Longitudinal Assessment of Moral Distress and Burnout during Pediatric Residency in a Canadian Site: Low Prevalence but Notable Risk of Attrition

Introduction: Although more than half of pediatric residents report burnout, the incidence of moral distress, the course of moral distress and burnout during residency, and associations between this course and personal characteristics of residents are unknown. The purpose of this work was to examine the incidence, temporal course, and associations of moral distress and burnout in pediatric residents. Methods: In the pediatric training program of British Columbia Children’s Hospital, all residents were invited to complete the Moral Distress Scale-Revised thrice yearly, and the Maslach Burnout Inventory annually, between July 2016 and October 2018. In addition, residents reported a measure of moral distress for each rotation. Responses were tracked longitudinally using a unique identifier for each resident. We used longitudinal mixed effect modeling and generalized estimating equations to account for clustering of data. Results: A total of 86/101 residents completed at least one sequence of the surveys. The average moral distress score was 20 (maximum possible: 336), but 10% of respondents had considered leaving residency in the past due to moral distress. Highest levels of moral distress occurred after international and intensive care rotations. Seven percent of respondents met criteria for burnout, but female residents reported higher burnout scores than males (p = 0.04). Conclusion: Although moral distress and prevalence of burnout are low in pediatric residents at this institution, moral distress contributes to potential attrition. High-acuity rotations are associated with increased levels of moral distress.