Assessing moral competence in medical and psychology students: effects on anxiety and test duration in online versus paper-based testing

Abstract Background Moral competence and anxiety are essential factors in medical and psychology education, but evidence on how these variables interact across different testing conditions is limited. The present study examined whether moral competence differs between medical and psychology students, how it relates to anxiety levels, and whether test format and duration influence outcomes. Methods A total of 717 students (620 medical, 97 psychology) completed the Moral Competence Test (MCT) and the State-Trait Anxiety Inventory (STAI). Participants were systematically (quasi-randomly) assigned to an online or paper-based version of the tests. Test duration was recorded in both formats. Group differences were analyzed using generalized linear models, with additional attention to the relationship between completion time and moral competence. Results Psychology students scored higher in moral competence than medical students, while anxiety remained elevated among medical students. Female students reported significantly higher trait anxiety than male students. No significant differences were found between online and paper-based formats in moral competence or anxiety outcomes. Longer test duration was associated with higher moral competence among medical students, although this relationship was correlational and should be interpreted cautiously. Conclusions Findings confirm that moral competence declines during medical education while anxiety persists at a higher level, particularly among female students. In contrast, psychology students demonstrated stable or higher moral competence. The absence of differences between online and paper-based formats suggests that both are suitable for assessing moral competence and anxiety in academic settings. The observed association between test duration and moral competence highlights a potential area for further research but should not be interpreted causally.