Moral distress from professionalism dilemmas and its association with self-rated professionalism behaviors among Chinese residents

Residents inevitably witness or participate in a diverse range of professionalism dilemmas. However, few studies have focused on residents’ moral distress from professionalism dilemmas and its relationship with residents’ professionalism. This study aimed to understand the moral distress that Chinese residents may face after exposure to professionalism dilemmas and to examine the associations between moral distress and residents’ perceived fulfillment of professionalism behaviors. We conducted a cross-sectional survey of residents from four standardized residency training bases in Liaoning Province, China, using stratified cluster sampling. A checklist of professionalism dilemmas, the Moral Distress Scale, and the Behavior-based Medical Professionalism Inventory were used to assess residents’ moral distress from professionalism dilemmas and their perceived fulfillment of professionalism behaviors. Descriptive statistics, non-parametric tests, multiple linear regressions, and binary logistic regressions were used to analyze the data. A total of 647 (81.1%) residents effectively completed the survey. The proportion of residents suffering from moral distress ranged from 58.4 to 90.6% for different professionalism dilemmas. As the number of professionalism dilemmas associated with moral distress increased, residents reported lower fulfillment of professionalism behaviors (<i>β</i> &lt; 0, <i>p &lt;</i> 0.05). Compared with residents with no distress, residents suffering from distress reported lower fulfillment of professionalism behaviors (OR &lt; 1, <i>p &lt;</i> 0.05). Among residents suffering from distress, as the distress intensity increased, residents reported higher fulfillment of professionalism behaviors (OR &gt; 1, <i>p &lt;</i> 0.05). Residents suffered a wide range of moral distress from professionalism dilemmas, and residents with moral distress reported lower fulfillment of professional behaviors. A responsive reporting system for residents and reflection on role modeling may help residents cope with the negative effects of moral distress and professionalism dilemmas.

住院医师不可避免地会目睹或参与到多种多样的职业操守困境之中。然而，目前鲜有研究关注住院医师在遭遇职业操守困境时产生的道德困扰，以及该困扰与住院医师职业操守表现之间的关联。本研究旨在探究中国住院医师在面临职业操守困境后可能遭遇的道德困扰，并分析道德困扰与住院医师自我报告的职业操守行为履行情况之间的关联。本研究采用分层整群抽样方法，对中国辽宁省四家住院医师规范化培训基地的住院医师开展横断面调查。本研究采用职业操守困境检查表、道德困扰量表（Moral Distress Scale）以及基于行为的医学职业操守量表（Behavior-based Medical Professionalism Inventory），对住院医师因职业操守困境产生的道德困扰及其自我报告的职业操守行为履行情况进行评估。研究采用描述性统计、非参数检验、多元线性回归以及二元logistic回归对数据进行分析。最终共有647名住院医师完成有效问卷，有效回收率为81.1%。针对不同类型的职业操守困境，出现道德困扰的住院医师占比介于58.4%至90.6%之间。随着与道德困扰相关的职业操守困境数量增多，住院医师报告的职业操守行为履行程度显著降低（β<0，p<0.05）。与未出现道德困扰的住院医师相比，存在道德困扰的住院医师报告的职业操守行为履行程度显著更低（OR<1，p<0.05）。在存在道德困扰的住院医师群体中，随着道德困扰强度的升高，住院医师报告的职业操守行为履行程度显著升高（OR>1，p<0.05）。研究结果显示，住院医师会因各类职业操守困境产生广泛的道德困扰，且存在道德困扰的住院医师其职业操守行为履行程度更低。建立面向住院医师的响应式报告机制并开展角色榜样反思，或可帮助住院医师应对道德困扰与职业操守困境带来的负面影响。

搜集汇总

背景与挑战

背景概述

该数据集基于2024年对中国辽宁省647名住院医师的横断面调查，聚焦于专业困境引发的道德困扰及其与自我评价专业行为的关系。研究发现，住院医师普遍面临道德困扰（比例58.4%-90.6%），且道德困扰数量增加与专业行为履行度降低相关，但有困扰的住院医师中，困扰强度越高反而报告更高专业行为履行度。数据集采用多种统计方法分析，揭示了道德困扰对住院医师专业行为的复杂影响。