Clarifying the relationship of medical education and moral development

Purpose. To assess the development of the moral reasoning skills of medical students through the course of their education, and to determine whether their scores would reflect the increases usually found at this age range and education level. Method. Using Rest's Defining Issues Test (DIT), the authors assessed the moral reasoning of a total of 95 Texas A&M medical students from the classes of 1991-94 at the beginning of their first semester, at the end of a required first-semester medical ethics course, and at the end of the students' fourth year. Results. The mean score on the first test was 47.7; on the second, 53.7; and on the third, 56.5. The +6.0 change in mean scores from the first to second test was statistically significant (p < .0001), as was the +8.8 change from the first to final test (p < .0001). The +2.8 change from the second to final test was also significant, although at a lower level (p < .0302). Analysis revealed no significant correlation between moral reasoning scores and age; however, there was a significant correlation between moral reasoning scores and sex, with women scoring higher than men on all three tests. Conclusion. While data from the current study seem to contradict earlier findings that medical education inhibits an increase in moral reasoning skills, the current findings may alternatively be interpreted as resulting mainly from the required first-semester medical ethics course, which involved small-group discussion of moral dilemmas, an educational method shown elsewhere to be effective in enhancing moral reasoning skills.