Regression of Moral Reasoning during Medical Education: Combined Design Study to Evaluate the Effect of Clinical Study Years

BACKGROUND: Moral reasoning is important for developing medical professionalism but current evidence for the relationship between education and moral reasoning does not clearly apply to medical students. We used a combined study design to test the effect of clinical teaching on moral reasoning. METHODS: We used the Defining Issues Test-2 as a measure of moral judgment, with 3 general moral schemas: Personal Interest, Maintaining Norms, and Postconventional Schema. The test was applied to 3 consecutive cohorts of second year students in 2002 (n = 207), 2003 (n = 192), and 2004 (n = 139), and to 707 students of all 6 study years in 2004 cross-sectional study. We also tested 298 age-matched controls without university education. RESULTS: In the cross-sectional study, there was significant main effect of the study year for Postconventional (F(5,679) = 3.67, P = 0.003) and Personal Interest scores (F(5,679) = 3.38, P = 0.005). There was no effect of the study year for Maintaining Norms scores. 3(rd) year medical students scored higher on Postconventional schema score than all other study years (p<0.001). There were no statistically significant differences among 3 cohorts of 2(nd) year medical students, demonstrating the absence of cohort or point-of-measurement effects. Longitudinal study of 3 cohorts demonstrated that students regressed from Postconventional to Maintaining Norms schema-based reasoning after entering the clinical part of the curriculum. INTERPRETATION: Our study demonstrated direct causative relationship between the regression in moral reasoning development and clinical teaching during medical curriculum. The reasons may include hierarchical organization of clinical practice, specific nature of moral dilemmas faced by medical students, and hidden medical curriculum

Self-concept, identification and national identity

No description supplie

Trust in organizations — organizational, intergroup, and value research perspective

In this overview article, we discuss the importance of trust for organizations by employing a multilevel and multidisciplinary perspective. We complement and contribute to the existing reviews by (1) considering trust not only within and between individuals and organizations, but also at the societal level, (2) bridging findings and literature from the fields of organizational, intergroup, and value research, and (3) summarizing recent research on the dynamics of trust and its development in organizations. Related to contemplating trust at various levels, we present multiple topics such as individual’s tendency to trust, employees’ trust in leaders, trust between groups with examples from organizational mergers and interethnic relations, and the relationship between trust and societies’ economic competitiveness. We conclude by summarizing recent organizational literature about the development of trust, transfers of trust towards different levels of leadership, and reciprocity in employees’ trust and fairness perceptions. In so doing, we contribute to the means to promote trust, active citizenship and socially sustainable growth of organizations and our societies

Positive auto-sterotyping and self-construal as predictors of national identification

No description supplie

Self-esteem and values

The purpose of the present study was to connect personal values to self-esteem in 14 samples (N = 3612) of pre-professionals, high school students, and adults, from Finland, Russia, Switzerland, Italy, and Estonia. Self-enhancement values (power, achievement) and openness to change values (self-direction, stimulation) were positively, and self-transcendence values (universalism, benevolence) and conservation values (tradition) were negatively related to self-esteem. These direct relations between values and self-esteem were only partly consistent with predictions derived from Maslow's theory of growth and deficiency needs. In samples of pre-professionals, self-esteem was correlated with congruence between personal values and the prevailing values environment. On the group-level, endorsement of achievement and universalism values was more strongly and positively related to self-esteem in samples where these values were considered more important. In contrast, endorsement of self-direction and hedonism values was more strongly and positively related to self-esteem in samples where these values were considered less important. These group-level results are interpreted as suggesting that attainment of culturally significant goals may raise self-esteem, but that high self-esteem may be required for the pursuit of less socially desirable goals