlight the roles of bullying sensitivity and moral disengagement in explaining the relation between bullying victimization and bystander behavior among adolescent students. The findings provide important implications for developing intervention programs aiming at school bullying prevention.
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Affiliation(s)
- Shuyang Jiang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing Normal University, Beijing, China
| | - Ru-De Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing Normal University, Beijing, China
| | - Yi Ding
- Fordham University, New York, NY, USA
| | - Ronghuan Jiang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing Normal University, Beijing, China
| | - Xinchen Fu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing Normal University, Beijing, China
| | - Wei Hong
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing Normal University, Beijing, China
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10
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Artificial intelligence ELSI score for science and technology: a comparison between Japan and the US. AI & SOCIETY 2022. [DOI: 10.1007/s00146-021-01323-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractArtificial intelligence (AI) has become indispensable in our lives. The development of a quantitative scale for AI ethics is necessary for a better understanding of public attitudes toward AI research ethics and to advance the discussion on using AI within society. For this study, we developed an AI ethics scale based on AI-specific scenarios. We investigated public attitudes toward AI ethics in Japan and the US using online questionnaires. We designed a test set using four dilemma scenarios and questionnaire items based on a theoretical framework for ethics, legal, and social issues (ELSI). We found that country and age are the most informative sociodemographic categories for predicting attitudes for AI ethics. Our proposed scale, which consists of 13 questions, can be reduced to only three, covering ethics, tradition, and policies. This new AI ethics scale will help to quantify how AI research is accepted in society and which area of ELSI people are most concerned with.
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Current and Future Perspectives of the Cerebellum in Affective Neuroscience. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1378:303-313. [DOI: 10.1007/978-3-030-99550-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Han H. Cerebellum and Emotion in Morality. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1378:179-194. [DOI: 10.1007/978-3-030-99550-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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13
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Kalet A, Ark TK, Monson V, Song HS, Buckvar-Keltz L, Harnik V, Yingling S, Rivera R, Tewksbury L, Lusk P, Crowe R. Does a measure of Medical Professional Identity Formation predict communication skills performance? PATIENT EDUCATION AND COUNSELING 2021; 104:3045-3052. [PMID: 33896685 DOI: 10.1016/j.pec.2021.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/05/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To validate an approach to measuring professional identity formation (PIF), we explore if the Professional Identity Essay (PIE), a stage score measure of medical professional identity (PI), predicts clinical communication skills. METHODS Students completed the PIE during medical school orientation and a 3-case Objective Structured Clinical Exam (OSCE) where standardized patients reliably assessed communication skills in 5 domains. Using mediation analyses, relationships between PIE stage scores and communication skills were explored. RESULTS For the 351 (89%) consenting students, controlling for individual characteristics, there were increases in patient counseling (6.5%, p<0.01), information gathering (4.3%, p = 0.01), organization and management (4.1%, p = 0.02), patient assessment (3.6%, p = 0.04), and relationship development (3.5%, p = 0.03) skills for every half stage increase in PIE score. The communication skills of lower socio-economic status (SES) students are indirectly impacted by their slightly higher PIE stage scores. CONCLUSION Higher PIE stage scores are associated with higher communication skills and lower SES. PRACTICE IMPLICATIONS PIE predicts critical clinical skills and identifies how SES and other characteristics indirectly impact future clinical performance, providing validity evidence for using PIE as a tool in longitudinal formative academic coaching, program and curriculum evaluation, and research.
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Affiliation(s)
- Adina Kalet
- Department of Medicine, NYU School of Medicine, New York, USA; Program on Medical Education and Technology, NYU School of Medicine, New York, USA; Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin.
| | - Tavinder K Ark
- School of Public Health, University of British Columbia, Vancouver, Canada; Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin
| | - Verna Monson
- Private Consultant; Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin
| | - Hyuksoon S Song
- Department of Education, Georgian Court University, Lakewood, USA
| | - Lynn Buckvar-Keltz
- Department of Medicine, NYU School of Medicine, New York, USA; Office of Student Affairs, NYU School of Medicine, New York, USA; Program on Medical Education and Technology, NYU School of Medicine, New York, USA
| | - Victoria Harnik
- Office of Medical Education, NYU School of Medicine, New York, USA
| | - Sandra Yingling
- Department of Medical Education, University of Illinois-Chicago, Chicago, USA
| | - Rafael Rivera
- Office of Admissions and Financial Aid, NYU School of Medicine, New York, USA
| | - Linda Tewksbury
- Office of Student Affairs, NYU School of Medicine, New York, USA
| | - Penelope Lusk
- Department of Medicine, NYU School of Medicine, New York, USA
| | - Ruth Crowe
- Office of Medical Education, NYU School of Medicine, New York, USA
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Macpherson I, Arregui M, Marchini L, Giner-Tarrida L. Analysis of moral reasoning in dentistry students through case-based learning (CBL). J Dent Educ 2021; 86:416-424. [PMID: 34796479 DOI: 10.1002/jdd.12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/11/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE The aim of this study was to develop a tool to analyze the ethical dimensions during dental students' decision making, by using case-based learning (CBL). METHODS Five clinical scenarios involving ethical aspects addressing different moral dilemmas were selected. The cases were then administered to students during a course on ethics, and the students responded using a narrative technique. To analyze the responses, a criterion inspired by Kohlberg's theory of moral development was used. Subsequently, the data were analyzed statistically, and possible associations between the answers and other variables, such as the student's gender and theoretical knowledge of ethics, were evaluated. RESULTS A total of 260 students participated (182 women and 78 men), and 1300 narratives were analyzed. The reliability of the construct, as tested by the Cronbach's alpha and the homogeneity index, was acceptable (0.7). The validity of the construct was also assessed, suggesting a component analysis. The descriptive analysis suggests a certain tendency to solve moral problems by referring to established norms and laws. Furthermore, the correlation anaylysis suggests the interrelation between dimensions linked to patient integrity and respect for the truth, even though this conclusion is not reflected in the component analysis, which only detects a generic component of moral sensitivity. No significant differences by gender were found in the narratives, nor a strong correlation of the responses with theoretical knowledge on ethics. CONCLUSION CBL through the narrative method on ethical dilemmas is an effective tool for assessing dental students' moral competencies and their possible interactions with other variables.
