The moment I made the error—an unfathomable vaginal laceration caused by my hands during the vacuum-assisted delivery—it felt as if a massive floodlight, centered right over my head, descended on me. All eyes in the room, aghast at my error and its outcome, bore straight through me. A rush of anxiety and fear flushed down my body, and I felt an overwhelming urge to disappear. So, I did. I slipped out quietly and eventually hid myself on other side of the labor and delivery unit, in a corner of a room, on the floor, behind a chair.
That’s when the really painful feelings hit me.
With an acute, dizzying sense of disorientation, I looked at myself, and I was aghast at what I saw: a broken, incompetent, unworthy resident who hurts patients. Before then, others had seen me—and I had seen myself—as a fairly strong resident, but I clearly had everyone fooled. My true colors and deeply flawed self were now on full display, and a rush of fears came into focus: What would others, particularly those I respected most, think of me? Would they trust me again? Who else would suffer from my incompetence? I plotted ways to leave the hospital completely unseen, and I wondered if I could return.
In the days after, I isolated myself, disengaged from the world around me, and suffered quietly.
It was brutal.
I later learned that I was experiencing shame, an emotion that occurs when a person blames a triggering event (e.g., a medical error) on deficiencies of the self (e.g., overall capability), rather than something specific that can be changed (e.g., limited experience with a vacuum delivery device). In other words, I felt that I was a horrible person, not that I had made an unfortunate mistake.
Eventually I healed, but not before enduring what my coauthors and I have recently labeled a “sentinel emotional event” in my medical training. In our study of shame experiences in medical residents, our participants recounted similar stories: shame could be a powerful, debilitating emotion triggered by singular events such as medical errors. The negative outcomes that often followed—including isolation, diminished physical and emotional wellness, unprofessional behavior, and impaired empathy—highlight the negative, destructive potential of this emotion. We also found, however, that shame could be triggered in the normal course of learning and by more frequent and less serious events (e.g., being wrong in public, underperforming on a clinical task) that could coalesce into significant, prolonged shame reactions.
Our data also point to factors that may contribute to shame—factors that could be addressed to mitigate its destructive potential—including perfectionism, comparisons to others, fear of judgment, and self-evaluating through a “skewed frame of reference.” These factors certainly contributed to my shame event. I held myself to unreasonable standards of performance, feared others’ judgment, and failed to recognize that my “error”—which occurred during an emergent placental abruption—was in fact an unfortunate and potentially unavoidable outcome that happened during a successful attempt to save a dying baby in a chaotic situation.
Our description of residents’ shame experiences is incomplete, and we have yet to identify how residents recover from their shame experiences. In the aftermath of my event, I did two things that helped me recover: I opened myself up to help, and I talked about the event and my shame with others. This was very difficult, and I relied heavily on trusted relationships with people who cared about me. Their support allowed me to see the situation more accurately, “unskew” my frame of reference, stop the cycle of self-blame, and focus on ways to grow and improve. A surprisingly cathartic and self-loving recovery ensued, and it ultimately led to my current research.
It is my hope that by sharing our stories, we will be able to “pull back the curtain” on shame in medical education, become more attune to its presence, and constructively engage with it in a way that promotes healing, community, and belonging.
By: Will Bynum, MD
W. Bynum is assistant professor, Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina.
Bynum WE IV, Artino AR Jr, Uijtdehaage S, Webb AMB, Varpio L. Sentinel emotional events: The nature, triggers, and effects of shame experiences in medical residents. Acad Med. 2019;94:85–93.