Electronic letters to:

Research:
Johane Patenaude, Theophile Niyonsenga, and Diane Fafard
Changes in students' moral development during medical school: a cohort study
CMAJ 2003; 168: 840-844 [Abstract] [Full text] [PDF]
*eLetters: Submit a response to this article

Electronic letters published:

[Read eLetter] Ethics Prior to Medical School
Donald L. Potvin   (27 June 2003)
[Read eLetter] Morality Requires Selflessness
Irene Fricker, BS, MS   (1 April 2003)

Ethics Prior to Medical School 27 June 2003
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Donald L. Potvin,
Assistant Professor Family Medicine
Queen's University

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Re: Ethics Prior to Medical School

potvind{at}post.queensu.ca Donald L. Potvin

To the Editor CMAJ

In reading the article by Patenaude et al. regarding the lack of advancement on Kohlberg’s moral development scale through medical school, I was disappointed, but not surprised.

Like Dr. Peter Singer , I have observed very high levels of ethical behaviour in students and residents at times. I have also witnessed from staff, and no doubt modelled myself, less than ideal professional ethical behaviour at times.

While “admitting students who have high levels of ethics and professionalism in the first place” 1 is desireable, I wonder if it will not be a strategy that comes too late. Competition to get into medical school is great. With the stakes so high, we hear about unethical behaviour in the premedical programs. Ideals of cooperation, mutual respect and interdependence that we encourage in the graduate physician may not be highly evident in traditional premedical classes. Are our selection processes biased against those who would rank higher on Kohlberg’s stages, in favour of those who are more likely to put themselves first?

In medical shool, the collegial atmosphere of cooperation and support nurtured in the first two years of medical training seems to diminish in the face of senior year competition for preferred residencies. Might this have an impact on the moral development of a cohort as well?

Although teaching and modelling ethical behaviour is essential, a further challenge will be how to practically integrate this ethical teaching, and its evaluation, into assessments that will have a tangible impact on selection to medical school, matching to postgraduate training programs, and eventually to physician performance. A further question might be whether these changes in ethical development are similar in other competetive professional programs such as law.

Morality Requires Selflessness 1 April 2003
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Irene Fricker, BS, MS,
Accountant/Student
Baltimore, Maryland, USA

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Re: Morality Requires Selflessness

irene.fricker{at}ssa.gov Irene Fricker, BS, MS

Dear CMAJ,

I read with interest, but not suprise, Patenaude, Niyonsenga and Fafard's survey results showing medical students' moral regression. I currently work full time and take nursing school college pre-requisites at night. While studying Anatomy & Physiology, I was totally consumed with it. I had no social life, I forgot important birthdays, failed to pay my bills and with no time to shop, I wrote checks for Christmas presents. I was in a constant state of preoccupation and sleep deprivation. As I drove or sat in meetings, I was thinking, "Olfactory, Optic, Oculomotor..." or "foramen ovale, ductus arteriorus, ductus venosus" or "I'd give anything for some sleep".

A higher sense of morality requires one to think beyond one's self. Yet, the rigors of medical study require the student to become totally self-absorbed. To be able to attend to the needs of others, we must first have our own basic needs met (Pavlov's Hierarchy of Needs). But, the medical student often lacks the most basic human requirements of sleep and proper nutrition.

I hope the researchers continue to follow these students to see if their moral development rebounds once they've completed their educations.