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Degree Name

PHD - Doctor of Philosophy




Accreditation standards for allopathic medical schools in the United States require that each institution have in place a mechanism by which student progress through the curriculum is monitored. These entities, referred to here as promotions committees, make important decisions in a high stakes medical education environment. Yet little is currently known about how promotions committee members make decisions about students who experience academic failures and lapses in professional behavior. Using the work of Lawrence Kohlberg and Carol Gilligan on moral development as a theoretical basis, the purpose of this study was to elucidate committee members’ perceptions of the role of promotions committees, the ethical orientations that guide individual decision making, and the influence of particular student characteristics and circumstances on that decision making process. An electronic survey was sent to representatives at 143 accredited allopathic medical schools in the United States with a request to distribute the survey to all voting members of that institution’s promotions committee. Survey questions were primarily quantitative in nature. A total of 241 surveys were completed by individuals at 55 medical schools. Data were examined by gender, age, participant role (medical student, faculty member, administrator), and years of committee experience. Major findings included the concurrent orientations of both justice and care in individual decision making, with some prioritization of responsiveness to particular student characteristics and circumstances over consistency across student cases. Significant differences by age, role and gender were identified, but these were limited in number. The aspects of student cases that were most influential to committee member decision making concerned student characteristics and circumstances that could reasonably be considered as being within the students’ control, in particular lapses in professional behavior. Recommendations for future research and promotions committee member training were discussed.



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