Principle-based structured case discussions: do they foster moral competence in medical students? - A pilot study

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Abstract

Background

Recent findings suggest that medical students’ moral competence decreases throughout medical school. This pilot study gives preliminary insights into the effects of two educational interventions in ethics classes on moral competence among medical students in Munich, Germany.

Methods

Between 2012 and 2013, medical students were tested using Lind’s Moral Competence Test (MCT) prior to and after completing different ethics classes. The experimental group (EG, N = 76) participated in principle-based structured case discussions (PBSCDs) and was compared with a control group with theory-based case discussions (TBCDs) (CG, N = 55). The pre/post C-scores were compared using a Wilcoxon Test, ANOVA and effect-size calculation.

Results

The C-score improved by around 3.2 C-points in the EG, and by 0.2 C-points in the CG. The mean C-score difference was not statistically significant for the EG ( P = 0.14) or between the two groups ( P = 0.34). There was no statistical significance for the teachers’ influence ( P = 0.54) on C-score. In both groups, students with below-average (M = 29.1) C-scores improved and students with above-average C-scores regressed. The increase of the C-Index was greater in the EG than in the CG. The absolute effect-size of the EG compared with the CG was 3.0 C-points, indicating a relevant effect.

Conclusion

Teaching ethics with PBSCDs did not provide a statistically significant influence on students’ moral competence, compared with TBCDs. Yet, the effect size suggests that PBSCDs may improve moral competence among medical students more effectively. Further research with larger and completely randomized samples is needed to gain definite explanations for the results.

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Most cited references 27

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Medical ethics education: where are we? Where should we be going? A review.

Patrick M. Gaffney, Rachael E Eckles, Eric M. Meslin … (2005)

The authors' primary goal was to provide a comprehensive and current review of the literature surrounding ethics education for medical students. Following this review, the authors summarize the deficits in the current literature and provide recommendations for future inquiries on medical ethics education. In 2004, the authors searched MEDLINE and PubMed using the following search terms: ethics, ethics education, medical ethics education, curriculum, undergraduate medical education, virtue, role model, philosophy of medicine, and outcomes research. No limit was placed on dates for this literature search. Articles whose primary focus was professionalism were excluded because the professionalism literature tends to focus on competencies and postgraduate education, whereas the primary focus of this study was on undergraduate education. Literature on physicians as role models to medical students as a form of teaching medical ethical ethics was excluded as well because the current discussion examines the formal undergraduate medical ethics curricula. Also excluded were reports from foreign countries (unless there were no equivalent studies in the United States). The authors found almost no literature exploring students' backgrounds (cultural, religious, socioeconomic, etc.) and the teaching of medical ethics in medical schools. Otherwise, the authors reviewed everything they could find, regardless of imperfections in individual reports such as small sample size or poor research methodology. The review, which encompassed articles from 1978 to 2004, revealed that deep shortcomings exist in the literature on medical ethics education. Deficits exist in all areas of the literature: (1) theoretical work done on the overall goals of medical ethics education; (2) empirical studies that attempt to examine outcomes for students; (3) studies examining teaching methods in medical ethics education, and (4) studies evaluating the effectiveness of various teaching methods. There are substantial opportunities for contribution to the literature on medical ethics education in all of the areas where deficits exist. The literature suggests that two points of view exist regarding the purpose of teaching medical ethics: (1) that it is a means of creating virtuous physicians; and (2) that it is a means of providing physicians with a skill set for analyzing and resolving ethical dilemmas. This dichotomy made it difficult to arrive at a consensus regarding the goals of medical ethics education. The field would benefit from further theoretical work aimed at better delineating the core content, core processes, and core skills relevant to the ethical practice of medicine. The time has come to organize an effort to improve and validate medical ethics education. In the end, effective medical ethics education will further the goals of medicine in dramatic and tangible ways.

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Framing the Issues: Moral Distress in Health Care

Bernadette Pauly, Colleen Varcoe, Jan Storch (2012)

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care.

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Changes in students' moral development during medical school: a cohort study.

