Structural distress: experiences of moral distress related to structural stigma during the COVID-19 pandemic

Residents experience structural distress as powerlessness, responding by doing extra and potentially worsening their psychological well-being

“I definitely do not think I have a voice …” (R02)

“I think like a resident’s response to a challenge is just to work like harder faster stronger better and so I think that’s why … they can be super high risk for burnout …” (F01)

Programs must draw explicit attention to structural distress as part of residency training

Critical perspectives on the hero narrative and culture of medical training must be highlighted as part of discussions on structural distress

Faculty responses to resident experiences mitigated the adverse impact of structural distress

“Faculty ultimately determine what I can do … My decision making is curtailed by … who approves my decisions because I am at such a junior level. Faculty create the norms in which we work.” (R03)

“We haven’t indoctrinated our faculty to be good faculty members and role models, as a result their residents are bearing the fruits of our failed system on health advocacy …” (F02)

Teaching faculty should be prepared to address structural distress and embed advocacy into training

Faculty must be supported in their own advocacy for themselves and on behalf of residents

Structural distress mitigated by enhancing resident agency

“I think in general a lot of us like I do feel powerless but there are certain things that we kind of do to try to get around that system.” (R11)

Faculty and organizations can enhance resident agency through creating a culture of transparency and involving residents in policy decisions