ArticlePloS one2011
Regression of moral reasoning during medical education: combined design study to evaluate the effect of clinical study years.
Article in PloS one, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.
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Who cites it
29 citing papers in PubMed.
- Principle-based structured case discussions: do they foster moral competence in medical students? - A pilot study.BMC medical ethics · 2017Trial
- Changes in medical students' perceptions of ethical climate during their medical training: a follow-up study of a student cohort.BMC medical education · 2026Article
- A Cross-Sectional Study of Postgraduate Orthodontic Students' Moral Reasoning Ability and Opinions on Professionalism and Dental Board of Australia Tribunal Outcomes.Dentistry journal · 2026Article
- Moral Reasoning and Final-Year Undergraduate Dentistry Students in Australia: A Cross-Sectional Questionnaire Study.Dentistry journal · 2025Article
- Factors Influencing Burnout in Croatian Medical Students: The roles of Lifelong Learning and Loneliness.Perspectives on medical education · 2025Article
- Tough Clinical Decisions: Experiences of Polish Physicians.HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues · 2024Article
- How the COVID-19 pandemic affects the moral reasoning of pediatric residents and the general population.BMC medical education · 2023Article
- Differences in moral reasoning among medical graduates, graduates with other degrees, and nonprofessional adults.BMC medical education · 2022Article
- Moral Judgement along the Academic Training.International journal of environmental research and public health · 2021Article
- Article
- Moral judgement development during medical student clinical training.BMC medical education · 2021Article
- Article
- Perception of Organizational Ethical Climate by University Staff and Students in Medicine and Humanities: A Cross Sectional Study.Science and engineering ethics · 2020Article
- Clerkship Ethics: Unique Ethical Challenges for Physicians-in-Training.HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues · 2020Article
- Perceptions of Ethical Climate and Research Pressures in Different Faculties of a University: Cross-Sectional Study at the University of Split, Croatia.Science and engineering ethics · 2019Article
- [Assessing bioethics education: Teaching to be virtuous doctors or just doctors with practical ethical skills].Atencion primaria · 2019Observational
- Predictors of medical student interest in Indigenous health learning and clinical practice: a Canadian case study.BMC medical education · 2018Article
- Is there a relationship between personal reflection ability and moral reasoning ability in Indonesian medical students?International journal of medical education · 2018Article
- A longitudinal study of empathy in pre-clinical and clinical medical students and clinical supervisors.BMC medical education · 2016Article
- Measuring 'virtue' in medicine.Medicine, health care, and philosophy · 2016Article
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMoral reasoning is important for developing medical professionalism but current evidence for the relationship between education and moral reasoning does not clearly apply to medical students. We used a combined study design to test the effect of clinical teaching on moral reasoning.
methodsWe used the Defining Issues Test-2 as a measure of moral judgment, with 3 general moral schemas: Personal Interest, Maintaining Norms, and Postconventional Schema. The test was applied to 3 consecutive cohorts of second year students in 2002 (n = 207), 2003 (n = 192), and 2004 (n = 139), and to 707 students of all 6 study years in 2004 cross-sectional study. We also tested 298 age-matched controls without university education.
resultsIn the cross-sectional study, there was significant main effect of the study year for Postconventional (F(5,679) = 3.67, P = 0.003) and Personal Interest scores (F(5,679) = 3.38, P = 0.005). There was no effect of the study year for Maintaining Norms scores. 3(rd) year medical students scored higher on Postconventional schema score than all other study years (p<0.001). There were no statistically significant differences among 3 cohorts of 2(nd) year medical students, demonstrating the absence of cohort or point-of-measurement effects. Longitudinal study of 3 cohorts demonstrated that students regressed from Postconventional to Maintaining Norms schema-based reasoning after entering the clinical part of the curriculum.
interpretationOur study demonstrated direct causative relationship between the regression in moral reasoning development and clinical teaching during medical curriculum. The reasons may include hierarchical organization of clinical practice, specific nature of moral dilemmas faced by medical students, and hidden medical curriculum.
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