Shame among medical learners: An uncertainty-focused conception

Abstract

Objective

To analyze the nature and etiology of shame, a common problem that diminishes the well-being of learners and clinicians in medical education and practice, and to explore the relationship between shame and medical uncertainty.

Discussion

We draw upon various theoretical insights on both shame and uncertainty, and argue that shame is ultimately a product of uncertainty and its transformation by medical learners. We argue that this transformation involves two key processes. The first is a personalization of uncertainty—i.e., a transformation of medical uncertainties focused on clinical care into personal uncertainties focused on one’s self-worth. The second is a resolution of personal uncertainty—i.e., a transformation of personal uncertainties about one’s self-worth into personal certainties about one’s lack of self-worth. These key processes linking medical uncertainty to shame suggest that shame might be prevented or mitigated by targeted interventions aimed at 1) depersonalizing medical uncertainties, 2) helping learners maintain their personal uncertainties, rather than resolving them in self-destructive ways, and 3) making uncertainty and its management a more central, explicit focus of medical training.

Conclusions

Medical uncertainty has a central, paradoxical relationship to shame among medical learners—representing both a source of the problem and a potential solution. Key processes that lead from uncertainty to shame represent potential targets for interventions to prevent and mitigate shame among medical learners, and fruitful directions for future research.