?Sip & Share?: Building Resilience in Surgery Residency Through Moral Distress Rounds

OBJECTIVE: Resident moral distress rounds were insti-tuted during the COVID-19 pandemic to provide a safe zone for discussion, reflection, and the identification of the ethical challenges contributing to moral distress. The sessions, entitled "Sip & Share," also served to foster connectedness and build resilience.DESIGN: A baseline needs assessment was performed and only 36% of general surgery residents in the program were satisfied with the current non-technical skills cur-riculum. Only 62% were comfortable with navigating ethical issues in surgery. About 72% were comfortable with leading a goals-of-care discussion, and 63% of resi-dents were comfortable with offering surgical palliative care options. Case-based discussions over video confer-encing were organized monthly. Each session was struc-tured based on the eight-step methodology described by Morley and Shashidhara. Participation was voluntary. The sessions explored moral distress, and the ethical ten-sions between patient autonomy and beneficence, and beneficence and non-maleficence.SETTING: Large general surgery residency in an urban tertiary medical center.PARTICIPANTS: General surgery residents.RESULTS: A post-intervention survey was performed with improvement in the satisfaction with the non-technical skills curriculum (70% from 36%). The proportion of resi-dents feeling comfortable with navigating ethical issues in surgery increased from 62% to 72%. A survey was per-formed to assess the efficacy of the moral distress rounds after eight Sip & Share sessions over ten months. All thir-teen respondents agreed that the discussions provided them with the vocabulary to discuss ethical dilemmas and define the ethical principles contributing to their moral distress. 93% were able to apply the templates learned to their practice, 77% felt that the discussions helped miti-gate stress. All respondents recommended attending the sessions to other residents. CONCLUSIONS: Moral distress rounds provide a struc-tured safe zone for residents to share and process mor-ally distressing experiences. These gatherings mitigate isolation, promote a sense of community, and provide a support network within the residency. In addition, resi-dents are equipped with the vocabulary to identify the ethical principles being challenged and are provided practical take-aways to avoid similar conflicts in the future.