Moral competence and medical education in contemporary times: a Brazilian study

Castro, Marcio Rodrigues de; Pereira, Alexandre de Araújo; Bataglia, Patrícia Unger Raphael

doi:10.1590/1983-80422022303551EN

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Research • Rev. Bioét. 30 (3) • Jul-Sep 2022 • https://doi.org/10.1590/1983-80422022303551EN copy

Moral competence and medical education in contemporary times: a Brazilian study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

To evaluate the moral competence of medical students, this article compares different moments of medical training, identifying sociodemographic and academic aspects related to this competence, then discussing the evaluation tool. This is a quantitative, cross-sectional and observational study, with application of the extended version of Lind’s Moral Competence Test and a socio-demographic and academic questionnaire. Low mean scores were identified in the periods evaluated—the first period’s mean was higher than the others—and behavior that deviates from the “physician’s dilemma” in relation to the others, regardless of the period. Low moral competency scores were detected in all periods evaluated, with decline or stagnation over the course and “segmentation phenomenon” of the test. No relevant correlation of sociodemographic and academic variables was identified. Finally, this study found scores for the initial periods lower than those described in the literature, suggesting a generational trend.

Keywords:
Education, medical; Ethics, medical; Moral development; Morals; Ethical analysis

		Descriptive measures
Dilemmas/period	n	Minimum	Maximum	Mean	Standard deviation
Total	–	–	–	–	–
1 ^st period	58.	2.3	45.1	15.7	10.5
5 ^th period	36	1.6	34.7	11.8	7.8
11 ^th /12 ^th periods	45	0.1	33.0	11.0	7.2
All	–	–	–	13.1 –	–
Conclusion:	p ^* * Probability of significance of the one-way analysis of variance, based on Welch’s robust test for equality of means, due to non-homogeneity of variances =0.019 – 1 ^st period>(5 ^th period=6 ^th year)
Worker/judge	–	–	–	–	–
1 ^st period	58	1.3	62.2	24.3	15.5
5 ^th period	36	0.5	44.2	19.8	10.7
11 ^th /12 ^th periods	45	0.6	55.1	16.8	11.0
All	–	–	–	20.7	–
Conclusion:	p ^* * Probability of significance of the one-way analysis of variance, based on Welch’s robust test for equality of means, due to non-homogeneity of variances =0.021 – 1 ^st period>6 ^th year
Doctor/judge	–	–	–	–	–
1 ^st period	58	1.6	49.4	16.0	11.6
5 ^th period	36	1.3	44.4	11.6	9.8
11 ^th /12 ^th periods	45	0.4	36.0	11.7	8.7
All	–	–	–	13.5	–
Conclusion:	p ^* * Probability of significance of the one-way analysis of variance, based on Welch’s robust test for equality of means, due to non-homogeneity of variances =0.068 – 1 ^st period=5 ^th period=6 ^th year
Worker/doctor	–	–	–	–	–
1 ^st period	58	2.0	52.8	19.4	12.8
5 ^th period	36	3.7	41.6	16.5	9.8
11 ^th /12 ^th periods	45	0.4	37.6	15.6	9.9
All	–	–	–	17.4	–
Conclusion:	p=0.198 – 1 ^st period=5 ^th period=6 ^th year
Worker	–	–	–	–	–
1 ^st period	58	2.1	81.2	39.4	22.6
5 ^th period	36	1.3	82.6	40.3	20.8
11 ^th /12 ^th periods	45	1.4	83.0	35.0	19.9
All	–	–	–	38.2	–
Conclusion:	p=0.463 – 1^stperiod=5^thperiod=6^thyear
Doctor	–	–	–	–	–
1 ^st period	58	0.7	88.0	22.9	17.7
5 ^th period	36	2.5	57.1	20.5	15.5
11 ^th /12 ^th periods	45	0.0	76.3	20.6	17.1
All	–	–	–	21.5	–
Conclusion:	p=0.715 – 1^stperiod=5^thperiod=6^thyear
Judge	–	–	–	–	–
1 ^st period	58	0.0	90.8	38.7	23.3
5 ^th period	36	0.5	74.5	30.0	21.0
11 ^th /12 ^th periods	45	2.2	64.6	28.3	17.3
All	–	–	–	33.3	–
Conclusion:	p=0.028 – 1 ^st period>6 ^th year

Classification	MCT C score	Course period
		1^st year		3^rd year		6^th year		General
		n	%	n	%	n	%	n	%
None	0.0 to 4.9	6	10.4	6	16.7	8	17.8	20	14.4
Very low	5.0 to 9.9	9	15.5	4	11.1	8	17.8	21	15.1
Low	10.0 to 19.9	20	34.5	14	38.9	14	31.1	48	34.5
Sufficient	20.0 to 29.9	10	17.2	9	25.0	10	22.2	29	20.9
High to very high	30.0 to 100	13	22.4	3	8.3	5	11.1	21	15.1
TOTAL		58	100.0	36	100.0	45	100.0	139	100.0

Period descriptive measures	Course
Period descriptive measures	Dilemma	n	Minimum	Maximum	Mean	Standard deviation
1 ^st period	Worker	58	2.1	81.2	39.4	22.6
	Doctor	58	0.7	88.0	22.9	17.7
	Judge	58	0.0	90.8	38.7	23.3
5 ^th period	Worker	36	1.3	82.6	40.3	20.8
	Doctor	36	2.5	57.1	20.5	15.5
	Judge	36	0.5	74.5	30.0	21.0
11 ^th /12 ^th periods	Worker	45	1.4	83.0	35.0	19.9
	Doctor	45	0.0	76.3	20.6	17.1
	Judge	45	2.2	64.6	28.3	17.3
ANOVA result based on a model with 2 independent factors:
Variation source:	Period – (F_{2; 118}=1.225; p=0.298)
	Dilemma×period – (F_{4; 236}=1.065; p=0.374)
	Dilemma – (F _{2; 236} =21.656; p<0.001)

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[1] Correspondence Marcio Rodrigues de Castro – Av. Japão, 309, Cariru CEP 35160-068. Ipatinga/MG, Brasil.