Advancing shame competent residency training 

Instilling shame competence within surgical and ob/gyn residency training (funding TBD).

Residency training--or the period of time between graduation from medical school and independent practice--is incredibly hard. The work is intense, the stakes are high, the hours are long, and the learning curves are relentless. Training in surgical subspecialties is particularly challenging. The mere nature of what must be learned for competent, safe independent practice (i.e., surgically interacting with a human body) drives the stakes higher, hours longer, and learning curves more relentless. 

Residency training comes at a time when medical trainees are actively building, negotiating, and shaping their identities as professionals and as people. After 4 years of medical school and the gauntlet of applying to residency training,  trainees' personal and professional identities are more interwoven than ever, with many dimensions of personal identity subservient to the growing, encroaching identity of doctor, or surgeon.

Such a milieu is a set up for shame. Learning struggle, failure, and even patient harm are all but inevitable. Physical and mental exhaustion are commonplace. Environments and interpersonal dynamics are easily strained and may become toxic. And self-concept--comprised of identity and contingencies of self-esteem--is at once malleable and vulnerable. 

At the same time, residency training offers, by far, the greatest potential for meaningful growth, competence development, and healthy identity formation. The pro-social and growth-inducing nature of shame can be a part of that development, but only if its presence is recognized, engaged with constructively, not weaponized or propagated, and not enculturated so as to avoid its destructive potential. 

In this project, we are partnering with the Duke Surgery and Ob/Gyn residency programs--as well as the Duke Clinical Psychology Internship Program--to advance shame competence within their trainees, teams, and organizations. Our ultimate goal with this pilot project is to build and evaluate a shame competent residency program.

The aims of the “Advancing shame competent residency program" are to:
1) Develop, utilizing a modular approach, evidence- and theory-based training materials to advance shame competence in residency education.
2) Implement and evaluate the training in the general surgery and OB/Gyn residency programs the Duke University School of Medicine.
3) Support participating programs in mitigating the destructive—and leveraging the prosocial—potential of shame in ways that 1) humanize and connect residents, faculty, and patients, 2) optimize team function, and 3) advance inclusive and psychologically safe environments.
4) Disseminate the outcomes of the training through peer reviewed conference presentation and scholarly publication.

In collaboration with Duke Clinical Psychology Internship Program, we are co-developing the four modules that will serve as the backbone of this program and plan to begin implementing them in/around July 2024. We will evaluate the training by assessing its impacts on learner and faculty well-being, psychological safety, reported shame frequency, and learner and patient outcomes.