의과대학 초기에 전문직정체성 측정하기(Med Teach, 2016)
Measuring professional identity formation early in medical school
Adina Kaleta, Lynn Buckvar-Keltza, Victoria Harnikb, Verna Monsonc, Steven Hubbardb, Ruth Crowea,
Hyuksoon S. Songd and Sandra Yinglingb,e
aDivision of General Internal Medicine and Clinical Innovation, New York University School of Medicine, New York, NY, USA; bNew York University School of Medicine, New York, NY, USA; cMonson Consulting and Evaluation, Minneapolis, MN, USA; dDepartment of Education, Georgian Court University, Lakewood, NJ, USA; eDepartment of Medical Education, University of Illinois College of Medicine, Chicago, IL, USA
도입
Introduction
의료 전문 직업적 정체성은 "의료 직업의 특성, 가치 및 규범이 내면화되는 시간이 지남에 따라 단계적으로 달성 된 자아의 표현"으로 정의되었다 (Cruess et al., 2014). 전문직 정체성 형성 (PIF)은 발달적 구조로서 신뢰성있고 의미있게 측정 될 수 있으며, 우리는 그 발달에 기여하는 것을 더 잘 연구 할 수 있을 뿐만 아니라, 의학 프로페셔널리즘에 대한 훈련생의 숙달을 명시적으로 지원하는 방법을 이해할 수있을 것입니다.
medical professional identity has been defined as a “… representation of self, achieved in stages over time during which the characteristics, values, and norms of the medical profession are internalized” (Cruess et al. 2014). If professional identity formation (PIF) can be reliably and meaningfully measured as a developmental construct, we will be better able to study what contributes to that development as well as understand how to explicitly support trainees’ mastery towards medical professionalism.
의대생은 의사가 되어간다. 여러 다른 정체성과 더불어서, 직업적 정체성을 형성하는 방식은 현재와 미래의 웰빙과 관계에 중요합니다 (Monrouxe 2010). 이것은 모두 역동적인 개인적, 복잡한 대인관계 및 사회문화적, 고도로 주관적인 발달 과정입니다.
Medical students are becoming physicians. The ways in which they form their professional identity along with multiple other identities matters to their present and future well-being and relationships (Monrouxe 2010). This is both, a dynamic personal as well as a complex interpersonal and socio-cultural, highly subjective developmental process.
일부 이론가들은, 초기 성인에게 있어서, PIF는 대체로 의과대학 지원과정에서 강화 된 외부적으로 정의된 과정이며, 이 과정은 대단히 경쟁이 심하고, 개인의 성취를 중시하는 과정이다. 그 결과 이 초기 성인기의 지원자들은 "외부에서 정의되고 개인에게 집중되는 업적"을 강조하는 전문직에 들어서는 압력을 받게 되는 것입니다. 의학교육자들은 이 학생들을 PIF와 도덕적 추론의 초기 단계에서 효과적이면서 이타주의적인 의사, 사회적 정의를 지향하는 의사라는 상위단계로 안내하는 중요한 임무를 수행합니다 (Jarvis-Selinger 외. 2012).
Some theorists posit that early on, in young adults, PIF is a largely externally defined process reinforced in the application process to medical school, which is highly competitive and emphasizes personal achievement. This pressures young adults seeking entr ee into the profession to focus on achievements that are externally defined and individually focused. Medical educators have the important task of guiding these students from early stages in PIF and moral reasoning toward the advanced stages needed to become effective, altruistic physicians, and social justice oriented (Jarvis-Selinger et al. 2012).
최근 강조되는 PIF는 프로페셔널리즘 교육은 학생들이 종종 깊은 생각과 헌신없이 생성하는 "가치와 행동 목록"으로 구성된 피상적 노력으로 간주될 수 있다는 우려를 제기합니다 (Wynia 외 2014). 강건하고 회복탄력적인 의료 전문직 정체성 (Goldie 2012, Holden et al 2015)의 발전을 장려하기 위해 부유하고, 종단적이고, 다중적 방식의 교육 과정이 시행되고 있지만, 벤치 마크 측정은 아직 이용 가능하지 않다.
The recent focus on PIF addresses the concern that professionalism education often has been seen as a superficial effort consisting of “lists of values and behaviors” that can be generated by students with insufficient depth of thought and commitment (Wynia et al. 2014). Rich, longitudinal, multi-method curricula are being implemented to encourage the development of a hardy, resilient medical professional identity (Goldie 2012; Holden et al. 2015), but benchmark measures are not yet available.
