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Using the Defining Issues Testin Dental Education
Sponsored byAmerican Society for Dental Ethics
Phyllis BeemsterboerUniversity of OregonMuriel J. Bebeau
University of Minnesota
Capacities that develop across the life span (Rest, 1983)
Moral Sensitivity
MoralReasoning
Moral Motivation (Identity formation)
Moral Implementation(Character & competence)
Empathy, role taking, projecting con-sequences
Stages of moral judgment development
Stages of identity formation
Will, personal qualities, problem solving and interpersonal abilities
ChildhoodProfessionalSchool
Professional Practice
Lawrence KohlbergStage theory of moral judgment
Lawrence KohlbergMJI –a production measureRarely identifiedPostconventionalreasoners
Lawrence Kohlberg
DIT—a recognition measure Identifies postconventional reasoners
MJI –a production measureRarely identifiedPostconventionalreasoners
Rest et al. (1999) Concluded: shifting distributions of moral schemas is a better representation of moral thinking than the “hard stage” model
05
101520253035404550
PIMNP
Experiencing theDefining Issues Test
• Find Blue Test Booklet • Use optical scan form to record your results• Use a # 2 Pencil
• Place the last four digits of your Social Security Number as your personal Identification Number
Place the last four digits of your Social Security Number
• Complete the DIT
. . . or at least the first three stories
Group Activity
Directions: 1. Arrange yourselves in groups of three. 2. See if you can come to consensus on the
most four most important items for the • Heinz and the Drug• Escaped Prisoner
3. Record your responses on the sheet
What does the DIT Assess?
The Defining Issues TestJames R. Rest
Sample 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 woman’s husband, Heinz, went to everyone he know to borrow the money, but he could only get together about $1, 000, which iis 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 I’m going to make money from it.” So Heinz got desperate and began to think about breaking into the man’s store to steal the drug for his wife. Should he steal the drug?
Three Types of Moral Justification
• Personal Interests• Self-Interest (e.g., Whether Heinz liked his wife, or was willing to take
a personal risk.)
• Interpersonal Concordance (e.g., Whether Heinz’s wife is a good person, or good mother who contributes to her family.)
• Maintaining Norms• Whether there is a law that prohibits the action; whether one intends to
follow the law.
• Postconventional• Whether the action can be justified based on moral ideals; whether the law
is fair and can be justified by appeals to moral theory or moral criteria.
Indices for Analyses of DIT Change
• Moral Schema• PI Personal Interests• MN Maintaining Norms• P Postconventional
• Consolidation/ Transition
• Type• Schema Predominance • Consolidation/ Transition
0
10
20
30
40
50
Tr Con
PIMNP
Type 3 Type 4
Types Schema predominance & consistency
0
10
20
30
40
50
60
1 2 3 4 5 6 7
PIMNP
Defining Issues Test
Scores: • Personal Interests Schema• Maintaining Norms Schema• Postconventional Schema (P Score)
• Proportion of times an individual selected arguments grounded in moral ideals
• N2 score • The extent to which a person discriminates among
the moral schemas
21.9 Junior High Students
31.8 Senior High Students
40.0 Average Adults
42.0 College Students
50.8 Medical Students
53.5 Graduate Students
59.8 Protestant Seminarians
65.2 Philosophy and Political ScienceDoctoral Students
Group means for DIT P scores
Dental Students
Freshmen
Seniors
College Students
Seniors
Freshmen
Pre and posttest DIT P scores for 23 cohorts
of U of MN dental students Classes of 1985-2007
0
10
20
30
40
50
60
85 87 89 91 93 95 97 99 1 3 5 7
PrePost
Medical Students
Average Adult
Distribution of DIT Pretest P Scores forEntering Dental Students Classes of 1997, 1998, 1999 (n = 230) (Similar distribution for Board Referrals)
0
2
4
6
8
10
12
14
16
18
Cou
nt
0
10 20 30 40 50 60 70 80 90 100
DIT Pretest P Score
Histogram
Types Schema predominance & consistency
0
10
20
30
40
50
60
1 2 3 4 5 6 7
PIMNP
Pretest42%
Posttest59%
Pre30%Post21%
8%5%
Pre9%
Post5%
Pre14%Post
13.5%
Pre 2.8%Post.7%
Pre2.6%Post.7%
Based on 15 cohorts of dental students (n=1,207)
Change from pretest to posttest15 cohorts of dental students, n = 1,207
0
10
20
30
40
50
60
Pretest Posttest
Type 2Type 3Type 4Type 5Type 6Type 7
Recent research (Rest, Thoma, Narvaez, & Bebeau, 1997)
• Reexamining intervention studies using the DIT showed two different effects: • Increased preference for postconventional
arguments (the familiar effect). • A systematic rejection of simplistic thinking
(decreased preference for personal interest arguments).
