Moral distress arising from professionalism dilemmas among medical interns

Moral distress is defined as a psycho-emotional experience that occurs when individuals recognize the morally appropriate course of action but are unable to carry it out due to external constraints such as institutional hierarchies, organizational norms, or authority pressures. In medical education, this phenomenon is particularly frequent, given the deeply ethical nature of clinical decisions and patient care.

The aim of this study was to translate and adapt the Moral Distress from Professionalism Dilemmas checklist into Brazilian Portuguese.

The translation and cross-cultural adaptation process followed internationally recognized guidelines. It included independent translations by two professionals (one with and one without medical training), synthesis of the versions, back-translation, expert committee review, pretesting with 200 medical interns, and final evaluation.

Of the 200 medical students invited, 160 (80%) completed the checklist, with no significant differences by year or gender. Depending on the item, between 0 and 57.5% of participants reported exposure to the professionalism dilemmas investigated. Among exposed students, the intensity of moral distress varied considerably across situations.

Moral distress is a prevalent phenomenon in medical education. The adapted checklist demonstrated semantic and conceptual equivalence to the original and may serve as a valuable tool to identify, quantify, and understand moral distress among medical students in clinical training.