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多种多样的职业素养困境。然而，鲜有研究聚焦于住院医师因职业素养困境产生的道德困扰，以及该困扰与住院医师职业素养之间的关联。本研究旨在了解中国住院医师在遭遇职业素养困境后可能面临的道德困扰，并探讨道德困扰与住院医师感知到的职业素养行为践行程度之间的关联。本研究采用分层整群抽样法，对中国辽宁省4家标准化住院医师培训基地的住院医师开展横断面调查。本研究使用职业素养困境核查表、道德困扰量表（Moral Distress Scale）以及基于行为的医学职业素养量表（Behavior-based Medical Professionalism Inventory），分别评估住院医师因职业素养困境产生的道德困扰，以及其感知到的职业素养行为践行情况。研究采用描述性统计、非参数检验、多元线性回归及二元logistic回归对数据进行分析。共有647名住院医师有效完成问卷，有效回收率为81.1%。针对不同类型的职业素养困境，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素养困境数量增多，住院医师报告的职业素养行为践行程度更低（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其职业素养行为践行程度更低（OR<1，p<0.05）。在存在道德困扰的住院医师群体中，随着困扰强度升高，其报告的职业素养行为践行程度反而更高（OR>1，p<0.05）。本研究结果显示，住院医师因职业素养困境所经历的道德困扰范围广泛，且存在道德困扰的住院医师其职业素养行为践行程度更低。建立针对住院医师的针对性上报系统并反思角色示范行为，或可帮助住院医师应对道德困扰及职业素养困境带来的负面影响。