Reflective ability and moral reasoning in final year medical students: A semi-qualitative cohort study

Chalmers, P. and Dunngalvin, A. and Shorten, G. (2011) Reflective ability and moral reasoning in final year medical students: A semi-qualitative cohort study. e281-e289. ISSN 0142159X (ISSN)

[img] Text
Chalmers et al 2011.pdf

Download (382kB)
Official URL:


Background: Moral reasoning and reflective ability are important concepts in medical education. To date, the association between reflective ability and moral reasoning in medical students has not been measured. Aim: This study tested the hypotheses that, amongst final year medical students, (1) moral reasoning and reflective ability improve over time and (2) positive change in reflective ability favourably influences moral reasoning. Methods: With Institutional Ethical approval, 56 medical students (of a class of 110) participated fully both at the beginning and end of the final academic year. Reflective ability and moral reasoning were assessed at each time using Sobral's reflection-in-learning scale (RLS), Boenink's overall reflection score and by employing Kohlberg's schema for moral reasoning. Results: The most important findings were that (1) Students' level of reflective ability scores related to medicine decreased significantly over the course of the year, (2) students demonstrated a predominantly conventional level of moral reasoning at both the beginning and end of the year, (3) moral reasoning scores tended to decrease over the course of the year and (4) RLS is a strong predictor of change in moral reasoning over time. Conclusion: This study confirms the usefulness of Sobral's RLS and BOR score for evaluating moral development in the context of medical education. This study further documents regression and levelling in the moral reasoning of final year medical students and a decrease in reflective ability applied in the medical context. Further studies are required to determine factors that would favourably influence reflective ability and moral reasoning among final year medical students. © 2011 Informa UK Ltd.

