Developing a Self-Scoring Comprehensive Instrument to Measure Rest's Four-Component Model of Moral Behavior: The Moral Skills Inventory.

One of the most extensively studied constructs in dental education is the four-component model of moral behavior proposed by James Rest and the set of instruments for measuring it developed by Rest, Muriel Bebeau, and others. Although significant associations have been identified between the four components Rest proposed (called here Moral Sensitivity, Moral Reasoning, Moral Integrity, and Moral Courage) and dental ethics courses and practitioners with disciplined licenses, there is no single instrument that measures all four components, and existing single component instruments require professional scoring. This article describes the development and validation of a short, self-scoring instrument, the Moral Skills Inventory, that measures all four components. Evidence of face validity, test/retest reliability, and concurrent convergent and divergent predictive validity are demonstrated in three populations: dental students, clinical dental faculty members, and regents and officers of the American College of Dentists. Significant issues remain in developing the Rest four-component model for use in dental education and practice. Specifically, further construct validation research is needed to understand the nature of the components. In particular, it remains undetermined whether moral constructs are characteristics of individuals that drive behavior in specific situations or whether particular patterns of moral behavior learned and used in response to individual circumstances are summarized by researchers and then imputed to practitioners.