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Affiliation(s)
- Ignacio Macpherson
- Department of Humanities, Faculty of Humanities, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - María Arregui
- Department of Dentistry, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - Leonardo Marchini
- Department of Preventive and Community Dentistry, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa, USA
| | - Luís Giner-Tarrida
- Department of Dentistry, Faculty of Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
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Dawson KJ, Han H, Choi YR. How are moral foundations associated with empathic traits and moral identity? CURRENT PSYCHOLOGY 2021; 42:10836-10848. [PMID: 34658610 PMCID: PMC8505223 DOI: 10.1007/s12144-021-02372-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 12/03/2022]
Abstract
We examined the relationship between moral foundations, empathic traits, and moral identity using an online survey via Mechanical Turk. In order to determine how moral foundations contribute to empathic traits and moral identity, we performed classical correlation analysis as well as Bayesian correlation analysis, Bayesian ANCOVA, and Bayesian regression analysis. Results showed that individualizing foundations (harm/care, fairness/reciprocity) and binding foundations (ingroup/loyalty, authority/respect, purity/sanctity) had various different relationships with empathic traits. In addition, the individualizing versus binding foundations showed somewhat reverse relationships with internalization and symbolization of moral identity. This suggests that moral foundations can contribute to further understanding of empathic traits and moral identity and how they relate to moral behavior in reality. We discuss the implications of these results for moral educators when starting to teach students about moral issues. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-021-02372-5.
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Affiliation(s)
- Kelsie J. Dawson
- Educational Psychology Program, University of Alabama, Tuscaloosa, AL 35487 USA
| | - Hyemin Han
- Educational Psychology Program, University of Alabama, Tuscaloosa, AL 35487 USA
| | - YeEun Rachel Choi
- Educational Psychology Program, University of Alabama, Tuscaloosa, AL 35487 USA
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Kuilman L, Jansen GJ, Mulder LB, Middel B, Roodbol PF. Re-assessing the validity of the Moral Sensitivity Questionnaire (MSQ): Two new scales for moral deliberation and paternalism. J Eval Clin Pract 2020; 26:659-669. [PMID: 31975512 DOI: 10.1111/jep.13353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/25/2019] [Accepted: 12/28/2019] [Indexed: 12/22/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The current study and previous research have called the six-component model of Lützen's 30-item Moral Sensitivity Questionnaire (MSQ) into question. For this reason, we re-examined the construct validity of this instrument. METHODS In this cross-sectional study, which was based on a convenience sample of Dutch nurse practitioners (NPs) and physician assistants (PAs), we tested the validity of MSQ items using exploratory and confirmatory factor analyses (EFA and CFA, respectively). RESULTS The EFA revealed a two-component model, which was then tested as a target model with CFA and was found to have good model fit. Some items were correlated with two uncorrelated latent constructs, which we labelled as "paternalistic" and "deliberate" attitudes towards patients. CONCLUSIONS As in previous studies, the analyses in the current study, which was conducted among PAs and NPs, did not reveal six dimensions for the 30 items. Two new latent dimensions of moral sensitivity were psychometrically tested and confirmed. These two components relate to studies investigating ethical behaviour, and they can be used to describe the moral climate in healthcare organizations. The scales are indicators of the extent to which health professionals behave in a deliberate (sensitive) or paternalistic (insensitive) manner towards the opinions of patients within the context of medical decision-making.
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Affiliation(s)
- Luppo Kuilman
- Nursing Research Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Physician Assistant Studies, College of Health and Human Service, Northern Arizona University, Arizona, USA
| | - Gerard J Jansen
- Nursing Research Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Laetitia B Mulder
- Department of Human Resource Management & Organizational Behaviour, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Berrie Middel
- Department of Health Sciences, Community & Occupational Medicine Division, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Petrie F Roodbol
- Nursing Research Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Friedland J, Emich K, Cole BM. Uncovering the moral heuristics of altruism: A philosophical scale. PLoS One 2020; 15:e0229124. [PMID: 32203528 PMCID: PMC7089536 DOI: 10.1371/journal.pone.0229124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 01/30/2020] [Indexed: 11/19/2022] Open
Abstract
Extant research suggests that individuals employ traditional moral heuristics to support their observed altruistic behavior; yet findings have largely been limited to inductive extrapolation and rely on relatively few traditional frames in so doing, namely, deontology in organizational behavior and virtue theory in law and economics. Given that these and competing moral frames such as utilitarianism can manifest as identical behavior, we develop a moral framing instrument-the Philosophical Moral-Framing Measure (PMFM)-to expand and distinguish traditional frames associated and disassociated with observed altruistic behavior. The validation of our instrument based on 1015 subjects in 3 separate real stakes scenarios indicates that heuristic forms of deontology, virtue-theory, and utilitarianism are strongly related to such behavior, and that egoism is an inhibitor. It also suggests that deontic and virtue-theoretical frames may be commonly perceived as intertwined and opens the door for new research on self-abnegation, namely, a perceived moral obligation toward suffering and self-denial. These findings hold the potential to inform ongoing conversations regarding organizational citizenship and moral crowding out, namely, how financial incentives can undermine altruistic behavior.
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Affiliation(s)
- Julian Friedland
- College of Business, Metropolitan State University of Denver, Denver, Colorado, United States of America
| | - Kyle Emich
- Lerner College of Business & Economics, The University of Delaware, Newark, Delaware, United States of America
| | - Benjamin M. Cole
- Gabelli School of Business, Fordham University, New York, New York, United States of America
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Gholamzadeh S, Shayestehfard M, Torabizadeh C, Ebadi A. Ethical Sensitivity in Nursing Students: Developing a Context–based Education. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Phillips CJC, Çöl R, I Zmirli S, Verrinder JM. Comparison of the Moral Sensitivity, Judgment, and Actions of Australian and Turkish Veterinary Students in Relation to Animal Ethics Issues. JOURNAL OF VETERINARY MEDICAL EDUCATION 2020; 47:8-17. [PMID: 31009292 DOI: 10.3138/jvme.1117-178r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Veterinarians regularly face animal ethics conflicts, and research has identified the moral reasoning methods that they utilize to solve these. It is unclear whether students' sensitivity to animal ethics conflicts influences their reasoning methods, and the recent development of appropriate tests allows this to be assessed. We compared the moral reasoning methods, intended action and sensitivity of 112 first-year veterinary students in two contrasting veterinary schools, in Australia and Turkey. Students were presented with two animal ethics issues: breeding blind hens to address welfare concerns in intensive housing, for moral reasoning evaluation; and a video of a lame dairy cow walking, for sensitivity assessment. The sensitivity score was not related to the principal moral reasoning methods, which are Personal Interest (PI), Maintaining Norms (MN), and Universal Principles (UP). However, less sensitive students were more concerned about professional criticism of emotional reactions when addressing the hen scenario. Turkish students, mostly males, used more MN reasoning when deciding the hen dilemma. Australian, mostly female, students did not. Overall, female students were more likely to consider the universal moral principles in moral reasoning than male students and were more likely to recommend against breeding blind hens. This suggests that females are more likely to consider the ethical implications of their actions than males. This study demonstrates relationships between ethical sensitivity (ES) and moral reasoning, and cultural and gender effects on moral action choices. Students placing greater importance on professional criticism about having an emotional reaction are more likely to be those who have less ES.
