Addressing the Elephant in the Room: A Shame Resilience Seminar for Medical Students

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

doi:10.1097/acm.0000000000002646

Cited by 12 publications

(6 citation statements)

References 9 publications

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“…51 One possible model for this could be based on Bynum and colleagues’ work on addressing issues of shame in medical students. 52 Their program involved faculty development activities to help small-group leaders develop comfort and skills in facilitating discussions about shame.…”

Section: Discussionmentioning

confidence: 99%

Adverse Childhood Experiences in Trainees and Physicians With Professionalism Lapses: Implications for Medical Education and Remediation

et al. 2020

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It is now well accepted that unprofessional behavior by practicing physicians can have a negative impact on patient safety and quality of care. [1][2][3] Further, unprofessional behavior during training is associated with unprofessional behavior in later practice and regulatory involvement. 4-6 Such behaviors can be classified into the following broad categories: failure to engage, dishonest and/or disrespectful behavior, and poor self-awareness. Specific behavioral examples include poor collaboration, failure to incorporate feedback, argumentative communication, poor teamwork, externalizing blame, and failing to establish and maintain appropriate boundaries. 7In our clinical experience, these behaviors are somewhat consistent with behaviors that are often demonstrated by those with a history of adverse childhood experiences (ACEs). ACEs can include actual and/ or vicarious exposure to physical or sexual abuse, neglect, or loss of a parent. Exposure to such experiences has a strong positive correlation with medical and mental health issues in adult life, [8][9][10][11][12] and there appears to be a dose-response (or exposure-response) relationship between the number of ACEs a person experiences and subsequent medical and mental health difficulties. 10,11 Additionally, developmental exposure to trauma appears to predispose individuals to problems in responding appropriately to subsequent trauma, as they may become self-protective, exert excessive energy scanning their environment for threats, and experience ongoing low levels of fear and heightened vigilance, which can contribute to decreased curiosity, exploration, and learning. 12 Other difficulties associated with exposure to ACEs include affect dysregulation, difficulties labeling and expressing feelings and internal states, difficulties with self-concept, lack of continuous and predictable sense of self, low self-esteem, and experiencing feelings of shame and guilt. 13 Exposure to ACEs may also contribute to a person's decision to choose a helping profession. [14][15][16][17][18] However, there is a small but developing literature suggesting a relationship between boundary issues or sexual misconduct and attachment issues in physicians. 19,20 Sequelae of ACEs in medical trainees and physicians may manifest as professionalism lapses and difficulties with practice-based learning and improvement, such as defensiveness, shame, mistrust, difficulty with collaboration, and heightened reactivity, which may restrict receptivity to feedback, impair learning, and play a potential role in the manifestation

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Section: Discussionmentioning

confidence: 99%

Adverse Childhood Experiences in Trainees and Physicians With Professionalism Lapses: Implications for Medical Education and Remediation

et al. 2020

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“…We elected to make the Keck Checks 15 minutes in duration, with an additional 15 minutes built into the appointment time for clinician record keeping. We hoped to lessen barriers 6,8–10 by advertising the appointments as routine, highly approachable, and requiring a minimal investment of time. For clinicians, the added 15 minutes gave sufficient opportunity to complete record keeping and extend the face-to-face time for students with great need, while maintaining high efficiency.…”

Section: The Keck Checks Programmentioning

confidence: 99%

“…5,6 Students tend to underestimate their level of distress, but personalized feedback on well-being promotes help-seeking. 11 A third key concept was to directly reduce barriers to help-seeking as indicated in the literature 6,8–10 by making these appointments brief (15 minutes), free of charge, and free from professional consequences.…”

Section: The Keck Checks Programmentioning

confidence: 99%

Universal Brief Mental Health Screenings for First-Year Medical Students: A 6-Year Retrospective of the Keck Checks Program

