Contributor: Cindy Donaldson
Summary:
This KeyLime podcast[1] addresses a paper reviewing the nature, triggers and effects of shame in medical residents[2]. Stories of residents were explored in a systematic qualitative approach, and a number of shame responses were identified. Shame was found to result in social isolation, disengagement from learning, burnout and depression, unprofessional behaviour, and impaired empathy for patients. The role of supervisors in the experience of shame was highlighted, as supervisor comments can be the trigger for shame, especially the practice of comparing one learner to another. The authors’ conclude that “shame reactions can be sentinel emotional events causing significant physical and/or psychological effects in medical leaners” and that by “revealing our experiences with shame in medical education we may be able to overcome the taboo and stigmatized nature of the emotion and confront it in a way that builds connection, community and healing.”
This thoughtful discussion of an important topic is certainly worth a listen!
Take Away Tidbits:
- Shame can cause social isolation, disengagement, depression, unprofessional behaviour and impaired empathy.
- Be mindful that interactions with supervisors can trigger or amplify shame experiences.
- Supervisors can mitigate shame responses through de-briefing following an error, understanding learner as a person, acknowledging struggles and focusing on strategies for improvement, and efforts to “unskew” learners’ negative perceptions of performance.
- Normalizing shame and redirecting it to a guilt response (i.e., focused on specific actions that can be changed) might also facilitate a more constructive emotional response in a learner.
References:
1. KeyLIME Podcast # 408 (re-run of 212), April 4, 2023
2. Bynum, William E. IV MD; Artino, Anthony R. Jr PhD; Uijtdehaage, Sebastian PhD; Webb, Allison M.B. MD; Varpio, Lara PhD. Sentinel Emotional Events: The Nature, Triggers, and Effects of Shame Experiences in Medical Residents. Academic Medicine 94(1):p 85-93, January 2019. | DOI: 10.1097/ACM.0000000000002479. https://journals.lww.com/academicmedicine/fulltext/2019/01000/sentinel_emotional_events__the_nature,_triggers,.28.aspx