This qualitative research program, led by consortium member Will Bynum, explores the nature of shame experiences across the continuum of medical education. Centering on four empiric research studies, this collection of articles also includes scholarly commentaries, perspectives, and methods papers.
SHAME IN MEDICAL RESIDENTS:
NATURE, TRIGGERS, & EFFECTS
In our first research paper, we presented a hermeneutic exploration into the the nature and meaning of medical residents’ shame experiences and the contextual factors that influence them.
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Shame experiences can be momentary and fleeting or major, “sentinel emotional events” while learning medicine.
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Shame may be triggered by events related to patient care (e.g., medical error), learning (e.g., receiving negative feedback), and personal goals (e.g., failing to be selected as chief resident).
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Various factors can contribute to shame (either its development or prolongation), including perfectionism, psychologically unsafe learning environments, comparisons to others, and performance-based self-esteem.
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Effects of shame may be significant. They include intense emotional and psychological distress (e.g., feelings of burnout, depression), impaired empathy, impaired physical health, unprofessional behavior, and social isolation.
This study has implications for learners, educators, and patients alike.
SHAME IN MEDICAL STUDENTS:
ORIGINS, TRIGGERS, & PROMOTERS
In this study, recognizing that the context of medical school is different than residency, we again used hermeneutic phenomenology to explore how shame originates in medical students. In this study, we:
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Identified shame triggers (i.e., mistreatment, low scores, learning struggle, and patient interactions) and shame promoters (i.e., being underrepresented, perfectionism, imposter syndrome, and comparisons to others) in medical students
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Expanded our understanding of shame as occurring not just from “what I did or what happened to me” but also related to “who I am.” In particular, we found underrepresentation in the learning environment (e.g., based on race/ethnicity, gender identity, sexual orientation, the student’s undergraduate institution, &/or where the student is from) to be a powerful contributor to shame in many participants.
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Created 3 vignettes based on our data that illustrate the interactions between shame triggers and promoters. These vignettes may also be useful in facilitating small group discussions.
SHAME IN MEDICAL RESIDENTS:
THE NATURE OF THE EXPERIENCE
In this study, we utilized hermeneutic phenomenology to explore how shame is experienced once it has been triggered. We found that:
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The phenomenological elements of shame, including affective feelings, cognitive processes, action tendencies, physical manifestations, and effects, form a highly complex, multi-faceted emotional experience.
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These elements may come together to form certain patterns, such as affective upswells, ruminating self-evaluations, flashbacks, and chronic shame.
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In essence, shame tends to be destabilizing emotional experience that can lead to psychological distress, isolation, and altered professional identity formation, among other effects.
In the discussion, we highlight the idea of educational trauma, outline possible links to shame, and call for greater trauma-informed medical education, among other implications for our community.