Self D J, Schrader D E, Baldwin D C, Wolinsky F D
Department of Humanities in Medicine, College of Medicine, Texas A&M University, College Station 77843-1114.
Med Educ. 1993 Jan;27(1):26-34. doi: 10.1111/j.1365-2923.1993.tb00225.x.
Medicine endorses a code of ethics and encourages a high moral character among doctors. This study examines the influence of medical education on the moral reasoning and development of medical students. Kohlberg's Moral Judgment Interview was given to a sample of 20 medical students (41.7% of students in that class). The students were tested at the beginning and at the end of their medical course to determine whether their moral reasoning scores had increased to the same extent as other people who extend their formal education. It was found that normally expected increases in moral reasoning scores did not occur over the 4 years of medical education for these students, suggesting that their educational experience somehow inhibited their moral reasoning ability rather than facilitating it. With a range of moral reasoning scores between 315 and 482, the finding of a mean increase from first year to fourth year of 18.5 points was not statistically significant at the P < or = 0.05 level. Statistical analysis revealed no significant correlations at the P < or = 0.05 level between the moral reasoning scores and age, gender, Medical College Admission Test scores, or grade point average scores. Along with a brief description of Kohlberg's cognitive moral development theory, some interpretations and explanations are given for the findings of the study.
医学认可一套道德准则,并鼓励医生具备高尚的道德品质。本研究考察医学教育对医学生道德推理和道德发展的影响。对20名医学生(占该班级学生的41.7%)进行了科尔伯格道德判断访谈。在医学课程开始时和结束时对这些学生进行测试,以确定他们的道德推理分数是否与接受正规教育的其他人有相同程度的提高。结果发现,在这4年的医学教育期间,这些学生的道德推理分数并未出现正常预期的提高,这表明他们的教育经历在某种程度上抑制了他们的道德推理能力,而非促进了这种能力。道德推理分数在315至482分之间,从第一年到第四年平均提高18.5分的结果在P≤0.05水平上无统计学意义。统计分析显示,在P≤0.05水平上,道德推理分数与年龄、性别、医学院入学考试分数或平均绩点分数之间无显著相关性。除了对科尔伯格的认知道德发展理论进行简要描述外,还对该研究结果给出了一些解读和解释。