R D Fafard, Johane Patenaude, Théophile Niyonsenga (2003)

The requirements of professionalism and the expected qualities of medical staff, including high moral character, motivate institutions to care about the ethical development of students during their medical education. We assessed progress in moral reasoning in a cohort of medical students over the first 3 years of their education. We invited all 92 medical students enrolled at the University of Sherbrooke, Que., to complete a questionnaire on moral reasoning at the start of their first year of medical school and at the end of their third year. We used the French version of Kohlberg's Moral Judgment Interview. Responses to the questionnaire were coded by stage of moral development, and weighted average scores were assigned according to frequency of use of each stage. Of the 92 medical students, 54 completed the questionnaire in the fall of the first year and again at the end of their third year. The average age of the students at the end of the third year was 21 years, and 79% of the students included in the study were women. Over the 3-year period, the stage of moral development did not change substantially (i.e., by more than half a stage) for 39 (72%) of the students, shifted to a lower stage for 7 (13%) and shifted to a higher stage for 8 (15%). The overall mean change in stage was not significant (from mean 3.46 in year 1 to 3.48 in year 3, p = 0.86); however, the overall mean change in weighted average scores showed a significant decline in moral development (p = 0.028). Temporal variations in students' scores show a levelling process of their moral reasoning. This finding prompts us to ask whether a hidden curriculum exists in the structure of medical education that inhibits rather than facilitates the development of moral reasoning.

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Author and article information

Contributors

Orsolya Friedrich:

ORCID: http://orcid.org/0000-0003-1608-175X

orsolya.friedrich@lrz.uni-muenchen.de

Kay Hemmerling: KayHemmerling@aol.com

Katja Kuehlmeyer: Katja.Kuehlmeyer@med.uni-muenchen.de

Stefanie Nörtemann: steffinoerte@web.de

Martin Fischer: Martin.Fischer@med.unimuenchen.de

Georg Marckmann: georg.marckmann@med.uni-muenchen.de

Journal

Journal ID (nlm-ta): BMC Med Ethics

Journal ID (iso-abbrev): BMC Med Ethics

Title: BMC Medical Ethics

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6939

Publication date (Electronic): 3 March 2017

Publication date PMC-release: 3 March 2017

Publication date Collection: 2017

Volume: 18

Electronic Location Identifier: 21

Affiliations

[1 ]ISNI 0000 0004 1936 973X, GRID grid.5252.0, Institute for Ethics, , History and Theory of Medicine at Ludwig Maximilian University (LMU), ; Lessingstr. 2, 80336 Munich, Germany

[2 ]ISNI 0000 0001 2230 9752, GRID grid.9647.c, , Institute for Pedagogic and Rehabilitation Psychology at the University of Leipzig, ; Neumarkt 9-19, 04109 Leipzig, Germany

[3 ]ISNI 0000 0004 1936 973X, GRID grid.5252.0, , Institute for Medical Education at the University Hospital of LMU Munich, ; Lessingstr. 2, 80336 Munich, Germany

Author information

Orsolya Friedrich http://orcid.org/0000-0003-1608-175X

Article

Publisher ID: 181

DOI: 10.1186/s12910-017-0181-1

PMC ID: 5335793

PubMed ID: 28253882

SO-VID: 2a8e2b64-c9db-4e26-80e8-fc551b7dae23

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 2 October 2016

Date accepted : 22 February 2017

Funding

Funded by: Decedent estate of Dr. Hildegard Hampp

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ScienceOpen disciplines: Medicine

Keywords: educational intervention,medical ethics class,medical students,moral competence test,moral competence

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ScienceOpen disciplines: Medicine

Keywords: educational intervention, medical ethics class, medical students, moral competence test, moral competence

Principle-based structured case discussions: do they foster moral competence in medical students? - A pilot study

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Abstract

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Conclusion

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25th European Students' Conference

Most cited references 27

Medical ethics education: where are we? Where should we be going? A review.

Framing the Issues: Moral Distress in Health Care

Changes in students' moral development during medical school: a cohort study.

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