Background: Although medical educators acknowledge the importance of ethics in medical training, there are few validated
instruments to assess ethical decision-making. One instrument is the Ethics in Health Care Questionnaire – version 2 (EHCQ-2).
The instrument consists of 12 scenarios, each posing an ethical problem in health care, and asking for a decision and rationale. The
responses are subjectively scored in four domains: response, issue identification, issue sophistication, and values.
Goals: This study was intended to examine the inter-rater and inter-case reliability of the AHCQ-2 and validity against a national
licensing examination of the EHCQ-2 in an international sample.
Methods: A total of 20 final year McMaster students and 45 final year Glasgow students participated in the study. All
questionnaires were scored by multiple raters. Generalizability theory was used to examine inter-rater, inter-case and overall test
reliability. Validity was assessed by comparing EHCQ-2 scores with scores on the Canadian written licensing examination, both
total score and score for the ethics subsection.
Results: For both samples, reliability was quite low. Except for the first task, which is multiple choice, inter-rater reliability was
0.08–0.54, and inter-case reliability was 0.14–0.61. Overall test reliability was 0.12–0.54. Correlation between EHCQ-2 task scores
and the licensing examination scores ranged from 0.07 to 0.40; there was no evidence that the correlation was higher with the
ethics subsection.
Conclusions: The reliability and validity of the measure remains quite low, consistent with other measures of ethical decisionmaking.
However, this does not limit the utility of the instrument as a tool to generate discussion on ethical issues in medicine.
Background: Although medical educators acknowledge the importance of ethics in medical training, there are few validatedinstruments to assess ethical decision-making. One instrument is the Ethics in Health Care Questionnaire – version 2 (EHCQ-2).The instrument consists of 12 scenarios, each posing an ethical problem in health care, and asking for a decision and rationale. Theresponses are subjectively scored in four domains: response, issue identification, issue sophistication, and values.Goals: This study was intended to examine the inter-rater and inter-case reliability of the AHCQ-2 and validity against a nationallicensing examination of the EHCQ-2 in an international sample.Methods: A total of 20 final year McMaster students and 45 final year Glasgow students participated in the study. Allquestionnaires were scored by multiple raters. Generalizability theory was used to examine inter-rater, inter-case and overall testreliability. Validity was assessed by comparing EHCQ-2 scores with scores on the Canadian written licensing examination, bothtotal score and score for the ethics subsection.Results: For both samples, reliability was quite low. Except for the first task, which is multiple choice, inter-rater reliability was0.08–0.54, and inter-case reliability was 0.14–0.61. Overall test reliability was 0.12–0.54. Correlation between EHCQ-2 task scoresand the licensing examination scores ranged from 0.07 to 0.40; there was no evidence that the correlation was higher with theethics subsection.Conclusions: The reliability and validity of the measure remains quite low, consistent with other measures of ethical decisionmaking.However, this does not limit the utility of the instrument as a tool to generate discussion on ethical issues in medicine.
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