의학 및 기타 전문 학교에서 PIF를 강조하는 움직임은 부분적으로는 "아는 것"과 "하는 것"의 gap을 연구 한 도덕 심리학자 연구에서 유래합니다. 개인이 직업의 가치에 따라 행동해야 한다는 강한 믿음을 가질 수는 있지만, 그 신념이 자신의 정체성에 깊이 뿌리 내리지 않은 경우, 이것만으로 행동을 보장하기에는 불충분합니다 (Blasi 1980, 2004). 우리는 시간에 걸쳐 변화하는 PIF를 측정하려고했기 때문에, '정체성 발달'이란 의과대학 입학하기 전부터 시작되어 그 이후로 전문직 생에에 결처 진행되는 인지적, 사회적, 감정적인 능력을 통합하는 평생의 과정이라고 제안한 건설적 발달 이론가인 로버트 케간 (Robert Kegan)의 연구에서 비롯된 프레임 워크를 선택했습니다 (Kegan 1982; Bebeau 2006).
The movement to emphasize PIF in medical and other professional schools stems in part from the work of moral psychologists who studied the gap between “knowing and doing,” noting that the individuals may profess strong beliefs in acting according to the values of a profession, but beliefs alone are insufficient to ensure behaviors if they are not deeply rooted in one’s identity (Blasi 1980, 2004). Because we were seeking to measure PIF over time, we have chosen a framework stemming from the work of constructive developmental theorist Robert Kegan, who proposed that identity development is a life long and process of integrating cognitive, social, emotional capacities which begins before entering professional school and continues throughout professional life (Kegan 1982; Bebeau 2006).
직업적 정체성 에세이 (PIE)는 사회에서의 전문직 역할에 대한 개념화를 도출하고 전문직 교육 (표 1 참조) (Kegan 1982)에서 사용하기에 적합한 Kegan 이론의 단계를 측정합니다. 학생들은 고도로 숙련 된 전문가가 전체 문서에 Kegan 무대 점수를 할당하는 기초가되는 7 가지 프롬프트 (표 2)에 대한 간단한 서술 응답을 작성합니다.
The professional identity essay (PIE) elicits a respondent’s conceptualization of a professional role in society and measures the stages of Kegan’s theory adapted for use in professional education (See Table 1) (Kegan 1982). Students write brief narrative responses to seven prompts (Table 2), which are the basis for assigning an overall Kegan stage score to that document by a highly trained expert.
치과대학 학생 정체성 에세이의 내용 분석에서 Monson, Roehrich 및 Bebeau는 3-4 단계 (코호트의 37 %를 대표하는)의 치과대학생이 의료의 격차를 줄이고, 의료가 필요한 사람을 위해 봉사할 것이라고 기술했기 때문에, 학생들을 보다 복잡한 정체성 단계로의 성장할 수 있도록 촉진하는 것이 중요함을 지지하였다(Monson et al., 2008).
In a content analysis of dental student identity essays, Monson, Roehrich, and Bebeau found that dental students at stage 3–4 (representing 37 percent of a cohort) were more likely to state that they expected to make a contribution to society in reducing healthcare disparities, serving medical assistance patients, and volunteering to help those in need, supporting the importance of promoting growth towards more complex stages of identity (Monson et al. 2008).
Table 1. Kegan stages: the four broad levels of mental complexity relevant for professional education.
Table 2. The PIE instructions and prompts (modified for use in medicine).
도덕적 추론
Moral reasoning
의학에서의 도덕적 딜레마에는 대개 단 하나의 정답만 있는 것이 아니다. 성숙한 전문가들은 개인적 관심사라든가, 좁게 정의된 규칙보다는, 윤리적 또는 전문적 원칙에 기초하여 그러한 딜레마에 대처하는 경향이있다 (Rest 1986, 1994; Beauchamp & Childress 2001). 우려되는 것은 medical training이 도덕적 딜레마에 대한 감수성을 무디게하고 도덕적으로 성장할 것으로 예상되는 나이와 교육 추론을 늦추는 것이다 (Self et al., 1993; Patenaude et al., 2003; Bebeau & Faber-Langendoen 2014; Murrell 2014).
Moral dilemmas in medicine typically do not have a single right answer. Mature professionals tend to respond to such dilemmas based on ethical or professional principles, rather than personal interest or narrowly defined rules (Rest 1986, 1994; Beauchamp & Childress 2001). Of concern is that medical training blunts sensitivity to moral dilemmas and slows the expected age and education reasoning based growth in moral (Self et al. 1993; Patenaude et al. 2003; Bebeau & Faber-Langendoen 2014; Murrell 2014).
