Background: Recent empirical studies have described and theorized a culture of shame within medical education in the Anglo‐American context (Bynum). Shame is universal and highly social human emotion characterized by a sense of feeling objectified and judged negatively, in contrast to one's own self‐concept. Shame has both an embodied and a relational dimension. Shame is considered especially relevant in healthcare settings (Dolezal and Lyons), and the tenets of patient care within the medical profession include respecting the dignity and upholding the safety of patients. However, shame is frequently deployed as a teaching tool within medical training. Method: Here I ask, what can shame do in medical education (Ahmed)? What epistemic and relational conditions does it construct? I draw from philosophical voices in higher education to illuminate how shaming practices in medical education can undermine dignity safety (Callan), preclude inclusivity, and in the context of the hierarchical and marginalizing medical system, propagate epistemic injustice (Fricker). Discussion: This argument shows how shame in education can be both phenomenologically and normatively problematic and may act differently upon students who experience marginalization and those who are majoritized. I further suggest that a medical education system which upholds the epistemological and relational frameworks of power, shame, and epistemic injustice, underscores those frameworks in the medical system at large, disserving individual patients who are already at risk of suffering epistemic injustice (Carel), and society at large. Conclusion: This analysis of shame in medical education focuses on the highly relational and interpersonal elements of learning to live and work in the medical system, highlighting the need for respect, trust, and resistance to reorient the relational learning environment toward individual and systemic forms of justice.
Developing a professional identity in physicians-in-training is a central, but contested, outcome of medical education. In recent years scholars have argued for the importance of including affective experiences, especially shame, in the discourse around medical training. This discourse reflects projection and anticipation around both shame and professional identity, and the question of how shame impacts the latter is critical. Shame is an affect that arises when the self is confronted by the gaze, judgment or awareness of an Other; it can have profound impacts on identity and self-concept, and is highly prevalent in medicine and healthcare. This article posits ‘anticipated shame’ as a potent factor implicit in the experience of developing a medical professional identity, and connects shame to stigma and marginalization in medical training. Shame, and the anticipation of shame in student–teacher and trainee–patient interactions, highlights aspects of interpersonal communication within medical training and then practice. The concept of anticipated shame offers rich ground to theorize the effects of affect in medical education, and how trainees internalize medical cultural values and then enter the field of clinical practice.
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