Shame at the Gates of Medicine: A Hermeneutic Exploration of Premedical Students' Experiences of Shame.

PURPOSE: Little is known about the nature of shame in students attempting to enter medical school, despite its potential to impact well-being and professional identity formation during training. In this study, the authors used hermeneutic phenomenology to ask: How do premedical students experience shame as they apply to medical school? METHOD: From September 2020 to March 2021, the authors recruited 12 students from a U.S. Master of Biomedical Sciences program who intended to apply to medical school. Data collection consisted of each participant creating a "rich picture" depicting a shame experience during their premedical training, a semistructured interview that deeply explored this and other shame experiences, and a debriefing session. Data were analyzed using Ajjawi and Higgs's 6 steps of hermeneutic analysis. RESULTS: Self-concept, composed of an individual's identities and contingencies of self-esteem, was central to participants' shame experiences. Through a confluence of past and future self-concepts and under the influence of external factors and the weight of expectations, shame often destabilized participants' present self-concepts. This destabilization occurred because of events related to application processes (repeat Medical College Admission Test attempts), interpersonal interactions (prehealth advisor meetings), and objective performance measures (grades, test scores). Participants' efforts to restabilize their self-concept catalyzed specific identity processes and self-concept formation. CONCLUSIONS: Shame provided a window into the emotional experiences, identity processes, and ideologies that shape students' attempts to enter medical school. The authors discuss the central role of contingencies of self-esteem, the potential origins of performance-based self-esteem in trainees, and the identity negotiation and identity work involved in shame reactions. They call for the adoption of contingencies of self-esteem within current conceptualizations of professional identity formation; training for faculty and prehealth advisors about the nature of shame in premedical learners; and consideration of the consequential validity of standardized tests, which may trigger damaging shame.

Duke Scholars

Author William Edwards Bynum IV Family Medicine and Community Health, Family Medicine

Author Joseph Augustus Jackson Pediatrics, General Pediatrics and Adolescent Health