Young

Juliani

2023

Academic Medicine

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Medical students are at elevated risk for mental health difficulties and may struggle to ask for help. Innovative outreach programs are warranted to reduce barriers and ensure that students receive the professional care they need and deserve. This article provides a 6-year retrospective of the Keck Checks program, a well-established initiative that offered universal 15-minute mental health screenings to every first-year medical student at the Keck School of Medicine of the University of Southern California from fall 2016 to fall 2022. This early detection program was designed to combat barriers to seeking mental health care by normalizing the concept of all students meeting with a psychologist early in their academic careers. The Keck Checks program showed promising feasibility, with a single full-time clinician successfully hosting appointments for entire classes of first-year medical students (mean of 189 students per class) during approximately 4 months, in addition to other work duties. Participation rates were high, with 715 eligible students (76.3%) choosing to attend their Keck Check. Students were frequently referred to follow-up services during the Keck Check, including mental health care (n = 360 [50.4%] referred), occupational therapy (n = 72 [10.1%] referred), and academic support services (n = 60 [8.4%] referred). Next steps include possible expansion of similar programs to medical students in years 2 to 4, residents, and physicians, as well as understanding the effect of brief mental health screenings on long-term help-seeking, adherence to mental health treatment plans, and general educational or professional success. Brief, universal mental health screenings are a relatively low-cost, high-impact approach for medical schools to consider in supporting the mental health of their student body.

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“…It is worth noting that the physical layout of domestic houses include male and female-only spaces, the primary health care centres and public buildings have gender-segregated waiting areas and that Qatar University has separate male and female campuses. Several studies in Western contexts report feelings of shame amongst medical students in their clinical training [16][17][18]. A study of Jordanian doctors and nurses reveals that they activate "Islamic self-surveillance" during their work [19].…”

Section: Introductionmentioning

confidence: 99%

A program evaluation reporting student perceptions of early clinical exposure to primary care at a new medical college in Qatar

et al. 2021

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Background Though common practice in Europe, few studies have described the efficacy of early clinical exposure (ECE) in the Middle East. The barriers to clinical learning experienced by these novice medical students have not been reported. This evaluation reports on introducing ECE in primary care, supported by Experiential Review (ER) debriefing sessions. The evaluation explores students’ experiences of their acquisition of clinical and non-technical skills, sociocultural issues commonly encountered but underreported and barriers to clinical learning experienced. Methods We conducted a cross-sectional study of three student cohorts in 2017–19: All second and third-year students at the new College of Medicine were invited to participate. The primary outcome was students’ perceptions of the aims of the Primary Health Centre Placement (PHCP) programme and how it facilitated learning. Secondary outcome measures were students’ perceptions of their learning in ER sessions and perceived barriers to learning during PHCPs. Student perceptions of the PHCPs were measured using a Likert scale-based questionnaire. Results One hundred and fifty-one students participated: 107 in year 2 and 44 in year 3; 72.3% were female. Overall, most students (> 70%) strongly agreed or agreed with the purposes of the PCHPs. Most students (71%) strongly agreed or agreed that the PCHPs allowed them to learn about patient care; 58% to observe doctors as role models and 55% to discuss managing common clinical problems with family physicians. Most students (year 2 = 62.5% and year 3 = 67%) strongly agreed/agreed that they were now confident taking histories and examining patients. Student barriers to clinical learning included: Unclear learning outcomes (48.3%); faculty too busy to teach (41.7%); lacking understanding of clinical medicine (29.1%); shyness (26.5%); and finding talking to patients difficult and embarrassing (25.8%). Over 70% reported that ER enabled them to discuss ethical and professional issues. Conclusions Overall, our Middle Eastern students regard ECE as beneficial to their clinical learning. PHCPs and ER sessions together provide useful educational experiences for novice learners. We recommend further exploration of the barriers to learning to explore whether these novice students’ perceptions are manifesting underlying cultural sensitivities or acculturation to their new environment.

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Addressing the Elephant in the Room: A Shame Resilience Seminar for Medical Students

Cited by 12 publications

References 9 publications

Adverse Childhood Experiences in Trainees and Physicians With Professionalism Lapses: Implications for Medical Education and Remediation

Adverse Childhood Experiences in Trainees and Physicians With Professionalism Lapses: Implications for Medical Education and Remediation

Universal Brief Mental Health Screenings for First-Year Medical Students: A 6-Year Retrospective of the Keck Checks Program

A program evaluation reporting student perceptions of early clinical exposure to primary care at a new medical college in Qatar

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