Objectives: The objective is to investigate the primary factors that created experiences leading to moral injury in family medicine residents during the COVID-19 pandemic and also to identify any barriers keeping these residents from seeking or receiving help when they experienced moral injury.
Method: A DELPHI model study utilizing three rounds of surveys was conducted at four family medicine residency programs in the United States. Resident responses to Survey 1 generated factors perceived to be causing them moral injury or constituting barriers to their seeking help. Thematic analysis identified common themes which were presented to residents in Survey 2 for rating and justification. Results and feedback from Survey 2 were shared with residents in Survey 3, where residents were prompted to reevaluate their ratings for factors and barriers for the purpose of generating consensus among themselves. A ranked list of factors and barriers was thereby created for the participating sites.
Results: Residents shared several stories about the factors that most pressured them to violate their moral values. The most severe and frequent factors contributing to moral injury involved disruptions to doctor-patient relationships, patient-family relationships, and relationships with other healthcare professionals. Time was the major barrier to residents seeking help.
Conclusion: During times of crisis, moral injury among residents may be minimized by protecting and promoting important clinical and professional relationships with patients, colleagues, and other medical professionals. While residents report that lack of time was the most significant barrier to seeking help, it is unclear how this complicated and ubiquitous problem would be resolved or mitigated.
Keywords: COVID-19; family practice; internship and residency; moral injury; post-traumatic; stress disorders.