'Practice not ignoring hard things': navigating moral distress, burnout symptoms, and resilience among medical...

Medical students can experience moral distress related to patient encounters during clinical training which can impact student wellbeing. We aimed to characterize themes associated with demonstrated resilience versus burnout symptoms in response to moral distress related to challenging patient encounters working with marginalized communities.

We conducted a qualitative analysis of written reflections on challenging clinical encounters by 3rd-year medical students placed in underserved clinical settings. Iterative thematic analysis with inductive and deductive coding was performed by two researchers.

Fifty reflections from 21 students during the 2022-2024 academic years were included in the analysis. Key themes emerging from reflections included approaching distressing patient encounters with curiosity and realistic optimism - defined as the ability to recognize and mitigate structural barriers without internalizing them as personal failures - was associated with empathy and resilient behavior. Reflections highlighted debriefing, 'rewind' skills, and written reflections as potential tools for promoting resilient framing of challenging clinical experiences.

Our findings highlight potential tools to promote resilience in medical students in response to challenging patient encounters leading to moral distress. This is particularly relevant when students are placed in clinical environments where the likelihood of experiencing moral distress is high.