Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-0685, USA.
Acad Med. 2010 Jan;85(1):111-7. doi: 10.1097/ACM.0b013e3181c4782b.
To develop an instrument for measuring moral distress in medical students, measuring the prevalence of moral distress in a cohort of students, and identifying the situations most likely to cause it. Moral distress, defined as the negative feelings that arise when one knows the morally correct thing to do but cannot act because of constraints or hierarchies, has been documented in nurses but has not been measured in medical students.
The authors constructed a survey consisting of 55 items describing potentially distressing situations. Responders rated the frequency of these situations and the intensity of distress that they caused. The survey was administered to 106 fourth-year medical students during a three-week period in 2007; the response rate was 60%.
Each of the situations was experienced by at least some of the 64 respondents, and each created some degree of moral distress. On average, students witnessed almost one-half of the situations at least once, and more than one-third of the situations caused mild-to-moderate distress. The survey measured individual distress (Cronbach alpha = 0.95), which varied among the students. Whereas women witnessed potentially distressing situations significantly more frequently than did men (P = .04), men tended to become more distressed by each event witnessed (P = .057).
Medical students frequently experience moral distress. Our survey can be used to measure aspects of the learning environment as well as individual responses to the environment. The variation found among student responses warrants further investigation to determine whether students at either extreme of moral distress are at risk of burnout or erosion of professionalism.
开发一种用于测量医学生道德困境的工具，测量一组学生中道德困境的普遍性，并确定最可能导致道德困境的情况。道德困境是指当一个人知道正确的道德行为但由于限制或等级制度而无法采取行动时产生的负面感受，这种现象在护士中已经有记录，但在医学生中尚未测量。
作者构建了一个包含 55 个项目的调查，描述了可能令人感到困扰的情况。回答者对这些情况的频率和引起的困扰强度进行了评分。该调查于 2007 年在三个星期的时间内对 106 名四年级医学生进行了管理，回应率为 60%。
至少有 64 名回答者中的一些人经历了每种情况，每种情况都造成了一定程度的道德困境。平均而言，学生们几乎每一半的情况至少经历过一次，超过三分之一的情况引起了轻度至中度的困扰。调查测量了个体的困扰（Cronbach alpha = 0.95），学生之间存在差异。尽管女性比男性更频繁地目睹潜在的困扰情况（P =.04），但男性对每一次目睹的事件的困扰程度更大（P =.057）。
医学生经常经历道德困境。我们的调查可以用于测量学习环境的各个方面以及个体对环境的反应。学生反应的差异需要进一步调查，以确定处于道德困境极端的学生是否有倦怠或职业操守受损的风险。