이슈 정의 테스트 (DIT2)는 도덕적 문제에 직면할 때 개인이 설득력있는 것으로 보이는 도덕적 논증의 유형을 측정하는 것으로, 도덕적 판단의 척도이다. 그러나 이는 도덕적 행동에 필수적이지만 충분하지는 않습니다 (Bebeau 2002).
The defining issues test (DIT2) measures the types of moral arguments an individual finds persuasive when confronted with a moral problem and therefore is a measure of moral judgment – a necessary but not sufficient component of moral behavior (Bebeau 2002).
행동에 대한 정당화는 세 가지 일반적인 도덕적 스키마로 묶이는 경향이 있습니다.
개인의 이익을 보호하고 (PI),
규칙과 규범을 지키고 (MN),
보편적인 윤리적 원칙을 적용하는 것(흔히 "포스트 관습적 사고"라고 불리며 N2 점수로 측정 됨)
Justifications for actions tend to cluster in three general moral schemas based on: protecting personal interests maintaining (PI), upholding rules and norms (MN), and applying universal ethical principles (often referred to as “post-conventional thinking” and measured as N2 scores).
PIF와 도덕적 개발 이론적 틀 모두가 건설적인 발달 이론 (예 : Piaget, Kohlberg)에서 공유 된 기초를 가지고 있다고 가정 할 때, 우리는 그것들이 상호 연관 될 것으로 기대할 수 있다.
Given that both PIF and moral development theoretical frameworks have a shared basis in constructive developmental theories (e.g. Piaget, Kohlberg), we would expect them to be correlated.
Methods
교육과정 맥락
Curricular context
A decade ago, along with many medical schools, we implemented a case-based and student-led professionalism curriculum spanning our four-year curriculum (Horlick et al. 2009) and an online portfolio to promote learners’ professional development (Kalet et al. 2007).
In 2015, (class of 2019), we introduced PIF during orientation, using the framework of Cruess (Cruess et al. 2014) and Bebeau (Bebeau & Faber-Langendoen 2014).
To facilitate self-awareness students completed both the PIE and the DIT2. On average, students completed both instruments within an hour.
Three weeks later, students received a detailed, individualized, six-page narrative feedback report from an expert (VM) (See Supplementary Appendix).
During a large-group debriefing session, the concepts of PIF were reviewed and students wrote portfolio reflections to the following prompts:
“Now that you have received your feedback, write your first impressions of your PIE and DIT2 information – What surprised you? What “rings true”? What information is helpful to you?”
채점과 분석
Scoring and data analysis
전문직 정체성 에세이
Professional identity essay scoring
PIEs were scored by a lifespan, developmental educational psychologist (VM) with expertise in measurement of moral capacities in professional education (Lahey et al. 1988; Bebeau & Monson 2012). Each student was assigned a Kegan PIF stage score in an individualized report with narrative feedback to each student. Five months later, the primary rater (VM) re-rated and a second trained rater rated 12 randomly selected PIEs (10%) to establish reliability (inter-rater ICC 0.83, 95% CI [0.57–0.96], intra-rater ICC 0.85, 95% CI [0.50–0.93]).
DIT 점수
Defining issues test scoring
The Center for the Study of Ethical Development at the University of Alabama (Development) scored DIT2s using established algorithms and provided metrics of students’ preferred moral schema (personal interest, maintaining norms, post conventional (N2)). For simplicity in this paper we report only the N2 score, which reflects the proportion of time students applied a social contract orientation or universal principles approach to the cases.
양적 분석
Quantitative
질적 분석
Qualitative
A directed and summative content analysis of students’ reflections was conducted by two readers (SY, RC) (Hsieh & Shannon 2005).
The first reader (SY) defined a set of thematic categories and subcategories (Table 3) which were then grouped into three clusters:
긍정적 반응 positive responses (student reported feeling positive about the exercise, or feeling positive about the journey ahead of them in medical school),
중립적 반응 neutral responses (student discussed metrics, had an analytic approach to their data), and
부정적 반응 negative responses (students reported disappointment with their feedback, or reported feeling negative or confused about the exercise).
After a training set (30) during which two readers (SY, RC) discussed disagreements to they resolve discrepancies, each independently applied the code categories to each student’s reflections.
