Abstract
BackgroundRecent 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.MethodsBetween 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.ResultsThe 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.ConclusionTeaching 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.
Highlights
Recent findings suggest that medical students’ moral competence decreases throughout medical school
For the experimental group (EG), the mean C-score improved considerably over the course, but was not statistically significant in the paired Wilcoxon Test (P = 0.14), which shows that Principle-based structured case discussion (PBSCD) do not foster moral competence significantly
The difference in pre/post Cscores between the two groups was not statistically significant in the unpaired Wilcoxon Test (P = 0.34). This indicates that the hypothesis of this study, namely that PBSCDs foster moral competence more than Theory-based case discussion (TBCD), cannot be proved with certainty
Summary
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. Since moral competence is becoming increasingly important for medicine, it is alarming that several studies with different instruments (with MCT [2,3,4,5,6,7,8], with MJI [9,10,11], and with DIT [12]) suggest that this competence, as well as moral reasoning ability, seem to decrease during medical school or do not increase to a similar extent as during other ongoing formal educational processes [1]. The findings that moral competence can decline are important to adjusting medical education in a way that allows for an increase of moral competence and for the ability of future medical professionals to better face morally challenging situations
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