Moral distress in the third year of medical school; a descriptive review of student case reflections

Am J Surg. 2009 Jan;197(1):107-12. doi: 10.1016/j.amjsurg.2008.07.048.


Background: Medical students may find certain clinical experiences particularly difficult. Moral distress occurs when a trainee sees a situation or behavior as undesirable, but, because of a position in the hierarchy, declines to address the problem. To prompt our students to reflect on such experiences, students are required to submit a brief case description and are assigned to mentor groups to discuss cases.

Methods: After exemption from our Institutional Review Board, a database of student submissions was de-identified. A total of 192 case descriptions were analyzed by a single reviewer to identify recurrent themes. Submissions were categorized in a binary fashion as higher or lower levels of distress. Frequency and correlation with levels of distress were assessed for each theme.

Results: Sixty-seven percent of the submissions were classified as higher distress. Seven major themes were identified, the most common being problems of communication (n = 179). Those students taking action correlated to lower distress.

Conclusions: Our review shows that specific situations can be expected to generate moral distress in trainees. Addressing such distress may support the ongoing professional growth of trainees.

MeSH terms

  • Communication
  • Education, Medical, Undergraduate*
  • Morals*
  • Students, Medical / psychology*