Reflective ability and moral reasoning in final year medical students: A semi-qualitative cohort study

Background: Moral reasoning and reflective ability are important concepts in medical education. To date, the association between reflective ability and moral reasoning in medical students has not been measured. Aim: This study tested the hypotheses that, amongst final year medical students, (1) moral reasoning and reflective ability improve over time and (2) positive change in reflective ability favourably influences moral reasoning. Methods: With Institutional Ethical approval, 56 medical students (of a class of 110) participated fully both at the beginning and end of the final academic year. Reflective ability and moral reasoning were assessed at each time using Sobral's reflection-in-learning scale (RLS), Boenink's overall reflection score and by employing Kohlberg's schema for moral reasoning. Results: The most important findings were that (1) Students' level of reflective ability scores related to medicine decreased significantly over the course of the year, (2) students demonstrated a predominantly conventional level of moral reasoning at both the beginning and end of the year, (3) moral reasoning scores tended to decrease over the course of the year and (4) RLS is a strong predictor of change in moral reasoning over time. Conclusion: This study confirms the usefulness of Sobral's RLS and BOR score for evaluating moral development in the context of medical education. This study further documents regression and levelling in the moral reasoning of final year medical students and a decrease in reflective ability applied in the medical context. Further studies are required to determine factors that would favourably influence reflective ability and moral reasoning among final year medical students.