Fostering an Ethical Professional Identity: Research, Curricular Engagements,

and Assessment

ABA Associate Dean’s ConferenceMinneapolis, June 25, 2010

The Four Component Model of MoralityMuriel J. Bebeau, PhD

University of Minnesota

ReferencesBebeau, M.J. & Monson, V.E. (2008). Guided by Theory, Grounded in Evidence: A way forward for professional ethics education. In: Nucci, L. & Narvaez, D., Eds., Handbook on Moral and Character Education. New York, NY: Routledge.

Thoma, S. J. (2006). Research on the Defining Issues Test. In M. Killen & J. G. Smetana (Eds.), Handbook of moral development. (pp. 67-92) Mahwah, N.J.: Erlbaum Associates.

Bebeau, M.J. (2008). Promoting Ethical Development and Professionalism: Insights from Educational Research in the Professions. University of St. Thomas Law Journal 5(2) 367-403.

Bebeau, M.J. (2009). Enhancing Professionalism Using Ethics Education as Part of a Dental Licensure Board’s Disciplinary Action. Part 1. An Evidence-Based Process. Journal of the American College of Dentists 76(2):38-50.

Bebeau, M.J. (2009). Enhancing Professionalism Using Ethics Education as Part of a Dental Licensure Board’s Disciplinary Action. Part 2. Evidence the Process Works. Journal of the American College of Dentists 76(3):32-45.

Four Component Model of Morality (FCM) (Rest, 1983)

Motivation & Identity

Moral BehaviorUnethical, Ethical, Unprofessional,

Professional

Reasons (Predictors)

Four Component Model of Morality (FCM) (Rest, 1983)

Motivation & Identity

Moral BehaviorUnethical, Ethical, Unprofessional,

Professional

Moral Capacity (Predictors) Operational Definition Measures

What is the evidence?

• What do we know about students & professionals? – Ethical sensitivity?

– Reasoning development?

– Identity formation?

– Ethical implementation abilities?

• What do we know about the possibility of developing ethical capacities during professional education? Or after?

Educational programs can:

• Promote sensitivity to the ethical issues that are likely to arise in practice.

• Build the capacity for reasoning carefully about conflicts inherent in practice.

• Develop a sense of personal identity that incorporates professional norms and values.– School’s role is “to help students to construct and

internalize a moral compass by which to lead their lives.” (Richard Vogel, 2006—Interim Dean, NYU)

• Build competence in problem solving and interpersonal skills.

Data Sources

• Studies of identity formation in medicine, dentistry, military, and business (Bebeau & Monson, 2008)

• Pre and Posttest data from 20 cohorts of Minnesota dental students (1985-2005)

• Data from 41 practitioners disciplined by a licensing board (Bebeau, 2009a; 2009b)

• Life-stories of 10 extraordinary professionals (Rule & Bebeau, 2005)

Study of Professional Identity Formation

What is the evidence?

• What do we know about students & professionals?

– Ethical sensitivity?

Dental Ethical Sensitivity Test

Student responds to cases and probe questions

Responses are transcribed

Student self assesses and receives feedback

0

1

2

3

4

5

6

7

8

9

10

Cou

nt

40 50 60 70 80 90 100Student DEST

Histogram

Distribution of Seniors’ DEST scores

Points Possible = 102Mean = 71.9

S.D.= 8.16N = 90

Range = 46-92

0

1

2

3

4

5

6

7

8

9

10

Cou

nt

40 50 60 70 80 90 100Student DEST

Histogram

Distribution of Seniors’ DEST scores

Board Referrals

Points Possible = 102Mean = 71.9

S.D.= 8.16N = 90

Range = 46-92

Moral sensitivity Research findings

• Validation studies* support these findings:– Ethical sensitivity can be reliably assessed.– Students and practitioners vary in sensitivity.– Women have a slight edge in recognizing ethical issues.

(Bebeau & Brabeck, 1985 [yes]; You, 2007 [no]) – Ethical sensitivity can be enhanced through instruction.– Ethical sensitivity is distinct from moral reasoning.

• Findings from dentistry have been replicated in other professions. – 23 Ethical sensitivity measures have been developed,

modeled after the DEST. (You & Bebeau, 2005)

*See Bebeau (2006) for a review

What is the evidence?

• What do we know about students & professionals? – Ethical sensitivity?

–Reasoning development?

The Defining Issues TestJames R. Rest

Sample Dilemma

Heinz and the DrugIn Europe a woman was near death from a special kind of cancer. There was one drug that doctors thought might save her. It was a form of radium that a druggist in the same town had recently discovered. The drug was expensive to make, but the druggist was charging ten times what the drug cost to make. He paid $200 for the radium and charged $2,000 for a small dose of the drug. The sick woman’s husband, Heinz, went to everyone he knew to borrow the money, but he could only get together about $1,000, which is half of what it cost. He told the druggist that his wife was dying, and asked him to sell it cheaper or let him pay later. But the druggist said, “No, I discovered the drug and I’m going to make money from it.” So Heinz got desperate and began to think about breaking into the man’s store to steal the drug for his wife. Should he steal the drug?

