Humphrey Cara Af, Aslanian R Evey, Bradley Sarah E, Awan Rija, Millis M Andrew, Firn Janice, Suwanabol Pasithorn A
University of Michigan Medical School, Ann Arbor, Michigan.
University of Michigan Medical School, Ann Arbor, Michigan.
J Surg Educ. 2025 Jan;82(1):103340. doi: 10.1016/j.jsurg.2024.103340. Epub 2024 Nov 23.
Moral distress, reported among healthcare workers across a variety of settings, is associated with negative mental health consequences, burnout, and intention to leave a position. The scant literature exploring medical students' moral distress does not specifically examine moral distress during the surgical clerkship nor does it characterize the type of moral distress experienced by medical students. Thus, we aimed to explore and characterize medical students' moral distress during the surgical clerkship.
SETTING/PARTICIPANTS: This study was conducted at the University of Michigan Medical School evaluating narrative essays written by 3 cohorts of students (2018-19, 2019-20, 2020-21) who completed the surgical clerkship during their third year of medical school.
Deductive content analysis was used to evaluate 180 narrative essays for the presence of moral distress using a 5-subcategorization schema developed by Morley et al. (constraint-distress, tension-distress, dilemma-distress, uncertainty-distress, and conflict-distress).
Four of the 5 sub-categories of moral distress (constraint-distress, tension-distress, dilemma-distress and uncertainty-distress) were identified in medical student essays. There were no examples of conflict-distress.
Medical students described 4 of the 5 sub-types of moral distress during their surgical clerkship. The sub-types of moral distress most often experienced by medical students are different than sub-types of moral distress previously reported among nurses, suggesting the varied roles and responsibilities of the healthcare team impact the scenarios most likely to present moral distress. Additionally, medical students were hesitant to raise concerns with their team when they experienced events discordant with their moral beliefs; they cited their position in the medical hierarchy, fearing implications on their future career, and perceived lack of knowledge and experience as factors limiting their willingness to share. Finally, this study identifies morally distressing scenarios as opportunities for transformative learning for medical students specifically in the realm of professional identity formation.
道德困扰在各类医疗环境中的医护人员中均有报道，它与负面心理健康后果、职业倦怠以及离职意愿相关。探索医学生道德困扰的文献较少，且未专门研究外科实习期间的道德困扰，也未描述医学生所经历的道德困扰类型。因此，我们旨在探索并描述医学生在外科实习期间的道德困扰。
背景/参与者：本研究在密歇根大学医学院开展，评估了3组学生（2018 - 19年、2019 - 20年、2020 - 21年）撰写的叙述性文章，这些学生在医学院三年级时完成了外科实习。
采用演绎性内容分析法，使用莫利等人开发的五分类模式（约束困扰、紧张困扰、两难困扰、不确定困扰和冲突困扰）评估180篇叙述性文章中道德困扰的存在情况。
在医学生的文章中识别出了道德困扰的5个亚类中的4个（约束困扰、紧张困扰、两难困扰和不确定困扰）。没有冲突困扰的例子。
医学生在外科实习期间描述了道德困扰5种亚类型中的4种。医学生最常经历的道德困扰亚类型与之前护士中报道的道德困扰亚类型不同，这表明医疗团队不同的角色和职责会影响最有可能引发道德困扰的场景。此外，医学生在经历与自己道德信念不一致的事件时，不愿向团队提出担忧；他们提到自己在医疗等级制度中的地位，担心对未来职业的影响，以及认为自己缺乏知识和经验是限制他们分享意愿的因素。最后，本研究将道德困扰场景确定为医学生特别是在职业身份形成领域进行变革性学习的机会。
