Bynum William E, Goodie Jeffrey L
National Capital Consortium Family Medicine Residency Programme, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA.
Med Educ. 2014 Nov;48(11):1045-54. doi: 10.1111/medu.12521.
Shame and guilt are subjective emotional responses that occur in response to negative events such as the making of mistakes or an experience of mistreatment, and have been studied extensively in the field of psychology. Despite their potentially damaging effects and ubiquitous presence in everyday life, very little has been written about the impact of shame and guilt in medical education.
The authors reference the psychology literature to define shame and guilt and then focus on one area in medical education in which they manifest: the response of the learner and teacher to medical errors. Evidence is provided from the psychology literature to show associations between shame and negative coping mechanisms, decreased empathy and impaired self-forgiveness following a transgression. The authors link this evidence to existing findings in the medical literature that may be related to unrecognised shame and guilt, and propose novel ways of thinking about a learner's ability to cope, remain empathetic and forgive him or herself following an error.
The authors combine the discussion of shame, guilt and learner error with findings from the medical education literature and outline three specific ways in which teachers might lead learners to a shame-free response to errors: by acknowledging the presence of shame and guilt in the learner; by avoiding humiliation, and by leveraging effective feedback.
The authors conclude with recommendations for research on shame and guilt and their influence on the experience of the medical learner. This critical research plus enhanced recognition of shame and guilt will allow teachers and institutions to further cultivate the engaged, empathetic and shame-resilient learners they strive to create.
羞耻感和内疚感是主观情绪反应，是对诸如犯错或遭受虐待等负面事件的回应，并且在心理学领域已得到广泛研究。尽管它们可能具有破坏性影响且在日常生活中普遍存在，但关于羞耻感和内疚感在医学教育中的影响却鲜有著述。
作者参考心理学文献来定义羞耻感和内疚感，然后聚焦于医学教育中它们显现的一个领域：学习者和教师对医疗差错的反应。心理学文献提供的证据表明，羞耻感与消极应对机制、同理心下降以及犯错后自我宽恕受损之间存在关联。作者将此证据与医学文献中可能与未被认识到的羞耻感和内疚感相关的现有研究结果联系起来，并提出了关于学习者在犯错后应对、保持同理心以及自我宽恕能力的新思考方式。
作者将对羞耻感、内疚感和学习者差错的讨论与医学教育文献的研究结果相结合，概述了教师引导学习者对差错做出无羞耻感反应的三种具体方式：承认学习者存在羞耻感和内疚感；避免羞辱；利用有效的反馈。
作者最后针对羞耻感和内疚感及其对医学学习者体验的影响的研究提出了建议。这项关键研究以及对羞耻感和内疚感的进一步认识将使教师和机构能够进一步培养他们努力塑造的专注、有同理心且能抵御羞耻感的学习者。
