Fostering an Ethical Professional Identity: Research, Curricular Engagements, and Assessment

1
Fostering an Ethical Professional Identity
Research, Curricular Engagements, and
Assessment

• ABA Associate Deans ConferenceMinneapolis,
  June 25, 2010
• The Four Component Model of Morality
• Muriel J. Bebeau, PhDUniversity of Minnesota

2
References

• Bebeau, 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 Boards 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 Boards Disciplinary Action. Part 2.
  Evidence the Process Works. Journal of the
  American College of Dentists 76(3)32-45.

3
Four Component Model of Morality (FCM) (Rest,
1983)
Reasons (Predictors)
Motivation Identity
Moral Behavior Unethical, Ethical,
Unprofessional, Professional
4
Four Component Model of Morality (FCM) (Rest,
1983)
Moral Capacity (Predictors) Operational Definition Measures
Motivation Identity
Moral Behavior Unethical, Ethical,
Unprofessional, Professional
5
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?

6
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.
• Schools role is to help students to construct
  and internalize a moral compass by which to lead
  their lives. (Richard Vogel, 2006Interim Dean,
  NYU)
• Build competence in problem solving and
  interpersonal skills.

7
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)

8
Study of Professional Identity Formation

9
(No Transcript)
10
What is the evidence?

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

11
Dental Ethical Sensitivity Test
12
Student responds to cases and probe questions
13
Responses are transcribed
14
Student self assesses and receives feedback
15
Distribution of Seniors DEST scores
Points Possible 102 Mean 71.9 S.D. 8.16 N
90 Range 46-92
16
Distribution of Seniors DEST scores
Points Possible 102 Mean 71.9 S.D. 8.16 N
90 Range 46-92
Board Referrals
17
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
18
What is the evidence?

• What do we know about students professionals?
• Ethical sensitivity?
• Reasoning development?

19
The Defining Issues TestJames R. RestSample
DilemmaHeinz and the Drug

• In 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 womans 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 Im going to make money
  from it. So Heinz got desperate and began to
  think about breaking into the mans store to
  steal the drug for his wife. Should he steal the
  drug?

20
(No Transcript)
21
DIT scores reflect percent of time respondent
selects each of Three kinds of moral
justification
Sample profiles

• 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

Type 3 Type 4
Note 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.
22
Possible Types based on schema predominance
consistency
Percent
Percent
Types 1, 4, 7 are consolidated 2, 3, 5, 6
are transitional.
23
Proportion of dental students displaying each
Type at pretest and posttest for 4 year dental
ethics curriculum
Pretest 42 Posttest 59
Pre 30 Post 21
Pre 9 Post 5
Pre 14 Post 13.5
Pre 2.8 Post .7
Pre 2.6 Post .7
8 5
Based on 15 cohorts of dental students (n1,207)
24
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)

25
What is the evidence?

• What do we know about students professionals?
• Ethical sensitivity?
• Reasoning development?
• Identity formation?

26
The Evolving Professional Identity

• Kegan, R. (1982) Bebeau Lewis (2005)

27
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)

28
What is the evidence?

• What do we know about students professionals?
• Ethical sensitivity?
• Reasoning development?
• Identity formation?
• Ethical implementation abilities?

29
Character and competence

• Research 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.

30
Four Component Model of Morality (FCM) (Rest,
1983)
Moral Capacity (Predictors) Operational Definition Measures
Motivation Identity
Moral Behavior Unethical, Ethical,
Unprofessional, Professional
31
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).

32
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

33
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.

34
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.

35
Questions?

• Thank you