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

Abstract

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 reflectionin-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.

Age and Gender Based Differences in Self-Assessed Reflectionin-Learning Scale

“…28 Studies that measure Reflection-in-Learning Scale of medical students in different countries including Saudi Arabia, London, U.K, Brazil, Netherland, Ireland, India, Australia, UK, Taiwan, Sweden, US and Estonia also demonstrate female dominance in the medicine. 4,6,7,12,14,15,16,19,20,21,29,30 In Balochistan, which is primarily a male predominating society, it is surprising to hear that females are dominating in dentistry. The percentage of female literacy is lower in Balochistan as compared to the other parts of the country due to a bundle of varying factors including remote educational institutes, financial constraints, social problems and cultural barriers.…”

“…However, in a study by Chalmers where more than half of the participants were females, (57%, 30/56) no difference in RLS score among genders was reported. 15 On contrary, Sobral DT (a Brazilian researcher) investigated reflective level of 6th year medical students in 2000 and 2005. 12,14 His established results demonstrate male predominance.…”

“…12 However controversy existed in the results finalized by an Irish investigator, Chalmers P (2011), who distinguished no progress in academic performance of 56 study participants from final year medicine. 15 Devi V, an Indian researcher, pointed out the level of reflection, but she didn't work on gender and age difference in RLS. 16 Reflection-in-Learning Scale is acceptable to manipulate in the discipline of medicine and dentistry.…”

“…17,18 Although foreign countries have carried out considerable efforts to assess reflective level of medical/dental students, but still no work has been accomplished to compare RLS score between male and female students. 12,14,15,16,17,19,20,21 Gender difference represents significant sources of variation in learning behavior of medical/dental students which should be detected and identified by medical educationists. 22,23 Although, research has been carried out and reflective level assessed previously in Pakistan, but the gender difference for RLS has yet not been checked.…”

Becoming the 'good doctor': medical students’ views on altruism and professional identity

“…This would help to address certain negative experiences within the 'hidden curriculum', which have been associated with loss of idealism and altered ethical integrity (Lempp and Seale, 2004), by exposing their influence on students' perspectives and allowing issues to be addressed in the formal curriculum (Chalmers et al, 2011). Furthermore, it would allow students' opinions to be either incorporated into an everevolving conceptualisation of professional values or, if inappropriate, to be "brought in line" (O 'Sullivan et al, 2012, p. e68) with the values of their institution.…”