Characterizing shame engagement in medical learners

Researching how medical learners navigate, respond, & recover from shame during training
Status: study completed
Funder: AAMC GEA National Grant; Duke Department of Family Medicine & Community Health
Paper: under 2nd review
This qualitative research study 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 cause significant emotional distress, interfere with learning, undermine personal well-being, and impair relationships. It can also catalyze positive impacts such as enhanced learning, strengthened social bonds. How and whether shame leads to more constructive or less constructive outcomes in medical learners is currently unknown.

In this study, we used hermeneutic phenomenology to describe the nature and meanings of medical students' and residents' engagement with shame. 
Our analysis yielded two types of shame engagement:  distressing, shame-integrating engagement and constructive, shame-disintegrating engagement, both of which sought to re-stabilize self-concept in the face of shame. Shame integrating engagement involved hiding the self, deflecting shame, and transferring shame whereas shame disintegrating engagement involved orienting towards others, exerting agency over self-evaluation, and reorienting to a core sense of self. 
The paper—first authored by current resident and former Duke medical student Anna Kulawiec— is currently under second review. 

Funders:

Association of American Medical Colleges
Group on Educational Affairs Nat'l Grant