The Effect of Medical Students' Moral Identity on Their Predisposition to Ethical Values

Abstract

Objective: The aim of this study was to investigate the relationships between medical students’ predispositions toward ethical values and moral identity and the sociodemographic factors affecting these predispositions. Methods: The population of this descriptive study consisted of first-year medical faculty students. The participants were administered the sociodemographic information form prepared by the researchers, the Disposition to Ethical Values Scale (EVPS) and the Moral Identity Scale (MIS). Results: The mean age of the 151 medical students who participated in the study was 18.9±0.9 years. There was no statistically significant relationship between the sociodemographic characteristics of the participants and the mean scores of the internalization and symbolization subscales of the MIS (P > .05). The mean score of the justice-honesty subscale (21.4±3.2) of students whose income was less than their expenses was higher than that of those whose income was equal to their expenses (18.1±4.2) and greater than their expenses (20.0±3.6). The mean score of the cooperation subscale (10.9±2.5) of the students whose mother's education level was high school and below was higher than that of the students whose mother was a university graduate (10.1±2.4). A significant positive correlation between the MIS and EVPS was found (r=0.226, P = .005). Conclusions: The levels of ethical sensitivity and moral identity of the medical students in this study were above average. Ethical sensitivity and moral identity were not influenced by sociodemographic variables. Ones who have greater moral identity are also more sensitive to ethics.

Keywords

• ethical sensitivity
• moral identity
• medical students

References

1. Cevizci A. Etiğe Giriş. Paradigma Yayıncılık, İkinci Baskı, İstanbul. 2008:5,
2. Losa Iglesias ME, Becerro de Bengoa Vallejo R, Fuentes PS, Trepal MJ. Comparative analysis of moral distress and values of the work organization between American and Spanish pediatric physicians. J Am Podiatr Med Assoc. 2012;102(1):57–63.
3. Abbasi M, Nejadsarvari N, Kiani M, et al. Moral distress in physicians practicing in hospitals affiliated to medical sciences universities. Iran Red Crescent Med J. 2014;16(10).
4. Cetin M, Cimen M. Assessing a group of physicians' ethical sensitivity in Turkey. Iran J Public Health. 2011;40(3):89–97.
5. Basaran CH. The Construction of the Physician's Presumed Moral Identity and the History of the Obligation to Care for All. New Research in the History of Medicine. 2023; 26(28): 75-114.
6. Kaya IS, Gocen N, Bingol G, Parlakyıldız T, Arslan B. The Meanings Attributed to the Concepts Related to Values by Students at Different Levels of Education. Int J Soc Res. 2017;10(52):743-772.
7. Tas F. University Students' Predisposition to Ethical Values and Related Factors. KSÜSBD 2018;15(2):627-42.
8. Hardy SA. Identity, Reasoning, and Emotion: An Empirical Comparison of Three Sources of Moral Motivation. Motivation and Emotion. 2006;30(3):205-213.

