Anticipated shame and professional identity formation
Theorizing affect in medical training
DOI:
https://doi.org/10.1558/cam.21481Keywords:
affect, medical education, narrative, philosophy, professional identity formation, shameAbstract
Developing a professional identity in physicians-in-training is a central, but contested, outcome of medical education. In recent years scholars have argued for the importance of including affective experiences, especially shame, in the discourse around medical training. This discourse reflects projection and anticipation around both shame and professional identity, and the question of how shame impacts the latter is critical. Shame is an affect that arises when the self is confronted by the gaze, judgment or awareness of an Other; it can have profound impacts on identity and self-concept, and is highly prevalent in medicine and healthcare. This article posits ‘anticipated shame’ as a potent factor implicit in the experience of developing a medical professional identity, and connects shame to stigma and marginalization in medical training. Shame, and the anticipation of shame in student–teacher and trainee–patient interactions, highlights aspects of interpersonal communication within medical training and then practice. The concept of anticipated shame offers rich ground to theorize the effects of affect in medical education, and how trainees internalize medical cultural values and then enter the field of clinical practice.
References
Ahmed, Sara (2014) The Cultural Politics of Emotion. Edinburgh: Edinburgh University Press.
Anderson, Nientara, Elle Lette, Emmanuella N. Asabor, Amanda L. Hernandez, Max J. Tiako Nguemeni, Christen Johnson, Roberto E. Montenegro et. al. (2021) The association of microaggressions with depressive symptoms and institutional satisfaction among a national cohort of medical students. Journal of General Internal Medicine 37 (2): 298–307. https://doi.org/10.1007/s11606-021-06786-6.
Beagan, Brenda (2000) Neutralizing differences: Producing neutral doctors for (almost) neutral patients. Social Science and Medicine 51 (8): 1253–1265. https://doi.org/10.1016/S02779536(00)00043-5.
Beagan, Brenda (2001) Micro inequities and everyday inequalities: ‘Race,’ gender, sexuality and class in medical school. Canadian Journal of Sociology 26 (4): 583–610. https://doi.org/10.2307/3341493
Billingham, Paul and Tom Parr (2020) Online public shaming: Virtues and vices. Journal of Social Philosophy 51 (3): 371–390.
Burr, Justin and Gary L. Beck Dallaghan (2019) The relationship of emotions and burnout to medical students’ academic performance. Teaching and Learning in Medicine 31 (5): 479–486. https://doi.org/10.1080/10401334.2019.1613237
Bynum, William E. and Jeffrey L. Goodie (2014) Shame, guilt, and the medical learner: Ignored connections and why we should care. Medical Education 48 (11): 1045–1054. https://doi.org/10.1111/medu.12521
Bynum, William E., Pim W. Teunissen and Lara Varpio (2021) In the ‘shadow of shame’: A phenomenological exploration of the nature of shame experiences in medical students. Academic Medicine 96 (11S): S23–S30. https://doi.org/10.1097/acm.0000000000004261
Bynum, William E., Lara Varpio, Janaka Lagoo and Pim W. Teunissen (2021) ‘I’m unworthy of being in this space’: The origins of shame in medical students. Medical Education 55 (2): 185–197. https://doi.org/10.1111/medu.14354
Chisholm, Leah P., Kianna R. Jackson, Heather A. Davidson, Andre L. Churchwell, Amy E. Fleming and Brian C. Drolet (2021) Evaluation of racial microaggressions experienced during medical school training and the effect on medical student education and burnout: A validation study. Journal of the National Medical Association 113 (3): 310–314. https://doi.org/10.1016/j.jnma.2020.11.009
Clement, Sarah, Oliver Schauman, Tanya Graham, F. Maggioni, Sara Evans-Lacko, N. Bezborodovs, Morgan Craig, Nicolas Rusch et al. (2015) What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine 45 (1): 11–27. https://doi.org/10.1017/S0033291714000129
Cruess, Richard L., Sylvia R. Cruess, J. Donald Boudreau, Linda Snell and Yvonne Steinert (2014) Reframing medical education to support professional identity formation. Academic Medicine 89 (11): 1446–1451.
Dennis, Alex and Peter J. Martin (2005) Symbolic interactionism and the concept of power. British Journal of Sociology 56 (2): 191–213. https://doi.org/10.1111/j.1468-4446.2005.00055.x
DeRoo, Neal (2013) Futurity in Phenomenology: Promise and Method in Husserl, Lévinas, and Derrida. New York: Fordham University Press.
