Keeping mum in clinical supervision: private thoughts and public judgements

Abstract

CONTEXT The seemingly obvious claim that people prefer to keep mum about undesirable messagestermed 'the MUM effect'was initially reported in the psychology literature in the 1970s. More recently, it has been discussed in contexts including performance appraisals and the reporting of unsuccessful projects in workplace settings, but only sparsely in educational ones. We wished to review the published literature on the MUM effect in order to understand the implications for clinical assessment.METHODS We performed a narrative literature review on the MUM effect and clustered findings together into three themes: those that describe what MUM behaviours look like, those that explore potential reasons for the MUM effect and those that consider factors that can influence MUM behaviours.RESULTS This paper summarises the extensive literature on the MUM effect, including its manifestations and modifiers and discusses how the effect may be used to consider issues faced by many clinical supervisors faced with delivering 'negative' assessment messages to trainees.DISCUSSION We suggest, that as a pervasive phenomenon, the MUM effect can both help to explain the difficulties that some assessors face when delivering undesirable messages (including feedback or ratings) and offer new insights in how to deal with such issues.

MUM effect in medical education: taking into account the recipient and training setting

“…To summarise, in addition to the actions to ameliorate the MUM effect described by Scarff et al, 2 we highlight the significance of the characteristics of the recipient and of the social cues in the clinical training setting. We propose that a setting that deemphasises competition with others and that accepts making mistakes as part of the learning process may stimulate a learning goal orientation, which may subsequently reduce unpleasant feelings towards negative messages for both the recipient and communicator.…”

“…Referring to this struggle, Scarff et al turn to the literature on the MUM effect (keeping Mum about Unpleasant Messages) in this issue of Medical Education. 2 The MUM effect indicates that individuals have more difficulty in delivering negative than positive messages, which often leads to avoiding or sugar-coating the negative information. Our own research and that of others suggested that people agree more on what is considered undesirable, as opposed to desirable, because undesirable actions always lead to negative outcomes.…”

“…Scarff et al attempt to answer this question by conducting a narrative review of the MUM literature. 2 Three potential causes of the MUM effect are mentioned, namely avoidance of feelings of guilt and distress, avoidance of bad feelings in the recipient of the negative message and conformation to societal rules (e.g. politeness).…”

“…we argue that the MUM effect will be less strong if recipients of unpleasant messages predominantly hold a learning goal orientation Scarff et al conclude their review with the proposition of several actions that may reduce the MUM effect in clinical training. 2 Examples of these propositions are appointing a supervisor as an expert feedback provider who is trained to deliver negative messages, using multiple feedback providers to deliver a negative message, and reframing a negative message as useful information for development. 2 In addition to these actions, we argue that attention should be directed to the social cues in the clinical training setting.…”

“…2 Examples of these propositions are appointing a supervisor as an expert feedback provider who is trained to deliver negative messages, using multiple feedback providers to deliver a negative message, and reframing a negative message as useful information for development. 2 In addition to these actions, we argue that attention should be directed to the social cues in the clinical training setting. Based on the literature on goal orientation and feedback-seeking behaviours, we speculate that the promotion of a learning goal orientation in an organisation could ease the provision of negative feedback.…”