Applying a Shame Lens to Understand Surgical Resident Well-Being: A Call for a Mixed Methods Research Agenda to Build...

There is a well-known but incompletely described well-being crisis in surgery. Rates of poor mental health, substance misuse, and self-harm ideation are concerningly high. There is a growing interest in, and a related body of literature seeking to understand, surgical residents' experiences of shame and how this emotionally complex phenomenon is related to established constructs such as burnout, grit, and depression. These early studies lay an important quantitative foundation for research into the shame experienced during surgical training and connect it to existing intellectual frameworks for understanding the phenomenon. Still, important opportunities exist to advance the rigor with which we conduct quantitative shame research, namely through the newly developed Shame Frequency Questionnaire, yet to be deployed, for studying shame in surgical trainees. Likewise, qualitative studies remain an underutilized area for deep exploration into the nature and meaning of shame experiences in surgical training. Leveraging a mixed methods approach will inform nuanced and relevant ways to apply tools such as shame competence - a framework to guide healthy engagement with shame - within surgical training environments.