Dolezal, Luna (2015) The Body and Shame: Phenomenology, Feminism, and the Socially Shaped Body. Washington, DC: Lexington Books.
Dolezal, Luna (2017) Shame, vulnerability and belonging: Reconsidering Sartre’s account of shame. Human Studies 40 (3): 421–438. https://doi.org/10.1007/s10746-017-9427-7
Dolezal, Luna (2021) Shame, stigma, HIV: Considering affective climates and the phenomenology of shame anxiety. lambda nordica 27 (2–3): 47–75. https://doi.org/10.34041/ln.v27.741
Dolezal, Luna and Barry Lyons (2017) Health-related shame: An affective determinant of health? Medical Humanities 43 (4): 257–263. https://doi.org/10.1136/medhum-2017-011186
Earnshaw, Valerie, Diane Quinn and Crystal Park (2012) Anticipated stigma and quality of life among people living with chronic illnesses. Chronic Illness 8 (2): 79–88.
Fanon, Franz (2008) [1952] Black Skin, White Masks. Trans. Charles L. Markmann. London: Pluto Press.
Fields, Jessica, Martha Copp and Sherryl Kleinman (2006) Symbolic interactionism, inequality, and emotions. In J. E. Stets and J. H. Turner (eds), Handbook of the Sociology of Emotions, 155–178. Boston, MA: Springer US.
Frost, Heather D. and Glenn Regehr (2013) ‘I AM a doctor’: Negotiating the discourses of standardization and diversity in professional identity construction. Academic Medicine 88 (10): 1570–1577.
Goffman, Erving (1959) The Presentation of Self in Everyday Life. New York: Anchor Books.
Goffman, Erving (1963) Stigma: Notes on the Management of Spoiled Identity. New York: Simon and Schuster.
Haidet, Paul and Howard F. Stein (2006) The role of the student-teacher relationship in the formation of physicians. Journal of General Internal Medicine 21 (1): 16–20. https://doi.org/10.1111/j.1525-1497.2006.00304.x
Hautz, Wolf E., Therese Schröder, Katja A. Dannenberg, Maren März, Henrike Hölzer, Olaf Ahlers and Anke Thomas (2017) Shame in medical education: A randomized study of the acquisition of intimate examination skills and its effect on subsequent performance. Teaching and Learning in Medicine 29 (2): 196–206. https://doi.org/10.1080/10401334.2016.1254636
Holden, Mark D., Era Buck, John Luk, Frank Ambriz, Eugene V. Boisaubin, Mark A. Clark, Angela P. Mihalic, John Z. Sadler et. al. (2015) Professional identity formation: Creating a longitudinal framework through TIME (Transformation in Medical Education). Academic Medicine 90 (6): 761–767. https://doi.org/10.1097/ACM.0000000000000719
Jacques, Helen (2011) NHS has a ‘blame and shame’ culture, most doctors agree. BMJ 343: Article d4527. https://doi.org/10.1136/bmj.d4527
Klass, Perri (1994) A Not Entirely Benign Procedure: Four Years As A Medical Student. New York: Plume.
Lazare, Aaron (1987) Shame and humiliation in the medical encounter. Archives of Internal Medicine 147 (9): 1653–1658.
Lindström, Ulf H., Katarina Hamberg and Eva E. Johansson (2011) Medical students’ experiences of shame in professional enculturation. Medical Education 45 (10): 1016–1024. https://doi.org/10.1111/j.1365-2923.2011.04022.x
Mata, Douglas A, Marco A. Ramos, Narinder Bansal, Rida Khan, Constance Guille, Emanuele Di Angelantonio and Srijan Sen (2015) Prevalence of depression and depressive symptoms among resident physicians: A systematic review and meta-analysis. Journal of the American Medical Association 314 (22): 2373–2383.
McEvoy, John W., John H. Shatzer, Sanjay V. Desai and Scott M. Wright (2019) Questioning style and pimping in clinical education: A quantitative score derived from a survey of internal medicine teaching faculty. Teaching and Learning in Medicine 31 (1): 53–64. https://doi.org/10.1080/10401334.2018.1481752
Meeks, Lisa M., Ben Case, Kurt Herzer, Melissa Plegue and Bonnielin K. Swenor (2019) Change in prevalence of disabilities and accommodation practices among US medical schools, 2016 vs 2019. Journal of the American Medical Association 322 (20): 2022–2024. https://doi.org/10.1001/jama.2019.15372
Meeks, Lisa M., Kurt Herzer and N.R. Jain (2018) Removing barriers and facilitating access: Increasing the number of physicians with disabilities. Academic Medicine 93 (4): 540–543. https://doi.org/10.1097/acm.0000000000002112
Mihailescu, Mara and Elena Neiterman (2019) A scoping review of the literature on the current mental health status of physicians and physicians-in-training in North America. BMC Public Health 19 (1): Article 1363. https://doi.org/10.1186/s12889-019-7661-9
Miles, Sandy (2020) Addressing shame: What role does shame play in the formation of a modern medical professional identity? BJPsych Bulletin 44 (1): 1–5. https://doi.org/10.1192/bjb.2019.49
Ofri, Danielle (2013) What Doctors Feel: How Emotions Affect the Practice of Medicine. New York: Beacon Press.
