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Published in: Journal of General Internal Medicine 2/2014

01-02-2014 | Perspective

Moral Distress in Medical Education and Training

Author: Jeffrey T. Berger, MD

Published in: Journal of General Internal Medicine | Issue 2/2014

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ABSTRACT

Moral distress is the experience of cognitive-emotional dissonance that arises when one feels compelled to act contrary to one’s moral requirements. Moral distress is common, but under-recognized in medical education and training, and this relative inattention may undermine educators’ efforts to promote empathy, ethical practice, and professionalism. Moral distress should be recognized as a feature of the clinical landscape, and addressed in conjunction with the related concerns of negative role modeling and the goals and efficacy of medical ethics curricula.
Literature
1.
go back to reference Rushton C, Kaszniak AW, Halifax J. A framework for understanding moral distress among palliative care clinicians. Palliat Med. 2013 Sep;16(9):1074–1079. doi:10.1089/jpm.2012.0490. Epub 2013 Jun 18. Rushton C, Kaszniak AW, Halifax J. A framework for understanding moral distress among palliative care clinicians. Palliat Med. 2013 Sep;16(9):1074–1079. doi:10.​1089/​jpm.​2012.​0490. Epub 2013 Jun 18.
2.
go back to reference DuBois JM, Burkemper J. Ethics education in U.S. medical schools: a study of syllabi. Acad Med. 2002;77(5):432–437. DuBois JM, Burkemper J. Ethics education in U.S. medical schools: a study of syllabi. Acad Med. 2002;77(5):432–437.
3.
go back to reference Lehmann LS, et al. A survey of medical ethics education at U.S. and Canadian medical schools. Acad Med. 2004;79(7):682–689. Lehmann LS, et al. A survey of medical ethics education at U.S. and Canadian medical schools. Acad Med. 2004;79(7):682–689.
4.
go back to reference Frank JE. Conscientious refusal in family medicine residency training. Fam Med. 2011;43(5):330–333. Frank JE. Conscientious refusal in family medicine residency training. Fam Med. 2011;43(5):330–333.
5.
go back to reference Knifed E, Goyal A, Bernstein M. Moral angst for surgical residents: a qualitative study. Am J Surg. 2010;199(4):571–576. Knifed E, Goyal A, Bernstein M. Moral angst for surgical residents: a qualitative study. Am J Surg. 2010;199(4):571–576.
6.
go back to reference Rosenbaum JR, et al. Sources of ethical conflict in medical housestaff training: a qualitative study. Am J Med. 2004;116(6):402–407. Rosenbaum JR, et al. Sources of ethical conflict in medical housestaff training: a qualitative study. Am J Med. 2004;116(6):402–407.
7.
go back to reference Wiggleton C, et al. Medical students’ experiences of moral distress: development of a web-based survey. Acad Med. 2010;85(1):111–117. Wiggleton C, et al. Medical students’ experiences of moral distress: development of a web-based survey. Acad Med. 2010;85(1):111–117.
8.
go back to reference Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethic. 2009;20(4):330–342. Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethic. 2009;20(4):330–342.
9.
go back to reference Mobley MJ, et al. The relationship between moral distress and perception of futile care in the critical care unit. Intensive Crit Care Nurs. 2007;23(5):256–263. Mobley MJ, et al. The relationship between moral distress and perception of futile care in the critical care unit. Intensive Crit Care Nurs. 2007;23(5):256–263.
10.
go back to reference Leiter MP, Frank E, Matheson TJ. Demands, values, and burnout: relevance for physicians. Can Fam Physician. 2009;55(12):1224–1225. Leiter MP, Frank E, Matheson TJ. Demands, values, and burnout: relevance for physicians. Can Fam Physician. 2009;55(12):1224–1225.
11.
go back to reference Poole AD, Sanson-Fisher RW. Long-term effects of empathy training on the interview skills of medical students. Patient Couns Health Educ. 1980;2(3):125–127. Poole AD, Sanson-Fisher RW. Long-term effects of empathy training on the interview skills of medical students. Patient Couns Health Educ. 1980;2(3):125–127.
12.
go back to reference Winseman J, Malik A, Morison J, Balkoski V. Students’ views on factors affecting empathy in medical education. Acad Psychiatry. 2009;33(6):484–491. Winseman J, Malik A, Morison J, Balkoski V. Students’ views on factors affecting empathy in medical education. Acad Psychiatry. 2009;33(6):484–491.
13.
go back to reference Tavakol S, Dennick R, Tavakol M. Medical students’ understanding of empathy: a phenomenological study. Med Educ. 2012;46(3):306–316. Tavakol S, Dennick R, Tavakol M. Medical students’ understanding of empathy: a phenomenological study. Med Educ. 2012;46(3):306–316.
14.
go back to reference Cohen MJ, Kay A, Youakim JM, Balaicuis JM. Identity transformation in medical students. Am J Psychoanal. 2009;69(1):43–52. Cohen MJ, Kay A, Youakim JM, Balaicuis JM. Identity transformation in medical students. Am J Psychoanal. 2009;69(1):43–52.
15.
go back to reference Lomis KD, Carpenter RO, Miller BM. Moral distress in the third year of medical school; a descriptive review of student case reflections. Am J Surg. 2009;197:107–112. Lomis KD, Carpenter RO, Miller BM. Moral distress in the third year of medical school; a descriptive review of student case reflections. Am J Surg. 2009;197:107–112.
