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Helping Trainees Deal with Moral Distress in the Clinical Setting

May 17, 2023

Moral distress describes psychological, physiological, and/or emotional suffering when individuals feel powerless to do what they believe is right. It often occurs in hierarchical situations where people may be asked to do something by their supervisor that they would prefer not to but cannot find the courage or do not have the ability to refuse that request. Residents are at high risk for moral distress, which can lead to burnout. Can we offer our trainees help to reduce moral distress?

Layman et al from the Children’s Hospital of Philadelphia (10.1542/peds.2022-060269) believe it is possible to do so using a simple intervention that they demonstrate in a proof-of-concept case-based randomized controlled study that they share with us in an article being early released this month. The authors created 6 hypothetical clinical cases that they expected would cause moral distress for residents. They then invited 5 residency programs to participate. Overall, 220 residents were offered 1 of 2 versions of the 6 cases—either a version that included a supportive statement such as from a supervising attending or a version that excluded the empathetic or supportive statement.

The authors found that in 4 of the 6 cases, including the 3 where the attending offered a supportive empathetic comment to the resident, there was a significant decrease in a resident’s perception of feeling morally distressed. The 2 cases where no differences were seen involved supportive institutional structures that were in place to ensure patient safety but no personal supportive comments.

The important take-away from this study is that power of an empathetic or supportive statement to defuse the stress surrounding a clinical experience. How do supervisors learn to incorporate such statements in their interactions with trainees? To answer this, we invited 2 experts in residency training and burnout prevention, Drs. Deanna Chieco from Mount Sinai in New York and Patricia Poitevien from Brown in Rhode Island as well as the current president of the Association of Pediatric Program Directors to share their thoughts in an accompanying commentary (10.1542/peds.2023-061372).

Drs. Chieco and Poitevien point out the benefits of the findings in the study by Layman et al, but note the need to try the use what they and Layman refer to as an “EASER” approach, using empathy and shared perspective or responsibility to reduce moral distress. Both the study and commentary will raise your awareness about opportunities to address moral. Link to both articles and learn more.

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