Purpose: To examine the impact of different bioethical values on how medical residents assess the importance of various factors in a case and make recommendations on how to proceed in a case.

Methods: An assessment instrument (Medical Values in Medicine, or MVM) has been developed which presents three cases: a trauma patient, a cancer patient, and a psoriasis patient. Respondents are asked to rate the importance of case facts and their agreement with certain bioethical statements. The trauma patient case was designed to highlight the conflicting duties of saving a life and respecting patients' values. The cancer patient case was designed to reflect the conflict between duties to champion a patient's best interest versus duties to allocate resources justly. The psoriasis patient case was designed to reflect a conflict between doing unnecessary harm, in addition to the conflict concerning what determines the patient's best interest, the physiological/medical factors or the psychosocial factors.

Six cohorts, from 1999 to 2005, of first-year medical residents at a Western United States hospital participated in the study (n=180). On the first day of their residency, they filled out the assessment instrument.

Results: Data indicate that different bioethical viewpoints are significantly associated with how medical residents evaluate the importance of facts about medical cases. For example, in the trauma patient case, those who strongly agreed that benefits of medical resources to others outweighed the obligation to save the trauma patient rated the fact that “the ICU was full” as much more important than other residents. Agreement with different bioethical viewpoints was also significantly associated with different recommendations of what one should do in the medical cases presented. Preliminary factor analyses indicated that the pattern of responses tapped into an overarching need to save the patient, a concern not to harm the patient unnecessarily, and a concern about how medical resources were distributed. No factor representing a concern over respecting patient's wishes was found.

Conclusions: Medical residents as a group have differing bioethical values, and these differences relate to how they make decisions in medical cases, and what case facts they consider to be important. The MVM assessment instrument is a necessary first step in being able to evaluate bioethical education and to examine how bioethical viewpoints are informed by clinical experience.