{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T12:41:13Z","timestamp":1775911273186,"version":"3.50.1"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T00:00:00Z","timestamp":1600300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T00:00:00Z","timestamp":1600300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["UIDB\/4255\/2020"],"award-info":[{"award-number":["UIDB\/4255\/2020"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Health Care Anal"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In a time marked by the development of innovative treatments in healthcare and the need for health professionals to deal with resulting ethical dilemmas in clinical practice, this study was developed to determine the influence of the bioethics teaching on the moral competence of medical and nursing students. The authors conduct a longitudinal study using the Moral Competence Test extended version before and after attending the ethics curricular unit, in three nursing schools and three medical schools of Portugal. In this questionnaire the participant is confronted with three ethical dilemmas (related to theft, euthanasia and the torture of a terrorist) and asked to evaluate arguments for and against the attitude of the main character (Worker, doctor and judge). For both nursing and medical students, C-score was lower after the attendance of the ethics curricular units, with a statistically significant decrease in the total score (from 21 to 19.5 on average; <jats:italic>p<\/jats:italic>\u2009=\u20090.046) for nursing students and a decrease not statistically significant for medical students (from 23.2 to 22 on average; <jats:italic>p<\/jats:italic>\u2009=\u20090.358). A multivariate analysis did not find any association between this decrease and gender, course, or age. The phenomenon of moral segmentation was observed, with better performance in the worker and judge dilemma, than in the doctor dilemma. These results highlight the need to reflect on the curricular strategies that can be implemented for health professionals to better develop moral competence and decision-making, allowing for the provision of humanized health care.<\/jats:p>","DOI":"10.1007\/s10728-020-00401-1","type":"journal-article","created":{"date-parts":[[2020,9,17]],"date-time":"2020-09-17T17:03:17Z","timestamp":1600362197000},"page":"113-126","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["The Teaching of Ethics and the Moral Competence of Medical and Nursing Students"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3829-0763","authenticated-orcid":false,"given":"Vera S\u00edlvia Meireles","family":"Martins","sequence":"first","affiliation":[]},{"given":"Cristina Maria Nogueira Costa","family":"Santos","sequence":"additional","affiliation":[]},{"given":"Patr\u00edcia Unger Raphael","family":"Bataglia","sequence":"additional","affiliation":[]},{"given":"Ivone Maria Resende Figueiredo","family":"Duarte","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,9,17]]},"reference":[{"key":"401_CR1","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1007\/s10728-008-0102-z","volume":"17","author":"TA Abma","year":"2009","unstructured":"Abma, T. A., Molewijk, B., & Widdershoven, G. A. M. (2009). Good care in ongoing dialogue. Improving the quality of care through moral deliberation and responsive evaluation. Health Care Analysis, 17, 217\u2013235.","journal-title":"Health Care Analysis"},{"key":"401_CR2","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1016\/j.nedt.2004.07.005","volume":"24","author":"J Auvinen","year":"2004","unstructured":"Auvinen, J., Suominen, T., Leino-Kilpi, H., & Helkama, K. (2004). The development of moral judgment during nursing education in Finland. Nurse Education Today, 24, 538\u2013546.","journal-title":"Nurse Education Today"},{"key":"401_CR3","unstructured":"Bataglia, P., Schillinger-Agati, M. M., Lind, G., & Quevedo, T.L. (2003). Testing the segmentation hypothesis with an Extended Version of the MJT. In Poster presented at the meeting of the Association for Moral Education, Krakow."},{"issue":"1","key":"401_CR4","first-page":"83","volume":"23","author":"P Bataglia","year":"2010","unstructured":"Bataglia, P. (2010). A Valida\u00e7\u00e3o do Teste de Ju\u00edzo Moral (MJT) para Diferentes Culturas: O Caso Brasileiro (Moral Judgment Test (MJT) Adaptation for Different Cultures: Brazilian Case). Psicologia: Reflex\u00e3o e Cr\u00edtica, 23(1), 83\u201391.","journal-title":"Psicologia: Reflex\u00e3o e Cr\u00edtica"},{"key":"401_CR5","volume-title":"Principles of biomedical ethics","author":"TL Beauchamp","year":"1994","unstructured":"Beauchamp, T. L., & Childress, J. F. (1994). Principles of biomedical ethics (4th ed.). New York: Oxford University Press.","edition":"4"},{"key":"401_CR6","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1016\/j.nedt.2012.06.016","volume":"33","author":"R Buzgov\u00e1","year":"2013","unstructured":"Buzgov\u00e1, R., & Sikorov\u00e1, L. (2013). Moral judgment competence of nursing students in the Czech Republic. Nurse Education Today, 33, 1201\u20131206.","journal-title":"Nurse Education Today"},{"key":"401_CR7","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1111\/medu.12252","volume":"47","author":"I Hegasi","year":"2013","unstructured":"Hegasi, I., & Wilson, I. (2013). Medical education and moral segmentation in medical students. Medical Education, 47, 1022\u20131028.","journal-title":"Medical Education"},{"issue":"3","key":"401_CR8","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1191\/0969733004ne693oa","volume":"11","author":"Y Kim","year":"2004","unstructured":"Kim, Y., Park, J., Son, Y., & Han, S. (2004). A longitudinal study on the development of moral judgment in Korean nursing students. Nursing Ethics, 11(3), 254\u2013265.","journal-title":"Nursing Ethics"},{"key":"401_CR9","unstructured":"Kohlberg, L. (1958). The development of modes of moral thinking and choice in the years ten to sixteen. Doctoral dissertation, University of Chicago (pp. 268\u2013284)."