Cognitive Moral Development and Clinical Performance: Implications for Pharmacy Education

Pharmaceutical care has been incorporated into the mission statements of virtually every pharmacy organization, including the American Association of Colleges of Pharmacy (AACP). As such, a major objective of pharmacy educators is to graduate pharmacists who are both capable and willing to render pharmaceutical care. The present investigation explores the notion that the moral reasoning skills are of consequence to the rendering of pharmaceutical care. Specifically, two classes of pharmacy students’ moral reasoning were examined as part of the admissions requirements of a large southeastern school of pharmacy. The scores of these students were then compared to the moral reasoning scores of a systematic random sample of pharmacy practitioners who had scored high on both a self-report measure of pharmaceutical care and two measures of actual clinical decision-making. Results indicated that the average score of the admitted students was significantly lower on moral reasoning than those clinicians scoring at the highest levels of clinical performance. This is disconcerting in light of the fact that investigations in pharmacy and several other health professions have consistently demonstrated that high moral reasoners rarely perform poorly on clinical performance measures. Additionally, comparisons on moral reasoning with a baseline of healthcare students revealed that these two classes of pharmacy students appear to be less morally developed than their counterparts in other health professions. Implications of the study include the possibility of using moral reasoning as one criterion in the admissions process of students to pharmacy schools and introducing curriculum changes to increase the probability of increasing students’ moral development during their pharmacy education.