Session Design Submission Review

No

Yes

Background:

Surgical learners face high-stakes decision-making in an emotionally, intellectually, and physically demanding environment. This primes students, residents, and teachers to encounter shame. Shame is an emotion wherein someone experiences a feeling of being globally flawed, deficient, and/or unworthy. Shame is increasingly recognized as a driver of intrapersonal distress and dysfunctional team dynamics in healthcare, with a growing body of scholarly literature describing its effects. Applying awareness and understanding of shame, i.e., a “shame lens,” to the work of becoming a surgeon is a novel way of understanding impaired well-being in the surgical learning environment. Shame competence is an emerging framework to facilitate constructive engagement with shame by mitigating its harmful effects while leveraging its prosocial potential.

Participants in this 90-minute workshop will engage with the shame lens, shame compass, and shame competence conceptual framework through didactics and interactive small-group case studies with hands-on activities. The target audience includes medical students, residents, fellows, and faculty. The facilitators will include faculty, resident, and student leaders who study shame in the surgical learning environment. They will organize the session around the five pillars of shame competence: awareness of shame, recognition of shame, avoiding inducing shame, proactive support, and transforming organizations (Lancet, 2024). Additionally, the facilitators will utilize Nathanson’s Compass of Shame to help participants recognize common reactions to shame at the individual level (Nathanson, 1992). Session participants will be equipped with the tools and skills needed to drive positive cultural change at their institutions through productive engagement with shame.

Part I: What is Shame?

Facilitators will help participants build their awareness of shame by discussing its definition, manifestations, and social functions. Participants will gain an understanding of the psychology of shame and how it influences behaviors. Participants will engage in an open-ended small group activity where they acknowledge the presence of shame in surgical education. Facilitators will solicit examples from the small groups of times they believe they observed or experienced shame in their contexts. The facilitators will use the Shame Compass to analyze the effects of shame in the given scenarios.

Part II: Responding to Shame

Facilitators will transition to a small group activity where we discuss strategies for avoiding inducing shame under circumstances where surgical learners are at increased risk of a shame reaction.  Recognizing opportunities to avoid inducing shame, participants will discuss strategies for proactively supporting learners they identify as experiencing a shame response (drawing again from the Shame Compass). We will highlight the pro-social potential that exists in the shame response with particular attention paid to catalyzed professional identity formation and community building. Examples will be drawn from original research being conducted on the experience of shame in surgical education (CESERT-funded), with opportunities to explore intentional shaming behavior, unintentionally inflicted shame across hierarchies, and shame that arises in response to negative clinical outcomes. Special attention will be paid to M&M conference and error response. Key points about how to engage productively with this inevitable emotion will be emphasized with brief returns to didactic instruction from the facilitators.

90-minute workshop

Yes

Yes

Understand the origins, functions, and impact of shame on surgical learners.

Recognize hidden shame and shaming behaviors in surgical training programs.

Formulate interpersonal strategies to respond constructively to shame in surgical education.

Apply shame competence principles to engage productively with shame in surgical education.