"In the Shadow of Shame": A Phenomenological Exploration of the Nature of Shame Experiences in Medical Students.
PURPOSE: Shame occurs when an individual blames a globally flawed self for a negative outcome. Much of the focus on shame in medical education has been directed towards graduate medical education with less recognition paid to shame occurring in medical school. In particular, while research has explored the triggers of medical students' shame, little is known about what shame feels like, what it makes an individual want to do, and what perceived effects it causes. Thus, this study asks: After shame has been triggered in medical students, how is it experienced? METHOD: The authors selected hermeneutic phenomenology to provide a rich description of the structures and meaning of medical students' lived experiences of shame. Sixteen medical students from a private medical school in the United States were recruited for the study. Data were collected using one-on-one semi-structured interviews and analyzed in accordance with Ajjawi and Higgs' 6 steps of hermeneutic analysis. RESULTS: Data analysis yielded component parts of participants' shame experiences, including affective feelings, physical manifestations, cognitive processes, action tendencies, and effects. Analysis of the relationships among these component parts yielded specific phenomenological structures, including patterns of shame (e.g., chronic shame, flashbacks), self-evaluative processes (e.g., battling voices, skewed frames of reference), and perceived effects of shame (e.g., isolation, psychological distress). An overarching theme of shame as a destabilizing emotion emerged across the data set. CONCLUSIONS: Shame is a complex emotion in medical students that, through its destabilizing effects, can lead to withdrawal, isolation, psychological distress, altered professional identity formation, and identity dissonance. The authors highlight the possibility that shame may be occurring as a response to educational trauma, present a metaphor of dominoes to conceptualize the destabilizing nature of shame, and outline the implications for individuals and institutions in medical education.
Bynum, WE; Teunissen, P; Varpio, L
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