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Affiliation(s)
- Clive J C Phillips
- Animal Welfare and Ethics, School of Veterinary Science, University of Queensland
| | - Ramazan Çöl
- Department of Physiology, Faculty of Veterinary Medicine, Selçuk University
| | - Serdar I Zmirli
- Department of History of Veterinary Medicine and Deontology, Veterinary Faculty, Selçuk University
| | - Joy M Verrinder
- Centre for Animal Welfare and Ethics, School of Veterinary Science, University of Queensland
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20
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Jenkin AC, Ellis-Caird H, Winter DA. Moral judgments and ethical constructs in clinical psychology doctoral students. ETHICS & BEHAVIOR 2019. [DOI: 10.1080/10508422.2019.1684294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Helen Ellis-Caird
- Department of Psychology and Sport Sciences, University of Hertfordshire, UK
| | - David A. Winter
- Department of Psychology and Sport Sciences, University of Hertfordshire, UK
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Kruijtbosch M, Göttgens-Jansen W, Floor-Schreudering A, van Leeuwen E, Bouvy ML. Moral reasoning among Dutch community pharmacists: testing the applicability of the Australian Professional Ethics in Pharmacy test. Int J Clin Pharm 2019; 41:1323-1331. [PMID: 31254151 PMCID: PMC6800840 DOI: 10.1007/s11096-019-00869-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
Background Moral reasoning competency is essential in healthcare practice, especially in situations of moral dilemmas when a professional has to choose a morally justifiable action among several suboptimal action options. The Australian Professional Ethics in Pharmacy test (PEP test) measures moral reasoning among pharmacists. In Australia three levels of moral reasoning (schemas) were measured (1) business orientation (2) rules and regulations, and (3) patient rights (i.e. most advanced schema). Objective To test the applicability of the PEP test to pharmacists working in the Netherlands. Setting Dutch community pharmacy. Methods The PEP test consists of 36 statements (items) accompanying 3 moral dilemma scenarios. It was translated into Dutch and completed by 390 pharmacists. Principle component analysis (PCA) was used to investigate construct validity and Cronbach's Alpha was used to indicate internal consistency of the Dutch version of the PEP test. The eligible grouped statements and perceived possible moral reasoning schemas were compared to the Australian findings. Main outcome measure Moral reasoning schemas. Results The PCA analysis resulted in 3 components (i.e. possible moral reasoning schemas) that together accounted 27% variance in the data. The statements that represented the moral reasoning schemas 'business orientation' and 'rules and regulations' were somewhat similar when comparing these with the statements that represented these schemas in the PEP test study. The most advanced moral reasoning schema identified in Dutch pharmacists contained different statements compared to the statements that represented that schema among Australian pharmacists. This schema was labelled 'professional ethics'. Conclusion The PEP test needs further adaptation to the Dutch pharmacy practice context: especially the statements that should reflect the most advanced moral reasoning schema, need more accurate representations of professional pharmacy ethics that guide pharmacists in the Netherlands. Moral reasoning tests for a specific professional setting or country should be developed and adapted by experts who share the same professional values and practice as the respondents.
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Affiliation(s)
- M Kruijtbosch
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331 JE, Leiden, The Netherlands. .,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands.
| | - W Göttgens-Jansen
- Department of Primary and Community Care, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 120, ELG, 6500 HB, Nijmegen, The Netherlands
| | - A Floor-Schreudering
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331 JE, Leiden, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands
| | - E van Leeuwen
- Department of Primary and Community Care, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. Box 9101, 120, ELG, 6500 HB, Nijmegen, The Netherlands
| | - M L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands
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Behar-Horenstein LS, Tolentino LA. Exploring Dental Student Performance in Moral Reasoning Using the Defining Issues Test 2. J Dent Educ 2019; 83:72-78. [DOI: 10.21815/jde.019.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/09/2018] [Indexed: 11/20/2022]
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Han H. The VIA inventory of strengths, positive youth development, and moral education. THE JOURNAL OF POSITIVE PSYCHOLOGY 2018. [DOI: 10.1080/17439760.2018.1528378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hyemin Han
- Educational Psychology Program, University of Alabama, Tuscaloosa, United States
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Sholikhah EN, Susani YP, Prabandari YS, Rahayu GR. Is there a relationship between personal reflection ability and moral reasoning ability in Indonesian medical students? INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:213-218. [PMID: 30121638 PMCID: PMC6129163 DOI: 10.5116/ijme.5b64.971a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To determine the relationship of personal reflection ability and moral reasoning ability of medical students of the Faculty of Medicine Universitas Gadjah Mada (UGM). METHODS A cross-sectional study was conducted by distributing questionnaires to 293 medical students in Year-3 at the Faculty of Medicine, Public Health, and Nursing after obtaining their agreement to participate in this research by signing an informed consent form. Personal reflection ability was measured by the Groningen Reflective Ability Scale (GRAS) questionnaire; moral reasoning ability was measured by the Defining Issues Test (DIT) questionnaire. Descriptive statistics, T-test, and regression analysis were used to analyze the anonymized results. RESULTS The mean GRAS score of all students was 89.59 (SD = 6.80) (GRAS score ranged 0-110) which showed a high level. The mean score of Principled Morality Score (P) DIT of all students was 32.39 (SD=11.04), ranging between 28-41 which indicated a moderate level. In general, personal reflection ability scores of all students were positively correlated with their moral reasoning ability score. However, this correlation was not significant statistically (r=0.080, p=0.239). CONCLUSIONS Personal reflection ability of medical students was correlated positively with their moral reasoning ability, however, statistically it was not significant . The high level of personal reflection ability needs to be maintained. The moderate moral reasoning ability needs some efforts to improve it. Further studies are necessary to assess other factors which influence the moral reasoning ability so that appropriate interventions can be developed.
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Affiliation(s)
- Eti N. Sholikhah
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yoga P. Susani
- Faculty of Medicine University of Mataram, Lombok, Indonesia
| | - Yayi S. Prabandari
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Gandes R. Rahayu
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Han H, Choi YJ, Dawson KJ, Jeong C. Moral growth mindset is associated with change in voluntary service engagement. PLoS One 2018; 13:e0202327. [PMID: 30110383 PMCID: PMC6093698 DOI: 10.1371/journal.pone.0202327] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/01/2018] [Indexed: 11/25/2022] Open
Abstract
Incremental implicit theories are associated with a belief regarding it is possible to improve one's intelligence or ability through efforts. Previous studies have demonstrated that incremental implicit theories contributed to better academic achievement and positive youth development. Our study aimed to examine whether incremental implicit theories of morality significantly influenced change in students' engagement in voluntary service activities. In our study, 54 Korean college students for Study 1 and 180 Korean 8th graders for Study 2 were recruited to conduct two two-wave studies. We surveyed participants' implicit theories of morality and participation in voluntary service activities. The effect of implicit theories of morality on change in service engagement was analyzed through regression analysis. In Study 1, the moral growth mindset significantly moderated longitudinal change in service engagement. In Study 2, the moral growth mindset significantly influenced engagement in art-related activities, while it significantly moderated change in engagement in youth-related activities.
