In their course in clinical ethics, Professor Dan Davis and Sister Carol Taylor (Director of the Center for Clinical Bioethics) felt it was crucial to improve their assessment of students' abilities to reason through ethically challenging medical situations. The traditional small group and case write-up methods used to determine moral agency, Davis believed, insufficiently measured the problem-solving and reasoning processes that students must employ in authentic care-giving situations.

As recipients of a CNDLS Fellowship, Davis and Taylor chose to utilize an assessment technique called 'think-alouds' in which students verbalize their thinking process as they tackle a real-life problem posed by a moderator. As a prototype for evaluating the students' reasoning, they developed a thorough checklist of questions and criteria for the moderators to track during the think-aloud sessions. CNDLS helped to analyze the video recordings and the efficacy of the checklist, which contributed to the development of a more flexible rubric to allow multiple moderators to rate and compare students' performance.

Ultimately, the difficult process of evaluating the ethical competencies of medical students was made more transparent by capturing students' thinking about an authentic ethical dilemma, and moved closer to a standardized process through the creation of a rubric to aid in assessing critical skills needed in clinical settings.