Associations between PIF, empathy and shame among Trainee physicians

Department of international Cooperation for
Medical Education
2022.11.30
Wu HanBackground

SHAME

Shame is a powerful, deeply uncomfortable, self-denigrating emotion that
influences behaviour and identity by sensitizing individuals to theperceived opinions of others[1,2].
Shame inheres in the experience of seeing oneself as critically flawed inrelation to some internalized ideal, thereby judging one’s self as globally
deficient or unworthy [3]..

[1] Tracy JL, Robins RW. Target Article: “putting the self into self-conscious emotions: a theoretical model”. Psychol Inq. 2004;15:103–25.
[2] Lazare A. Shame and humiliation in the medical encounter. Arch Intern Med. 1987;147:1653–8.
[3] Scheff T. Goffman on emotions: the pride-shame system. Symb Interact. 2014;37:108–21.

Backgroundl A pro-social device promoting
group cohesion and preventingsocial disintegration ;SHAMEl Receives East Asian cultural
influence [4].

[4] Song T R . Shame and guilt in the Japanese culture: A study of lived experiences of moral failures of Japanese emerging generation and its relation to the church missions inJapan.[D]. Trinity International University. 2009.

Background
When physicians fail to live up to the values essential to maintaining theirprofessional identity formation (PIF) [5].

Experience ofillness

SHAME

Complaint
Supervisor to judge .
[6][5] Bynum WE 4th, Goodie JL. Shame, guilt, and the medical learner: ignored connections and why we should care. Med Educ. 2014
[6] Whelan B, Hjörleifsson S, Schei E. Shame in medical clerkship: "You just feel like dirt under someone's shoe". Perspect Med Educ. 2021Background
When physicians fail to live up to the values essential to maintaining theirprofessional identity formation (PIF) [5].
Inability to focus on learning

Experience ofillness

SHAME

Loss of motivation
Impact on career choice[6]Complaint

Loss of empathy

Supervisor to judge .
[6]

Influence on professional
identity formation
Death[7][5] Bynum WE 4th, Goodie JL. Shame, guilt, and the medical learner: ignored connections and why we should care. Med Educ. 2014
[6] Whelan B, Hjörleifsson S, Schei E. Shame in medical clerkship: "You just feel like dirt under someone's shoe". Perspect Med Educ. 2021
[7] Elton, C. Also Human: The Inner Lives of Doctors. Heinemann, 2018

Background

SHAME
During the outbreaks, doctors, along with other health-care workers,
have become the targets of online shaming pile-ons.
The online shaming directed at doctors has shifted its focus throughout
the pandemic, from shaming health-care professionals for potentiallyspreading the virus to discrediting them as witnesses[8].

[8] Dolezal L, Rose A, Cooper F. COVID-19, online shaming, and health-care professionals. Lancet. 2021
[9] Matsuo T, Kobayashi D, Taki F, et al. Prevalence of Health Care Worker Burnout During the Coronavirus Disease 2019 (COVID-19) Pandemic in Japan. JAMA Netw Open. 2020

Background

EMPATHY
veit
gaen

SHAME
neg
ative

failto liveup

PIF

Background

EMPATHYveit
gaen

Experiences, concerns, and the perspectives of the patient, combined with acapacity to communicate this understanding, and an intention to help [10].

SHAME
neg
ative

failto liveup

PIF[10] Dolezal L, Rose A, Cooper F. COVID-19, online shaming, and health-care professionals. Lancet. 2021

BackgroundExperiences, concerns, and the perspectives of the patient, combined with acapacity to communicate this understanding, and an intention to help [10].

EMPATHY[10] Dolezal L, Rose A, Cooper F. COVID-19, online shaming, and health-care professionals. Lancet. 2021
[11] Casas RS, Xuan Z, Jackson AH, Stanfield LE, Harvey NC, Chen DC. Associations of medical student empathy with clinical competence. Patient Educ Couns. 2017

Background

EMPATHY[12] Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians' empathy and clinical outcomes for diabetic patients. Acad Med. 2011

Background

EMPATHYveitgaen
criticalstepSHAME
neg
ative

failtoliveup

PIF

Positively correlated with physicians'
ability to learn, test scores, andpatient outcomes.

Background
Interpretation of what being a good doctor means and how he or sheshould behave [13].
Positively correlated with physicians'
ability to learn, test scores, andpatient outcomes.

EMPATHYveitgaencriticalstep

SHAME
neg
ative

failtoliveup

PIF[13] Kalet A, Buckvar-Keltz L, Monson V et al. Professional Identity Formation in medical school: One measure reflects changes during pre-clerkship training [version 1].
MedEdPublish 2018.
[14] Sarraf-Yazdi S, Teo Y N, How A E H, et al. A scoping review of professional identity formation in undergraduate medical education[J]. Journal of general internal medicine, 2021.

BackgroundEMPATHY
veitgaen
criticalstep

SHAMEnegative

failtoliveup

PIF

Healthcare workers develop their professional
identity and subsequently conceptualize theirmultiple identities as important implications fortheir well-being and the relationships they
form with fellow workers and patients.

Background

EMPATHYveitgaen
critical
step

SHAME
neg
ative

failtoliveupPIF

l The literature addressing the relationshipbetween PIF, empathy, and shameamong Trainee healthcare workers isnascent.
l Need quantitative experiments toquantify the relationship.
l To help trainee physicians to regulate
shame, increase their empathy and shapethemselves PIF.

Research Methodology

Research Methodology

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