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. 2023 Apr;80(4):556-562.
doi: 10.1016/j.jsurg.2022.11.007. Epub 2022 Dec 15.

"Sip & Share": Building Resilience in Surgery Residency Through Moral Distress Rounds

Richard Teo  1 , Rachel Grosser  1 , Hayavadhan Thuppal  1 , Mindy B Statter  2
Affiliations

"Sip & Share": Building Resilience in Surgery Residency Through Moral Distress Rounds

Richard Teo et al. J Surg Educ. 2023 Apr.

Abstract

Objective: Resident moral distress rounds were instituted during the COVID-19 pandemic to provide a safe zone for discussion, reflection, and the identification of the ethical challenges contributing to moral distress. The sessions, entitled "Sip & Share," also served to foster connectedness and build resilience.

Design: A baseline needs assessment was performed and only 36% of general surgery residents in the program were satisfied with the current non-technical skills curriculum. Only 62% were comfortable with navigating ethical issues in surgery. About 72% were comfortable with leading a goals-of-care discussion, and 63% of residents were comfortable with offering surgical palliative care options. Case-based discussions over video conferencing were organized monthly. Each session was structured based on the eight-step methodology described by Morley and Shashidhara. Participation was voluntary. The sessions explored moral distress, and the ethical tensions between patient autonomy and beneficence, and beneficence and non-maleficence.

Setting: Large general surgery residency in an urban tertiary medical center.

Participants: General surgery residents.

Results: A post-intervention survey was performed with improvement in the satisfaction with the non-technical skills curriculum (70% from 36%). The proportion of residents feeling comfortable with navigating ethical issues in surgery increased from 62% to 72%. A survey was performed to assess the efficacy of the moral distress rounds after eight Sip & Share sessions over ten months. All thirteen respondents agreed that the discussions provided them with the vocabulary to discuss ethical dilemmas and define the ethical principles contributing to their moral distress. 93% were able to apply the templates learned to their practice, 77% felt that the discussions helped mitigate stress. All respondents recommended attending the sessions to other residents.

Conclusions: Moral distress rounds provide a structured safe zone for residents to share and process morally distressing experiences. These gatherings mitigate isolation, promote a sense of community, and provide a support network within the residency. In addition, residents are equipped with the vocabulary to identify the ethical principles being challenged and are provided practical take-aways to avoid similar conflicts in the future.

Keywords: Ethics; Moral distress; Moral resilience; Surgery residency.

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Conflict of interest statement

Conflict of interest None.

Figures

Figure 1:
Figure 1
Summary of eight-step process for moral distress rounds.
See this image and copyright information in PMC

Comment in

  • Power Distance Impacts Surgical Staff and Patients.
    Kovoor JG, Gupta AK, Bacchi S, Stretton B, Padbury RT. Kovoor JG, et al. J Surg Educ. 2024 Feb;81(2):178-179. doi: 10.1016/j.jsurg.2023.10.011. Epub 2023 Dec 29. J Surg Educ. 2024. PMID: 38160115 No abstract available.

References

    1. Jameton A. Prentice-Hall; Englewood Cliffs, N.J.: 1984. Nursing Practice : The Ethical Issues.
    1. Lamiani G, Borghi L, Argentero P. When healthcare professionals cannot do the right thing: a systematic review of moral distress and its correlates. J Health Psychol. 2017;22:51–67. - PubMed
    1. Morley G, Bradbury-Jones C, Ives J. What is 'moral distress' in nursing? A feminist empirical bioethics study. Nurs Ethics. 2020;27:1297–1314. - PMC - PubMed
    1. Kodner IJ. Surgeons and clinical ethics. Surgery. 2008;143:460–462. - PubMed
    1. Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89:443–451. - PubMed