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Affiliation(s)
- Hyemin Han
- Educational Psychology Program, University of Alabama, Tuscaloosa, AL, United States of America
| | - Youn-Jeng Choi
- Educational Research Program, University of Alabama, Tuscaloosa, AL, United States of America
| | - Kelsie J. Dawson
- Educational Psychology Program, University of Alabama, Tuscaloosa, AL, United States of America
| | - Changwoo Jeong
- Changwoo Jeong, Department of Ethics Education, Seoul National University, Seoul, South Korea
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Kalet A, Buckvar-Keltz L, Monson V, Harnik V, Hubbard S, Crowe R, Ark TK, Song HS, Tewksbury L, Yingling S. Professional Identity Formation in medical school: One measure reflects changes during pre-clerkship training. MEDEDPUBLISH 2018; 7:41. [PMID: 38089226 PMCID: PMC10712001 DOI: 10.15694/mep.2018.0000041.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Professional Identity Formation (PIF), the process of internalizing a profession's core values and beliefs, is an explicit goal of medical education. The Professional Identity Essay (PIE), a developmental measure of the extent to which individuals have a complex and self-defined understanding of their professional role, is a tool to both study and scaffold PIF. PIE staging has internal reliability and response process validity and correlates with a validated measure of moral reasoning. In this study, we investigate whether PIF, as measured by PIE, changes during pre-clerkship training. Medical students in the class of 2019 completed the PIE during orientation to medical school (PIE#1) and 15 months later, during orientation to clerkships (PIE#2), to the same prompts. These written responses are PIF-staged by an expert rater. On average, PIF scores reveal that 46% of the group remained at the same stage as they were on entry to medical school, 42% scored at a higher stage of PIF, and 15% of students scored at a lower stage of PIF after pre-clerkship training. This result suggests that medical students are heterogeneous with respect to the development of their medical PIF early in medical school training.
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Verrinder JM, Phillips CJC. The Relationship between Intuitive Action Choices and Moral Reasoning on Animal Ethics Issues in Students of Veterinary Medicine and Other Relevant Professions. JOURNAL OF VETERINARY MEDICAL EDUCATION 2018; 45:269-292. [PMID: 29767568 DOI: 10.3138/jvme.0117-016r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
With growing understanding of animals' capabilities, and public and organizational pressures to improve animal welfare, moral action by veterinarians and other relevant professionals to address animal issues is increasingly important. Little is known about how their action choices relate to their moral reasoning on animal ethics issues. A moral judgment measure, the VetDIT, with three animal and three non-animal scenarios, was used to investigate the action choices of 619 students in five animal- and two non-animal-related professional programs in one Australian university, and how these related to their moral reasoning based on Personal Interest (PI), Maintaining Norms (MN), or Universal Principles (UP) schemas. Action choices showed significant relationships to PI, MN, and UP questions, and these varied across program groups. Having a previous degree or more experience with farm animals had a negative relationship, and experience with horses or companion animals a positive relationship, with intuitive action choices favoring life and bodily integrity of animals. This study helps to explain the complex relationship between intuitive moral action choices and moral reasoning on animal ethics issues. As a useful research and educational tool for understanding this relationship, the VetDIT can enhance ethical decision making.
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Affiliation(s)
- Joy M Verrinder
- Centre for Animal Welfare and Ethics, School of Veterinary Science, University of Queensland, Gatton, Queensland 4343, Australia.
| | - Clive J C Phillips
- Centre for Animal Welfare and Ethics, School of Veterinary Science, University of Queensland, Gatton, Queensland 4343, Australia
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Naudé A, Bornman J. Measuring Instrument for Ethical Sensitivity in the Therapeutic Sciences. THE JOURNAL OF CLINICAL ETHICS 2017. [DOI: 10.1086/jce2017284290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kalet A, Buckvar-Keltz L, Harnik V, Monson V, Hubbard S, Crowe R, Song HS, Yingling S. Measuring professional identity formation early in medical school. MEDICAL TEACHER 2017; 39:255-261. [PMID: 28033728 DOI: 10.1080/0142159x.2017.1270437] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
AIM To assess the feasibility and utility of measuring baseline professional identity formation (PIF) in a theory-based professionalism curriculum for early medical students. METHODS All 132 entering students completed the professional identity essay (PIE) and the defining issues test (DIT2). Students received score reports with individualized narrative feedback and wrote a structured reflection after a large-group session in which the PIF construct was reviewed. Analysis of PIEs resulted in assignment of a full or transitional PIF stage (1-5). The DIT2 score reflects the proportion of the time students used universal ethical principles to justify a response to 6 moral dilemma cases. Students' reflections were content analyzed. RESULTS PIF scores were distributed across stage 2/3, stage 3, stage 3/4, and stage 4. No student scores were in stages 1, 2, 4/5, or 5. The mean DIT2 score was 53% (range 9.7?76.5%); the correlation between PIF stage and DIT score was ρ = 0.18 (p = 0.03). Students who took an analytic approach to the data and demonstrated both awareness that they are novices and anticipation of continued PIF tended to respond more positively to the feedback. CONCLUSIONS These PIF scores distributed similarly to novice students in other professions. Developmental-theory based PIF and moral reasoning measures are related. Students reflected on these measures in meaningful ways suggesting utility of measuring PIF scores in medical education.
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Affiliation(s)
- Adina Kalet
- a Division of General Internal Medicine and Clinical Innovation , New York University School of Medicine , New York , NY , USA
| | - Lynn Buckvar-Keltz
- a Division of General Internal Medicine and Clinical Innovation , New York University School of Medicine , New York , NY , USA
| | - Victoria Harnik
- b New York University School of Medicine , New York , NY , USA
| | - Verna Monson
- c Monson Consulting and Evaluation , Minneapolis , MN , USA
| | - Steven Hubbard
- b New York University School of Medicine , New York , NY , USA
| | - Ruth Crowe
- a Division of General Internal Medicine and Clinical Innovation , New York University School of Medicine , New York , NY , USA
| | - Hyuksoon S Song
- d Department of Education , Georgian Court University , Lakewood , NJ , USA
| | - Sandra Yingling
- b New York University School of Medicine , New York , NY , USA
- e Department of Medical Education , University of Illinois College of Medicine , Chicago , IL , USA
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Abstract
Background: Clinical group supervision has existed for over 20 years in nursing. However, there is a lack of studies about the role of supervision in nursing students’ education and especially the focus on ethical reasoning. Aim: The aim of this study was to explore and describe nursing students’ ethical reasoning and their supervisors’ experiences related to participation in clinical group supervision. Research design: The study is a qualitative interview study with interpretative description as an analysis approach. Participants and research context: A total of 17 interviews were conducted with nursing students (n = 12) who had participated in clinical group supervision in their first year of nursing education, and with their supervisors (n = 5). Ethical considerations: The study was based on the ethical principles outlined in the Declaration of Helsinki, and permission was obtained from the Regional Ethical Review Board in Sweden. Findings: The analysis revealed that both the form and content of clinical group supervision stimulated reflection and discussion of handling of situations with ethical aspects. Unethical situations were identified, and the process uncovered underlying caring actions. Discussion and conclusion: Clinical group supervision is a model that can be used in nursing education to train ethical reflection and to develop an ethical competence among nursing students. Outcomes from the model could also improve nursing education itself, as well as healthcare organizations, in terms of reducing moral blindness and unethical nursing practice.
