Psychometric properties of instruments assessing the ethics of teaching: a COSMIN-based systematic review

This systematic review aimed to identify and critically evaluate instruments assessing the ethics of teaching and related moral constructs among educators, with a focus on their psychometric properties and applicability to health professions education.

A systematic search was conducted in PubMed, ERIC, Scopus, and Emerald Insight databases through January 31, 2026. Only English-language studies were included. Measurement properties were evaluated using COSMIN (consensus-based standards for the selection of health measurement instruments) and COSMIN-modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approaches.

Of 246 records, 6 instruments met the inclusion criteria: ESSQ (Ethical Sensitivity Scale Questionnaire), ELS (Ethical Leadership Scale), EEQ (Ethical Evaluation Questionnaire), TEPI (Teaching-Profession Ethical Principles Inventory), TCPERSS (Teachers' Compliance with Professional Ethics in Relations with Students Scale), and MCI (Moral Competency Inventory). Psychometric properties were sufficiently reported for selected domains, primarily internal consistency and structural validity (Cronbach's α=0.74-0.97). However, construct validity (hypothesis testing), test-retest reliability, and cross-cultural validation were inconsistently reported. The quality of evidence was moderate because of limited cross-context validation. Notably, no tools were specifically developed for health professions education. Most identified instruments focused on classroom pedagogy, potentially overlooking clinical instruction, bedside teaching, and workplace-based learning, where power dynamics and clinical pressures coexist. Developing tools that capture the "ethics of the clinical encounter" would help more accurately reflect the realities faced by health professions educators.

Existing instruments demonstrate sufficient psychometric properties in general education but reveal critical measurement gaps for health professions education. These findings provide an empirical basis for developing context-specific instruments to improve the evaluation of ethical teaching in clinical and healthcare settings.