Hard then, harder now: internal medicine residents’ moral distress pre and amidst COVID-19

Abstract

Background: Moral distress, which occurs when the ethically correct action cannot be taken because of internal or external constraints, is associated with depression, burnout, and the desire to leave the healthcare profession among healthcare workers. This study compares internal medicine (IM) residents’ experiences of moral distress while caring for patients with COVID-19 in the year prior to and during the first year of the COVID-19 pandemic. Methods: This is a mixed methods prospective observational cohort study that enrolled IM residents on a rolling basis beginning December 2018. Moral distress was evaluated via the validated Moral Distress Score-Revised (MDS-R) and Measure of Moral Distress for Healthcare Professionals (MDD-HP) and open-ended questions every 4-months via online surveys and through five resident focus groups. The moral distress scores (MDS) before and during the COVID-19 pandemic were compared using paired t-tests. Transcripts and free text were independently coded by investigators and analyzed by major themes and sub-themes. Results: Forty-five residents (42% response rate) completed at least one survey during the pre-COVID and COVID periods. Analysis revealed no significant difference in individuals’ pre-to-COVID mean MDS, but significant differences between the overall MDS mean intensity scores pre-to-COVID (62.2 to 68.3 p