Differences in Ethical Issues and Moral Distress in Medical Students on Obstetrics and Gynecology Clerkship Based on Setting (Catholic vs. Public Hospital)

Abstract: During clinical rotations, medical students providing direct patient care for the first time are exposed to ethically and emotionally challenging clinical situations that may bring their own values in conflict with those of patients, families, and other members of the healthcare team, leading to moral distress. While much has been reported on the moral distress of physicians, residents, nurses, and pharmacists when confronting ethical issues in settings such as the ICU or on obstetrics and gynecology (OB-GYN) services, literature on medical students’ experiences of ethical issues and moral distress is lacking. Therefore, we conducted a content analysis of medical student essays reflecting on ethical scenarios encountered during OB-GYN rotations at two teaching hospital systems to characterize the types of ethical issues encountered and types of moral distress experienced using established typology for ethical issues and moral distress.
In this presentation, we describe the different types of ethical issues and moral distress experienced by medical students. Next, we compare the ways in which the ethical issues and moral distress in these narratives differ based on institution: one, an academic hospital, the other a community, Catholic-affiliated hospital. We then describe which types of moral distress were associated with which ethical issue. Lastly, we discuss how enhanced awareness of these issues informs interventions to support medical students in navigating ethically challenging situations, maintain well-being, and uphold professional values, and how these interventions can be tailored based on clinical practice setting.

Janice Firn – University of Michigan-Ann Arbor