DIT scores reflect percent of time respondent selects each of

Three kinds of moral justification

• Personal Interests (PI)

– Arguments that appeal to personal interests

• Maintaining Norms (MN)

– Arguments that appeal to laws and norms

• Postconventional (P)

– Arguments that appeal to moral ideals

05

101520253035404550

Tr Con

PIMNP

Type 3 Type 4Note: A profile is Transitional (TR) when a respondent has difficulty discriminating between justifications; consolidated (Con) when respondent clearly discriminates among justifications. Type reflects a particular pattern of schema (justification) predominance and consistency. Types range from 1-7.

Sample profiles

Possible

Types –based on schema predominance & consistency

0

10

20

30

40

50

60

1 2 3 4 5 6 7

PIMNP

*Types 1, 4, & 7 are consolidated; 2, 3, 5, & 6 are transitional.

Per

cent

Pe

rce

nt

Proportion of dental students* displaying each Type at pretest and posttest for 4 year dental ethics curriculum

0

10

20

30

40

50

60

1 2 3 4 5 6 7

PIMNP

Pretest42%

Posttest59%

Pre30%Post21%

8%5%

Pre9%

Post5%

Pre14%Post

13.5%

Pre 2.8%Post .7%

Pre2.6%Post.7%

*Based on 15 cohorts of dental students (n=1,207)

Moral reasoning Research findings

• Higher education has a powerful effect on moral reasoning development. (King & Mayhew, 2002)

• For over 20 years, the DIT has been used to assess moral education outcomes in accounting, dentistry, law, medicine, nursing, and veterinary medicine. (Thoma, 2006)

• In a review of 33 studies of the effects of professional education, none were associated with statistically significant increases in moral reasoning without a well-validated ethics curriculum. (Bebeau, 2002)

• Legal education can facilitate moral reasoning development. (Hartwell, 1995; Landsman & McNeel, 2004)

• There is a great deal of variability in students’ & sanctioned professionals’ ability to reason about moral issues. (Bebeau & Thoma, 1994; Bebeau. 2009)

What is the evidence?

• What do we know about students & professionals? – Ethical sensitivity?

– Reasoning development?

– Identity formation?

The Evolving Professional Identity

Kegan, R. (1982); Bebeau & Lewis (2005)

Professional identity formation

Research findings

• We can distinguish levels of identity formation. (Forsythe, et al., 2002; Roehrich & Bebeau, 2005; Monson & Bebeau, 2006; Forsythe, et al. 2007)

• It is possible to facilitate identity development during professional school. (Bebeau, 2010)

– You (2007) detected a time by gender interaction indicating that MN women (from five cohorts of MN graduates) made greater gains in formation of a moral identity than their male colleagues.

• Difficulty articulating key concepts of professionalism distinguishes referrals from the Board of Dentistry. – Opportunities to reflect on identity promotes a sense of professional

renewal. (Bebeau, 2006)

What is the evidence?

• What do we know about students & professionals? – Ethical sensitivity?

– Reasoning development?

– Identity formation?

– Ethical implementation abilities?

Character and competenceResearch findings• If you approach a task with dread, you are less likely to persevere. If you

see a task as fun and challenging, you will keep trying until you perfect the skill or ability. (Bandura, 1977)

• Developing self-regulation, self-efficacy, and implementation abilities is critical for effective professional functioning. – Deficiencies account for malpractice suits and disciplinary actions

• Practice is critical to developing survival skills. (Fisher & Zigmond, 1998)

– Learning by trial and error can lead to professional fatality, particularly for individuals without a great deal of experience with the culture of the profession.

• Practitioners highly value the emphasis on ethical implementation. (Bebeau, 2009)

– Instead of stopping with “What is happening?” and “What ought to be done?,” typical of most ethics instruction, they want to know what to say and how to say it.

Four Component Model of Morality (FCM) (Rest, 1983)

Motivation & Identity

Moral BehaviorUnethical, Ethical, Unprofessional,

Professional

Moral Capacity (Predictors) Operational Definition Measures

Evidence of links to behaviors• Moral judgment (DIT) scores are linked to a wide range of pro-social

behaviors (Thoma, 1994) – Clinical performance ratings

• Nursing, Medicine, Dentistry– Preference for altruistic law disciplines

• Law students (Landsman & McNeel, 2004)

– Likelihood of fraud detection. • Auditors (Ponemon & Gabhart, 1994)

– Willingness to inform superiors or law enforcement of wrong-doing • Employees (Arnold & Ponemon, 1991; Bernardi, 1994)

• Deficiencies on components are linked to disciplinary actions in professions– Baldwin (1994) orthopedics and malpractice claims– Bebeau (2006) dental board referrals

• Unprofessional behavior in medical school linked with disciplinary action by stage medical board. (Papadikis, et al., 2004; Stern, et al., 2005).

Conclusions: What stands out?

Educational significance

• The power of the FCM for understanding moral failing– Deconstruct summary judgments about character– See them as capacities that can be further

developed

Conclusions: What stands out?

Educational significance

• The power of the FCM for guiding the design of assessments– That provide insight about personal short comings

in abilities that contribute to moral failings.– That are sensitive to the effects of intervention.

Conclusions: What stands out?

Educational significance • The power of the FCM for guiding

development of meaningful learning activities– Beginning with discussions of the distinguishing

features of professions and expectations that follow is uplifting and renewing.

– Cases used to promote sensitivity and reasoning are viewed as relevant and useful.

– Practitioners highly value the emphasis on ethical implementation.

Questions?

Thank you