August 8, 2008

Study to track impact of moral distress on medical students

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Bonnie Miller, M.D.

Study to track impact of moral distress on medical students

Several Vanderbilt University School of Medicine faculty have been awarded a $199,000 grant from the Arthur Vining Davis Foundation to further their research into the effects of moral distress on medical students.

Bonnie Miller, M.D., associate dean for Undergraduate Medical Education, heads the research effort. She defines “moral distress” as the negative feelings that arise when one knows the morally correct thing to do but cannot take action because of system constraints or hierarchies.

“Moral distress could lead to burnout, cause students to lose their idealism and make them more jaded and cynical about the practice of medicine,” Miller said.

Moral distress has been highly studied in the nursing profession, but medical students had never been studied prior to the Vanderbilt research.

Miller and colleagues met with third- and fourth-year medical students monthly from 1999-2006. They recognized that students often reacted with distress when they witnessed situations or events that seemed to counteract the patient's best interests. They later developed a survey for medical students and residents that showed that episodes of moral distress are frequently experienced by VUSM students.

The second phase of research implemented small group case discussions between students and faculty Master Clinical Teachers.

The idea was that talking about the situations could prevent the erosion of compassion among physicians-in-training.

The Arthur Vining Davis grant will allow the group to hold more discussions between the students and their Master Clinical Teachers, and to design studies to measure the impact of interventions on the problem

“What trainees and practicing physicians envision as ideal medicine is often not attained due to limitations of the larger health care system,” said Kim Lomis, M.D., assistant professor of Surgery, Master Clinical Teacher and a study investigator.

Lomis' research on moral distress has recently been accepted for publication in the American Journal of Surgery.

“Discrepancies between the ideal and the real may lead to distress and ultimately to cynicism among providers,” Lomis added. “This project aims to better understand this issue and to create viable responses. It has the potential to improve the learning environment, improve job satisfaction of all team members and ultimately to improve patient care.”