Structural distress: experiences of moral distress related to structural stigma during the COVID-19 pandemic.

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  • Author(s): Sukhera J;Sukhera J; Kulkarni C; Kulkarni C; Taylor T; Taylor T
  • Source:
    Perspectives on medical education [Perspect Med Educ] 2021 Aug; Vol. 10 (4), pp. 222-229. Date of Electronic Publication: 2021 Apr 29.
  • Publication Type:
    Journal Article; Research Support, Non-U.S. Gov't
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Ubiquity Press Country of Publication: Netherlands NLM ID: 101590643 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2212-277X (Electronic) Linking ISSN: 22122761 NLM ISO Abbreviation: Perspect Med Educ Subsets: MEDLINE
    • Publication Information:
      Publication: 2023- : [London] : Ubiquity Press
      Original Publication: [Houten] : Bohn Stafleu van Loghum
    • Subject Terms:
      COVID-19* ; Internship and Residency* ; Mental Health* ; Pandemics*; Physicians/*ethics ; Social Discrimination/*ethics ; Stress, Psychological/*etiology; Canada ; Ethics, Medical ; Faculty, Medical ; Female ; Health Equity ; Humans ; Male ; Morals ; Physicians/psychology ; Policy ; Power, Psychological ; Qualitative Research ; SARS-CoV-2 ; Social Discrimination/psychology ; Social Justice ; Vulnerable Populations
    • Abstract:
      Introduction: The COVID-19 pandemic has taken a significant toll on the health of structurally vulnerable patient populations as well as healthcare workers. The concepts of structural stigma and moral distress are important and interrelated, yet rarely explored or researched in medical education. Structural stigma refers to how discrimination towards certain groups is enacted through policy and practice. Moral distress describes the tension and conflict that health workers experience when they are unable to fulfil their duties due to circumstances outside of their control. In this study, the authors explored how resident physicians perceive moral distress in relation to structural stigma. An improved understanding of such experiences may provide insights into how to prepare future physicians to improve health equity.
      Methods: Utilizing constructivist grounded theory methodology, 22 participants from across Canada including 17 resident physicians from diverse specialties and 5 faculty members were recruited for semi-structured interviews from April-June 2020. Data were analyzed using constant comparative analysis.
      Results: Results describe a distinctive form of moral distress called structural distress, which centers upon the experience of powerlessness leading resident physicians to go above and beyond the call of duty, potentially worsening their psychological well-being. Faculty play a buffering role in mitigating the impact of structural distress by role modeling vulnerability and involving residents in policy decisions.
      Conclusion: These findings provide unique insights into teaching and learning about the care of structurally vulnerable populations and faculty's role related to resident advocacy and decision-making. The concept of structural distress may provide the foundation for future research into the intersection between resident well-being and training related to health equity.
      (© 2021. The Author(s).)
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    • Contributed Indexing:
      Keywords: COVID-19; Marginalized populations; Moral distress; Professional identity formation; Stigma
    • Publication Date:
      Date Created: 20210429 Date Completed: 20210902 Latest Revision: 20240612
    • Publication Date:
      20240612
    • Accession Number:
      PMC8082743
    • Accession Number:
      10.1007/s40037-021-00663-y
    • Accession Number:
      33914288