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Biomedical subjects

D J Self

Publications and source records attributed to D J Self.

At least 19 recordsLinked to original sources
PubMed2000

Should moral reasoning serve as a criterion for student and resident selection?

The aim of medical school and residency training is to produce well-trained physicians. One problem has been in knowing which applicants to select. Academic criteria have not correlated well with clinical performance. The current study suggests consideration of an important variable that has been found to be associated with exemplary clinical performance. In recent studies a significant relationship between moral reasoning skills and clinical performance has been found for medical students and residents and dental and nursing students. A similar relationship has been found between levels of moral reasoning and malpractice claims among practicing orthopaedic surgeons. Rest has developed the Defining Issues Test, as a paper and pencil, objective test for assessing moral reasoning. With it being deemed appropriate to assess applicants' scientific reasoning, the authors support the development of an assessment of moral reasoning as a selection criterion for medical school and residency training. More research is required. If additional research confirms the relationship of moral reasoning and superior clinical performance, then the results of moral reasoning tests might legitimately be used in the selection process.

Humans↗
PubMed1998

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. CONCLUSIONS: 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.

Adult↗
PubMed1998

The amount of small-group case-study discussion needed to improve moral reasoning skills of medical students.

PURPOSE: To examine how much exposure to small-group case-study discussion is necessary to significantly increase moral reasoning skills. METHOD: For the classes of 1991-1998 at Texas A&M, using Rest's Defining Issues Test, the authors tested groups of students for moral reasoning skills both before and after the students participated in small-group case-study discussions of medical ethics. RESULTS: From 960 students asked to participate, the authors collected complete data for 729 students (75.9% response rate). Small-group case-study exposures ranged from 0 to 44 hours. Groups of students exposed to 20 hours or more demonstrated a significant increase in their moral reasoning scores. Groups with less than 20 hours of exposure demonstrated no significant increase in their scores. CONCLUSION: This study indicates that moral reasoning skills are teachable and measurable, and that small-group discussion significantly increases moral reasoning skills. Further studies are needed to increase the generalizability of these findings.

Education, Medical, Undergraduate↗
PubMed1996

Clarifying the relationship of veterinary medical education and moral development.

OBJECTIVE: To clarify the relationship between veterinary medical education and moral development in response to 2 previous studies that presented conflicting evidence that the experience of veterinary medical education may inhibit moral development. DESIGN: The Defining Issues Test (DIT) was used to survey the moral reasoning of veterinary medical students at the beginning and end of their education. SAMPLE POPULATION: First and fourth-year veterinary medical students. PROCEDURE: The moral reasoning of 98 veterinary medical students was assessed at the beginning of their first semester of veterinary medical education and again, 4 years later, at the end of their last semester to determine whether their moral reasoning scores would reflect the expected maturity-related increases usually found at this age range and education level. RESULTS: The DIT scores ranged from 8.3 to 70.0 for first-year students and from 16.7 to 76.7 for fourth-year students. The first-year mean was 44.0 and the fourth-year mean was 45.4. The mean change of +1.45 points was not significant. Statistical analysis did not reveal any significant correlation between the moral reasoning scores and age; however, there was a significant correlation between the moral reasoning scores and gender, with females scoring higher on the first and second test. The difference in the rate of change between tests by gender was not significant. CONCLUSION: This study appears to confirm the findings of an earlier study suggesting veterinary medical education inhibits an increase of moral reasoning in veterinary medical students.

Adult↗
PubMed1996

Moral reasoning and malpractice. A pilot study of orthopedic surgeons.

The relationship between moral reasoning and malpractice claims was studied in 53 orthopedic surgeons. Levels of moral reasoning were defined by the percentage of principled responses (P-score) on Rest's Defining Issues Test, while annualized rates of malpractice claims were computed on the basis of data from a regional, physician-owned, interindemnity/liability protection trust. Orthopedic surgeons with fewer than 0.20 claims per year demonstrated significantly (P = 0.04) higher levels of moral reasoning (mean P-score of 43.8) than did those with claims rates higher than 0.40 claims per year (mean P-score of 38.0). Only 1 of 13 orthopedists with P-scores over 50 was found in the higher claims group, suggesting that high levels of moral reasoning may provide a protective element against malpractice claims.

Ethics, Medical↗
PubMed1993

The educational philosophies behind the medical humanities programs in the United States: an empirical assessment of three different approaches to humanistic medical education.

