Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
When health care providers experience moral distress, it influences not only their wellness, but that of their patients. Although moral distress in health care is believed to be universal, the majority of literature on the topic describes the experiences of nurses. Moral distress among physician trainees is poorly understood. In this study, I report the findings of a systematic review of studies of moral distress experienced by physician trainees. I reviewed three key questions: (1) What are the root causes of moral distress (clinical situations, internal constraints, and external constraints) in physician trainees? (2) Is the experience of moral distress influenced by a physician trainee’s gender, subspecialty, or level of training? (3) How do physician trainees cope with their moral distress? I screened 1492 articles for eligibility; 38 articles met criteria for full-text review. The final qualitative analysis included eight studies. Five studies employed qualitative methods and three studies used quantitative methods. I could not perform a quantitative synthesis of the 8 appraised articles. The most commonly identified clinical situations leading to moral distress were “powerlessness due to position in the hierarchy,” “witnessing unprofessional/unethical/substandard conduct or scenarios,” and “caring for critically ill patients at the end-of-life.” The most common form of adaptive coping reported was open discussions among staff involved with specific cases. The most common form of maladaptive coping reported was depersonalization. Few studies explored the relationship between moral distress and demographic characteristics. Of the five qualitative studies, the majority were of moderate quality. All three quantitative studies were of low or very low quality. High quality research that enables us to understand the best ways to identify, respond to, and prevent moral distress among physician trainees will support their wellbeing and may be helpful for curriculum development.