Shame Competence for Healthcare Workers Training

The Shame Competence for Healthcare Workers Training adopts a modular format to equip healthcare workers–including providers, trainees, and staff–to mitigate the destructive effects of shame and improve patient safety, team function, and individual well-being. This training, which is currently under development, will offer synchronous (i.e., in-person) and asynchronous (i.e., web-based) training materials that advance shame competence at individual, relational, and institutional levels.

Module #1—What is Shame and Why Address It?—provides foundational knowledge about the psychological, evolutionary, and sociocultural origins of shame. It introduces the distributed nature of shame within an institution, or the tendency for shame to have impacts at individual, relational, and organizational levels. It asks participants to reflect on their own shame experiences and provides opportunities for voluntary sharing of these experiences. This module utilizes creative mediums such as graphic medicine, film, and audio to drive engagement, imbue shared experience, and create psychological safety.

 Module #2—Recognizing Hidden Shame and Shaming Treatment—utilizes Nathanson’s Compass of Shame as a framework for identifying behaviors insidiously driven by shame, such as withdrawal, isolation, defensiveness, and blame. It asks participants to reflect on how these behaviors manifest in themselves and others. The module focuses on four types of shaming—intentional, inconspicuous, mindless, and accidental—which are differentiated based on intent, awareness of shame, and likelihood of shame. Participants are asked to consider examples of each type of shaming, and they gain strategies for avoiding intentional/inconspicuous shaming and repairing relationships after mindless/accidental sharing.

Module #3—Responding to Shame—focuses on skill development to constructively respond to one’s own shame and shame experienced by others. It utilizes existing literature from shame in medical learners and incorporates specific skills informed by cognitive behavioral therapy and dialectical behavioral therapy. These skills center on the ability to accurately self-evaluate, reorient self-evaluation towards growth, identify and modify contingencies of self-esteem, proactively reach out for support, and leverage agency, self-advocacy, and self-compassion.

Module #4—Shame in Organizations—explores organizational shame competence and is designed for institutional leaders. It  focuses on identification and modification of organizational policies, practices, and material conditions (PPMCs) that may drive shame in individuals and teams. This module presents information about how shame can be enculturated in an organization (e.g., through hierarchies, pedagogies, human resources policies) and how it can be used for social control, conformity, and exclusion. With explicit focus on equity, diversity, and inclusion, this module prompts reflection and awareness about how individuals from minoritized and/or underrepresented backgrounds may experience shame, and how environmental factors and PPMCs mitigate or exacerbate this experience.

Who should take this training? 

This training is designed for professionals working and learning in healthcare settings. Training modules adopt a healthcare-specific lens and consider scenarios relevant to clinicians (including physicians and advanced practitioners, nurses, and allied health professionals), health professions learners, and administrative staff. Leaders, providers, and/or staff should attend who want to optimize their work environments, enhance team function, provide proactive support to colleagues experiencing shame, and navigate their own shame in healthy, constructive ways.

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