Pattison, Stephen (2000) Shame: Theory, Therapy, Theology: Cambridge: Cambridge University Press.
Rebellon, Cesar J., Nicole Leeper Piquero, Alex R. Piquero and Stephen G. Tibbetts (2010) Anticipated shaming and criminal offending. Journal of Criminal Justice 38 (5): 988–997. https://doi.org/10.1016/j.jcrimjus.2010.06.016
Robertson, J. J. and B. Long (2018) Suffering in silence: Medical error and its impact on health care providers. Journal of Emergency Medicine 54 (4): 402–409. https://doi.org/10.1016/j.jemermed.2017.12.001
Rothman, Elizabeth L. (2000) White Coat: Becoming a Doctor at Harvard Medical School. New York: William Morrow Paperbacks.
Sarangi, Srikant (2010) Reconfiguring self/identity/status/role: The case of professional role performance in healthcare encounters. Journal of Applied Linguistics and Professional Practice 7 (1): 75–95. https://doi.org/10.1558/japl.v71l.75
Sartre, Jean-Paul (2003) [1943] Being and Nothingness: An Essay on Phenomenological Ontology. Trans. Hazel E. Barnes. London: Routledge.
Scheff, Thomas J. (2014) The ubiquity of hidden shame in modernity. Cultural Sociology 8 (2): 129–141. https://doi.org/10.1177/1749975513507244
Schenk, Roy U. and John Everingham, eds. (1995) Men Healing Shame: An Anthology. New York: Springer.
Scott, Susie (2017) A sociology of nothing: Understanding the unmarked. Sociology 52 (1): 3–19. https://doi.org/10.1177/0038038517690681
Sedgwick, Eve Kosofsky (2002) Touching Feeling: Affect, Pedagogy, Performativity. Durham, NC: Duke University Press.
Serafini, Kelly, Catilin Coyer, Joedrecka Brown Speights, Dennis Donovan, Jessica Guh, Judy Washington and Carla Ainsworth (2020) Racism as experienced by physicians of color in the health care setting. Family Medicine 52 (4): 282–287.
Shepherd, Lee, Russell Spears and Antony S. R. Manstead (2013) ‘This will bring shame on our nation’: The role of anticipated group-based emotions on collective action. Journal of Experimental Social Psychology 49 (1): 42–57. https://doi.org/10.1016/j.jesp.2012.07.011
Sklar, David P. (2019) Recognizing and eliminating shame culture in health professions education. Academic Medicine 94 (8): 1061–1063. https://doi.org/10.1097/ACM.0000000000002770
Slavin, Stuart J., Debra L. Schindle, and John T. Chibnall (2014) Medical student mental health 3.0: Improving student wellness through curricular changes. Academic Medicine 89 (4): 573–577.
Tweedy, Damon (2015) Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine. London: Picador.
Wald, Hedy S., David Anthony, Tom A. Hutchinson, Stephen Liben, Mark Smilovitch and Anthony A. Donato (2015) Professional identity formation in medical education for humanistic, resilient physicians: Pedagogic strategies for bridging theory to practice. Academic Medicine 90 (6): 753–760. https://doi.org/10.1097/ACM.0000000000000725
Wyatt, Tasha R., Nicole Rockich-Winston, DeJuan White and Taryn R. Taylor (2021) ‘Changing the narrative’: A study on professional identity formation among Black/African American physicians in the U.S. Advances in Health Sciences Education 26 (1): 183–198. https://doi.org/10.1007/s10459-020-09978-7
Yousif, Hisham, Nworah Ayogu and Taison Bell (2020) The path forward – An antiracist approach to academic medicine. New England Journal of Medicine 383 (15): Article e91. https://doi.org/10.1056/NEJMpv2024535
Zahavi, Dan (2016) Self and Other: Exploring Subjectivity, Empathy, and Shame. Oxford: Oxford University Press.
Published
Issue
Section
License
copyright Equinox Publishing Ltd.
