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Research

Changes in students' moral development during medical school: a cohort study

Johane Patenaude, Theophile Niyonsenga and Diane Fafard
CMAJ April 01, 2003 168 (7) 840-844;
Johane Patenaude
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Theophile Niyonsenga
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Diane Fafard
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  • Ethics Prior to Medical School
    Donald L. Potvin
    Posted on: 27 June 2003
  • Morality Requires Selflessness
    Irene Fricker, BS, MS
    Posted on: 01 April 2003
  • Posted on: (27 June 2003)
    Page navigation anchor for Ethics Prior to Medical School
    Ethics Prior to Medical School
    • Donald L. Potvin, Assistant Professor Family Medicine

    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 profession...

    Show More

    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.

    Show Less
    Competing Interests: None declared.
  • Posted on: (1 April 2003)
    Page navigation anchor for Morality Requires Selflessness
    Morality Requires Selflessness
    • Irene Fricker, BS, MS, Accountant/Student

    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 ch...

    Show More

    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.

    Show Less
    Competing Interests: None declared.
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Vol. 168, Issue 7
1 Apr 2003
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Changes in students' moral development during medical school: a cohort study
Johane Patenaude, Theophile Niyonsenga, Diane Fafard
CMAJ Apr 2003, 168 (7) 840-844;

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Changes in students' moral development during medical school: a cohort study
Johane Patenaude, Theophile Niyonsenga, Diane Fafard
CMAJ Apr 2003, 168 (7) 840-844;
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