Pilot study of the Defining Issues Test
=======================================

* William P. Fleisher
* Cheryl Kristjanson
* Gisele Bourgeois-Law
* Bryan Magwood

We have performed a preliminary study1 to examine whether the moral reasoning skills of medical students and residents change over the course of their training. We provide here some data for comparison with the results of Johane Patenaude and associates2 and the reports cited in their paper. Our group used the Defining Issues Test, version 2 (DIT-2),3,4 a short, validated, self-administered test for measuring such skills. The instrument was administered in 2001 to all first- and fourth-year medical students at the University of Manitoba, as well as to a random sample of first- and final-year medical residents. Confidentiality was assured by the use of unique identification numbers. Comparisons between groups and the data analysis were conducted by the Center for the Study of Ethical Development at the University of Minnesota, Minneapolis, which developed the DIT-2. The centre has shown that higher scores are linked to positive valuing of democratic ideals and to community and civic responsibility.5 In addition, orthopedic surgeons with higher scores had a significantly lower risk of malpractice claims.6

As was the case in the study by Patenaude and associates,2 there appeared to be little difference in moral reasoning skills between our first- and fourth-year medical students and those in the postgraduate years (Table 1), despite a generally well-rated ethics education program presented in the first 2 years of both the undergraduate and the postgraduate curricula. The DIT scores of the medical students and the residents were consistent with those of college level students (Table 1). 

View this table:
[Table1](http://www.cmaj.ca/content/169/11/1145.3/T1)

Table 1. 

We intend to continue this study over the next few years to track our current first-year undergraduate cohort, to see if these preliminary data are replicated in the future. If so, we as medical educators will need to consider how to promote the development of moral reasoning skills within the medical profession and other health care professions, to keep pace with growing demands for sophistication in this area.

**William P. Fleisher** Associate Dean Postgraduate Medical Education **Cheryl Kristjanson** Director of Educational Development Continuing Medical Education **Gisele Bourgeois-Law** Director Clinician Assessment Programs **Bryan Magwood** Coordinator Medical Humanities Programme Faculty of Medicine University of Manitoba Winnipeg, Man.

## References

1.  1. Kristjanson C, Bourgeois-Law G, Fleisher W, Magwood B. *Assessment of moral reasoning skills of medical students and residents* [abstract P41]. 2002 annual meeting of the Canadian Association for Medical Education; 2002 Apr 27-30; Calgary. Available: [www.acmc.ca/abstracts\_poster.html](http://www.acmc.ca/abstracts_poster.html) (accessed 2003 Jul 10). 
    
    

2.  2. Patenaude J, Niyonsenga T, Fafard D. Changes in students' moral development during medical school: a cohort study. CMAJ 2003;168(7):840-4.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjgvNy84NDAiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTY5LzExLzExNDUuMy5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

3.  3. Rest JR, Narvey D, Thoma J, Bebeau MJ. DIT2: devising and testing a revised instrument of moral judgement. J Educ Psychol 1999;91(4):644-59.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1037/0022-0663.91.4.644&link_type=DOI) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000084513400007&link_type=ISI) 

4.  4. Rest J, Narvaez D. *Guide for DIT-2*. Minneapolis: University of Minnesota, Center for the Study of Ethical Development; 1998.
    
    

5.  5. Rest J, Thoma SJ, Edwards L. Designing and validating a measure of moral judgment: stage preference and stage consistency approaches. J Educ Psychol 1997;89(1):5-28.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1037//0022-0663.89.1.5&link_type=DOI) 

6.  6. Baldwin DC Jr, Adamson TE, Self DJ, Sheehan TJ, Oppenberg AA. Moral reasoning and malpractice: a pilot study of orthopedic surgeons. Am J Orthopedics 1996;25(7):481-4.