Moral Distress in Resident Physicians: A Scoping Review.

Abstract

Moral distress has been linked to burnout, emotional exhaustion, and intention to leave medicine. Although it has been widely studied in other health professionals, research into the experience of resident physicians, who work in unique sociocultural environments, is in the early stages. The objective of this scoping review is to identify, examine, and summarize the literature on moral distress in residents. Using the methodology described by Arksey & O'Malley, we queried five databases and screened and analyzed 2,991 articles. In the 36 included articles, authors' definitions of moral distress varied; however, external constraint was emphasized as a core feature. An analysis of quantitative, qualitative, and theoretical or commentary articles produced several key findings. First, conditions contributing to moral distress included tensions surrounding end-of-life care, hierarchical cultural norms, ambiguities associated with work-based learning, and structural factors in healthcare delivery. Second, frequency and intensity of moral distress were inconsistent across studies. Third, impacts of moral distress included callousness, burnout, depersonalization, and attrition. Fourth, residents employed a range of coping mechanisms such as seeking peer support, engaging in meaning-making, going above and beyond expectations, internalizing thoughts and emotions, or employing detachment and cynicism. Finally, suggested mitigation strategies included debriefing and reflection, culture change initiatives, and educational programming. The findings offer a unique analysis of how moral distress is defined in residency education and illuminate the interplay of relational, systemic, and sociocultural factors shaping residents' experiences. Further, the results provide a meaningful overview of the literature and identify important directions for future inquiry. .