• Observation lead to the construction of the N2 index, which outperforms the P index on the seven validation criteria.
Defining Issues Test
Scores: • Personal Interests Schema• Maintaining Norms Schema• Postconventional Schema (P Score)
• Proportion of times an individual selected arguments grounded in moral ideals
• N2 score • The extent to which a person discriminates among
the moral schemas
The DIT Measures life-span moral judgment development
• Validity and reliability assessed in terms of seven criteria• Differentiation of various age/education groups• Longitudinal gains• Related to cognitive capacity measures • Sensitive to moral education interventions• Linked to prosocial behaviors • Linked to political attitudes and political choices• Adequate reliability
Questions
BREAK
Interpreting a Set of Hypothetical ResultsImagine your scores were as follows:• PI: 15.7 MN: 29.40 P: 49.06
Imagine your group scores were as follows: • PI: 18.7 MN: 49.40 P: 29.06
What would these data tell you about you? What Type are you? What Type is your group?
Communicating results to students
Examining a Printout with Results
• Find the green data summary
Page 1 green handout
Page 1 green handout
Page 2 green handout --Type & Utilizer
Types Schema Predominance & Consistency
0
10
20
30
40
50
60
1 2 3 4 5 6 7
PIMNP
U score
• U score (for Utilizer), which ranges from -1.0 to +1.0, describes the degree of consistency between reasoning and judgment—persons whose reasoning and judgments are reasonably consistent achieve scores of .4 or above.Example: Should steal the drug
• Gives high rating to “Whether the Communities laws will be withheld.”
Page 2 green handout Type & Utilizer
Page 3 green handout Humanitarian Liberalism & Religious Orthodoxy
Humanitarian/Liberalism
• a proxy for a humanitarian liberal perspective on moral issues. • Philosophers & Political scientists (“Experts in the
domain”) obtained high scores on the DIT, and were quite consistent in their action choices.
• Eg: Heinz should steal, neighbor should not turn in escaped prisoner, principal should not shut down the newspaper, etc.
• Scores range from 0 to 6 (DIT) or 0 to 5 (DIT-2)
Religious Orthodoxy• An item on the doctor’s dilemma (called DOC9)
evokes the idea that • only God can determine whether or not
someone should live or die.• correlates highly with the Brown & Low
Inventory of Religious Beliefs.
• This proxy measure is the sum of rates and ranks for item 9. Scores range from 0 to 9
Page 3 green handout Humanitarian Liberalism & Religious Orthodoxy
Page 4 green handout Reliability Checks
Reliability Checks• New Checks Total Score
• Whether respondents’ scores represent moral thinking or bogus data.
• Meaningless Item Check• Items that are lofty sounding, using complex style or
verbiage, but are essentially meaningless• Antisocial Score
• Items reflect an anti-establishment attitude. Considerations presume an understanding of maintaining norms moral schema, but fault existing authorities and “the establishment” for being hypocritical and inconsistent in their own rationale.
• Useful for providing developmental feedback
Page 4 green handout Reliability Checks
Page 5 green handout Descriptive Statistical Summary of the Data
• For norms see last page of excerpt from Guide (white)
Recent Norms for DIT-2 White handout –following the green
Education level N P score N2 scoreJr. high 37 15.78 12.84Sr. high 667 33.13 31.69Voc/tech 111 32.19 28.70Jr. college 236 31.06 29.48Freshman 2,096 32.32 31.05Sophomore 1,028 32.62 31.24Junior 1,333 34.45 32.65Senior 2,441 37.84 36.84M.S. degree 853 41.06 40.56Prof. degree 1,582 44.87 44.97Ph D/Ed D 169 50 69 48 99
Examining Data Sets from Recent Administrations of the DIT in Dentistry
• Our thanks to consortium members for sharing their data• MN; IN; MI; OR; OK; FL
• Go to next slide presentation
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