title: Moral reasoning strategies of orthopaedic surgery residents.
abstract: BACKGROUND
  Little is known about the moral reasoning utilized by orthopaedic surgery residents when resolving moral dilemmas.
  
  
  METHODS
  Sixty-three residents in an accredited program took the Defining Issues Test-2, an online examination designed to measure and analyze moral reasoning. Scores approximate how often residents utilize three schemas in their moral reasoning: personal interest, maintaining social norms, and postconventional. Scores were analyzed for differences among years of training, previous literature, and established norms.
  
  
  RESULTS
  Approximately 9.5% of residents utilized personal interest heavily in their moral reasoning, 27% utilized maintaining norms, and 63.5% utilized postconventional reasoning. There were no significant differences between years of training. The fourth-year (R4) class recorded the highest utilization of principled reasoning, while the fifth-year (R5) class recorded the lowest. The range of principled reasoning scores narrowed from the first year (R1) to R5. The principled reasoning scores of residents were significantly lower than previously reported scores of professional degree-holders and medical students, and empirically lower than previously reported scores of orthopaedic attendings and medical students.
  
  
  CONCLUSIONS
  Residents utilized principled reasoning less frequently than expected for physicians. It remains unclear as to what factors contributed to high utilization of principled reasoning in the R4 class but low utilization in the R5 class. Our cross-sectional data suggest that each year of training homogenizes toward a class-specific utilization of principled reasoning. It remains unclear why residents utilized principled reasoning less than orthopaedic attendings, medical students, and other professional degree-holders.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 East 17th Street, Room 1402, New York, NY 10003, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Mercuri
authors.forename: Raj J
authors.initials: RJ
authors.lastname: Karia
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Zuckerman
mesh_terms: D000328:Adult; D003657:Decision Making / Q000941:ethics*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009014:Morals; D009519:New York City; D009985:Orthopedics / Q000193:education* / Q000941:ethics; D010820:Physicians / Q000941:ethics / Q000523:psychology*; D011581:Psychological Tests