A systematic scoping review moral distress amongst medical students

Abstract

Background Characterised by feelings of helplessness in the face of clinical, organization and societal demands, medical students are especially prone to moral distress (MD). Despite risks of disillusionment and burnout, efforts to support them have been limited by a dearth of data and understanding of MD in medical students. Yet, new data on how healthcare professionals confront difficult care situations suggest that MD could be better understood through the lens of the Ring Theory of Personhood (RToP). A systematic scoping review (SSR) guided by the RToP is proposed to evaluate the present understanding of MD amongst medical students. Methods The Systematic Evidence-Based Approach (SEBA) is adopted to map prevailing accounts of MD in medical students. To enhance the transparency and reproducibility, the SEBA methodology employs a structured search approach, concurrent and independent thematic analysis and directed content analysis (Split Approach), the Jigsaw Perspective that combines complementary themes and categories, and the Funnelling Process that compares the results of the Jigsaw Perspective with tabulated summaries to ensure the accountability of these findings. The domains created guide the discussion. Results Two thousand six hundred seventy-one abstracts were identified from eight databases, 316 articles were reviewed, and 20 articles were included. The four domains identified include definitions, sources, recognition and, interventions for MD. Conclusions MD in medical students may be explained as conflicts between the values, duties, and principles contained within the different aspects of their identity. These conflicts which are characterised as disharmony (within) and dyssynchrony (between) the rings of RToP underline the need for personalised and longitudinal evaluations and support of medical students throughout their training. This longitudinal oversight and support should be supported by the host organization that must also ensure access to trained faculty, a nurturing and safe environment for medical students to facilitate speak-up culture, anonymous reporting, feedback opportunities and supplementing positive role modelling and mentoring within the training program.

Systematic scoping review on moral distress among physicians

“…The innermost ring or the microenvironment is influenced and influences the two outer rings. The microenvironment considers the physician’s narratives including their previous experiences,37 demographics, training, skills, personality, attitudes, resilience, current coping, and the values, beliefs,39 and principles10 62 within each of the 4 rings of the RToP 38. This ring also considers conflicts between and within the rings of the physician’s RToP.…”

“…In addition, recognising MD's complex sociocultural nature underscores the importance of appreciating the physician's narratives, competencies, experiences, reflections, abilities and available coping and support mechanisms that provide MD with its personalised and evolving nature. Two, with a physician's personal, moral, ethical and professional beliefs, values, and principles informed by their self-concepts of identity and personhood or 'what makes you, you', 36 the link between personalised concepts [37][38][39] of MD and self-concepts of personhood become clearer. Ho et al 38 Kuek et al 3 Chan and Chia 40 and Huang et al 41 provide clinical evidence of these ties between self-concepts of personhood and identity using the ring theory of personhood (RToP) to study the experiences of physicians, nurses and medical students caring for terminally ill patients and confronting the death of their patients.…”

“…Two, with a physician’s personal, moral, ethical and professional beliefs, values, and principles informed by their self-concepts of identity and personhood or ‘what makes you, you’,36 the link between personalised concepts37–39 of MD and self-concepts of personhood become clearer. Ho et al 38 Kuek et al 3 Chan and Chia40 and Huang et al 41 provide clinical evidence of these ties between self-concepts of personhood and identity using the ring theory of personhood (RToP) to study the experiences of physicians, nurses and medical students caring for terminally ill patients and confronting the death of their patients.…”

A systematic scoping review of reflective writing in medical education

“…The Krishna Model of RW posits that the RToP is able to encapsulate various aspects of the physician’s belief system. The Innate Ring which represents the innermost ring of the four concentric rings depicting the RToP is derived from currently held spiritual, religious, theist, moral and ethical values, beliefs and principles [ 13 , 51 , 53 , 252 ]. Encapsulating the Innate Ring is the Individual Ring.…”

“…Encapsulating the Innate Ring is the Individual Ring. The Individual Ring’s belief system is derived from the physician’s thoughts, conduct, biases, narratives, personality, decision-making processes and other facets of conscious function which together inform the physician’s Individual Identity [ 13 , 51 , 53 , 252 ]. The Relational Ring is shaped by the values, beliefs and principles governing the physician’s personal and important relationships [ 13 , 51 , 53 , 252 ].…”