This study investigates the three major educational philosophies behind the medical humanities programs in the United States. It summarizes the characteristics of the Cultural Transmission Approach, the Affective Developmental Approach, and the Cognitive Developmental Approach. A questionnaire was sent to 415 teachers of medical humanities asking for their perceptions of the amount of time and effort devoted by their programs to these three philosophical approaches. The 234 responses constituted a 54.6% return. The approximately 80:20 gender ratio of males to females and other demographic data on age and educational background were consistent with other studies of the field of medical humanities. Reflections on the results in Table II indicate that some changes need to take place in the teaching of the medical humanities if the perceived ideal is to be achieved. In order for the current teachers of the medical humanities to think that the appropriate philosophies behind the teaching of the medical humanities are being implemented as they should be, much less time and effort need to be devoted to the Cultural Transmission Approach. With no other published reports on the educational philosophies behind the medical humanities programs, this study created a new knowledge base about this relatively young and rapidly emerging field.

Education, Medical↗
PubMed1993

The influence of gender on conflicts of interest in the allocation of limited critical care resources: justice versus care.

After noting that the principle of autonomy has been inadequate for the resolution of many of the complex and difficult moral dilemmas involving conflicts of interest in the allocation of limited critical care resources, this paper analyzes the concepts of justice and care as alternative solutions to moral problems and applies them to the issue of repeat organ transplants to a single recipient. These concepts are found to be the basis of the notions of moral reasoning and moral orientation, respectively, which serve in moral development theory as two fundamentally different ways to approach moral problem solving. Following an elaboration of moral reasoning as found in Kohlberg's cognitive moral development theory, the influence of gender on moral reasoning is investigated. The empirical data show that women (mean Defining Issues Test score, 47.18) score significantly higher (P < or = .0001) than men (mean Defining Issues Test score, 41.77) in the use of moral reasoning based on the concept of justice for resolving moral dilemmas. Following an elaboration of moral orientation as found in Gilligan's moral theory of the ethics of care, the influence of gender on moral orientation is investigated. The empirical data show that women use the concept of care significantly more often (P < or = .0139) than their male colleagues in resolving moral dilemmas. From these data it is concluded that men are more likely than women to use justice in the resolution of moral dilemmas, such as the conflicts of interest in the allocation of limited critical care resources, but that if women do use, or are required by the social system to use, justice in the resolution of moral dilemmas, they do a better job of it than men.

Critical Care↗
PubMed1993

Teaching medical ethics to first-year students by using film discussion to develop their moral reasoning.

PURPOSE: To evaluate a project on teaching medical ethics to first-year students by using film discussion to develop the students' moral reasoning. METHOD: The participants were 114 first-year students at Texas A&M University Health Science Center College of Medicine in 1989-90, 1990-91, and 1991-92: (1) 48 (20 women and 28 men) who participated during the fall quarter in an elective course on social issues in medicine, which consisted of weekly one-hour discussions of short films; (2) 37 (18 women and 19 men) who participated in the course during both the fall and winter quarters; and (3) a control group of 29 (8 women and 21 men) who did not take the course and so had no exposure to the film discussions. The influence of the discussions on the students' moral reasoning was measured by using Rest's Defining Issues Test for pretests and posttests. The scores of the three groups were compared by using multivariate analysis of variance. RESULTS: There were statistically significant increases in the moral reasoning scores of both the course registrants with one-quarter exposure to the film discussions (p < .002) and those with two-quarter exposure (p < .008) compared with the scores of the students who did not take the course and had no exposure (p < .109). CONCLUSION: No doubt there was a self-selecting bias on the part of the course registrants; however, since both groups of registrants showed significant increases on their posttest scores, clearly the course did have a positive influence on these students' moral reasoning. Thus, it is possible to develop young people's moral reasoning in medical school as well as in earlier educational environments.

Control Groups↗
PubMed1993

The influence of philosophical versus theological education on the moral development of clinical medical ethicists.

PURPOSE: Because of the increasing involvement of clinical medical ethicists in patient care and the resultant controversy over the appropriate background, training, and certification of clinical ethicists, this study was designed to investigate whether different educational backgrounds (philosophical versus theological) affected the moral reasoning of clinical ethicists and their orientations toward justice or care. METHOD: From 1987 through 1990, extensive oral interviews were conducted with 50 clinical medical ethicists (26 philosophers and 24 theologians) who were at 32 medical centers in 14 states from all sections of the United States. The interviews were used to gather selected demographic characteristics about the ethicists (age, gender, and educational background) as well as to determine the ethicists' scores for stages of moral reasoning and for moral orientation. Polyserial correlations and multivariant analyses were then performed between the demographic characteristics and the data on moral reasoning and moral orientation. RESULTS: The philosophers and theologians were found not to be significantly different (p > .05) in their moral reasoning skills in terms of either moral stage score or weighted average score. Similarly, the philosophers and theologians were found not to be significantly different in their moral orientations toward justice or care in terms of recognition, predominance, or alignment. No significant relationship was found between age or gender and moral reasoning or moral orientation. CONCLUSION: Based on the results of this study, it appears that clinical medical ethicists, whether philosophers or theologians, are a fairly homogeneous group with regard to their moral development, in terms of both their stages of moral reasoning and their moral orientations toward justice and care.

Adult↗