Sentinel Emotional Events: The Nature, Triggers, and Effects of Shame Experiences in Medical Residents
Sentinel Emotional Events: The Nature, Triggers, and Effects of Shame Experiences in Medical Residents
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DOI：
10.1097/acm.0000000000002479
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发表时间：
2019-01-01
影响因子：
7.4
通讯作者：
Varpio, Lara
中科院分区：
文献类型：
--
作者：
Bynum, William E.;Artino, Anthony R., Jr.;Varpio, Lara
目的本研究探讨了一个调查不足的话题，医疗居民如何在临床学习环境中体验羞耻，要求居民反思（1）他们的羞耻体验的性质;（2）触发的事件，以及促成这些羞耻体验的因素;（3）这些羞耻体验的感知效果。方法在这项解释学现象学研究中，作者从美国一家大型教学医院的内科住院医师中招募了12名（自我提名）住院医师。从2016-2017年的每位参与者收集的数据包括：（1）关于参与者在医疗培训期间感到“有缺陷，不足或不值得”的经历的书面反映，以及（2）深入探讨参与者羞耻经历的半结构化访谈。根据解释学传统对数据进行分析，产生了关于参与者羞耻体验的丰富描述。结果：参与者的羞耻经历从使人虚弱的情感和身体反应到更阴险、短暂的反应不等。参与者报告了与患者护理、学习过程和个人目标有关的羞耻触发因素;许多因素导致了他们的羞耻经历。羞耻反应的影响包括社交孤立、脱离学习、健康受损、不专业的行为和同情心受损。羞耻反应的积极影响包括增强学习，增加寻求帮助的意愿，改善关系。结论羞耻反应可能是医学生的一种具有显著生理和/或心理影响的哨兵性情绪事件。这项研究对学习者、教育者和患者都有意义，它可能为关于羞耻在医学教育中的作用的公开、诚实的对话铺平道路。
Purpose This study explores an under-investigated topic, how medical residents experience shame within clinical learning environments, by asking residents to reflect on (1) the nature of their shame experiences; (2) the events that triggered, and factors that contributed to, those shame experiences; and (3) the perceived effects of those shame experiences. Method In this hermeneutic phenomenology study, the authors recruited 12 (self-nominated) residents from an internal medicine residency at a large teaching hospital in the United States. Data collection from each participant in 2016-2017 included (1) a written reflection about an experience during medical training in which the participant felt "flawed, deficient, or unworthy," and (2) a semi-structured interview that explored the participant's shame experience(s) in depth. The data were analyzed according to hermeneutic traditions, producing rich descriptions about participants' shame experiences. Results Participants' shame experiences ranged from debilitating emotional and physical reactions to more insidious, fleeting reactions. Participants reported shame triggers relating to patient care, learning processes, and personal goals; numerous factors contributed to their shame experiences. The effects of shame reactions included social isolation, disengagement from learning, impaired wellness, unprofessional behavior, and impaired empathy. Positive effects of shame reactions included enhanced learning, increased willingness to reach out for help, and improved relationships. Conclusions Shame reactions can be sentinel emotional events with significant physical and/or psychological effects in medical learners. This study has implications for learners, educators, and patients, and it may pave the way toward open, honest conversations about the role shame plays in medical education.