Measuring moral development in the pharmacy profession from undergraduate to established practitioner: a longitudinal study

The aim of this study was to measure and evaluate the moral reasoning of undergraduate pharmacy students as they progressed through the University of Hertfordshire undergraduate pharmacy programme, and through the early years of their professional practice. A mixed methods approach to the study utilised Rest’s Defining Issues Test 2 (DIT-2) in a longitudinal design, evaluating a single cohort of future pharmacists, who commenced their four-year Master of Pharmacy (MPharm) degree programme in 2008-09, successfully registered as pharmacists after completing their pre-registration training and progressed through their early careers. The last dataset from the DIT-2 was collected in 2019. Both descriptive and inferential statistical analysis were carried out. In addition, semi-structured interviews were conducted with four pharmacists after the completion of the final DIT-2 administration, to elucidate findings from the DIT-2 and to gain insight into their experiences of moral development in professional practice. The cohort experienced significant moral growth during the four years of their undergraduate degree, where they were exposed to an ethical education designed to engage students at the “plus one” level of moral reasoning. There was also evidence for experiential augmentation of moral development between completion of the MPharm programme and qualification as pharmacists. The participants displayed a substantial increase in moral development as they progressed through their undergraduate studies, which continued through their pre-registration year. The pharmacists who took part in the interviews shared insights into their experiences of moral education while they were studying on the MPharm programme and the extent to which they were able to utilise this training in real-world practice. It was clear from this, that consideration needs to be given to enhancements to the MPharm programme, so that it is of more value to pharmacists while in practice. The interview participants also shared their experiences of factors in practice that hinder their ability to respond to dilemmas affectively and situations that give rise to dilemmas. They discussed the personal and professional influences on decision-making and how this changed as they progressed through their careers. This study was unique in its longitudinal nature, evaluating a single cohort’s moral development for over ten years. The identification of the retrograde step in moral development observed between Newly Qualified level and Established Practitioner level shed light on the need for interventions like peer support, continuing professional development focused on moral development and enhancement of moral education in undergraduate teaching to simulate real-world dilemmas. Although the study offers valuable longitudinal insights, its findings must be interpreted within the limitations of the small sample size achieved in the latter phases of data collection. The reduced number of respondents, common in longitudinal cohort studies, limits the generalisability of the quantitative results and restricts opportunities for statistical inference. Nonetheless, the developmental patterns observed remain informative and were strengthened by the complementary qualitative data, which provided depth and contextual understanding of pharmacists’ moral reasoning in practice.