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Table 1 The 12 clinical scenarios experienced by medical students during the major clinical year that may invoke moral distress

From: Moral distress and burnout in caring for older adults during medical school training

Scenario NumberScenario Prompta
1Following the family’s wishes to continue life support even though I felt it was not in the best interest of the elderly patient.
2Administration of life-extending therapy to an elderly patient even though I felt it was futile or harmful.
3Administration of tests or treatments that I felt would be unlikely to benefit an elderly patient (e.g. daily labs, cancer screening).
4Performance of painful procedures on elderly patients by trainees in order to increase skill level.
5Felt that an elderly patient’s capacity to make medical decisions was incorrectly assessed.
6Use of physical or pharmacologic restraints for an elderly patient that I felt to be unwarranted.
7Avoidance of communication with an elderly patient because communication was made more difficult by disability (e.g. cognitive impairment, difficulty hearing, difficulty seeing, speech impairment).
8Lack of concern for the bodily privacy of an older patient.
9Felt that the wishes of an elderly person regarding end-of-life care had not been asked in a timely or appropriate manner.
10Felt that an elderly patient’s prognosis was not adequately communicated.
11Felt that a hospitalized elderly patient did not have the financial resources or social support to adequately care for him or herself after discharge.
12Witnessed ageist remarks or attitudes from the health care team about an elderly patient.
  1. aScenarios 1,2,3,4,8,9, and 10 were adapted from the Moral Distress Scale (25)