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Affiliation(s)
| | - Birgitta Bisholt
- Karlstad University, Sweden; The Swedish Red Cross University College, Sweden
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Blažun Vošner H, Železnik D, Kokol P, Vošner J, Završnik J. Trends in nursing ethics research: Mapping the literature production. Nurs Ethics 2016; 24:892-907. [PMID: 27364534 DOI: 10.1177/0969733016654314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There have been a number of debates in the field of nursing ethics. Researchers have focused on various aspects of nursing ethics, such as professional ethics, professional, nursing and ethical values. Within this research, a variety of literature reviews have been conducted, but to the best of our knowledge, bibliometric mapping has not yet been used. OBJECTIVE This article aims to analyse the production of literature within nursing ethics research. RESEARCH DESIGN In order to examine publishing patterns, we focused on publishing dynamics, prolific research entities and the most-cited articles. We additionally visualised the content of the literature using a novel mixed-method approach, combining bibliometric analysis and mapping with thematic analysis. Ethical considerations: In our study, ethical review was not required. FINDINGS A total of 1416 information sources were found in the Scopus database. Overall, literature production has increased; however, in recent years, the quantity of published material has begun to decrease. The most prolific countries are the United States, the United Kingdom and Canada, and the most prolific source titles are Nursing Ethics, Journal of Advanced Nursing and Nursing Times. Lately, research in the field of nursing ethics has been focused more on life care (providing for the basic needs of older residents), moral distress and community nursing. DISCUSSION The dynamics of research literature production showed an exponential rise in the number of published information sources - a rise which started in the period between 1974 and 1998. Since that period, the trend has stabilised, which might indicate that nursing ethics research is starting a transition to a mature phase. CONCLUSION The innovative use of bibliometric analysis and mapping, together with thematic analysis, is a useful tool for analysis of research production in the field of nursing ethics. The results presented can be an excellent starting point for literature reviews and more exhaustive data, information and knowledge seeking.
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Affiliation(s)
| | - Danica Železnik
- University College of Health Sciences Slovenj Gradec, Slovenia
| | | | - Janez Vošner
- Faculy of Electrical Enginering and Computer Science, University of Maribor, Slovenia
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Abstract
Virtue-approaches to medical ethics are becoming ever more influential. Virtue theorists advocate redefining right or good action in medicine in terms of the character of the doctor performing the action (rather than adherence to rules or principles). In medical education, too, calls are growing to reconceive medical education as a form of character formation (rather than instruction in rules or principles). Empirical studies of doctors' ethics from a virtue-perspective, however, are few and far between. In this respect, theoretical and empirical study of medical ethics are out of alignment. In this paper, we survey the empirical study of medical ethics and find that most studies of doctors' ethics are rules- or principles-based and not virtue-based. We outline the challenges that exist for studying medical ethics empirically from a virtue-based perspective and canvas the runners and riders in the effort to find virtue-based assessments of medical ethics.
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Affiliation(s)
- Ben Kotzee
- School of Education, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Verrinder JM, Ostini R, Phillips CJC. Differences in Moral Judgment on Animal and Human Ethics Issues between University Students in Animal-Related, Human Medical and Arts Programs. PLoS One 2016; 11:e0149308. [PMID: 26934582 PMCID: PMC4774973 DOI: 10.1371/journal.pone.0149308] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/29/2016] [Indexed: 11/29/2022] Open
Abstract
Moral judgment in relation to animal ethics issues has rarely been investigated. Among the research that has been conducted, studies of veterinary students have shown greater use of reasoning based on universal principles for animal than human ethics issues. This study aimed to identify if this was unique to students of veterinary and other animal-related professions. The moral reasoning of first year students of veterinary medicine, veterinary technology, and production animal science was compared with that of students in non-animal related disciplines of human medicine and arts. All students (n = 531) completed a moral reasoning test, the VetDIT, with animal and human scenarios. When compared with reasoning on human ethics issues, the combined group of students evaluating animal ethics issues showed higher levels of Universal Principles reasoning, lower levels of Personal Interest reasoning and similar levels of Maintaining Norms reasoning. Arts students showed more personal interest reasoning than students in most animal-related programs on both animal and human ethics issues, and less norms-based reasoning on animal ethics issues. Medical students showed more norms-based reasoning on animal ethics issues than all of the animal-related groups. There were no differences in principled reasoning on animal ethics issues between program groups. This has implications for animal-related professions and education programs showing that students’ preference for principled reasoning on animal ethics issues is not unique to animal-related disciplines, and highlighting the need to develop student (and professional) capacity to apply principled reasoning to address ethics issues in animal industries to reduce the risk of moral distress.
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Affiliation(s)
- Joy M. Verrinder
- Centre for Animal Welfare and Ethics, School of Veterinary Science, University of Queensland, Gatton, Queensland 4343, Australia
- * E-mail:
| | - Remo Ostini
- Rural Clinical School Research Centre, School of Medicine, University of Queensland, Toowoomba, Australia
| | - Clive J. C. Phillips
- Centre for Animal Welfare and Ethics, School of Veterinary Science, University of Queensland, Gatton, Queensland 4343, Australia
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Beever J, Brightman AO. Reflexive Principlism as an Effective Approach for Developing Ethical Reasoning in Engineering. SCIENCE AND ENGINEERING ETHICS 2016; 22:275-291. [PMID: 25697306 DOI: 10.1007/s11948-015-9633-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/12/2015] [Indexed: 06/04/2023]
Abstract
An important goal of teaching ethics to engineering students is to enhance their ability to make well-reasoned ethical decisions in their engineering practice: a goal in line with the stated ethical codes of professional engineering organizations. While engineering educators have explored a wide range of methodologies for teaching ethics, a satisfying model for developing ethical reasoning skills has not been adopted broadly. In this paper we argue that a principlist-based approach to ethical reasoning is uniquely suited to engineering ethics education. Reflexive Principlism is an approach to ethical decision-making that focuses on internalizing a reflective and iterative process of specification, balancing, and justification of four core ethical principles in the context of specific cases. In engineering, that approach provides structure to ethical reasoning while allowing the flexibility for adaptation to varying contexts through specification. Reflexive Principlism integrates well with the prevalent and familiar methodologies of reasoning within the engineering disciplines as well as with the goals of engineering ethics education.
