2021 Trauma/Critical Care Presentations

Madeline Y Ryu1; Alex H Jin1; Holly K Tabor, PhD2; Sherry Wren, MD3; Matthew Martin, MD4; 1Stanford Medical School; 2Stanford University Medical Center; 3Palo Alto Veterans Affairs Health Care System; 4Scripps Mercy Hospital

OBJECTIVE: Moral injury and distress (MID) is a psychological conflict from awareness that ideal medical choices cannot be carried out due to situational/external factors. This can lead to impaired physical and psychological well-being. The experience of MID may also be modified by demographic factors such as gender, particularly in military medicine where females are underrepresented. We sought to analyze MID characteristics and any gender disparities among military surgeons following combat deployments.

METHODS: Convergent mixed-methods study evaluating MID among military surgeons with combat deployment experiences during high casualty periods (Iraq 2003-2008 or Afghanistan 2009-2012). Subjects completed the Measure of Moral Distress for Healthcare Professionals (MMD-HP) and detailed, semi-structured interviews. Patterns within the data were located, analyzed, and identified through thematic analysis using Dedoose and compared by demographic factors including gender.

RESULTS: 20 detailed interviews and MMD-HP were completed. 75% of the female participants scored in the highest quartile and 25% scored in the second highest quartile. This score showed no correlation in all participants with the following factors during the time of the deployment: age, rank, time after residency, number of deployments before, number of other surgeons, and number of casualties seen per week. Qualitative findings revealed that the main gender differences in experiences were within the themes of disagreement with the commander, methods of coping, and the worries during the deployment. Female surgeons more frequently identified bullying and toxic leadership as primary contributors to MID. Although they were more likely to rely on support from friends/family at home, females more frequently cited higher levels of stress related to these situations at home compared to male respondents. Figure 1 shows a word map of identified themes, and highlights how many times each code was mentioned in each gender corresponding to the text size of the concepts.

CONCLUSION: Although some degree of MID was identified among all respondents, 100% of females scored in the top two quartiles of the MMD-HP indicating markedly high levels of moral injury and distress related to combat medical deployments. Significant thematic and qualitative differences were noted between male and female surgeons for deployment-related stressors and contributors to post deployment moral injury and distress. Identification and delineation of these high-risk areas tailored to specific populations may be useful in improving pre and post-deployment interventions to reduce MID.

Word Map

Figure 1: Word maps for most prominent concepts and themes identified by female (left) versus male (right) surgeons