A student in the Institute of Health Sciences Education’s new PhD program, Allison Chrestensen will use in-depth interviews to document and research residents’ experiences of pressure to act out of alignment with values
Allison Chrestensen, MPH, OT, began her career as an occupational therapist working with breast cancer patients, before teaching in the humanities program at the Duke University School of Medicine, and becoming a consultant involved with a national healthcare quality initiative in the United States.
These roles, as well as her own experience of illness, solidified her passion for educating the next generation of health professionals. Now a PhD student at McGill’s Institute of Health Sciences Education (IHSE), she is addressing these professional and personal experiences through her thesis on moral distress.
“I started to think about how patient experience is deeply connected with the experience that clinicians have,” Chrestensen recalls. “Clinicians who are unhappy are not going to give a good patient experience.”
“It was a moment where I started to go back to some of the experiences that impacted me as a clinician, and the experiences I had as a patient, and to think about how I wanted to bring these together.”
Chrestensen is one of 13 students enrolled in the newly approved PhD in Health Sciences Education at the IHSE. In her thesis, supervised by Elizabeth Anne Kinsella, PhD, Director of the IHSE, she will investigate experiences of moral distress in medical residents across three specialities and two different countries.
“We know that moral distress is a major challenge for medical residents,” says Prof. Kinsella. “Chrestensen’s research will help us to map what is currently known, and to inquire into residents’ lived experiences, so that we can improve residency education and residents’ capacity to navigate moral distress in the future.”
Already, Chrestensen’s research is attracting attention. In August, she joined IHSE members at the 2023 Association of Medical Education Europe (AMEE)’s International Association for Health Professions Education Conference in Glasgow, where she gave a lauded Point-of-View presentation on the urgent need to address moral distress in medical residents.
Beyond burnout
“When I say moral distress, I mean when people know the ‘right’ thing to do but feel there are institutional constraints that cause them to act out of alignment with those values,” says Chrestensen. According to the Canadian Public Health Association, understaffing and time constraints are among the factors that can lead to moral distress. Other contributors include making difficult decisions on who should receive critical care amid resource scarcity, providing aggressive care to patients at the end of life and disagreements with family members about the course of care.
“Until this point, we have put everything in one bucket and said: ‘Well, people are burned out.’ Well, we don’t really know what that means.” She adds that the COVID-19 pandemic encouraged scholars to think more deeply about difficult experiences that professionals have had or continue to have.
The “unique position” of medical residents as learners, mentors, and providers of care can make them particularly vulnerable to moral distress, she continues.
Illuminating experiences of moral distress
To document experiences of moral distress, Chrestensen will use hermeneutic phenomenology, which invites participants to share their stories of lived experience through in-depth interviews. Rather than attempting to provide concrete, measurable data, this methodology seeks to understand the meaning people make of their experiences. This approach can illuminate elements that can otherwise remain hidden from both participants and researchers.
Chrestensen hopes that, by shedding light on the experiences of moral distress, her research can illustrate the importance of creating more supportive work and learning environments for residents, as well as preparing future residents for these experiences. Ultimately, these changes could contribute to improved clinician well-being and better patient care.
“My hope is that if we understand more about the experience, we can be very clear with aspiring health professions students that moral questions are normal, and they will come up,” she says. “We need to be explicit about the fact that they will experience that, and then help them navigate it.”
Welcomed and included
Chrestensen first heard about the PhD program when she met Prof. Kinsella.
“I didn’t know that anything that was interdisciplinary in this way existed,” she says. “The intended purpose of the program is clear – through the coursework, the comprehensive exam, the way the curriculum is built.”
Chrestensen has felt welcomed and included in the IHSE community since she first started.
“Every instructor I had made a concerted effort to make me feel like I was in the room,” she says. “I felt right away, and continue to feel, that the faculty want me to be successful.”
The PhD in Health Sciences Education is accepting applications for the Fall 2024 semester. For more info, visit the IHSE website.
Related:
Institute of Health Sciences Education’s new PhD program gets green light
