154 - Shame at the Gateway of Medicine: A Qualitative Exploration in Pre-Health Learners

Poster Number: 154
Publication Number: 154.218

Joseph A. Jackson, Duke University School of Medicine, Durham, NC, United States; Will Bynum, Duke University School of Medicine, Durham, NC, United States

Background: Shame occurs when an individual attributes a triggering event to a globally flawed self. Research has characterized shame as a driver of distress in medical students and residents. However, little is known about the nature of shame in individuals attempting to enter medical school. This gap is problematic as emotional experiences at the gateway of medicine may impact future well-being and professional identity formation in medical training.

Objective: To explore how pre-medical students experience shame within the context of a pre-doctoral training program in the health professions, specifically events that trigger, factors that promote, and effects that follow shame experiences and how they shape students’ attempts to enter the profession.

Design/Methods: This qualitative study utilized hermeneutic phenomenology, an interpretivist methodology that seeks to convey the nature and meaning of a phenomenon. We recruited 12 pre-medical students from a Master of Biomedical Sciences program in the US and collected data through a single, three-phase session: 1) a “rich picture” activity to elicit a shame experience from pre-medical training; 2) a semi-structured interview to explore the shame experience(s); and 3) a debriefing session. We analyzed the data according to Ajjawi and Higgs’s six steps of hermeneutic analysis.

Results: Our analysis revealed phenomenological elements (i.e., affective feelings, action tendencies) and structures (i.e., triggers, promoters, and effects) of shame in pre-medical students. Analysis of relationships among them highlighted shame as a critical emotion occurring as multiple “trajectories” intersect at the gateway of medicine. In examining the nature of these trajectories, we identified factors influencing pre-medical students’ emotional states as they attempt to enter the profession: the central role of previous life experiences; the high value placed on objective assessment; and the powerful influence of a dominant ideology. We identified identity negotiation as a central process intertwined with—and catalyzed by—shame experiences in pre-medical students.Conclusion(s): This exploratory study illuminates: the nature and origins of shame experiences at the beginning of medical training; the factors that influence these emotional experiences; and the complex self-evaluative and identity processes that shape students’ attempts to enter the profession. We highlight how these findings provide new ways of understanding professional identity formation in medical trainees and the ideologies that govern admission into the medical profession.