Murray Esther, Krahé Charlotte, Goodsman Danë
Centre for Medical Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Emerg Med J. 2018 Oct;35(10):590-594. doi: 10.1136/emermed-2017-207216. Epub 2018 Jun 26.
The term 'moral injury' may be useful in conceptualising the negative psychological effects of delivering emergency and prehospital medicine as it provides a non-pathological framework for understanding these effects. This is in contrast to concepts such as burnout and post-traumatic stress disorder which suggest practitioners have reached a crisis point. We conducted an exploratory, pilot study to determine whether the concept of moral injury resonated with medical students working in emergency medicine and what might mitigate that injury for them.
Structured interviews and focus groups were carried out with medical students involved in the delivery of prehospital and emergency medicine. The study was carried out at Barts and the London School of Medicine and Dentistry in May and June 2017. The data were analysed using theoretically driven thematic analysis.
Concepts of moral injury such as witnessing events which contravene one's moral code, especially those involving children, or acts of violence, resonated with the experiences of medical students in this study. Participants stated that having more medical knowledge and a clear sense of a job to do on scene helped reduce their distress at the time. While social support was a protective factor, not all students found the process of debrief easy to access or undergo, those with more established relationships with colleagues fared better in this regard.
The term moral injury is useful in exploring the experience of medical students in emergency medicine. More effort should be made to ensure that students effectively access debrief and other support opportunities. It is hoped that future work will be undertaken with different professional groups and explore the potential psychological and neuropsychological impact of witnessing trauma.
“道德伤害”这一术语在概念化急诊医学和院前医学所带来的负面心理影响方面可能有用，因为它为理解这些影响提供了一个非病理学框架。这与诸如职业倦怠和创伤后应激障碍等概念形成对比，后者表明从业者已达到危机点。我们进行了一项探索性的试点研究，以确定道德伤害的概念是否能引起从事急诊医学工作的医学生的共鸣，以及什么可能减轻他们的这种伤害。
对参与院前和急诊医学工作的医学生进行了结构化访谈和焦点小组讨论。该研究于2017年5月和6月在巴茨和伦敦医学院及牙科学院开展。使用理论驱动的主题分析法对数据进行了分析。
诸如目睹违背个人道德准则的事件，尤其是涉及儿童的事件或暴力行为等道德伤害概念，与本研究中医学生的经历产生了共鸣。参与者表示，拥有更多医学知识以及对现场工作有清晰的认识有助于减轻他们当时的痛苦。虽然社会支持是一个保护因素，但并非所有学生都觉得汇报过程易于获得或接受，在这方面，与同事关系更融洽的学生表现更好。
道德伤害这一术语在探索医学生在急诊医学方面的经历时很有用。应做出更多努力，以确保学生能有效地获得汇报及其他支持机会。希望未来能与不同专业群体开展研究，并探索目睹创伤的潜在心理和神经心理影响。
