Bynum presents on shame competence at the invitation-only ACGME Symposium on Physician Well-Being in Chicago

Nov 24
The Accreditation Council for Graduate Medical Education (ACGME) accredits and oversees all residency training programs in the United States. An organization deeply committed to resident and physician well-being, the ACGME recently hosted a Symposium on Physician Well-Being, described as "the first meeting dedicated solely to GME well-being since the COVID-19 pandemic [that brought together] an international group of thought leaders and professionals dedicated to the well-being of residents, fellows, and faculty members in the GME clinical learning environment."

Dr. Bynum was among the ~100 invited leaders to participate in the symposium, and he was also asked to speak about the role of shame in graduate medical education.

In his 15-minute presentation to the group, Bynum opened with his own story of shame as a family medicine resident, using provocative art from Hannah Mumby's Shame Spiral to provide a window into his emotional experience.

The 'present absence' of shame

He pointed out what he found to be a "present absence" of shame, both in his interactions with the environments in residency training as well as the medical literature. In other words, there was signal for the presence of shame around him and in a lot of the literature on resident and physician well-being, but hardly any direct attention to it.

As an example of the present absence of shame in the literature, he used the National Academy of Medicine's Coalition on Physician Well-Being as an example. He showed the results of a search for papers on various well-being topics using their Knowledge Hub, which is a set of resources accumulated by the coalition.

Shame at the base of the iceberg

Bynum then argued that the NAM Knowledge Hub provides a stark example of the significant skew towards well-being-related constructs that are easier to measure and talk about. By failing to open space, awareness, and engagement with experiences like shame, we neglect the more fundamental aspects of human experience--and we miss opportunities for greater connection, belonging, healing, and well-being in the process. 

Shame competence as a bridging framework

He ended with an overview of shame competence as a framework to help address the present absence of shame in graduate medical education. He provided a brief set of immediate actions for the audience to begin implementing each pillar of shame competence, the net effect of which--he argued--will be psychologically safer, more connected, and more humanistic residency training.