},{"key":"401_CR10","first-page":"381","volume-title":"Review of child development research","author":"L Kohlberg","year":"1964","unstructured":"Kohlberg, L. (1964). Development of moral character and moral ideology. In M. L. Hoffman & W. Hoffman (Eds.), Review of child development research (Vol. 1, pp. 381\u2013431). New York: Russel Sage Foundation."},{"key":"401_CR11","first-page":"15","volume-title":"Moral development, moral education and Kohlberg: Basic issues in philosophy, psychology, and Education","author":"L Kohlberg","year":"1980","unstructured":"Kohlberg, L. (1980). Stages of moral development as a basis for moral education. In B. Munsey (Ed.), Moral development, moral education and Kohlberg: Basic issues in philosophy, psychology, and Education (pp. 15\u201398). Birmingham: Religious Education Press."},{"issue":"3","key":"401_CR12","first-page":"399","volume":"24","author":"G Lind","year":"2000","unstructured":"Lind, G. (2000). Moral regression in medical students and their learning environment. Revista Brasileira de Educa\u00e7\u00e3o M\u00e9dica, 24(3), 399\u2013416.","journal-title":"Revista Brasileira de Educa\u00e7\u00e3o M\u00e9dica"},{"issue":"3","key":"401_CR13","first-page":"399","volume":"13","author":"G Lind","year":"2000","unstructured":"Lind, G. (2000). O significado e medida da compet\u00eancia moral revisitada- um modelo do duplo aspecto da compet\u00eancia moral. Psicologia: Reflex\u00e3o e Cr\u00edtica, 13(3), 399\u2013416.","journal-title":"Psicologia: Reflex\u00e3o e Cr\u00edtica"},{"key":"401_CR14","first-page":"59, 181","volume-title":"How to teach morality: Promoting deliberation and discussion, reducing violence and deceit","author":"G Lind","year":"2016","unstructured":"Lind, G. (2016). How to teach morality: Promoting deliberation and discussion, reducing violence and deceit (pp. 59, 181\u201389, 186). Berlin: Logos."},{"key":"401_CR15","unstructured":"Lind, G. (2018). Studies on the measurement, nature and development of Moral-democratic competence (MCT). http:\/\/www.uni-konstanz.de\/ag-moral\/mut\/mjt-references.htm. Retrieved May 10, 2019."},{"key":"401_CR16","unstructured":"Lind, G. (2018). Reporting the C score. https:\/\/www.uni-konstanz.de\/ag-moral\/mut\/_Reporting_the_C_score.pdf. Retrieved August 3, 2020."},{"key":"401_CR17","unstructured":"Moreno, C. (2005). Moral education in higher education and the transformation of a concern: a historical account. In Paper presented at the 31st annual meeting or the association for moral education, Cambridge."},{"issue":"5","key":"401_CR18","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1007\/s10459-013-9449-5","volume":"18","author":"H Neves Feitosa","year":"2013","unstructured":"Neves Feitosa, H., Rego, S., Bataglia, P., Sancho, K., Rego, G., & Nunes, R. (2013). Moral judgment competence of medical students: A transcultural study. Advances in Health Sciences Education: Theory and Practice, 18(5), 1067\u20131085.","journal-title":"Advances in Health Sciences Education: Theory and Practice"},{"key":"401_CR19","unstructured":"Oliveira, M. S. (2008). Desenvolvimento da compet\u00eancia de ju\u00edzo moral e ambiente de ensino-aprendizagem: uma investiga\u00e7\u00e3o com estudantes de gradua\u00e7\u00e3o em enfermagem. Master\u2019s thesis, National School of Public Health, Rio de Janeiro. https:\/\/www.arca.fiocruz.br\/bitstream\/icict\/5138\/2\/1019.pdf. Retrieved May 10, 2019."},{"issue":"7","key":"401_CR20","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1177\/0969733014549884","volume":"22","author":"E Peter","year":"2015","unstructured":"Peter, E., Mohammed, S., & Simmonds, A. (2015). Sustaining hope as a moral competency in the context of aggressive care. Nursing Ethics, 22(7), 743\u2013753.","journal-title":"Nursing Ethics"},{"key":"401_CR21","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s40889-016-0009-8","volume":"1","author":"A Serodio","year":"2016","unstructured":"Serodio, A., Kopelman, B. I., & Bataglia, P. (2016). The promotion of medical student\u2019s moral development: A comparison between a traditional course on bioethics and a course complemented with the Konstanz method of dilemma discussion. International Journal of Ethics Education, 1, 81\u201389.","journal-title":"International Journal of Ethics Education"},{"key":"401_CR22","unstructured":"Schillinger, M. (2016). Learning environment and moral development: How University education fosters moral judgment competence in Brazil and two German-speaking countries. Doctoral dissertation, Konstanz University. Retrieved from https:\/\/www.researchgate.net\/publication\/326030965_Learning_environment_and_moral_development_how_university_education_fosters_moral_judgment_competence_in_Brazil_and_two_German-speaking_countries. Retrieved May 10, 2019."},{"issue":"3","key":"401_CR23","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1177\/0969733007075867","volume":"14","author":"B Slovackov\u00e1","year":"2007","unstructured":"Slovackov\u00e1, B., & Slov\u00e1cek, L. (2007). Moral judgement competence and moral attitudes of medical students. Nursing Ethics, 14(3), 320\u2013328.","journal-title":"Nursing Ethics"}],"container-title":["Health Care Analysis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10728-020-00401-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10728-020-00401-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10728-020-00401-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T01:48:13Z","timestamp":1631843293000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10728-020-00401-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,17]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["401"],"URL":"https:\/\/doi.org\/10.1007\/s10728-020-00401-1","relation":{},"ISSN":["1065-3058","1573-3394"],"issn-type":[{"value":"1065-3058","type":"print"},{"value":"1573-3394","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,17]]},"assertion":[{"value":"29 August 2020","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 September 2020","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declares that there is no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}