Assessing Medical Student Fear and Shame as Barriers to Active Participation on the Wards

Imposter syndrome is common among medical trainees, who have been shown to experience self-doubt and burnout at alarming rates. Trainees also experience anxiety and fear about asking and answering questions on their clinical rotations, which may affect engagement and ability to learn. This study seeks to characterize fear and shame that fourth year medical students have felt during their time on clinical rotations, as well as the effect that this has had on their willingness to participate in clinical discussions.

The authors sent a survey to all fourth-year medical students at a US medical school. Survey questions included assessment of experiencing fear and anxiety while being asked questions during ward rounds. Students completed the survey using a web link to 10 questions on a 5-point Likert scale.

58 students completed the questionnaire. Fifty one (87.9%) of the students responded they experienced stress or anxiety when an attending physician asked them questions at least sometimes. Forty five (77.6%) experienced fear when questioned on rounds. Fourty four (75.9%) did not answer questions for fear of being wrong and exposing lack of knowledge. Thirty five (60.3%) experienced shame when questioned on rounds. Over 50% reported they were afraid to answer questions in specialties they were interested in. Most cited specialties that caused fear were Internal Medicine, Emergency Medicine, Surgery, and Obstetrics and Gynecology.

Though attempts are being made to improve the clinical learning environment and reduce the effects of imposter syndrome and anxiety in medical education, fear still plays a role in medical students' minds when choosing to ask or answer questions on the wards. Larger studies are needed to further look at the prevalence of this phenomenon and efforts should continue to be made to mitigate fear on the wards.