title: Medical students' experiences of moral distress: development of a web-based survey.
abstract: OBJECTIVE
  To develop an instrument for measuring moral distress in medical students, measuring the prevalence of moral distress in a cohort of students, and identifying the situations most likely to cause it. Moral distress, defined as the negative feelings that arise when one knows the morally correct thing to do but cannot act because of constraints or hierarchies, has been documented in nurses but has not been measured in medical students.
  
  
  METHODS
  The authors constructed a survey consisting of 55 items describing potentially distressing situations. Responders rated the frequency of these situations and the intensity of distress that they caused. The survey was administered to 106 fourth-year medical students during a three-week period in 2007; the response rate was 60%.
  
  
  RESULTS
  Each of the situations was experienced by at least some of the 64 respondents, and each created some degree of moral distress. On average, students witnessed almost one-half of the situations at least once, and more than one-third of the situations caused mild-to-moderate distress. The survey measured individual distress (Cronbach alpha = 0.95), which varied among the students. Whereas women witnessed potentially distressing situations significantly more frequently than did men (P = .04), men tended to become more distressed by each event witnessed (P = .057).
  
  
  CONCLUSIONS
  Medical students frequently experience moral distress. Our survey can be used to measure aspects of the learning environment as well as individual responses to the environment. The variation found among student responses warrants further investigation to determine whether students at either extreme of moral distress are at risk of burnout or erosion of professionalism.
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-0685, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Wiggleton
authors.forename: Emil
authors.initials: E
authors.lastname: Petrusa
authors.forename: Kim
authors.initials: K
authors.lastname: Loomis
authors.forename: John
authors.initials: J
authors.lastname: Tarpley
authors.forename: Margaret
authors.initials: M
authors.lastname: Tarpley
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: O'Gorman
authors.forename: Bonnie
authors.initials: B
authors.lastname: Miller
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002055:Burnout, Professional / Q000517:prevention & control; D003625:Data Collection / Q000379:methods; D003657:Decision Making; D004501:Education, Medical; D004992:Ethics, Medical; D005260:Female; D017144:Focus Groups; D006801:Humans; D020407:Internet; D008297:Male; D009014:Morals; D016730:Program Development; D011594:Psychometrics; D012307:Risk Factors; D013315:Stress, Psychological; D013337:Students, Medical / Q000523:psychology; D013714:Tennessee