Characterizing shame engagement in medical learners

Researching how medical learners recover from, navigate, and/or struggle with shame experienced during training (supported by a grant from the Duke Department of Family Medicine & Community Health and the AAMC Group on Educational Affairs National Grant)

This qualitative research study, led by Duke Medical Student Anna Kulawiec, is a continuation of a program of research exploring the nature of shame in medical learners. To date, that program has shown that shame can be a "sentinel emotional event" in the life of a medical learner and that it can cause significant emotional distress, interfere with learning, undermine personal well-being, and impair relationships. We found that shame can catalyze more positive impacts such as enhanced learning, strengthened social bonds, though how this occurs and the factors that influence this process are currently unknown. 

Our analysis--which is ongoing and has not yet been published--has revealed that:
- Shame recovery often includes a transition from an internalized, distressed state to an externalized, other-oriented state.
- Constructive shame engagement entails efforts to stabilize self-concept (one's identities and contingencies of self-esteem), the success of which is afforded by underlying emotional "scaffolding." We are still in the process of more fully understanding what comprises this scaffolding, but its origins and architecture reach well back into childhood.
- Shame often centers on--and is sustained by--entrenched assumptions operating as facts. These assumptions often center on oneself in relation to others (e.g., feeling judged by others or lesser than others).
- Constructive engagement with shame involves challenging these assumptions and considering alternate possibilities. This requires transitioning from a mindset in which a primary reality dominates to one in which multiple realities are possible. 

We anticipate submitting this study for publication around August 2024. Read more from this program of research here:

Bynum WE, Artino AR, Jr., Uijtdehaage S, Webb AMB, Varpio L. Sentinel emotional events: the nature, triggers, and effects of shame experiences in medical residents. Academic Medicine 2019;94(1):85-93. Access publication here (open)

Bynum WE, Varpio L, Lagoo J, Teunissen PW. 'I'm unworthy of being in this space': the origins of shame in medical students. Medical Education 2021;55(2):185-197. Access publication here

Bynum WE, Teunissen P, Varpio L. In the "shadow of shame": a phenomenological exploration of the nature of shame experiences in medical students. Academic Medicine 2021;96(11S):S23-S30. Access publication here (open)

Bynum WE, Jackson JA, Varpio L, Teunissen PW. Shame at the gates of medicine: a hermeneutic exploration of premedical students' experiences of shame. Academic Medicine 2023;98(6):709-716. Access publication here (open)