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Affiliation(s)
- Jonathan Beever
- The Rock Ethics Institute, Penn State University, 131 Sparks Building, University Park, PA, 16802, USA.
| | - Andrew O Brightman
- Weldon School of Biomedical Engineering, Purdue University, Martin Jischke Drive, West Lafayette, IN, 47907, USA.
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Hudon A, Perreault K, Laliberté M, Desrochers P, Williams-Jones B, Ehrmann Feldman D, Hunt M, Durocher E, Mazer B. Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators. Disabil Rehabil 2016; 38:2244-54. [PMID: 26750086 DOI: 10.3109/09638288.2015.1123308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: (1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programmes and (2) explore useful and innovative teaching and evaluation methods. METHOD Data for this qualitative descriptive study were collected during a 1-d knowledge exchange workshop focused on ethics teaching in rehabilitation. RESULTS Twenty-three educators from 11 OT and 11 PT Canadian programmes participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important. CONCLUSION The CREW Day provided ethics educators the opportunity to share knowledge and begin creating a community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge. Implications for Rehabilitation According to the study participants, rehabilitation ethics education should include learning about foundational knowledge related to ethical theory; be grounded in examples and cases drawn from clinical rehabilitation practice; and contribute to building professional competencies such as self-knowledge and critical thinking in students. Regardless of the methods used by occupational therapy (OT) and physical therapy (PT) educators for teaching and evaluation, the value of creating spaces that support open discussion for students (e.g. protected discussion time in class, peer-discussions with the help of a facilitator, use of a web discussion forum) was consistently identified as an important facet. Educators from OT and PT programmes should work with various professionals involved in OT and PT student training across the curricula (e.g. clinical preceptors, other educators) to extend discussions of how ethics can be better integrated into the curriculum outside of sessions specifically focused on ethics. The CREW Day workshop was the first opportunity for Canadian rehabilitation ethics educators to meet and discuss their approaches to teaching and evaluating ethics for OT and PT students. Including international rehabilitation ethics educators in this dialogue could positively expand on this initial dialogue by facilitating the sharing of tacit and experiential knowledge amongst a larger and more diverse group of ethics educators.
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Affiliation(s)
- Anne Hudon
- a Rehabilitation Sciences, School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Québec , Canada ;,b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada
| | - Kadija Perreault
- c Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Québec , Canada
| | - Maude Laliberté
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,d Department of Social and Preventive Medicine, École De Santé Publique , University of Montreal , Montreal , Québec , Canada
| | - Pascal Desrochers
- e Department of Physical Therapy, School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Québec , Canada
| | - Bryn Williams-Jones
- d Department of Social and Preventive Medicine, École De Santé Publique , University of Montreal , Montreal , Québec , Canada
| | - Debbie Ehrmann Feldman
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,e Department of Physical Therapy, School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Québec , Canada
| | - Matthew Hunt
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,f School of Physical and Occupational Therapy , McGill University , Montreal , Québec , Canada
| | - Evelyne Durocher
- f School of Physical and Occupational Therapy , McGill University , Montreal , Québec , Canada
| | - Barbara Mazer
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,f School of Physical and Occupational Therapy , McGill University , Montreal , Québec , Canada
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Han H, Chen J, Jeong C, Glover GH. Influence of the cortical midline structures on moral emotion and motivation in moral decision-making. Behav Brain Res 2016; 302:237-51. [PMID: 26772629 DOI: 10.1016/j.bbr.2016.01.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/30/2015] [Accepted: 01/03/2016] [Indexed: 11/29/2022]
Abstract
The present study aims to examine the relationship between the cortical midline structures (CMS), which have been regarded to be associated with selfhood, and moral decision making processes at the neural level. Traditional moral psychological studies have suggested the role of moral self as the moderator of moral cognition, so activity of moral self would present at the neural level. The present study examined the interaction between the CMS and other moral-related regions by conducting psycho-physiological interaction analysis of functional images acquired while 16 subjects were solving moral dilemmas. Furthermore, we performed Granger causality analysis to demonstrate the direction of influences between activities in the regions in moral decision-making. We first demonstrate there are significant positive interactions between two central CMS seed regions-i.e., the medial prefrontal cortex (MPFC) and posterior cingulate cortex (PCC)-and brain regions associated with moral functioning including the cerebellum, brainstem, midbrain, dorsolateral prefrontal cortex, orbitofrontal cortex and anterior insula (AI); on the other hand, the posterior insula (PI) showed significant negative interaction with the seed regions. Second, several significant Granger causality was found from CMS to insula regions particularly under the moral-personal condition. Furthermore, significant dominant influence from the AI to PI was reported. Moral psychological implications of these findings are discussed. The present study demonstrated the significant interaction and influence between the CMS and morality-related regions while subject were solving moral dilemmas. Given that, activity in the CMS is significantly involved in human moral functioning.
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Affiliation(s)
- Hyemin Han
- Stanford Graduate School of Education, Stanford University, CA, USA.
| | - Jingyuan Chen
- Department of Electrical Engineering, School of Engineering, Stanford University, CA, USA
| | - Changwoo Jeong
- Department of Ethics Education, College of Education, Seoul National University, Seoul, Republic of Korea
| | - Gary H Glover
- Department of Radiology, School of Medicine, Stanford University, CA, USA
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Batchelor CEM, Creed A, McKeegan DEF. A preliminary investigation into the moral reasoning abilities of UK veterinarians. Vet Rec 2015; 177:124. [PMID: 26109285 DOI: 10.1136/vr.102775] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 11/04/2022]
Abstract
Veterinary medicine is an ethically challenging profession, but the ethical reasoning abilities of practising veterinarians in the UK have never been formally assessed. This study investigated moral reasoning ability in 65 qualified veterinarians (38 practising and 27 academic) and 33 members of the public in the UK using the Defining Issues Test. Academic veterinarians had higher scores than members of the public but practising veterinarians did not. There was large variation in moral reasoning abilities among qualified veterinarians. Moral reasoning score in veterinarians did not improve with years of experience. These results show that despite having a professional degree moral reasoning skills of practising veterinarians may be insufficient to deal with the demands of their profession. This could have implications for animal welfare, client services and veterinarian wellbeing. The results highlight the need for more training in this area.
