Becoming-a-physician through medical education is a process which can be mediated by shame experiences. The pervasiveness of shame in medical training suggests that there is a ‘shame culture’ in medicine across predominantly English-speaking learning contexts. Shame is frequently used as a tool for professional discipline in medical training. Consider the July 2020 article in the Journal of Vascular Surgery that classified surgery trainee social media posts as either ‘professional’ or ‘unprofessional.’ The ensuing public response highlighted how shame is deployed to discipline medical trainees, and inequities in how shaming practices are directed. Indeed, some elements of medicine’s ‘shame culture’ are reproduced through academic research on professionalism in medical education.
The article—which was peer reviewed and validated by the norms of the academic medical community—was called “Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons.” The writers set up fake social media accounts so that they could follow and observe vascular surgeon trainees who had public accounts. The article found that of the 235 vascular surgery trainees who had public accounts, 26% of those accounts demonstrated unprofessional or “potentially unprofessional content.” Posts classified as unprofessional included controversial social or political comments, and “inappropriate” attire including bikinis and swimwear.
The article was interpreted by many in the medical community as explicit shaming of gendered bodies within the profession and met public backlash in the form of a Twitter campaign in which healthcare workers posted their bikini pictures with the hashtag #MedBikini. By responding to the public shaming of gendered bodies by making bikinis (and bodies) more visible, the campaign seemed to undo some of the work that shaming practices and pedagogies can manifest in a learning community. Instead of making bikinis and gendered dress less acceptable and something that should be hidden, the hashtag made bikinis more visible, part of common conversation, and almost a badge of pride.
The article was redacted by the Journal of Vascular Surgery, an institutional rejection of sanctioned norms in response to community outrage. In that sense, the #MedBikini movement was a success. The visibility of gendered bodies and accompanying discourse acted as a check on the shaming processes in the professionalism literature and professionalism standards in public discourse. But the movement had limits, evident from its inception and its focus on the bikini as a gendered symbol without further consideration of race, religion and other forms of marginalization and stigmatization in the medical community. Furthermore, the #MedBikini movement, as an online campaign out of context of specific work or learning environments, does not necessarily connect to shaming pedagogies or shame experiences for healthcare workers when in practice, as opposed to in private life (doctors are not typically in swimwear at work).
Professionalism in Anglo-American contexts has long been defined through gendered and racialized attire and appearance. There is no universal standard for professionalism, and professional attire itself has changed and been pressured for decades. Consider for example the CROWN (Creating a Respectful and Open World for Natural Hair) Act, a USA state-level act to prohibit race-based hair discrimination in recognition of the long history of racist workplace and school standards in the United States. Even as standards and laws shift, stigmatizing and shaming practices and premises in research on education still need to be questioned. Some of the responses to the #Medbikini movement pointed out that, for example, while shame was redirected away from bikinis, wearing a hijab is still stigmatized in medical learning contexts in the United Kingdom, United States and Canada.
The narrow scope of the #Medbikini response stymied its potential to engage with the intersectional nature of shaming and stigma in discourse around medical professionalism in learning, but the hashtag does demonstrate the value of naming and making visible the shaming pedagogies and practices in the medical learning environment, and in medicine at large. As these conversations continue to grow and layers of shame and related stigmas are peeled back, standards of “professionalism” and professional discipline may shift to become more inclusive and less marginalizing. For these actions to be meaningful, they must tie to the lived experiences of healthcare workers and students in and out of the hospital—the shaming associated with bikini-wearing is not the same as shaming of a person’s natural hair in their workplace, for example.
The retraction of the article, though, is both a symbol of possible change to come and a real change in the knowledge produced about and in support of professionalism standards in the medical community. Seeking to recognize and to name the ‘shame culture’ at all these levels, from knowledge production to implied and explicit standards to the lived experiences of individuals is one important avenue to support shame-sensitivity, destigmatization, and ultimately structural change in the processes, pedagogies, and paradigms of medical education.
Penelope Lusk – PhD Candidate in Education, Culture, and Society, University of Pennsylvania
4th October 2022