Structural Equation Models of Moral Reasoning and Physician Performance

Abstract

In order to identify and explain those aspects of clinical performance related to moral reasoning, 39 family medicine residents were studied as they interacted with each of two simulated patients. Residents were interviewed to assess their performance with each patient, elicit their general philosophy of being a doctor, and measure their moral reasoning. General performance as residents was rated by three faculty supervisors. Scoringprotocols were developedfor each measure to ensure objectivity. Factor analysis of each measure guided selection of the most meaningful variablefrom each instrument. Based upon general models relating attitude to behavior, structural equations were used to explicate the relationship between moral reasoning, performance on the simulated cases, performance as a resident, attitude, and intention. Chi-square goodness offit indicates that the general attitude-behavior models adequatelyfit the data. These models would suggest that moral reasoning and physician attitudes have more of an influence on behavior than physician intentions.