Item Type: Article
Additional Information: Cited By :4; Export Date: 23 February 2015; CODEN: MEDTD; Correspondence Address: Chalmers, P.; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, University College Cork, Wilton, Cork, Ireland; email:; References: Boenink, A.D., Oderwald, A.K., De Jonge, P., Van Tilburg, W., Smal, J.A., Assessing student reflection in medical practice. The development of an observer-rated instrument: Reliability, validity and initial experiences (2004) Medical Education, 38 (4), pp. 368-377. , DOI 10.1046/j.1365-2923.2004.01787.x; Branch, W.T., Supporting the moral development of medical students (2000) J Gen Intern Med, 15, pp. 503-508; Denzin, N.K., Lincoln, Y.S., (1998) Collecting and Interpreting Qualitative Materials, , London: Sage; Gipe, J.P., Levitovj, R., Speaker, R., Psychological and personal dimensions of prospective teachers' reflective ability (2001) Educ Psychol Meas, 51, pp. 913-922; (2003) Tomorrow's Doctors, , GMC London: GMC Publications; (2008) Licensing and Revalidation Process, ,, GMC London: GMC Publications [Published 2009 May 25]. Available from; Goldie, J., Dowie, A., Cotton, P., Morrison, J., Teaching professionalism in the early years of a medical curriculum: A qualitative study (2007) Medical Education, 41 (6), pp. 610-617. , DOI 10.1111/j.1365-2923.2007.02772.x; Gordon, J., Assessing students' personal and professional development using portfolios and interviews (2003) Medical Education, 37 (4), pp. 335-340. , DOI 10.1046/j.1365-2923.2003.01475.x; Gough, D., Weight of evidence: A framework for the appraisal of the quality and relevance of evidence (2007) Special Edition of Res Papers Educ, 22 (2), pp. 213-228. , In: Furlong J, Oancea A, editors. Applied and practice-based research; Grant, A., Kinnersley, P., Metcalf, E., Pill, R., Houston, H., Students' views of reflective learning techniques: An efficacy study at a UK medical school (2006) Med Educ, 40, pp. 379-388; Hilton, S.R., Slotnick, H.B., Proto-professionalism: How professionalism occurs across the continuum of medical education (2005) Med Educ, 39, pp. 58-65; Hinman, L., Emotions, morality, and understanding (1985) Moral Dilemmas. Philosophical and Psychological Issues in the Development of Moral Reasoning, pp. 57-70. , In: Harding CG, editor Chicago: Precedent Publishing Inc; Hogan, K., Pitfalls of community-based learning: How power dynamics limit adolescents' trajectories of growth and participation (2002) Teach Coll Rec, 104, pp. 586-624; King, P.M., Kitchener, K.S., Developing reflective judgement (2001) Measuring Medical Professionalism, pp. 207ff. , San Francisco: Jossey-Bass 1994. In: Stern DT, editor New York: Oxford, University Press; Kneebone, R.L., Scott, W., Darzi, A., Horrocks, M., Simulation and clinical practice: Strengthening the relationship (2004) Medical Education, 38 (10), pp. 1095-1102. , DOI 10.1111/j.1365-2929.2004.01959.x; Kohlberg, L., (1984) The Psychology of Moral Development: Moral Stages, Their Nature and Validity. Vol. 2 of Essays in Moral Development, , San Francisco: Harper & Row; Lachman, N., Pawlina, W., Integrating professionalism in early medical education: The theory and application of reflective practice in the anatomy curriculum (2006) Clinical Anatomy, 19 (5), pp. 456-460. , DOI 10.1002/ca.20344; Lave, J., (1998) Cognition in Practice: Mind, Mathematics and Culture in Everyday Life, , Cambridge, UK: Cambridge University Press; Lind, G., Growth and regression in moral-cognitive development (1985) Moral Dilemmas. Philosophical and Psychological Issues in the Development of Moral Reasoning, pp. 99-114. , In: Harding C, editor Chicago: Precedent Publishing Inc; Lind, G., Moral regression in medical students and their learning environment (2000) Rev Bras Educ Med, 24, pp. 24-33; Mamede, S., Schmidt, H.G., Penaforte, J.C., Effects of reflective practice on the accuracy of medical diagnoses (2008) Medical Education, 42 (5), pp. 468-475. , DOI 10.1111/j.1365-2923.2008.03030.x; Norcini, J., Back to the future: Clinical vignettes and the measurement of physician performance (2004) Annals of Internal Medicine, 141 (10), pp. 813-814; Patenaude, J., Niyonsenga, T., Fafard, D., Changes in students' moral development during medical school: A cohort study (2003) Canadian Medical Association Journal, 168 (7), pp. 840-844; Phillips, C.B., Student portfolios and the hidden curriculum on gender: Mapping exclusion (2009) Med Educ, 43, pp. 847-853; Schön, D.A., (2006) The Reflective Practitioner: How Professionals Think in Action, , England: Ashford; Sobral, D.T., An appraisal of medical students' reflection-in-learning (2000) Medical Education, 34 (3), pp. 182-187. , DOI 10.1046/j.1365-2923.2000.00473.x; Spencer, L., Ritchie, J., Lewis, J., Dillon, L., (2003) Quality in Qualitative Evaluation: A Framework for Assessing Research Evidence, , London: Government Chief Social Researchers Office; Stephenson, A.E., Adshead, L.E., Higgs, R.H., The teaching of professional attitudes within UK medical schools: Reported difficulties and good practice (2006) Medical Education, 40 (11), pp. 1072-1080. , DOI 10.1111/j.1365-2929.2006.02607.x; Tabachnick, B.G., Fidell, L.S., (2007) Using Multivariate Statistics. 5th Ed, , Boston, MA: Allyn and Bacon; Young, L., Rego, P., Peterson, R., Clinical location and student learning: Outcomes from the LCAP program in Queensland, Australia (2008) Teach Learn Med, 20, pp. 261-266
Uncontrolled Keywords: adult; article; cohort analysis; female; human; learning; male; medical ethics; medical student; morality; observer variation; psychological aspect; qualitative research; time; Cohort Studies; Ethics, Medical; Humans; Morals; Students, Medical; Time Factors
Depositing User: National Forum
Date Deposited: 30 Nov 2015 17:19
Last Modified: 30 Nov 2015 17:19

Actions (login required)

View Item View Item


Downloads per month over past year