Medical Residents Do Not Further Moral Reasoning Skills
July 6, 2000
Hershey, Pa. -- We deal with moral and ethical questions, both large and small, every day. As we mature from children to adults, our moral reasoning evolves, moving our focus from ourselves to society at large. In spite of the importance of ethical issues in medicine, John George, Ph.D., director of pre-doctoral education for the department of family and community medicine at Penn State's College of Medicine, has found that moral reasoning scores do not increase during residency training.

George studied the moral reasoning of residents in internal medicine, family medicine and surgery in Hawaii and Ohio by administering the Defining Issues Test (DIT). This test poses six moral dilemmas to the test-takers and also asks them to prioritize a list of twelve items that may have an impact on their decisions. This test is accepted as a good indicator of a person's level of moral reasoning.

He found that residents' scores did not increase during their training and that their average scores were lower than those of many other professions, including law students.

(A higher score indicates a more mature level of moral reasoning.) He also tested the faculty teaching the residents and found that the two groups had very similar DIT scores. Previous studies have observed similar trends in medical school students.

George believes that this lack of moral reasoning development is due to the nature of most residency programs. Residents are focused on learning medicine almost to the exclusion of anything else. Residents may also be reluctant to ask about ethical problems because faculty members rarely discuss moral issues. George adds that the lack of moral reasoning development experienced during the residency affects the doctors later in their careers. Studies have found a correlation between DIT scores and the numbers of malpractice suits brought against doctors.

To encourage residents to develop their moral reasoning skills, George proposes integrating discussions of ethical issues into their curriculum. This requires that faculty are also trained to identify and discuss moral dilemmas with their residents. "The residents won't learn unless the faculty will discuss these issues with them," he explains. In addition, George says that ethics courses should be integrated into clinical rotations during medical school to give students more opportunities to identify and discuss moral dilemmas.

On July 10, George will present the results of his research, "Lack of moral development in residency training," at the Association for Moral Education meeting in Glasgow, Scotland.