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Study: Pediatric residents need empathy, partnership in tough situations

May 8, 2023

Empathy and partnership are more effective in reducing distress among pediatric residents in tough situations than simply providing information, according to a new study.

“Recognition and targeting of distress through supportive statements or program structure imply that supervisors care about residents, thereby creating an environment that feels supportive and collaborative,” researchers wrote in “Simple Interventions for Pediatric Residents’ Moral Distress: A Randomized, Controlled Experiment,” (Layman AAK, et al. Pediatrics. May 8, 2023). “As residents learn and confront new and distressing scenarios, they need to know that they are not alone in their responsibility or distress.”

Researchers from Children’s Hospital of Philadelphia surveyed 220 pediatric residents from five residency programs at large hospitals. They aimed to look at ways to alleviate moral distress, which they described as “psychological, emotional, physiological suffering that clinicians experience when they feel powerless or unable to do what they think is right.”

Residents were given six clinical vignettes describing potentially distressing scenarios. They were randomly assigned to see a version in which the resident was provided with support or one without support.

For instance, in the case deemed to be the most distressing, a resident is told to coordinate a procedure for a patient with severe neurological impairment that the resident believes is futile. In the supported version, the supervising physician assures the resident the family is fully informed and on board. In the unsupported version, the physician does not address the resident’s concerns.

The support in this scenario was one of four deemed helpful in reducing residents’ distress. Others included a supervising physician speaking up in support of a resident’s competency or offering to be present during a difficult procedure. In the fourth, the resident concerned about a colleague’s error was able to rely on the health care system’s review process to handle the situation.

These effective supports are examples of EASER interventions, which authors said include “providing the resident with both empathy and shared perspective or responsibility, in partnership with a supervisor, or shared accountability with a structural aspect of the program.”

“Research on leadership shows that good leaders reduce distress by identifying situations likely to cause negative feelings and sharing responsibility — and even blame,” authors wrote.

The two supports that did not reduce distress were giving the resident additional outpatient experience and a supervising physician providing educational materials for a family hesitant about a routine vitamin K shot.

“Broadly, the failure of these interventions calls into question the common suggestion that information and education alone can resolve ethical issues and alleviate residents’ moral distress,” authors wrote. “Information and education may not themselves provide agency.”

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