Breaking the Silence Around Shame in Medical Education

As a child, I was deemed good at math. And so my fourth-grade teacher expressed surprise when I scored an 89% on a test. After passing out our grades, she called me to her desk. I remember feeling very small as I stood before her in my green and yellow plaid tunic, the uniform at my Catholic school. She looked at me sternly, pointed to my score, and asked, “What happened?”

I now recognize that the emotion I experienced in that moment was shame. Whereas guilt is an emotion focused on a specific action, shame is a global feeling about oneself. Rather than thinking, “I made a mistake,” the way I felt was “I am a failure.”

In a recent Academic Medicine Podcast episode, Drs. Will Bynum, Lara Varpio, and Ashley Adams bring necessary attention to feelings of shame in medical education. Bynum points out that there are internal factors that may make someone more prone to feeling shame, as well as qualities of medical culture broadly and certain supervising physicians that make shame reactions more likely.

I see these internal and external factors coming together in my own experiences with shame in my medical training. When I started my clinical rotations as a third-year medical student, I expected that, with hard work, time, and support, I would develop the skills necessary to care for patients. I knew there would be so much I didn’t know. I didn’t expect, however, that rounds each morning would feel like a performance. I was interrupted during my presentations and asked pimping questions I didn’t know the answers to. Perhaps other students could brush off these experiences, but they were emotionally taxing for me. I again felt like that little girl in the green and yellow plaid tunic standing in front of her disappointed teacher. I felt like a failure.

In the August issue of Academic Medicine, Bynum et al offer one approach to addressing shame in medical training: a seminar that normalizes feelings of shame in large part through the vulnerable storytelling of the seminar leaders. This approach reflects one of the most powerful lessons from Brené Brown, a pioneering researcher on shame: Shame thrives in silence.

For me, talking openly about my shame experiences, and learning that I am far from alone, has helped me move into a growth mindset in which I am better able to see challenges as learning opportunities rather than as assessments of my overall worth and abilities. Another strategy that has helped me is being able to recognize when a supervisor is interacting with me in a way that is shaming. If I recognize the supervisor’s behavior as inappropriate, I can distance myself from it, rather than internalize the shame. When I feel shame encroaching, I silently say to myself another phrase I learned from Brené Brown: I am imperfect, and I am enough.

My experiences of shame certainly didn’t start with my medical training. However, the high stakes and rigid hierarchy of medicine have contributed to my experiencing shame much more frequently in my medical training than during any other stage of my education or work experience. I’m grateful to Drs. Bynum, Varpio, and Adams and to Academic Medicine for breaking the silence around shame in medicine and moving us towards a culture of courageous vulnerability and belonging.

By: Colleen M. Farrell, MD

C.M. Farrell is a third-year resident physician in internal medicine at NYU and Bellevue Hospital in New York City; Twitter: @colleenmfarrell.

Editor’s Note: This trainee-authored blog post is part of the Advancing Trainee Leaders and Scholars (ATLAS) initiative, which aims to engage students, residents, and fellows in medicine, nursing, and pharmacy in the scholarly publishing process and feature their voices more regularly in Academic Medicine. You can read more ATLAS blog posts here and find out more about the ATLAS initiative here.

Further Reading

Bynum WE IV, Adams AV, Edelman CE, Uijtdehaage S, Artino AR Jr, Fox JW. Addressing the elephant in the room: A shame resilience seminar for medical students. Acad Med. 2019;94:1132-1136.