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Affiliation(s)
- C E M Batchelor
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Jarrett Building, Bearsden Road, Glasgow G61 1QH, UK
| | - A Creed
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Jarrett Building, Bearsden Road, Glasgow G61 1QH, UK
| | - D E F McKeegan
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Jarrett Building, Bearsden Road, Glasgow G61 1QH, UK
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The First Shared Online Curriculum Resources for Veterinary Undergraduate Learning and Teaching in Animal Welfare and Ethics in Australia and New Zealand. Animals (Basel) 2015; 5:395-406. [PMID: 26479241 PMCID: PMC4494409 DOI: 10.3390/ani5020362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 11/17/2022] Open
Abstract
Simple Summary There is a need for teaching Animal Welfare and Ethics in veterinary schools and we are developing online resources to meet this need. In this paper we describe how we prioritized the development of these resources by polling experts in the field. Abstract The need for undergraduate teaching of Animal Welfare and Ethics (AWE) in Australian and New Zealand veterinary courses reflects increasing community concerns and expectations about AWE; global pressures regarding food security and sustainability; the demands of veterinary accreditation; and fears that, unless students encounter AWE as part of their formal education, as veterinarians they will be relatively unaware of the discipline of animal welfare science. To address this need we are developing online resources to ensure Australian and New Zealand veterinary graduates have the knowledge, and the research, communication and critical reasoning skills, to fulfill the AWE role demanded of them by contemporary society. To prioritize development of these resources we assembled leaders in the field of AWE education from the eight veterinary schools in Australia and New Zealand and used modified deliberative polling. This paper describes the role of the poll in developing the first shared online curriculum resource for veterinary undergraduate learning and teaching in AWE in Australia and New Zealand. The learning and teaching strategies that ranked highest in the exercise were: scenario-based learning; a quality of animal life assessment tool; the so-called ‘Human Continuum’ discussion platform; and a negotiated curriculum.
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Astbury JL, Gallagher CT, O'Neill RC. The issue of moral distress in community pharmacy practice: background and research agenda. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2015; 23:361-6. [PMID: 25639156 DOI: 10.1111/ijpp.12174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/12/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Moral distress arises from situations in which the individual identifies the morally right action required, but feels unable to act accordingly due to organisational constraints within the work place. Research into this phenomenon has focused predominately on the experience of those in the nursing profession, due to its perceived moral grounding and its traditionally subordinate role. As the conceptual boundaries of moral distress have developed, so too has the research interest in the experiences of other professional groups. Here, we seek to determine if there is scope to study moral distress in pharmacists. METHODS A review of the literature on moral distress in healthcare professions was undertaken. KEY FINDINGS Pharmacists working in the UK operate within a highly-regulated occupational sphere, and are bound by strict legal frameworks and codes of professional conduct. This regulatory environment, when combined with the emerging recognition that pharmacy is a value-based profession with a strong ethical grounding, creates the potential for moral distress to occur due to the limitations placed on acting in congruence with ethical judgements. Studies concerning moral distress in nurses have identified significant negative consequences for both the practitioner and for the quality of patient care. CONCLUSIONS To date, the incidence of moral distress among UK-based community pharmacists remains unexamined. Research must be undertaken to determine what situations cause the highest instances of moral distress for community pharmacists, and the extent to which these pharmacists experience moral distress in their working lives.
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Affiliation(s)
- Jayne L Astbury
- Department of Pharmacy, University of Hertfordshire, Hatfield, UK
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Bensimon CM. The Dalhousie Dentistry Story: A Case for Proportionality, Professionalism, and the Promotion of Moral Character. BIOÉTHIQUEONLINE 2015. [DOI: 10.7202/1035488ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bebeau MJ. An evidence-based guide for ethics instruction. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2014; 15:124-129. [PMID: 25574261 PMCID: PMC4278460 DOI: 10.1128/jmbe.v15i2.872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Drawing from multiple sources of evidence, this paper updates previous descriptions (IOM, 2002) of measurement strategies and teaching techniques to promote four theoretically derived abilities thought to be necessary conditions for the responsible conduct of research. Data from three samples (exemplary professionals, professionals disciplined by a licensing board, and graduates who completed an ethics program designed to promote the four interrelated abilities) suggest that development of a moral identity that is consistent with the norms and values of a profession is the driving force that gives rise to ethical sensitivity, ethical reasoning, and ethical implementation. Evidence from the cited studies supports the usefulness of the theoretical model to (a) deconstruct summary judgments about character and see them as abilities that can be assessed and developed; (b) guide the design assessments that are sensitive to the effects of interventions; and (c) augment previous IOM recommendations for the development of meaningful learning activities.
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Affiliation(s)
- Muriel J. Bebeau
- Corresponding author. Mailing address: Department of Primary Dental Care, School of Dentistry, University of Minnesota, 515 Delaware SE, Minneapolis, MN 55455. Phone: 612-625-4633. Fax: 612-626-6096. E-mail:
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Benbassat J. Changes in wellbeing and professional values among medical undergraduate students: a narrative review of the literature. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2014; 19:597-610. [PMID: 24615278 DOI: 10.1007/s10459-014-9500-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 02/24/2014] [Indexed: 05/28/2023]
Abstract
BACKGROUND Educators are concerned by the high prevalence of emotional distress among medical students, and by the alleged decline in their humanitarian values. OBJECTIVE To re-examine these concerns by reviewing studies of medical students' wellbeing and development. METHOD Narrative review of the literature. MAIN FINDINGS (a) Medical students' emotional distress increases during their undergraduate training. However, although higher than in the general population, the prevalence of distress among medical students is similar to that among other university students. (b) Medical students' distress is independently related to endogenous factors (personality traits and life events) and to their perception of the medical learning environment. (c) Medical students do not display a measurable increase in moral reasoning, empathy and tolerance of uncertainty. (d) Students' wellbeing, moral development, reflectivity and tolerance of uncertainty have been shown to be interrelated, and associated with clinical performance. CONCLUSIONS The findings of this review endorse the concerns about the wellbeing and development of undergraduate medical students. The design of the reviewed studies does not permit inferences about causality. Yet, these findings are consistent with the hypothesis that medical training causes emotional distress that delays students' development and affects their clinical performance.
