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Addressing the Elephant in the Room

A Shame Resilience Seminar for Medical Students

Bynum, William E. IV, MD; Adams, Ashley V.; Edelman, Claire E.; Uijtdehaage, Sebastian, PhD; Artino, Anthony R. Jr, PhD; Fox, James W., MD

doi: 10.1097/ACM.0000000000002646
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Problem: Medical schools face the challenge of developing efficacious resources to promote well-being and foster resilience in students. The authors developed, implemented, and evaluated a shame resilience seminar for second-year clerkship medical students.

Approach: In February 2018, the authors conducted a 2.5-hour seminar (part of a longitudinal series) about shame, a common and potentially damaging emotion. The seminar consisted of a large group session to introduce the psychology of shame, during which speakers shared their personal experiences with the emotion. Next, a small group session allowed students to discuss their reactions to the large group content in a safe and familiar environment. Before the seminar, faculty development was provided to small group leaders (upper-level medical students and faculty) to increase their comfort leading discussions about shame. Students completed a pre/post retrospective survey immediately following the seminar.

Outcomes: The authors found statistically significant increases in students’ confidence in identifying shame and differentiating it from guilt; in their attitudes regarding the importance of identifying shame reactions in themselves and others; and in their willingness to reach out to others during a shame reaction. Surveys of group leaders revealed no reports of significant student distress during or after the seminar.

Next Steps: This seminar represents a reproducible means of promoting shame resilience in medical students. The speakers’ personal shame experiences and the safety of the small groups for discussions about shame were central to the seminar’s apparent success. Next steps include developing an empirically-derived, longitudinal shame resilience curriculum spanning the medical school years.

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.

W.E. Bynum IV is assistant professor, Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina; ORCID: https://orcid.org/0000-0003-3796-9301.

A.V. Adams is a fourth-year medical student, Duke University School of Medicine, Durham, North Carolina.

C.E. Edelman is a fourth-year medical student, Duke University School of Medicine, Durham, North Carolina.

S. Uijtdehaage is professor, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0001-8598-4683.

A.R. Artino Jr is professor, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0003-2661-7853.

J.W. Fox is associate professor, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.

Supplemental digital content for this article is available at [WK INSERT URL].

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: The study portion of this seminar was approved by the Duke University institutional review board (reference number: Pro00091896).

Disclaimer: The views expressed in this paper are those of the authors and do not reflect the official views or policies of the United States Government, Army, Air Force, Navy, or Department of Defense.

Correspondence should be addressed to William E. Bynum IV, Department of Community and Family Medicine, Duke University School of Medicine, 2100 Erwin Road, Durham, NC 27705; e-mail: william.e.bynum@duke.edu; Twitter: @WillBynumMD.

© 2019 by the Association of American Medical Colleges