TY - JOUR
T1 - How Shame Shaped Me
T2 - Exploring the Impact of Shame on Professional Identity Formation in Medical Trainees
AU - Haischer-Rollo, Gayle
AU - Meyer, Holly
AU - McMains, K Christopher
AU - Varpio, Lara
AU - Bynum, William E
N1 - Copyright © 2025 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.
PY - 2025/3/26
Y1 - 2025/3/26
N2 - PURPOSE: In medical education, the influence of shame is largely absent from current conceptualizations of professional identity formation (PIF), even though this process is susceptible to the effects of shame experiences. This study endeavors to examine how shame influences PIF among medical learners.METHOD: Adopting a constructivist approach and hermeneutic phenomenology, the authors interviewed 9 final-year graduate medical trainees at 2 U.S. military medical centers between September 2022 and February 2023. The authors used a semistructured interview guide and photo-elicitation to deeply explore participants' shame experiences and how these influenced participants' PIF. Data analysis focused on understanding the lived experiences of these events and their impact on PIF, yielding themes central to the phenomenon of shame-induced PIF that helped characterize its deeper meaning.RESULTS: Participants described shame events triggered by incidents like board exam failure, patient care mistakes, and needing educational remediation. Analyzing the influence of these events on PIF revealed 2 processes that helped propel identity arcs toward-and sometimes away from-an ideal version of the self: identity disruption and identity work. Identity disruption led to a distancing from the community and could lead to isolation, anxiety, and impaired belonging. These feelings of disruption often led to significant identity work, which involved modifying self-talk, leveraging agency, and engaging in identity negotiation (often in service of growth toward a modified professional identity).CONCLUSIONS: This study uncovers the potential for shame to serve as a catalyst for meaningful identity work in medical trainees. The findings expand on existing conceptualizations of PIF by highlighting that it is a dynamic, ongoing, nonlinear, and multidimensional process. The analysis points to actions educators and learners can take to support learners' constructive navigation of shame experiences and their impact on PIF.
AB - PURPOSE: In medical education, the influence of shame is largely absent from current conceptualizations of professional identity formation (PIF), even though this process is susceptible to the effects of shame experiences. This study endeavors to examine how shame influences PIF among medical learners.METHOD: Adopting a constructivist approach and hermeneutic phenomenology, the authors interviewed 9 final-year graduate medical trainees at 2 U.S. military medical centers between September 2022 and February 2023. The authors used a semistructured interview guide and photo-elicitation to deeply explore participants' shame experiences and how these influenced participants' PIF. Data analysis focused on understanding the lived experiences of these events and their impact on PIF, yielding themes central to the phenomenon of shame-induced PIF that helped characterize its deeper meaning.RESULTS: Participants described shame events triggered by incidents like board exam failure, patient care mistakes, and needing educational remediation. Analyzing the influence of these events on PIF revealed 2 processes that helped propel identity arcs toward-and sometimes away from-an ideal version of the self: identity disruption and identity work. Identity disruption led to a distancing from the community and could lead to isolation, anxiety, and impaired belonging. These feelings of disruption often led to significant identity work, which involved modifying self-talk, leveraging agency, and engaging in identity negotiation (often in service of growth toward a modified professional identity).CONCLUSIONS: This study uncovers the potential for shame to serve as a catalyst for meaningful identity work in medical trainees. The findings expand on existing conceptualizations of PIF by highlighting that it is a dynamic, ongoing, nonlinear, and multidimensional process. The analysis points to actions educators and learners can take to support learners' constructive navigation of shame experiences and their impact on PIF.
U2 - 10.1097/ACM.0000000000006048
DO - 10.1097/ACM.0000000000006048
M3 - Article
C2 - 40137955
SN - 1040-2446
JO - Academic Medicine
JF - Academic Medicine
ER -