27 - Beyond Burnout: Institutional Signals and Moral Injury Recalibrate Professional Identity Trajectories Among Underrepresented in Medicine (UIM) Pediatric Residents

Publication Number: 4026.27

Courtney A.. Gilliam, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Becky Blankenburg, Stanford University School of Medicine, Stanford, CA, United States; Tessy A. Thomas, Geisinger Commonwealth School of Medicine, danville, PA, United States; Chanelle Coble-Sadaphal, NYU Grossman School of Medicine, New York, NY, United States; Alissa Darden, University of Washington School of Medicine, SHORELINE, WA, United States; Rebecca Hart, University of Louisville School of Medicine, Floyds Knobs, IN, United States; Oriaku A. Kas-Osoka, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; MIchelle Kiger, MD, PhD, University of Colorado School of Medicine, Aurora, CO, United States; Brian Lurie, Hasbro Children's Hospital at Rhode Island Hospital, Providence, RI, United States; Uchechi Oddiri, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States; Emma Omoruyi, McGovern Medical School at UTHealth Houston, Houston, TX, United States; Mark Ward, Baylor College of Medicine, Houston, TX, United States; Lahia Yemane, Stanford University School of Medicine, Palo Alto, CA, United States; Audrea Burns, PhD, Baylor College of Medicine, Houston, TX, United States

Background: Burnout and diminished belonging among underrepresented in medicine (UIM) residents remain persistent concerns in academic medicine. Few studies examine how sociopolitical and institutional dynamics contribute to these outcomes. Recent social disruptions including racial justice movements, anti-DEI legislation, restrictions on gender-affirming care, immigration enforcement, and the COVID-19 pandemic have intensified moral distress in training.

Objective: This study explores how these disruptions manifest as moral injury and compromise professional identity formation (PIF) to inform program-level support for UIM pediatric residents.

Design/Methods: We conducted a national, IRB-approved, convergent mixed-methods study anchored in the PIF conceptual framework that was updated to incorporate the Being, Belonging, Becoming guide ( Sternszus R, 2024). Qualitative data were collected via semi-structured interviews (July-October 2025) with UIM pediatric residents and analyzed using Reflexive Thematic Analysis with iterative memoing and investigator triangulation. Quantitative data included sociodemographics and the Moral Injury Symptom Scale-Healthcare Professionals (MISS-HP).

Results: 10 residents from 8 programs participated; 60% were PGY-1 and 50% Hispanic/Latinx. MISS-HP scores indicated moderate to high moral injury (mean 38.2; median 46; range 13-85). Six integrated themes described the trajectory of injury and repair: (1) Policy climates as practice constraint: legislation limited trainees' values-based practice; (2) Vigilant Performance: trainees described continuous self-monitoring and drained cognitive bandwidth; (3) Institutional Signal Management: selective institutional silence produced moral strain and disconnection; (4) Bottom-Up Belonging: peer and faith networks provided safety; (5) Programmatic Support for Dialogue: safe, validating spaces helped process injury; and (6) Career Plans Recalibrated: moral injury shaped PIF, prompting reaffirmed advocacy or altered career trajectories (Table 1).

Conclusion(s): Social disruptions influence residency through institutional signaling; through what is said, omitted, or censored, producing structural, not individual, contributors to burnout. MISS-HP patterns mirrored the qualitative divide between buffered safety and unbuffered risk. Programs can mitigate harm by establishing transparent communication standards, acknowledging identity-based workload tax, resourcing affinity-based debriefs, and guiding safe advocacy and career planning. These feasible levers target Belonging to protect Being and stabilize Becoming in UIM trainees' PIF.

Table 1: Illustrative Quotes