Examining the Impact of Moral Injury on Burnout, Impostor Syndrome, and Low Self-Compassion Among Female Medical Trainees: A Secondary Analysis.

Abstract

To examine the prevalence of moral injury and its association with burnout, impostor syndrome, and low self-compassion in physician trainees. This is a secondary analysis of baseline data from 1017 female physician trainees across 26 institutions who volunteered for a randomized controlled trial of a well-being program in 2022. Participants completed the Moral Injury Symptom Scale-Healthcare Professionals (MISS-HP), Maslach Burnout Inventory, Young Impostor Syndrome Scale, and Neff Self-Compassion Scale-Short Form. Univariate and multivariate logistic regressions were used to assess outcomes. Of 1017 participants, 787 (77.4%) completed the MISS-HP, of whom 600 (76.2%) experienced moral injury (≥36 score). All models adjusted for postgraduate year and race. After additionally controlling for impostor syndrome and self-compassion, moral injury was associated with positive burnout (odds ratio [OR], 3.79; 95% CI, 2.55 to 5.66), high emotional exhaustion (OR, 2.96; 95% CI, 2.04 to 4.32), high depersonalization (OR, 4.28; 95% CI, 2.94 to 6.29), and low personal accomplishment (OR, 1.96; 95% CI, 1.34 to 2.88). Moral injury was also associated with positive impostor syndrome (OR, 1.71; 95% CI, 1.12 to 2.58) after controlling for burnout and self-compassion as well as with low self-compassion (OR, 3.35; 95% CI, 2.15 to 5.34) after controlling for burnout and impostor syndrome. Female medical trainees have a high prevalence of moral injury, which has significant associations with burnout, impostor syndrome, and low self-compassion. Effective interventions require further implementation and analysis to reduce moral injury among medical trainees.