Table 3 shows the frequency for the 9 of 17 response categories that showed adequate inter-rater reliability (Cohen’s kappa >0.300) (Landis & Koch 1977). The remaining categories were useful for descriptive purposes and hypothesis generation.
결과
Results
The correlation between N2 score and Kegan PIF stage was q¼ 0.18 (p¼0.03). The mean DIT N2 differed by Kegan PIF stages (early, 52.0 (SD¼11.8) vs. late, 56.0 (SD¼11.1) (p¼0.046).
내용 분석과 DIT 점수
Content analysis of student reflective writing on PIE stage and DIT score report
Table 3 lists identified themes. Of the 130 students,
117 (90%) reported positive reactions to the PIF curriculum.
Mixed negative reactions (28/130, 21%, not mutually exclusive) included confusion, concern about future training, or dissatisfaction with the gap between their self-perception and the results.
Very few reported only negative reactions. Students who described an analytic approach to evaluating their feedback tended not to report negative reactions, even when they were surprised by the feedback.
고찰
Discussion
우리는 각 학생에게 PIF 단계를 제공하고, 선호하는 도덕적 추론 스키마 및 개별화 된 피드백을 제공하는 것이 타당하다는 것을 발견했습니다. 이 접근 방식은 학생들에게 받아 들여지고 흥미로우며 잠재적으로 역량 기반 전문성 커리큘럼에 대한 접근 방식으로 유용합니다.
We found that it was feasible to provide each student with a PIF stage, their preferred moral reasoning schema and individualized feedback. This approach is acceptable and intriguing to our students and potentially has utility as an approach to competency-based professionalism curricula.
우리 학생들의 Kegan PIF 단계 분포는 다른 비슷한 연령대의 전문직 학생과 유사합니다 (Bebeau & Monson 2012). other-defined 정체성에서 self-defined 정체성 (단계 3-4)으로 바뀌는 것은 완전히 발달 된 직업적 정체성의 신호이다(Bebeau 2008). 엄격하게 나이에 좌우되지는 않지만, 대부분의 북미 의사들은 레지던트 훈련 후인 30 대 초중반 사이에 이러한 shift가 가장 자주 발생합니다. 따라서 우리는 의사들에게 PIF에 대한 장기적인 관점을 가져야합니다. 일반 인구의 많은 성인들이 케건의 청소년기 (2 단계, 13 %) 또는 초기 성인기 (3 단계, 46 %)와 1 % 미만의 단계 (5 단계 Kegan & Lahey 2009)를 벗어나 발전하지 못합니다.
The distribution of the Kegan PIF stages among our students is similar to that of other age-comparable professional students (Bebeau & Monson 2012). Fully-developed professional identity is signaled by the shift from ther- to self-defined identity (stage 3–4) (Bebeau 2008). While not strictly age-dependent, this shift most often takes place at the age of early- to mid-30s – which is after residency training for most North American physicians. So we must take a long-term view of PIF in physicians. Many adults in the general population do not develop beyond the Kegan stages of adolescence (stage 2, 13%) or early adulthood (stage 3, 46%) and less than 1% achieve stage 5 (Kegan & Lahey 2009).
그러나 의사들이 우리의 사회적 계약을 존중하기 위해 평균 성인보다 더 높은 수준에 도달해야하느냐에 대해서는 논쟁의 여지가 있습니다. 도덕적 정체성에 대한 연구에서 PIF의 후기 단계에있는 사람들은
다른 사람들에게 봉사하는 데 집중할 가능성이 높고,
관심사가 이기심에 의해 동기 부여될 가능성이 낮으며,
동료들에 의해서 효과적이라고 인식될 가능성이 높고,
잠재 커리큘럼(알려진 것과 실제로 가르쳐지는 것) 사이의 단절에 덜 취약합니다(Kegan & Lahey 2016).
However, it is arguable that physicians must reach higher levels than the average adult to honor our social contract. In studies of moral identity, those at later-stages of PIF are
more likely to focus on service to others,
less likely to articulate concerns motivated by self-interest,
be perceived as more effective by peers (Kegan & Lahey 2016), and
less vulnerable to the disconnect between what is taught and what is actually practiced – known as the hidden curriculum (Kegan & Lahey 2016).
