Evaluating moral reasoning outcomes in physical therapy ethics education: stage, schema, phase, and type

Abstract Background: Physical therapists must have skills in moral reasoning (the ability to analyze ethical situations in order to determine a right action). The cognitive developmental perspective initiated by Kohlberg and developed by James Rest and associates proposes that moral reasoning progresses in stages or schemas (default frameworks for determining a right course of action) with periods of transition or consolidation between schemas. The purpose of this research was to evaluate changes among physical therapy students in moral reasoning and organization of ethical knowledge following an intensive 6-week ethics course focused on transformative learning, self-knowledge/reflection, relationships between ethical and clinical knowledge, and responding to ethical disequilibrium. This paper focuses on evaluating changes in moral reasoning from the cognitive developmental perspective using the Defining Issue Test (DIT2). The DIT2 evaluates the proportion of moral reasoning that an individual uses in three schemas (personal interest, maintaining norms, post-conventional) with a focus on the shift to post-conventional reasoning. Methods: A pre-test–post-test design was used to evaluate changes in moral reasoning schema. Results: Of the 54 final year physiotherapy students invited to participate, 37 students completed all portions of the research, a usable response rate of 68·5%. The resulting sample was predominantly female (59·5%, n = 22) with a mean age of 24·2 years. Paired t-tests were not significant for changes in personal interest or maintaining norms, but were significant for changes in post-conventional reasoning. Discussion: Results indicate that an intensive ethics course can be successful in producing changes in post-conventional moral reasoning among physical therapy students.

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