Moral sensitivity in medical education: a longitudinal and cross-sectional study of personality and moral foundations among medical and psychology students

Moral sensitivity is an important component of ethical decision-making, but little is known about how its deliberative and paternalistic dimensions change during medical education or how they relate to moral foundations and personality traits. This study examined longitudinal and cross-sectional patterns of moral sensitivity among medical students and explored their associations with moral foundations and Big Five personality traits. We conducted an observational study combining a one-year longitudinal cohort and a cross-sectional comparison. The longitudinal sample included 90 of 151 (59.6%) Croatian-language medical students assessed during transitions from the third to fourth and fifth to sixth study years. The cross-sectional sample included 574 medical students and 31 psychology students (exploratory comparison). Moral sensitivity was assessed using the revised Moral Sensitivity Questionnaire (MSQ), moral foundations using the Moral Foundations Questionnaire, and personality using the Big Five Inventory. Non-parametric tests, Spearman correlations, and adjusted linear regression models were used. Longitudinally, paternalistic attitude scores (MSQ-PATER) remained stable ( p = .968), whereas deliberative scores (MSQ-DELIB) increased ( p < .001), most clearly from the third to the fourth year ( p < .001, r = − .742). Cross-sectionally, clinical-phase students had higher MSQ-PATER ( p < .001) and MSQ-DELIB ( p = .006) scores than preclinical students; for MSQ-PATER, this between-cohort difference was not accompanied by within-student change. MSQ-DELIB showed broader, mostly small, bivariate associations with moral foundations and Big Five traits than MSQ-PATER. In adjusted models, Fairness was positively associated with both MSQ dimensions, while higher Loyalty and lower Care were associated with higher MSQ-PATER. Big Five traits showed less consistent adjusted and longitudinal associations. Exploratory medical–psychology differences disappeared after adjustment. Deliberative and paternalistic dimensions of moral sensitivity showed different patterns: deliberative scores increased during the transition to clinical training, whereas paternalistic attitude scores remained stable within students, supporting their interpretation as separate dimensions. Moral foundations, particularly Fairness, were more consistently associated with both dimensions than personality traits. Based on these associations, the transition to clinical training may be a relevant period for ethics education that addresses moral values, patient autonomy, and professional responsibilities.