Developing Deontological Competence in Medical Students Through a Master Adaptive Learner–Based Program: A Quasi-Experimental Controlled Study

Medical deontology—the ethical duties that govern a physician's conduct toward patients, families, colleagues, and society—is often taught through lectures that are weakly linked to clinical behavior. The Master Adaptive Learner (MAL) model frames learning as a self-regulated cycle of planning, learning, assessing, and adjusting. This quasi-experimental, nonequivalent pretest–posttest control-group study allocated intact academic groups of medical students to a MAL-structured program combining simulation, problem-based and team-based learning, OSCE, ethical debate, role-play, and reflective diaries (n = 170) or to the standard curriculum (n = 170). Deontological competence (motivational-value, cognitive, adaptive-activity, and reflective components) was classified as high, intermediate, or low, and the intervention effect was estimated with a proportional-odds model including a group × time interaction. The groups were equivalent at baseline (χ²(2) = 0.32, p = 0.854). The proportion of high-level students rose from 12.9% to 44.1% in the experimental group and from 11.2% to 12.4% in the control group (difference-in-differences 30.0 percentage points, 95% CI 18.7–41.3). The group × time interaction was significant (OR = 4.29, 95% CI 2.34–7.86, p < 0.001), and the posttest difference was of medium-to-large magnitude (Cliff's δ = 0.38; Cramér's V = 0.37). A MAL-structured program was associated with a substantial improvement in overall deontological competence; because the program was multicomponent, the effect is attributable to the program as a whole rather than to MAL or any single method.

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