Role Model-Based Ethics Education and Moral Injury Prevention in Second-Year Medical Students

Role Model-Based Ethics Education and Moral Injury Prevention in Second-Year Medical Students: A Mixed-Methods Quasi-Experimental Study

This study examines whether role model-based ethics education can reduce moral injury and perceived stress, and improve resilience, among second-year medical students in Taiwan. Students participated in a general education ethics course and self-selected into one of two groups: a standard-intensity group receiving role model narratives and guided handouts, or an enhanced-intensity group receiving the same content plus reflective writing assignments and live guest appearances by featured practitioners. Validated questionnaires measuring moral injury (MIDS), perceived stress (PSS-14), and resilience (CD-RISC-10) were administered before and after the course. Open-ended written responses were also collected and analyzed. The study aims to inform early curricular integration of ethics education in medical training and to identify instructional designs that support moral agency without inadvertently promoting emotional disengagement.

Study Overview

• Status: Completed
• Conditions: Resilience; Perceived Stress; Moral Injury; Ethics Education
• Intervention / Treatment: Behavioral: Role Model-Based Ethics Education (Standard Intensity); Behavioral: Role Model-Based Ethics Education (Enhanced Intensity)

• Study Type: Interventional
• Enrollment (Actual): 101
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Taipei, Taiwan
    • National Defense Medical University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Second-year medical students enrolled in a general education ethics course at National Defense Medical University, Taiwan
• Willing to complete pre- and post-course questionnaires

Exclusion Criteria:

- Students who did not complete both pre-test and post-test assessments

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Standard-Intensity Group (Group A); Participants received role model narratives and guided reflection handouts as part of a semester-long general education ethics course.	Behavioral: Role Model-Based Ethics Education (Standard Intensity); Participants attended a semester-long general education ethics course incorporating role model narratives drawn from real clinical practitioners. Guided reflection handouts were provided to facilitate structured engagement with the ethical themes presented. This condition served as the active comparator.
Experimental: Enhanced-Intensity Group (Group B); Participants received the same role model narratives and guided reflection handouts as Group A, supplemented with structured reflective writing assignments and live guest appearances by the featured practitioners.	Behavioral: Role Model-Based Ethics Education (Enhanced Intensity); Participants attended the same role model-based ethics course as the standard-intensity group, with two additional components: structured reflective writing assignments requiring personal ethical reflection, and live guest appearances by the practitioners featured in the role model narratives. This condition served as the experimental arm.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Moral Injury (MIDS)	Moral injury symptoms measured using the Moral Injury and Distress Scale (MIDS). Higher scores indicate greater moral injury.	Baseline and up to 6 weeks (immediately after course completion)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived Stress (PSS-14)	Perceived stress measured using the 14-item Perceived Stress Scale (PSS-14). Higher scores indicate greater perceived stress.	Baseline and up to 6 weeks (immediately after course completion)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Resilience (CD-RISC-10)	Psychological resilience measured using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). Higher scores indicate greater resilience.	Baseline and up to 6 weeks (immediately after course completion)

Collaborators and Investigators

• Sponsor: Chun Lun Hsu
• Investigators: Principal Investigator: Chun Lun Hsu, National Defense Medical University, Taiwan

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2025
• Primary Completion (Actual): December 31, 2025
• Study Completion (Actual): February 20, 2026

Study Registration Dates

• First Submitted: June 11, 2026
• First Submitted That Met QC Criteria: June 14, 2026
• First Posted (Actual): June 18, 2026

Study Record Updates

• Last Update Posted (Actual): June 18, 2026
• Last Update Submitted That Met QC Criteria: June 14, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Trauma and Stressor Related Disorders; Mental Disorders; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
• Other Study ID Numbers: TSGHIRB-C202505117

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No