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Acad Med. 1998 May;73(5):521-3.

The amount of small-group case-study discussion needed to improve moral reasoning skills of medical students.

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Department of Humanities in Medicine, College of Medicine, Texas A & M University, USA.



To examine how much exposure to small-group case-study discussion is necessary to significantly increase moral reasoning skills.


For the classes of 1991-1998 at Texas A&M, using Rest's Defining Issues Test, the authors tested groups of students for moral reasoning skills both before and after the students participated in small-group case-study discussions of medical ethics.


From 960 students asked to participate, the authors collected complete data for 729 students (75.9% response rate). Small-group case-study exposures ranged from 0 to 44 hours. Groups of students exposed to 20 hours or more demonstrated a significant increase in their moral reasoning scores. Groups with less than 20 hours of exposure demonstrated no significant increase in their scores.


This study indicates that moral reasoning skills are teachable and measurable, and that small-group discussion significantly increases moral reasoning skills. Further studies are needed to increase the generalizability of these findings.

[Indexed for MEDLINE]

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