Department of Medical Education, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, 69778, Israel.
Department of Human Services, Max Stern Yezreel Valley College, Yezreel Valley, Israel.
BMC Psychol. 2024 May 27;12(1):296. doi: 10.1186/s40359-024-01787-6.
Medical students, especially during the clinical years, are often exposed to breaches of safety and professionalism. These contradict personal and professional values exposing them to moral distress and to the dilemma of whether and how to act. Acting requires moral courage, i.e., overcoming fear to maintain one's core values and professional obligations. It includes speaking up and "doing the right thing" despite stressors and risks (e.g., humiliation). Acting morally courageously is difficult, and ways to enhance it are needed. Though moral courage efficacy, i.e., individuals' belief in their capability to act morally, might play a significant role, there is little empirical research on the factors contributing to students' moral courage efficacy. Therefore, this study examined the associations between perceived stress, academic burnout, and moral courage efficacy.
A cross-sectional study among 239 medical students who completed self-reported questionnaires measuring perceived stress, academic burnout ('exhaustion,' 'cynicism,' 'reduced professional efficacy'), and moral courage efficacy (toward others' actions and toward self-actions). Data analysis via Pearson's correlations, regression-based PROCESS macro, and independent t-tests for group differences.
The burnout dimension of 'reduced professional efficacy' mediated the association between perceived stress and moral courage efficacy toward others' actions. The burnout dimensions 'exhaustion' and 'reduced professional efficacy' mediated the association between perceived stress and moral courage efficacy toward self-actions.
The results emphasize the importance of promoting medical students' well-being-in terms of stress and burnout-to enhance their moral courage efficacy. Medical education interventions should focus on improving medical students' professional efficacy since it affects both their moral courage efficacy toward others and their self-actions. This can help create a safer and more appropriate medical culture.
医学生，尤其是在临床阶段，经常会遇到违反安全和专业规范的情况。这些情况与个人和专业价值观相冲突，使他们陷入道德困境，不知是否以及如何采取行动。采取行动需要道德勇气，即克服恐惧，坚持自己的核心价值观和职业义务。这包括在面临压力和风险（例如羞辱）时直言不讳并“做正确的事”。勇敢地采取行动并不容易，需要寻找增强道德勇气的方法。尽管道德勇气效能，即个人相信自己有能力采取道德行动的信念，可能发挥着重要作用，但关于影响学生道德勇气效能的因素的实证研究却很少。因此，本研究调查了感知压力、学业倦怠与道德勇气效能之间的关系。
对 239 名医学生进行了横断面研究，他们完成了自我报告问卷，以衡量感知压力、学业倦怠（“疲惫”、“玩世不恭”、“职业效能降低”）和道德勇气效能（针对他人的行动和针对自己的行动）。通过 Pearson 相关分析、基于回归的 PROCESS 宏和独立样本 t 检验进行数据分析，以检验组间差异。
“职业效能降低”这一倦怠维度在感知压力与针对他人的行动的道德勇气效能之间起中介作用。“疲惫”和“职业效能降低”这两个倦怠维度在感知压力与针对自我行动的道德勇气效能之间起中介作用。
研究结果强调了促进医学生的幸福感——包括压力和倦怠——以增强他们的道德勇气效能的重要性。医学教育干预措施应注重提高医学生的职业效能，因为它会影响他们对他人和自身行动的道德勇气效能。这有助于营造更安全、更合适的医疗文化。