일반적으로 우리 학생들은 exercise에 의해서 활성화되었고, 그들의 baseline PIF에 대해 알게되었습니다. PIF 피드백에 대한 분석적 접근과 초보자로서의 자신에 대한 인식을 가진 사람들은 (숙달 획득에 대한 기대를 포함하여) 정서적으로 긍정적 인 반응을 나타내는 경향이있었습니다. 개인화된 PIF 단계 데이터는 '프로페셔널리즘의 결여'에 초점을 맞춘 대화를 '전문적 "지혜"' 개발에 대한 숙달 접근법에 대한 대화로 확대 시켰습니다(Rees, 2005; McGaghie 2015).
In general, our students were activated by the exercise and intrigued to learn about their baseline PIF. Those with an analytical approach to their PIF feedback and an awareness of themselves as novices tended to have emotionally positive responses, including anticipation of acquiring mastery. Personalized PIF stage data expanded the conversation beyond a focus on lapses in professionalism into a conversation about a mastery approach to the development of professional “wisdom” (Rees, 2005; McGaghie 2015).
생각 지도자는 성인 발달의 선형 단계 모델이 너무 단순하다고 지적하며 (Rees 2005), 우리는 여기에 동의합니다. 우리는 의대생의 PIF가 부드럽거나 예측가능하거나 선형적인 방식으로 진행될 것으로 예상하지 않으며, 경로는 개별화되어있고, 맥락에 민감할 것이라고 생각한다. 그러나 아직 알려지지 않았기 때문에 우리가 이 연구를 한 것이다.
예상보다 낮은 PIF 무대 점수를 받은 소수의 학생들이 실망한 것은, 이것이 평생 성장 단계가 아니라 결함이라는 인식을 반영 할 수 있습니다. 이러한 입장은 학습을 방해 할 수 있습니다 (Blackwell 외. 2007). 의대생은 개인 성취도에 따라 선발되기 때문에, 개인 성취도에 중점을 둔 의대 진학이 적절합니다. 그러나 그들은 사회 계약에 의해서 정의 된 의료 전문직의 원칙과 가치에 헌신하는 방향으로 옮겨가야 한다. 이것은 실천 공동체의 구성원이 되는 복잡성을 address하겠다는 의지를 의미합니다 (Hafferty & Levinson 2008; Levinson 외 2014).
The disappointment of a small number of students receiving earlier than expected PIF stage scores may reflect their perception that this is a flaw rather than stage in life-long growth. This stance can interfere with learning (Blackwell et al. 2007). Since medical students are selected based on their individual accomplishments, it is appropriate for them to enter medical school focused on personal achievement. However, they must move on to commit to the principles and values of the medical profession as defined by our social contract. This means a commitment to addressing the complexities of being a member of the community of practice (Hafferty & Levinson 2008; Levinson et al. 2014).
학생들이 피드백을 찾고 자신의 전문성 개발에 관한 대화에 참여하는 학습 문화를 통해서 [자신의 정체성은 완벽하거나 거의 완벽한 성취에 의해서만 보여진다로 느끼는 학생들]이 사고 방식을 바꾸는 것을 가능하게합니다. 이러한 방식으로 자기를 돌아볼 수 있는 의사들은 의료의 문화를 경쟁적 문화를 협력적 문화로 변화시키기 위해서 필요하다 (Hafferty & Castellani 2010). 왜냐하면 이러한 문화는 환자의 건강은 물론, 점점 경쟁이 치열해지는 시장에서의 조직의 생존 능력과도 연관되어 있기 때문이다(Brennan & Monson 2014).
A learning culture in which students seek feedback and engage in dialog about their professional development enables the needed shift in mindset for students who feel their identity is only reflected in perfect or near perfect achievements. Physicians capable of such introspection are needed to lead change in the culture of medical practice from competitive to cooperative (Hafferty & Castellani 2010), because such a culture is associated with improved outcomes for both the health of patients and organizations’ ability to thrive in an increasingly competitive marketplace (Brennan & Monson 2014).
Conclusions
전통적으로 의학 전문 직업에 대한 가르침은 미덕, 성격 "특성"및 예상되는 행동에 초점을두고 있습니다. 수십 년 동안 우리는 전문성의 행동적 징후를 해체하고 측정 가능한 역량을 생성해냈다 (Irby & Hamstra 2016). 도덕적 추론과 전문적인 가치에 헌신하는 능력이 강할수록 medical trainee는 전문성의 결여를 초래할 수있는 상황 요인 (예 : 피로, 모호함, 정서적 스트레스)에 덜 susceptible해질 수 있다. 성격 및 행동 관점에, 심리적 발달적 구조를 추가함으로써, 우리는 직업적 정체성과 전문성을 이해할 수 있으며, 더 중요한 것은 학생이 어떻게 "의사처럼 생각하고 행동하고 느끼는"과정에 영향을 미칠 수 있는가를 학습 할 수 있습니다 (Cruess et al., 2014).
