As in the US longitudinal study,13 we did not observe the
increase in the development of moral reasoning that was
expected with maturation and involvement in university
studies. We found a significant decrease in weighted average
scores after 3 years of medical education. Our findings
do not, however, establish a direct causal relation between
the observed decrease in moral development and medical
education. Yet they do clearly indicate the occurrence over
time of a levelling to a lower threshold of development
than that expected for this age group. Colby and Kohlberg19
stated that the conventional level of moral reasoning
(represented by intermediate stage 3–4 and stage 4) is the
one most commonly found in the adolescent and adult
population. In contrast, among children and young adolescents,
the preconventional level (represented by stages 1 to
3) prevails; at this level parental authority and the desire to
avoid punishment are determinative. The postconventional
level (represented by intermediate stage 4–5 and stage 5) is
characterized by the adoption of a societal perspective and
is found only in a minority of adults.
The decrease in the weighted average scores we observed
among 45 of the 54 students is explained by their more frequent
use of arguments related to self-interest or their immediate
environment (stage 1, 2 or 3). After 3 years of training,
the students adopted the social perspective that considers ethical
stakes (stage 4 or 5) in the decision-making process less
frequently than they had upon entering medical school.