Moral Injury: What It Is, What It's Not, and What We Can Do About It
Emergency medicine (EM), by EMTALA (Emergency Medical Treatment and Active Labor Act) definition, accepts and evaluates everyone. Simultaneously, EM physicians practice medicine in line with rapidly evolving evidence at a speed that is often adapting and filled with uncertainty and scarcity of time. Because of this, EM physicians are at high risk for moral injury. As leaders, emergency department physicians make decisions for and must instill confidence in their teams. They are often called on to act as emotional pillars for their departments during challenging cases. This role does not facilitate a space for physicians themselves to express feelings of moral distress or seek support. When there is dissonance between one’s values and an act that someone witnesses or perpetrates, this can lead to “moral injury.”
In this webinar, sponsored by the SAEM Wellness Committee, presenters will discuss what moral injury is, and what it’s not. We want our audience to feel validated for the distressing times they have encountered and apply knowledge of moral injury to understand what is within and beyond their control.
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Al’ai Alvarez, MD, FACEP, FAAEM
Director of Well-Being, Co-Lead, Human Potential Team, Fellowship Director, Stanford Emergency Medicine Wellness Fellowship
Stanford Emergency Medicine
Dr. Al'ai Alvarez MD, FACEP, FAAEM is a clinical assistant professor of Emergency Medicine (EM) and the Director of Well-Being at Stanford Emergency Medicine. He co-leads the Human Potential Team and serves as the Fellowship Director of the Stanford EM Physician Wellness. He co-chairs the Stanford WellMD Physician Wellness Forum. His work focuses on humanizing physician roles as individuals and teams through the harnessing of our individual human potential in the context of high-performance teams. This includes optimizing the interdependence between Process Improvement (Quality and Clinical Operations), Recruitment (Diversity), and Well-being (Inclusion). -
Amanda J. Deutsch, MD
Thomas Jefferson University
Dr. Amanda J. Deutsch, MD is a Clinical Assistant Professor and Director of Well-Being for the Department of Emergency Medicine at Thomas Jefferson University. Dr. Deutsch earned her undergraduate degree at Harvard University. She subsequently completed her post-baccalaureate and did quality improvement research at Boston Children’s Hospital before starting her career as a medical student at the University of Iowa, where she is from. She completed an Emergency Medicine residency at the University of Pennsylvania, where she completed a track in Healthcare Leadership and Quality Improvement. She most recently completed a fellowship in Physician Wellness at Stanford Emergency Medicine. In her inaugural role as Director of Well-Being at the Department of Emergency Medicine at Thomas Jefferson University she combines her interests in clinical operations, process improvements and well-being.
Dr. Deutsch chairs the #StopTheStigmaEM subcommittee and hopes to normalize conversations around mental health for emergency medicine physicians, address barriers, and foster better mental health care for emergency medicine. Her interests include focusing on gratitude and appreciation to develop a sense of community and a team that can excel for their patients without the cost of their interests, self, and career. Dr. Deutsch loves to tweak process improvements to help foster well-being.
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Stephanie Balint, APRN
Medical Student Representative
Quinnipiac University
Ms. Stephanie Balint is a third-year medical student (M3) at Quinnipiac University, with a diverse and extensive background in emergency medicine (EM). Before embarking on her journey through medical school, Stephanie cultivated her passion for EM through her experiences as an Emergency Medical Technician (EMT), National Guard Healthcare Specialist, Emergency Department (ED) Registered Nurse (RN), and Advanced Practice Registered Nurse (APRN). Her pre-medical school clinical experience in community centers allowed her to witness the power of cohesive teams and the importance of supporting one another in high-pressure environments.In her roles with SAEM and RAMS, Stephanie made significant contributions to the field of emergency medicine. She participated in didactics covering topics such as the Post-Roe Landscape of EM, the Management of APPs in the ED, and Moral Injury, while also working on research related to workforce trends. Her efforts resulted in the publication of several articles, including four Pulse pieces. However, her most cherished role involved connecting fellow students to research opportunities, mentorship, and committee work, ensuring that those with interest or limited access could still find meaningful engagement in the EM community. -
Cindy C. Bitter, MD, MA, MPH
Saint Louis University School of Medicine
Dr. Cindy Bitter is an associate professor in Emergency Medicine at Saint Louis University (SLU) School of Medicine. She serves as the Wellness co-Champion for SLU EM Residency and is a member of the interdisciplinary wellness taskforce for the SSM-Saint Louis University Hospital. Trained in International EM and Global Health at the University of Illinois Chicago, Dr. Bitter has published on post-traumatic stress disorder in EM. She is an active member of the Society of Academic Emergency Medicine (SAEM) Wellness Committee and has done work on moral injury and faculty vitality during the COVID19 pandemic. Dr. Bitter is passionate about ensuring EM practitioners around the world have the knowledge they need to save lives, while also empowering them with the tools needed for them to thrive throughout their career in medicine. Dr. Bitter completed medical school at the University of Kansas and a year of Internal Medicine at Northwestern University prior to finishing her EM training at the Medical College of Wisconsin. She also completed a Masters in Bioethics from MCW.
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Amy Kontrik, MD
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Vytas P. Karalius, MD, MPH, MA
Stanford University
"The Resident Unionization Study: A Qualitative Analysis of Drivers and Outcomes"
Dr. Karalius is an Assistant Program Director and is completing his Medical Education Scholarship Fellowship at Stanford University’s Department of Emergency Medicine. He earned his medical degree from the Mayo Clinic School of Medicine and completed his emergency medicine residency at Northwestern University. He also holds a Master of Public Health and a Master of Medical Sciences from Loyola University.
Dr. Karalius also continues to serve as a faculty member for the Harvard Macy Institute Program for Educators in the Health Professions, and recently awarded the Exceptional Faculty designation. As a former SAEM RAMS Board member, Dr. Karalius continues to be involved with SAEM and is a member of the SAEM Education Committee, SAEM Wellness Committee, and SAEM Equity & Inclusion Committee.
Dr. Karalius’ primary focus is on graduate medical education, physician/trainee wellness and workforce attrition. He was recently awared the SAEMF Education Research Training Grant in 2024, for his work focusing on resident unionization as it relates to trainee well-being. He is involved in numerous projects and sitting on numerous department, institutional and national committees focused on wellness and medical education, including the Diversity Advisory Group at Stanford, School of Medicine Admissions Committee, and SAEM. Dr. Karalius has co-authored articles for peer-reviewed publications such as Annals of Emergency Medicine and Journal of Graduate Medical Education. He also has contributed to numerous online publications and podcasts, including articles, podcasts and national webinars on education and physician/trainee wellbeing. -
Amanda M. Ritchie, MD
Louisiana State University
Dr. Amanda Michelle Ritchie is a 4th year resident in the Internal Medicine / Emergency Medicine program at Louisiana State University in New Orleans. Dr. Ritchie initially trained as a registered nurse in Canada before pursuing her degree in medicine.