Irony and Insight: Exploring Moral Descriptors in Modern Medical Training
Benjamin Frush, MD, MA, Kennedy Institute of Ethics, Georgetown University, Washington, DC; Brewer Eberly, MD, MA, Theology, Medicine, and Culture Initiative, Duke Divinity School, Durham, NC, Fischer Clinic, Raleigh, NC; Ashley Moyse , PhD, Columbia Center for Clinical Medical Ethics, New York, NY; and Emmy Yang, MD, MTS, UNC School of Medicine, Chapel Hill, NC
While criticisms of the medical education and training process are longstanding, the language invoked by students and trainees to voice their grievances has changed significantly within the past five years. Whereas the “burnout” narrative characterized the challenges felt throughout medicine in the early aughts, increasingly the language of “moral distress” and “moral injury” seems to have assumed this primary descriptive role. Moreover, whereas critiques of the medical education and training system have traditionally been raised by faculty, ethicists, and social theorists, it is now medical students and trainees themselves who seem to be harnessing this terminology to voice their grievances.
The use of the terms “moral injury” and “moral distress” by physicians and physicians-in-training—ideas drawn from their original context in the military and nursing ethics literature—is itself a contested move by those who question its fittingness in this context. Setting this question aside, it is nonetheless noteworthy that contemporary students and trainees are now quick to describe the challenges they face as “moral” in nature, within a field of practice that has become increasingly “de-moralized,” as Jacob Blythe and Farr Curlin have written.
That is to say, there is a strange and evident irony in medical students and trainees drawing on “moral” terminology when factors both internal to the practice (increasing bureaucratization and corporatization; elision of moral or conscience-based consideration in medical decision-making; progressive technological creep and documentation burden reducing time at the bedside) and generational dispositions of Millennial and Gen-Z trainees (rejection of “vocational” language; strong support of separation between personal and professional beliefs; high rates of students pursuing non-clinical work within medicine) seem to depict the work as increasingly a-moral in nature. How are we to make sense of this irony—that the challenges of medical training have invited moral descriptors despite the work of medicine resisting description as a moral practice—and what might it look like to understand medicine as “moral” not merely when beliefs seem to be transgressed or harms experienced, but also in a constructive sense?
This proposed panel will consist of participants who have encountered and thought about the prevalence of this “moral” language in medical training from different contexts, disciplines, and practices. Ben Frush is a current post-doctoral research fellow trained in med-peds and palliative care, whose experiences in residency and chief residency involved frequent discussion of the moral challenges of training, particularly during the COVID pandemic. Brewer Eberly is a family physician, artist, and writer whose academic interests include questions of moral formation in training, with particular attention to students’ and trainees’ moral description of their work, while also seeking to reinvigorate moral delight in the practice of medicine. Emmy Yang is a current resident training in internal medicine, who has previously considered questions of time and efficiency, and how these pressures bear upon the moral agency of medical trainees. Ashley Moyse is a theologian and bioethicist who works directly with residents seeking to make sense of the moral challenges of contemporary training, and who has considered the Aristotelian notion of medicine understood as techne to be both intellectual and moral in nature, with important implications for how trainees conceive of and engage in their work.
The goal of this panel will be to draw on the interdisciplinary experience of these panelists to offer insight into the reasons underlying this increased use of moral descriptive language among medical trainees, while offering a more robust account of what a constructively “moral” view of the practice might look like.
The use of the terms “moral injury” and “moral distress” by physicians and physicians-in-training—ideas drawn from their original context in the military and nursing ethics literature—is itself a contested move by those who question its fittingness in this context. Setting this question aside, it is nonetheless noteworthy that contemporary students and trainees are now quick to describe the challenges they face as “moral” in nature, within a field of practice that has become increasingly “de-moralized,” as Jacob Blythe and Farr Curlin have written.
That is to say, there is a strange and evident irony in medical students and trainees drawing on “moral” terminology when factors both internal to the practice (increasing bureaucratization and corporatization; elision of moral or conscience-based consideration in medical decision-making; progressive technological creep and documentation burden reducing time at the bedside) and generational dispositions of Millennial and Gen-Z trainees (rejection of “vocational” language; strong support of separation between personal and professional beliefs; high rates of students pursuing non-clinical work within medicine) seem to depict the work as increasingly a-moral in nature. How are we to make sense of this irony—that the challenges of medical training have invited moral descriptors despite the work of medicine resisting description as a moral practice—and what might it look like to understand medicine as “moral” not merely when beliefs seem to be transgressed or harms experienced, but also in a constructive sense?
This proposed panel will consist of participants who have encountered and thought about the prevalence of this “moral” language in medical training from different contexts, disciplines, and practices. Ben Frush is a current post-doctoral research fellow trained in med-peds and palliative care, whose experiences in residency and chief residency involved frequent discussion of the moral challenges of training, particularly during the COVID pandemic. Brewer Eberly is a family physician, artist, and writer whose academic interests include questions of moral formation in training, with particular attention to students’ and trainees’ moral description of their work, while also seeking to reinvigorate moral delight in the practice of medicine. Emmy Yang is a current resident training in internal medicine, who has previously considered questions of time and efficiency, and how these pressures bear upon the moral agency of medical trainees. Ashley Moyse is a theologian and bioethicist who works directly with residents seeking to make sense of the moral challenges of contemporary training, and who has considered the Aristotelian notion of medicine understood as techne to be both intellectual and moral in nature, with important implications for how trainees conceive of and engage in their work.
The goal of this panel will be to draw on the interdisciplinary experience of these panelists to offer insight into the reasons underlying this increased use of moral descriptive language among medical trainees, while offering a more robust account of what a constructively “moral” view of the practice might look like.