Moral distress and burnout in caring for older adults during medical school training

Wendy C. Gonzalez,Matthew R. Baldwin,Subha Perni,Lauren R. Pollack,Elizabeth Dzeng

doi:10.1186/s12909-020-1980-5

Abstract

BackgroundMoral 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.MethodsA 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.ResultsTwo-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.ConclusionsMoral 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.

Highlights

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
Medical students may be susceptible to experiencing moral distress while caring for older adults because it involves complex medical decision making and end-of-life care [5], and because medical students spend a significant amount of time with patients, but lack clinical-decision making power compared to resident or attending physicians [6]
We investigated strategies that medical students used to cope with moral distress, and elicited suggestions for interventions to treat medical student moral distress

Summary

Introduction

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. Prior studies show that American medical students frequently experience moral distress on clinical rotations [2, 3], and most often when caring for older adult patients [4]. Medical students may be susceptible to experiencing moral distress while caring for older adults because it involves complex medical decision making and end-of-life care [5], and because medical students spend a significant amount of time with patients, but lack clinical-decision making power compared to resident or attending physicians [6]. Medical students have reported thoughts of dropping out of medical school or choosing a non-clinical specialty due to moral distress [22]

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Conclusion