Seeking stabilization: how medical learners engage with shame during training

Shame is a deeply personal, complex, and underexplored emotion in medical training; however, how medical learners engage with shame (ie, how they process, recover from, and/or address shame) and the environmental factors affecting this process are currently unknown. This study used hermeneutic phenomenology to explore how medical learners (ie, resident physicians and medical students) engage with shame once it has occurred and the factors that influence this engagement.

This study, which is part of a qualitative research program addressing shame in medical learners, used data collected from 12 residents (2016 and 2017) and 16 medical students (2018) from a residency program and a medical school in the United States. Data collection occurred via semistructured interviews during which participants reflected on shame experiences, including their engagement with it. The authors selected 14 transcripts (7 medical students, 7 residents) to achieve a range of shame experiences and impacts. Data were analyzed using Ajjawi and Higgs' 6 steps of hermeneutic analysis.

Internal scaffolding (thought processes, self-evaluative tendencies, and position relative to others that informed participants' self-concept) was central to shame engagement. Learners' internal scaffoldings shaped and were shaped by distressing shame-integrating engagement (ie, hiding the self, deflecting shame, and transferring shame) and constructive shame-disintegrating engagement (ie, orienting toward others, exerting agency over self-evaluation, and reorienting to a core sense of self). Learning environments influenced shame engagement; environmental values that promoted shame-disintegrating engagement included learner centeredness, inclusivity, vulnerability, and respect.

Although struggle in medical training is inevitable, how learners respond to the shame that can follow is not. The divergent nature of shame engagement highlights the importance of learner agency and environmental response to shame. The authors provide specific suggestions for learners, faculty, and leaders to advance constructive shame engagement and the growth, connection, and belonging it can inspire.