Project title

Toward evidence-based guidelines: The role of psychological flexibility in mitigating moral injury and secondary traumatic stress among doctors in Malaysia

Country

Malaysia

Background

Doctors in Malaysia frequently work in fast-paced, emotionally demanding clinical environments, where they encounter ethically challenging situations, exposure to patient suffering, and overwhelming workloads. 

These experiences heighten the risk of moral injury and secondary traumatic stress – both of which can affect clinical judgment, workplace functioning, and long-term psychological wellbeing. Although international research has begun addressing these issues, culturally grounded evidence from Malaysian healthcare remains extremely limited. At the same time, psychological flexibility, the ability to remain open, present, and values-driven during distress has been identified globally as a key resilience factor for healthcare providers. 

This project addresses a critical evidence gap by examining how psychological flexibility may buffer the negative mental health impacts of moral injury and secondary traumatic stress among doctors in Malaysia.

Summary

This mixed-methods study will focus on doctors across three career stages: house officers, medical officers, and specialists/consultants. 

The project involves:

  • Nationwide quantitative survey (n = 250-300) using validated measures, including the AAQ-II, the Moral Injury Symptoms Scale-Healthcare Professionals (MISS-HP), the Secondary Traumatic Stress Scale (STSS), and the DASS-21.
  • In-depth qualitative interviews (n = 10-15) with participants who score high on the STSS to explore their experiences of secondary traumatic stress.
  • Integrated analysis to identify protective psychological processes across career stages.
  • Development of practical, context-sensitive guidelines to strengthen resilience, wellbeing, and psychological safety among doctors.

The project is co-produced with healthcare stakeholders to ensure relevance for medical training, workplace wellbeing initiatives, supervision structures, and continuing professional development.

Outcome

  • Evidence-based understanding of how psychological flexibility mitigates moral injury and secondary traumatic stress among doctors in Malaysia.
  • Practical guidelines and resilience-building recommendations tailored for different career stages and specialties.
  • Development of toolkits and training modules that can be incorporated into medical education, supervision, and workplace wellbeing programmes.
  • Policy-relevant insights to support healthcare institutions, the Ministry of Health, and professional bodies in designing sustainable wellbeing initiatives.
  • Capacity-building opportunities for junior researchers and clinicians in mixed-methods research and mental health skills.