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Affiliation(s)
- Jochanan Benbassat
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, PO Box 3886, 91037, Jerusalem, Israel,
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Bohm KC, Van Heest T, Gioe TJ, Agel J, Johnson TC, Van Heest A. Assessment of moral reasoning skills in the orthopaedic surgery resident applicant. J Bone Joint Surg Am 2014; 96:e151. [PMID: 25187595 DOI: 10.2106/jbjs.m.00706] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Assessing orthopaedic surgery residency applicants is a complex process. One important applicant characteristic not commonly measured during the interview process is moral behavior, a key component of the guidelines of the Accreditation Council for Graduate Medical Education for professionalism competency. We sought to determine whether a relationship exists between the results of residency selection interviews, as measured by match rank order, and moral reasoning skills, as measured by the revised version of the Defining Issues Test (DIT-2). METHODS The DIT-2, a psychological tool that has been validated in assessing moral reasoning in >30,000 subjects, was administered to orthopaedic surgery residency candidates on a voluntary basis during their interview day. Data were collected annually from four applicant classes (2009 to 2012) at one institution. Each candidate was interviewed by an orthopaedic faculty team and was ranked comparatively with the other interviewing applicants. The five-part aggregate interview method for ranking applicants for the match list included a focused interview station presenting ethical dilemmas as one part of determining rank order. RESULTS One hundred and twenty-four fourth-year medical students interviewing for orthopaedic surgery residency were assessed with the DIT-2. The results from the DIT-2 produced a postconventional score, which correlates with various levels of moral development. Each applicant's postconventional score was then compared with the patient's overall rank order. Applicants had highly variable moral reasoning skills, with no relationship to the final rank list. CONCLUSIONS Despite a wide range of DIT-2 scores, the interview process did not differentiate applicants based on moral reasoning skills. It remains unclear whether the DIT-2 could (or should) be used as an additional data point to help stratify orthopaedic residency applicants and to predict their performance.
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Affiliation(s)
- Kyle C Bohm
- Department of Orthopaedic Surgery, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55454. E-mail address for A. Van Heest:
| | - Tyler Van Heest
- Center for Bioethics, University of Minnesota, N504 Boynton, 410 Church Street S.E., Minneapolis, MN 55455
| | - Terence J Gioe
- Department of Orthopaedic Surgery, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55454. E-mail address for A. Van Heest:
| | - Julie Agel
- Department of Orthopaedic Surgery, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55454. E-mail address for A. Van Heest:
| | - Todd C Johnson
- Department of Orthopaedic Surgery, Regions Hospital, 640 Jackson Street, Saint Paul, MN 55101
| | - Ann Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55454. E-mail address for A. Van Heest:
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Greco PM. What values most? Am J Orthod Dentofacial Orthop 2014; 146:139. [PMID: 25085294 DOI: 10.1016/j.ajodo.2014.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 11/16/2022]
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Cianci AM, Hannah ST, Roberts RP, Tsakumis GT. The effects of authentic leadership on followers' ethical decision-making in the face of temptation: An experimental study. LEADERSHIP QUARTERLY 2014. [DOI: 10.1016/j.leaqua.2013.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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From Workshop to E-Learning: Using Technology-Enhanced “Intermediate Concept Measures” As a Framework for Pharmacy Ethics Education and Assessment. PHARMACY 2014. [DOI: 10.3390/pharmacy2020137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Verrinder JM, Phillips CJC. Development of a moral judgment measure for veterinary education. JOURNAL OF VETERINARY MEDICAL EDUCATION 2014; 41:258-264. [PMID: 25000883 DOI: 10.3138/jvme.1113-152r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Veterinarians increasingly face animal ethics issues, conflicts, and dilemmas, both in practice and in policy, such as the tension between clients' and animals' interests. Little has been done to measure the capacity of veterinarians to make ethical judgments to prevent and address these issues or to identify the effectiveness of strategies to build this capacity. The objectives of this study were, first, to develop a test to identify the capacity of veterinarians to make ethical decisions in relation to animal ethics issues and, second, to assess students' perceptions of the usefulness of three methods for the development of ethical decision making. The Veterinary Defining Issues Test (VetDIT) was piloted with 88 first-year veterinary students at an Australian university. The veterinary students were at a variety of reasoning stages in their use of the Personal Interest (PI), Maintaining Norms (MN), and Universal Principles (UP) reasoning methods in relation to both human ethics and animal ethics issues and operated at a higher level of reasoning for animal than human ethics. Thirty-eight students assessed three methods for developing ethical decision-making skills and identified these as being helpful in clarifying their positions, clarifying others' positions, increasing awareness of the complexity of making ethical decisions, using ethical frameworks and principles, and improving moral reasoning skills, with two methods identified as most helpful. These methods and the VetDIT have the potential to be used as tools for development and assessment of moral judgment in veterinary education to address animal ethics issues.
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Verrinder JM, Phillips CJC. Identifying veterinary students' capacity for moral behavior concerning animal ethics issues. JOURNAL OF VETERINARY MEDICAL EDUCATION 2014; 41:358-370. [PMID: 25335645 DOI: 10.3138/jvme.1113-153r] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Veterinarians face unique animal ethics challenges as practitioners and policy advisors to government and industry. Changing societal attitudes, cultural diversity, and the often conflicting needs and interests of patients and clients contribute to moral distress. Yet little has been done to identify veterinarians' capacity to address these animal ethics issues. In this study, first-year and final-year veterinary students in an Australian university were surveyed to explore moral sensitivity, moral motivation, and moral character and their relationship with moral reasoning. The majority of students were concerned about animal ethics issues and had experienced moral distress in relation to the treatment of animals. Most believed that veterinarians should address the wider social issues of animal protection and that veterinary medicine should require a commitment to animals' interests over owners'/caregivers' interests. There was less agreement that the veterinary profession was sufficiently involved in addressing animal ethics issues. The principal motivators for studying veterinary medicine were, in declining importance, enjoyment in working with animals, helping sick and injured animals, and improving the way animals are treated. However, most students had taken little or no action to address animal ethics issues. These results suggest that both first- and fifth-year veterinary students are sensitive to animal ethics issues and are motivated to prioritize the interests of animals but have little experience in taking action to address these issues. Further research is needed to determine ways to identify and assess these moral behavior components in veterinary education to develop veterinarians' capacity to address animal ethics issues.
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Abstract
Evidence-based practice suggests the best approach to improving professionalism in practice is ethics curricula. However, recent research has demonstrated that millennium graduates do not advocate for patients or assert themselves during moral conflicts. The aim of this article is the exploration of evaluation techniques to evaluate one measurable outcome of ethics curricula: moral reasoning. A review of literature, published between 1995 and 2013, demonstrated that the moral orientations of care and justice as conceptualized by Gilligan and Kohlberg are utilized by nursing students to solve ethical dilemmas. Data obtained by means of reflective journaling, Ethics of Care Interview (ECI) and Defining Issues Test (DIT), would objectively measure the interrelated pathways of care-based and justice-based moral reasoning. In conclusion, educators have an ethical responsibility to foster students' ability to exercise sound clinical judgment, and support their professional development. It is recommended that educators design authentic assessments to demonstrate student's improvement of moral reasoning.
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Swisher LL, Kessel GV, Jones M, Beckstead J, Edwards I. Evaluating moral reasoning outcomes in physical therapy ethics education: stage, schema, phase, and type. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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