title: Assessment of moral reasoning skills in the orthopaedic surgery resident applicant.
abstract: BACKGROUND
  Assessing orthopaedic surgery residency applicants is a complex process. One important applicant characteristic not commonly measured during the interview process is moral behavior, a key component of the guidelines of the Accreditation Council for Graduate Medical Education for professionalism competency. We sought to determine whether a relationship exists between the results of residency selection interviews, as measured by match rank order, and moral reasoning skills, as measured by the revised version of the Defining Issues Test (DIT-2).
  
  
  METHODS
  The DIT-2, a psychological tool that has been validated in assessing moral reasoning in >30,000 subjects, was administered to orthopaedic surgery residency candidates on a voluntary basis during their interview day. Data were collected annually from four applicant classes (2009 to 2012) at one institution. Each candidate was interviewed by an orthopaedic faculty team and was ranked comparatively with the other interviewing applicants. The five-part aggregate interview method for ranking applicants for the match list included a focused interview station presenting ethical dilemmas as one part of determining rank order.
  
  
  RESULTS
  One hundred and twenty-four fourth-year medical students interviewing for orthopaedic surgery residency were assessed with the DIT-2. The results from the DIT-2 produced a postconventional score, which correlates with various levels of moral development. Each applicant's postconventional score was then compared with the patient's overall rank order. Applicants had highly variable moral reasoning skills, with no relationship to the final rank list.
  
  
  CONCLUSIONS
  Despite a wide range of DIT-2 scores, the interview process did not differentiate applicants based on moral reasoning skills. It remains unclear whether the DIT-2 could (or should) be used as an additional data point to help stratify orthopaedic residency applicants and to predict their performance.
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55454. E-mail address for A. Van Heest: vanhe003@umn.edu.
authors.forename: Kyle C
authors.initials: KC
authors.lastname: Bohm
authors.affiliation: Center for Bioethics, University of Minnesota, N504 Boynton, 410 Church Street S.E., Minneapolis, MN 55455.
authors.forename: Tyler
authors.initials: T
authors.lastname: Van Heest
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55454. E-mail address for A. Van Heest: vanhe003@umn.edu.
authors.forename: Terence J
authors.initials: TJ
authors.lastname: Gioe
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55454. E-mail address for A. Van Heest: vanhe003@umn.edu.
authors.forename: Julie
authors.initials: J
authors.lastname: Agel
authors.affiliation: Department of Orthopaedic Surgery, Regions Hospital, 640 Jackson Street, Saint Paul, MN 55101.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Johnson
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55454. E-mail address for A. Van Heest: vanhe003@umn.edu.
authors.forename: Ann
authors.initials: A
authors.lastname: Van Heest
mesh_terms: D000328:Adult; D002321:Career Choice; D002983:Clinical Competence; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D007586:Job Application; D008297:Male; D028681:Moral Obligations; D009985:Orthopedics / Q000193:education*; D010560:Personnel Selection / Q000379:methods*; D014481:United States