Medical student moral distress in the clinical learning environment: Identifying the sources and pedagogical implications

INTRODUCTION: Moral distress arises when clinicians feel unable to act according to their ethical beliefs due to various constraints. Medical students transitioning from classroom to clinical settings are particularly vulnerable due to limited authority and fear of repercussions. This study examines how medical students experience and report moral distress, the role of supervising physicians, and the implications for professional development. METHOD: 407 case reports from third-year students at a U.S. allopathic medical school were quantitatively and qualitatively analyzed to assess instances of moral distress and students' experiences and relationship with clinical mentors. RESULTS: Moral distress was reported in 170 (41.8%) cases. Of those, "actions by another" (n=56, 32.9%) and "systemic concerns" (n=39, 22.9%) were the most common causes of moral distress. Mentor status (attending vs. trainee) had no significant impact on moral distress scores (p=0.6). Students without moral distress were more likely to rate their mentors more positively than those with moral distress (73.9% vs 54.0%, p