The promotion of medical students’ moral development: a comparison between a traditional course on bioethics and a course complemented with the Konstanz method of dilemma discussion

Abstract

There is evidence that medical students do not develop their moral competence as expected for university students and that medical training, via formal and hidden curricula, somehow contributes to the scenario known as dehumanization of medicine. Education in Bioethics may be an interesting strategy to change this scenario. We investigated the impact of a course in Bioethics and a method of dilemma discussion (the Konstanz Method of Dilemma Discussion, or KMDD) on medical students’ moral competence. We conducted an observational controlled study at a public Brazilian medical school. The extended version of the Moral Competence Test (MCT-xt) was applied at first and last days of a course on Bioethics in two consecutive years. These two courses were perfectly similar, except that with the second group two discussions according to the KMDD complemented the course. 165 undergraduate students participated in this research. Competence score (c score) slightly decreased in the group who took the traditional course while it slightly increased in the group who had the course complemented by KMDD’s discussions. Though these differences were not statiscally significant (qui-square test, p < 0.05), absolute effect size (aES) measurement suggests that KMDD’ s discussions had a small but positive effect on students’ moral competence. If, as suggested by empirical evidence, medical education stagnates students’ moral competence, then medicine is severely ill. Treatment may be found in a set of bioethical educative interventions, aimed at cognitive and affective aspects of moral competence.