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

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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

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Tr Con

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Type 3 Type 4

Types Schema predominance & consistency

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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

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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)

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DIT Pretest P Score

Histogram

Types Schema predominance & consistency

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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

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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

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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

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