Table 1.

What Can Residency Directors Do to Combat Moral Distress and Prevent Moral Injury Among Residents?

Have organized support programs Develop an early residency ethics curriculum in graduate medical education to help residents anticipate difficult ethical situations they may experience. 21 Advertise existing institution support structures such as crisis counseling programs, employee assistance programs, and grief counseling programs. 2

Awareness of collective ethics decision making structures in the hospital Encourage residents to seek assistance from hospital ethics, rationing, and/or palliative care teams.

Mindfulness 22 programs Encourage mindfulness and mediation training or structured thought self‐regulation patterns to help disrupt negative thinking and behavior and reflect on how they have overcome difficult situations in the past.

Structured reflection Create small group forums or conferences designed for collective sharing on difficult ethical cases, enhancing communication, and conflict management development. 21 Offer “narrative ethics” in which residents journal or write short stories about ethical challenges. 23

Time off from clinical duties Flexibility with assigning residents to electives or non‐clinical training modules to allow time to process grief. Adequate scheduling of residents on shifts to allow for call‐outs or short‐term leaves of absence. This will allow residents to reestablish existing support systems outside of residency.