Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA.
Department of Medicine, University of Washington, Seattle, WA, USA.
BMC Med Educ. 2020 Mar 23;20(1):84. doi: 10.1186/s12909-020-1980-5.
Moral distress is a reason for burnout in healthcare professionals, but the clinical settings in which moral distress is most often experienced by medical students, and whether moral distress is associated with burnout and career choices in medical students is unknown. We assessed moral distress in medical students while caring for older patients, and examined associations with burnout and interest in geriatrics.
A cross-sectional survey study of second-, third-, and fourth-year medical students at an American medical school. The survey described 12 potentially morally distressing clinical scenarios involving older adult patients. Students reported if they encountered each scenario, and whether they experienced moral distress, graded on a 1-10 scale. We conducted a principal axis factor analysis to assess the dimensionality of the survey scenarios. A composite moral distress score was calculated as the sum of moral distress scores across all 12 scenarios. Burnout was assessed using the Maslach Abbreviated Burnout Inventory, and interest in geriatrics was rated on a 7-point Likert scale.
Two-hundred and nine students responded (47%), of whom 90% (188/209) reported moral distress in response to ≥1 scenario with a median (IQR) score of 6 (4-7). Factor analysis suggested a unidimensional factor structure of the 12 survey questions that reliably measured individual distress (Cronbach alpha = 0.78). Those in the highest tertile of composite moral distress scores were more likely to be burnt out (51%) than those in the middle tertile of scores (34%), or lowest tertile of scores (31%) (p = 0.02). There was a trend towards greater interest in geriatrics among those in the higher tertiles of composite moral distress scores (16% lowest tertile, 20% middle tertile, 25% highest tertile, p-for-tend = 0.21). Respondents suggested that moral distress might be mitigated with didactic sessions in inpatient geriatric care, and debriefing sessions with peers and faculty on the inpatient clerkships on medicine, neurology, and surgery, where students most often reported experiencing moral distress.
Moral distress is highly prevalent among medical students while caring for older patients, and associated with burnout. Incorporating geriatrics education and debriefing sessions into inpatient clerkships could alleviate medical student moral distress and burnout.
道德困境是医疗保健专业人员倦怠的一个原因，但医学生最常经历道德困境的临床环境，以及道德困境是否与医学生的倦怠和职业选择有关，目前尚不清楚。我们评估了医学生在照顾老年患者时的道德困境，并研究了与倦怠和对老年医学的兴趣的关系。
这是一项在美国一所医学院进行的横断面调查研究，调查了二年级、三年级和四年级的医学生。该调查描述了 12 种可能涉及老年患者的具有潜在道德困境的临床情况。学生报告他们是否遇到了每种情况，以及他们是否经历了 1-10 分的道德困境。我们进行了主成分因子分析，以评估调查情景的维度。将 12 个场景的所有道德困境得分相加得出综合道德困境得分。使用 Maslach 简化倦怠量表评估倦怠情况，使用 7 点李克特量表评估对老年医学的兴趣。
209 名学生（47%）做出了回应，其中 90%（188/209）报告说，在应对至少 1 个场景时感到道德困境，中位数（IQR）得分为 6（4-7）。因子分析表明，12 个调查问题的单维结构能够可靠地衡量个体的困境（Cronbach alpha = 0.78）。综合道德困境得分最高的三分位组比中间三分位组（34%）或最低三分位组（31%）更容易倦怠（51%比 34%，p = 0.02）。在综合道德困境得分较高的三分位组中，对老年医学的兴趣呈上升趋势（最低三分位组 16%，中间三分位组 20%，最高三分位组 25%，p 趋势 = 0.21）。受访者认为，在住院老年护理中的教学课程，以及在住院内科、神经科和外科实习中与同伴和教师进行的汇报课程，可以减轻医学生的道德困境和倦怠。
在照顾老年患者时，医学生的道德困境非常普遍，并且与倦怠有关。将老年医学教育和汇报课程纳入住院实习可以减轻医学生的道德困境和倦怠。
