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AMA J Ethics. 2017 Jun 1;19(6):585-594. doi: 10.1001/journalofethics.2017.19.6.stas1-1706.

Initiatives for Responding to Medical Trainees' Moral Distress about End-of-Life Cases.

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Professor in the Departments of Internal Medicine, Pediatrics, and Behavioral Science at the University of Kentucky in Lexington, and founding director of the Program for Bioethics and chair of the healthcare ethics committee, and a co-creator of the novel self-guided documentary, The Moral Distress Education Project.
Chair of the Department of Bioethics and Interdisciplinary Studies at East Carolina University's Brody School of Medicine in Greenville, North Carolina, and director of the Office of Clinical Skills Assessment and Education and an adjunct professor in the College of Education, and a co-creator of the novel self-guided documentary, The Moral Distress Education Project.


Moral distress frequently arises for medical trainees exposed to end-of-life cases. We review the small literature on best practices for reducing moral distress in such cases and propose two areas to target for moral distress reduction: medical education and organizational ethics programs. Students require training in end-of-life dialogues and truthful prognostication, which are not generally available without skilled mentors. But physician-mentors and teachers can suffer from lingering moral residue themselves, which can affect the teaching culture and student expectations. Finally, reducing unit moral distress that affects learners requires formal educational opportunities to debrief about difficult end-of-life cases and formal institutional mechanisms for effective clinical ethics consultation.

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