9. Hardy SA, Carlo G. (2011). Moral identity. In S. J. Schwartz, K. Luyckx, & V. L. Vignoles (Eds.), Handbook of identity theory and research (p. 495–513). Springer Science + Business Media. https://doi.org/10.1007/978-1-4419-7988-9_19
10. Krettenauer T, Hertz S. What Develops in Moral Identities? A Critical Review. Human Development 2015;58:137-153
11. Shao R, Aquino K, Freeman D. Beyond Moral Reasoning: A Review of Moral Identity Research and Its Implications for Business Ethics, Business Ethics Quarterly, Cambridge University Press, 2008;18(4):513-540
12. Lapsley D. Moral Identity and Developmental. Human Develop. 2015; 58: 164-71.
13. Hardy SA, Francis SW, Zamboanga BL, Kim SY, Anderson SG, Forthun LF. The roles of identity formation and moral identity in college student mental health, health-risk behaviors, and psychological well-being. J Clin Psychol. 2013;69(4):364-382. doi:10.1002/jclp.21913
14. Kaya I. Disposition to Ethical Values Scale: Validity and Reliability Study. Int J Soc Res. 2015;8(41):968- 974.
15. Aquino K. Reed A. II. The self-importance of moral identity. J Person Soc Psychol. 2002;83:1423-40.
16. Yılmaz F, Yılmaz F. Validity and Reliability Study of Moral Identity Scale Turkish Form. CBU J Soc Sci . 2015;13(4):112-34.
17. Manson H. The need for medical ethics education in family medicine training. Fam Med. 2008;40(9):658-64.
18. Manson HM, Satin D, Nelson V, Vadiveloo T. Ethics education in family medicine training in the United States: a national survey. Fam Med. 2014;46(1):28-35.
19. Wynia MK, Papadakis MA, Sullivan WM, Hafferty FW. More than a list of values and desired behaviors: a foundational understanding of medical professionalism. Acad Med. 2014;89(5):712-714. doi:10.1097/ACM.0000000000000212
20. Newton BW, Barber L, Clardy J, Cleveland E, O'Sullivan P. Is there hardening of the heart during medical school? Acad Med. 2008;83(3):244-9. doi: 10.1097/ACM.0b013e3181637837.
21. Kahriman I, Yesilcicek Calik K. Ethical Sensitiv Clin Nurses. GÜSBD 2017; 6(3):111-121.
22. Walsh C, Abelson HT. Medical Professionalism crossing a generational divide. Perspect Biol Med. 2008; 51 (4): 554–64.
23. Hebert P, Meslin EM, Dunn EV, Byrne N, Reid SR. Evaluating ethical sensitivity in medical students; using vignettes as an instrument. J Med Ethics. 1990;6:141–45.
24. Hebert PC, Meslin EM, Dunn EV. Measuring the ethical sensitivity of medical students: A study at the University of Toronto. J Med Ethics. 1992;18:142–7. doi: 10.1136/jme.18.3.142.
25. Schulz S, Woestmann B, Huenges B, Schweikardt C, Schäfer T. How important is medical ethics and history of medicine teaching in the medical curriculum? An empirical approach toward students' views. GMS Z Med Ausbild. 2012;29(1):Doc08. doi: 10.3205/zma000778.
26. Alyousefi N, Alibrahim A, Taleb H, et al. The Predictors of Moral Sensitivity Among Physicians. Int J Gen Med. 2021;14:6815-6823. doi: 10.2147/IJGM.S336121.
27. Lützén K, Johansson A, Nordström G. Moral sensitivity: some differences between nurses and physicians. Nurs Ethics. 2000;7(6):520-30. doi: 10.1177/096973300000700607.
28. Lützén K, Dahlqvist V, Eriksson S, Noberg A. Developing the concept of moral sensitivity in health care practice. Nurs Ethics. 2006;13(2):187–96.
29. Ersoy N, Gündoğmuş UN. A study of the ethical sensitivity of physicians in Turkey. Nurs Ethics. 2003 Sep;10(5):472-84. doi: 10.1191/0969733003ne6290a.
30. Bazmi S, Samadi F, Forouzandeh M. Investigating the Moral Sensitivity of Medical Students in the Preclinical and Late Clinical Courses. Med J Islam Repub Iran. 2023 Apr 17;37:39. doi: 10.47176/mjiri.37.39. PMID: 37284691; PMCID: PMC10240546.
31. Ozyer K. Azizoglu O. The Effects of Demographic Variables on People's Ethical Attitudes. J Econ Soc Res. 2010;6(2):59-84.
32. Di You, YM, Bebeau MJ. Gender Differences in Moral Sensitivity: A Meta-Analysis, Ethics & Behavior. 2011; 21: 4, 263-282
33. Nejadsarvari N et al. Relationship of Moral Sensitivity and Distress Among Physicians Trauma Mon. 2015;20(2):e26075 doı: 10.5812/traumamon.26075
34. Jaeger SM. Teaching health care ethics: the importance of moral sensitivity for moral reasoning. Nurs Philos. 2001;2(2):131–42.
35. Pellegrino ED. Professionalism, profession and the virtues of the good physician. Mt Sinai J Med. 2002; 69: 378-84.
36. Karaoglu, N. Professionalism Education in the Post-Graduation Period. Turk Clin Med EdU -Special Issue 2016;1:16-23.