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

Figures & data

Table

Practice points

Students’ level of reflective ability scores related to medicine decreased significantly over the course of the year. The greater or lesser an individual student's scores in RLS and BOR at the beginning, the greater or lesser the corresponding score will be at the end of the year. Students demonstrate a predominantly conventional level of moral reasoning at both the beginning and end of the year. Moral reasoning scores tended to decrease over the course of the year. RLS is a strong predictor of change in moral reasoning over time.

Figure 1. Kohlberg schema levels among students at beginning and end of the year.

Table 1.  Kohlberg Schema, RLS score and BOR score for the participant group at start and finish

	Kohlberg		RLS^a		BOR^b
	Start	Finish	Start	Finish	Start	Finish
Level*	N (%)	N (%)	M (SD)	M (SD)	M (SD)	M (SD)
1	1 (1.8%)	4 (7.1%)	60.0 (0.0)	63.8 (10.3)	2.0 (0.0)	3.8 (1.0)
1.5	6 (10.7%)	2 (3.6%)	46.5 (9.2)	52.5 (16.3)	3.5 (1.8)	5.6 (0.9)
2	44 (78.6%)	48 (85.7%)	61.9 (13.5)	62.6 (12.5)	5.4 (1.1)	4.5 (1.3)
2.5	2 (3.6%)	1 (1.8%)	54.5 (20.5)	70.0 (0.0)	4.6 (0.5)	2.8 (0.0)
3	3 (5.4%)	1 (1.8%)	66.3 (7.2)	81.0 (0.0)	4.3 (1.9)	3.0 (0.0)

Start: beginning of academic year. Finish: end of academic year.

*denotes Kohlberg ‘Schema Levels of Moral Reasoning’ where 1/1.5 equates preconventional levels, 2 equates the conventional level and 2.5/3 equates the postconventional levels of moral reasoning.

^aScore 0 < RLS > 98.

^bScore 0 < BOR > 10.

Table 2.  Paired-samples t-tests for Case Scenarios 1–4 (BOR)

	Start		End
	M	SD	M	SD	Df	T	p	Eta^2
CS 1	5.357	2.039	4.536	1.684	55	2.376	<0.05	0.10
CS 2	5.125	1.641	4.113	1.218	55	3.241	<0.05	0.14
CS 3	5.304	1.672	4.821	1.889	55	1.660	>0.05	0.01
CS 4	4.250	1.708	3.912	1.957	55	1.274	>0.05	0.07

Table 3.  Regression modelling for Kohlberg's schema at both beginning and end of the year

Factor	Beta	Part	p
Model 1: Beginning
RLS	0.396	0.384	<0.01
BOR	0.312	0.299	<0.05
Nationality	0.235	0.219	<0.05
Model 2: End
RLS	0.269	0.265	<0.05
BOR	0.212	0.209	>0.05

Table

1.	Carefully planned my learning tasks in the courses and training activities of the medical programme	1	2	3	4	5	6	7
2.	Talked with my colleagues about learning and methods of study	1	2	3	4	5	6	7
3.	Reviewed previously studied subjects during each term	1	2	3	4	5	6	7
4.	Integrated all topics in a course among themselves and with those of other courses and training activities	1	2	3	4	5	6	7
5.	Mentally processed what I already knew and what I needed to know about the topics or procedures	1	2	3	4	5	6	7
6.	Been aware of what I was learning and for what purposes	1	2	3	4	5	6	7
7.	Sought out interrelations between topics in order to construct more comprehensive notions about some theme	1	2	3	4	5	6	7
8.	Pondered over the meaning of the things I was studying and learning in relation to my personal experience	1	2	3	4	5	6	7
9.	Conscientiously sought to adapt myself to the varied demands of the different courses and training activities	1	2	3	4	5	6	7
10.	Systematically reflected about how I was studying and learning in different contexts and circumstances	1	2	3	4	5	6	7
11.	Mindfully summarised what I was learning day in, day out in my studies	1	2	3	4	5	6	7
12.	Exerted my capacity to reflect during a learning experience	1	2	3	4	5	6	7
13.	Diligently removed negative feelings in relation to aims, objects, behaviours, topics or problems pertaining to my studies	1	2	3	4	5	6	7
14.	Constructively self-assessed myself as a learner	1	2	3	4	5	6	7