16.
go back to reference Carrese JA, McDonald EL, Moon M, Taylor HA, Khaira K, Beach CM, Hughes MT. Everyday ethics in internal medicine resident clinic: an opportunity to teach. Med Educ. 2011;45(7):712–721. Carrese JA, McDonald EL, Moon M, Taylor HA, Khaira K, Beach CM, Hughes MT. Everyday ethics in internal medicine resident clinic: an opportunity to teach. Med Educ. 2011;45(7):712–721.
17.
go back to reference Ousager J, Johannessen H. Humanities in undergraduate medical education: a literature review. Acad Med. 2010 Jun;85(6):988–998. Ousager J, Johannessen H. Humanities in undergraduate medical education: a literature review. Acad Med. 2010 Jun;85(6):988–998.
18.
go back to reference Cordingley L, Hyde C, Peters S, Vernon B, Bundy C. Undergraduate medical students’ exposure to clinical ethics: a challenge to the development of professional behaviours? Med Educ. 2007;41(12):1202–1209. Cordingley L, Hyde C, Peters S, Vernon B, Bundy C. Undergraduate medical students’ exposure to clinical ethics: a challenge to the development of professional behaviours? Med Educ. 2007;41(12):1202–1209.
19.
go back to reference Hu YY, Fix ML, Hevelone ND, Lipsitz SR, Greenberg CC, Weissman JS, Shapiro J. Physicians’ needs in coping with emotional stressors: the case for peer support. Arch Surg. 2012 March;147(3):212–217. Hu YY, Fix ML, Hevelone ND, Lipsitz SR, Greenberg CC, Weissman JS, Shapiro J. Physicians’ needs in coping with emotional stressors: the case for peer support. Arch Surg. 2012 March;147(3):212–217.
21.
go back to reference Rogers DA, Boehler ML, Roberts NK, Johnson V. Using the hidden curriculum to teach professionalism during the surgery clerkship. J Surg Educ. 2012;69(3):423–427. Rogers DA, Boehler ML, Roberts NK, Johnson V. Using the hidden curriculum to teach professionalism during the surgery clerkship. J Surg Educ. 2012;69(3):423–427.
22.
go back to reference Ubel PA. The predictable irrationality of righteous minds, and the work of ethicists. Hastings Center Rep. 2013;43(3):18–22. Ubel PA. The predictable irrationality of righteous minds, and the work of ethicists. Hastings Center Rep. 2013;43(3):18–22.
23.
go back to reference Stephens MB, Reamy BV, Anderson D, Olsen C, Hemmer PA, Durning SJ, Auster S. Writing, self-reflection, and medical school performance: the human context of health care. Mil Med. 2012;177(9 Suppl):26–30. Stephens MB, Reamy BV, Anderson D, Olsen C, Hemmer PA, Durning SJ, Auster S. Writing, self-reflection, and medical school performance: the human context of health care. Mil Med. 2012;177(9 Suppl):26–30.
24.
go back to reference Self DJ, Baldwin JR, Wolinsky FD. Evaluation of teaching medical ethics by an assessment of moral reasoning. Med Educ. 1992;26(3):178–184. Self DJ, Baldwin JR, Wolinsky FD. Evaluation of teaching medical ethics by an assessment of moral reasoning. Med Educ. 1992;26(3):178–184.
25.
go back to reference Patenaude J, Niyonsenga T. Changes in students’ moral development during medical school: a cohort study. CMAJ. 2003;7:840–844. Patenaude J, Niyonsenga T. Changes in students’ moral development during medical school: a cohort study. CMAJ. 2003;7:840–844.
26.
go back to reference Self DJ, Schrader DE, Baldwin JR, Wolinsky FD. The moral development of medical students: a pilot study of the possible influence of medical education. Med Educ. 1993;27(1):26–34. Self DJ, Schrader DE, Baldwin JR, Wolinsky FD. The moral development of medical students: a pilot study of the possible influence of medical education. Med Educ. 1993;27(1):26–34.
27.
go back to reference Dubler NN, Liebman CB. Bioethics Mediation: A Guide to Shaping Shared Solutions. Vanderbilt University Press Nashville; 2011. Dubler NN, Liebman CB. Bioethics Mediation: A Guide to Shaping Shared Solutions. Vanderbilt University Press Nashville; 2011.
28.
go back to reference Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE, Gooley TA, Tulsky JA. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007;167(5):453–460. Back AL, Arnold RM, Baile WF, Fryer-Edwards KA, Alexander SC, Barley GE, Gooley TA, Tulsky JA. Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med. 2007;167(5):453–460.
29.
go back to reference Hamric AB, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med. 2007;35(2):422–429. Hamric AB, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med. 2007;35(2):422–429.
30.
go back to reference Ganz FD, Raanan O, Khalaila R, Bennaroch K, Scherman S, Bruttin M, Sastiel Z, Fink NF, Benbenishty J. Moral distress and structural empowerment among a national sample of Israeli intensive care nurses. J Adv Nurs. 2013 Feb;69(2):415–424. doi:10.1111/j.1365-2648.2012.06020. Ganz FD, Raanan O, Khalaila R, Bennaroch K, Scherman S, Bruttin M, Sastiel Z, Fink NF, Benbenishty J. Moral distress and structural empowerment among a national sample of Israeli intensive care nurses. J Adv Nurs. 2013 Feb;69(2):415–424. doi:10.​1111/​j.​1365-2648.​2012.​06020.
Metadata
Title
Moral Distress in Medical Education and Training
Author
Jeffrey T. Berger, MD
Publication date
01-02-2014
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 2/2014
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-013-2665-0

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