Sentinel Emotional Events: The Nature, Triggers, and Effects of Shame Experiences in Medical Residents

Abstract

Purpose This study explores an under-investigated topic, how medical residents experience shame within clinical learning environments, by asking residents to reflect on (1) the nature of their shame experiences; (2) the events that triggered, and factors that contributed to, those shame experiences; and (3) the perceived effects of those shame experiences. Method In this hermeneutic phenomenology study, the authors recruited 12 (self-nominated) residents from an internal medicine residency at a large teaching hospital in the United States. Data collection from each participant in 2016–2017 included (1) a written reflection about an experience during medical training in which the participant felt “flawed, deficient, or unworthy,” and (2) a semi-structured interview that explored the participant’s shame experience(s) in depth. The data were analyzed according to hermeneutic traditions, producing rich descriptions about participants’ shame experiences. Results Participants’ shame experiences ranged from debilitating emotional and physical reactions to more insidious, fleeting reactions. Participants reported shame triggers relating to patient care, learning processes, and personal goals; numerous factors contributed to their shame experiences. The effects of shame reactions included social isolation, disengagement from learning, impaired wellness, unprofessional behavior, and impaired empathy. Positive effects of shame reactions included enhanced learning, increased willingness to reach out for help, and improved relationships. Conclusions Shame reactions can be sentinel emotional events with significant physical and/or psychological effects in medical learners. This study has implications for learners, educators, and patients, and it may pave the way toward open, honest conversations about the role shame plays in medical education.

How phenomenology can help us learn from the experiences of others

“…A recent study published by Bynum et al. illustrates how hermeneutic phenomenology may be employed in HPE [2]. In this paper, Bynum et al.…”

“…Use imaginative variation to create structural (the how) description. Combine these descriptions to form the essence of the phenomenonIterative cycles of capturing and writing reflections towards a robust and nuanced analysis; consider how the data (or parts) contributed to evolving understanding of the phenomena (whole)Methodological textsPolkinghorne [28]Moustakas [18]Giorgi [27]Van Manen [12]ExamplesTakavol [32]Bynum [2]…”

“…The questions that phenomenology can answer, and the insights this kind of research can provide, are of foundational importance to HPE: What is the experience of shame and the impact of that experience for medical learners [2]? What does it mean to be an empathetic clinician [3]?…”

When patients die: patient memorials and group reflection in an internal medicine residency program

“…These data resonate with studies indicating that physicians who experience negative patient outcomes are at risk of a "second victim" experience and sense of shame, which can lead to social isolation, an impaired sense of belonging, and decreased wellness. 7,[9][10][11][12] While it is unclear why residents often cope with death in isolation, fear of failure, guilt, and a lack of time dedicated to reflection likely contribute. Initiatives such as Schwartz rounds and Balint groups focus more broadly on the provider-patient relationship, while our patient memorial format provides a unique experience for trainees to discuss patient deaths with peers without requiring significant time, resources, or faculty leadership for implementation.…”

‘There shouldn't be anything wrong with not knowing’: epistemologies in simulation

“…Instead, we suggest that the culture of medical education and potentially the larger culture of academic medicine may act as the dominant culture shaping students’ beliefs about knowledge and learning . Well‐documented indicators of medicine's dominant culture include instances of the conflation of expertise with experience and hierarchy, a culture that sometimes shames and silences rather than supports and explores experiences of error, and one that often prioritises a pursuit of objectivity . We speculate that the epistemic values underpinning these cultural phenomena may not provide optimal grounds for SBE principles to flourish; however, more research on the epistemic culture within medical education is needed.…”