title: Principle-based structured case discussions: do they foster moral competence in medical students? - A pilot study.
abstract: Recent findings suggest that medical students' moral competence decreases throughout medical school. This pilot study gives preliminary insights into the effects of two educational interventions in ethics classes on moral competence among medical students in Munich, Germany.
  
  
  
  Between 2012 and 2013, medical students were tested using Lind's Moral Competence Test (MCT) prior to and after completing different ethics classes. The experimental group (EG, N = 76) participated in principle-based structured case discussions (PBSCDs) and was compared with a control group with theory-based case discussions (TBCDs) (CG, N = 55). The pre/post C-scores were compared using a Wilcoxon Test, ANOVA and effect-size calculation.
  
  
  
  The C-score improved by around 3.2 C-points in the EG, and by 0.2 C-points in the CG. The mean C-score difference was not statistically significant for the EG (P = 0.14) or between the two groups (P = 0.34). There was no statistical significance for the teachers' influence (P = 0.54) on C-score. In both groups, students with below-average (M = 29.1) C-scores improved and students with above-average C-scores regressed. The increase of the C-Index was greater in the EG than in the CG. The absolute effect-size of the EG compared with the CG was 3.0 C-points, indicating a relevant effect.
  
  
  
  Teaching ethics with PBSCDs did not provide a statistically significant influence on students' moral competence, compared with TBCDs. Yet, the effect size suggests that PBSCDs may improve moral competence among medical students more effectively. Further research with larger and completely randomized samples is needed to gain definite explanations for the results.
authors.affiliation: Institute for Ethics, History and Theory of Medicine at Ludwig Maximilian University (LMU), Lessingstr. 2, 80336, Munich, Germany. orsolya.friedrich@lrz.uni-muenchen.de.
authors.forename: Orsolya
authors.identifier: 0000-0003-1608-175X
authors.initials: O
authors.lastname: Friedrich
authors.affiliation: Institute for Pedagogic and Rehabilitation Psychology at the University of Leipzig, Neumarkt 9-19, 04109, Leipzig, Germany.
authors.forename: Kay
authors.initials: K
authors.lastname: Hemmerling
authors.affiliation: Institute for Ethics, History and Theory of Medicine at Ludwig Maximilian University (LMU), Lessingstr. 2, 80336, Munich, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Kuehlmeyer
authors.affiliation: Institute for Ethics, History and Theory of Medicine at Ludwig Maximilian University (LMU), Lessingstr. 2, 80336, Munich, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Nörtemann
authors.affiliation: Institute for Medical Education at the University Hospital of LMU Munich, Lessingstr. 2, 80336, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Institute for Ethics, History and Theory of Medicine at Ludwig Maximilian University (LMU), Lessingstr. 2, 80336, Munich, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Marckmann
mesh_terms: D000328:Adult; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D028663:Ethical Theory; D004992:Ethics, Medical / Q000193:education*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D035863:Moral Development; D009014:Morals; D010865:Pilot Projects; D028662:Principle-Based Ethics; D011340:Problem Solving; D018794:Problem-Based Learning; D011361:Professional Competence; D013337:Students, Medical; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Educational intervention; Medical ethics class; Medical students; Moral competence; Moral competence test