Traditionally, teaching about medical professionalism is focused on virtues, character “traits”, and expected behaviors. Over several decades, we have deconstructed the behavioral manifestations of professionalism and created measurable competencies (Irby & Hamstra 2016). A strong capacity for moral reasoning and commitment to professional values makes medical trainees less susceptible to situational factors (e.g. fatigue, ambiguity, emotional stress), which may cause lapses in professionalism. By adding a psychological development framework to character and behavior perspectives, we can better understand professional identity and professionalism and, more importantly, how the students themselves can influence the process of being able to “think, act, and feel like a physician” (Cruess et al. 2014).
Glossary
전문직 정체성 형성
Professional Identify Formation:
Medical professional identify formation (PIF) is both a process of personal development and a social construction and has long been claimed to be the fundamental goal of the learning process in medical education (Cooke et al. 2010).
In 1957, Merton stated that the task of medical education is to provide the medical trainee “with a professional identity so that he comes to think, act, and feel like a physician” (as quoted by Cruess et al. (2016), italics theirs).”
It has been further defined as an ongoing, self-reflective process aimed at developing habits of “thinking, feeling and acting” that allow learners to be compassionate and socially responsible physicians (Cooke 2010 quoting Ware and Castelini 2000).
A staged, developmental framework for PIF has been applied in health professions education (Bebeau & FaberLangendoen 2014). There is an enthusiastic dialog in the medical education literature about whether PIF can be measured. And it was recently proposed that we add PIF to the tip of Miller’s Pyramid for the assessment of clinical competence and performance (Cruess et al. 2016).
Bebeau MJ, Faber-Langendoen K. 2014. Remediating lapses in professionalism. In: Kalet A, Chou C, editors. Remediation in medical education. New York: Springer; p. 103–127. XXX
McGaghie WC. 2015. Mastery learning: it is time for medical education to join the 21st century. Acad Med. 90:1438–1441.
Goldie J. 2012. The formation of professional identity in medical students: considerations for educators. Med Teach. 34:e641–e648.
Wynia MK, Papadakis MA, Sullivan WM, Hafferty FW. 2014. More than a list of values and desired behaviors: a foundational understanding of medical professionalism. Acad Med. 89:712–714.
Med Teach. 2017 Mar;39(3):255-261. doi: 10.1080/0142159X.2017.1270437. Epub 2016 Dec 30.
Measuring professional identity formation early in medical school.
Author information
- 1
- a Division of General Internal Medicine and Clinical Innovation , New York University School of Medicine , New York , NY , USA.
- 2
- b New York University School of Medicine , New York , NY , USA.
- 3
- c Monson Consulting and Evaluation , Minneapolis , MN , USA.
- 4
- d Department of Education , Georgian Court University , Lakewood , NJ , USA.
- 5
- e Department of Medical Education , University of Illinois College of Medicine , Chicago , IL , USA.
Abstract
AIM:
To assess the feasibility and utility of measuring baseline professional identity formation (PIF) in a theory-based professionalism curriculum for early medical students.
METHODS:
All 132 entering students completed the professional identity essay (PIE) and the defining issues test (DIT2). Students received score reports with individualized narrative feedback and wrote a structured reflection after a large-group session in which the PIF construct was reviewed. Analysis of PIEs resulted in assignment of a full or transitional PIF stage (1-5). The DIT2 score reflects the proportion of the time students used universal ethical principles to justify a response to 6 moral dilemma cases. Students' reflections were content analyzed.
RESULTS:
PIF scores were distributed across stage 2/3, stage 3, stage 3/4, and stage 4. No student scores were in stages 1, 2, 4/5, or 5. The mean DIT2 score was 53% (range 9.7?76.5%); the correlation between PIF stage and DIT score was ρ = 0.18 (p = 0.03). Students who took an analytic approach to the data and demonstrated both awareness that they are novices and anticipation of continued PIF tended to respond more positively to the feedback.
CONCLUSIONS:
These PIF scores distributed similarly to novice students in other professions. Developmental-theory based PIF and moral reasoning measures are related. Students reflected on these measures in meaningful ways suggesting utility of measuring PIF scores in medical education.
- PMID:
- 28033728
- DOI:
- 10.1080/0142159X.2017.1270437
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