Shame and Medicine Exeter
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Reflective Practice: A Tool to Process Shame 

It was really odd starting medical school in the middle of the pandemic. Continually reminded of the pertinent reality of the career paths upon which we had embarked, we remained incredibly distant from any true clinical learning environment. For this reason, personal and witnessed shame permeated my medical school experience right from the onset. I recall the toxic stories of blind panic and overpreparation by other students, and how the pressures of academic competition emanated through our screens during online teaching. Flamboyant displays of labelled anatomical models were strategically mounted within Zoom backgrounds, alongside vainglorious boasts of countless completed Anki* cards in breakout rooms. Whether it was underlying feelings of inadequacy, veiled anxiety, or the fear of falling behind, I now appreciate that these behaviours were likely varying manifestations of shame. In an era of seemingly endless isolation and disconnect, I personally found reflective practice to be an incredibly powerful means of catharsis and self-development by which to navigate the unfamiliarity and hostility.

I can still remember walking into our first medical school lecture on reflective practice. I say walking, I really mean hopping on a Teams call, bleary-eyed after a manic virtual Freshers week. For context, our medical school requires all students to create an electronic portfolio part of which is a reflective writing log. As such, over the last few years I have written many reflections to critically analyse clinical encounters for the development of my professional practice. Through this process, I have learnt how insightful and therapeutic it can be to evaluate these experiences, particularly when exposed to emotionally or ethically challenging situations. Through sharing some excerpts of my reflections from my degree so far, I hope to convey the value of reflective practice for a student trying to navigate and digest complex clinical situations, often with minimal external outlets.

Caring for my palliative grandmother, and consequently mourning her loss, overshadowed the greater part of my second year at medical school. Pre-pandemic, my grandmother had few health concerns, outliving all elders in the family. However, shielding from Covid-19, and consequently up-to-date medical care, had wet the appetite of an insidious stage 4 throat cancer, diagnosed and feebly targeted far too late. Fresh in the aftermath of her passing, there was most definitely a pervasive sense of guilt in relation to not challenging previous health records, which had dismissed a precancerous lesion as benign several years before. In light of this, visiting one particular palliative cancer patient with the urgent care response team was a hard-hitting reminder of my own experience as a carer: ‘The initial shock of this lady’s deterioration even within such a short space of time – I recall a similar decline in communication and general state with my grandmother…the impact of this on the family with her health fluctuating so much across her final days’. Working in the community, I felt emotional ‘seeing all of the patient’s family photos and memories of the past’, remembering my own grandmother’s insistence that she remain in the comfort of her own home. This was such that I was led to reflect that ‘the human side of end-of-life medicine is often lost in the clinical, sterile hospital environment’. This encounter was a stark realisation of how personal attachment to a patient scenario can be just as much a strength as a weakness, through practising empathy and understanding: ‘I was extremely gentle and tried to explain what I was doing to this patient as I went along, so that even if she could not respond back, she could still comprehend my role and purpose in her care.’

Undoubtedly, hierarchies and power imbalances within multidisciplinary healthcare teams continue to exist, with medical students arguably placed just below the mess coffee machine. I recall a specific consultant-led grilling during my first placement on a stroke ward. Despite completing my pre-reading, it was a classic case of snowballing, with one incorrect answer precipitating more, to such an extent that the consultant berated me in front of the entire team on ward round, including the patient. To be the only student, the only female and the only person of colour in this interaction, characteristics that often amplify the need to prove individual merit, exacerbated the humiliation I felt even further. Personally, I cannot fathom how soul-crushing, age-old teaching methods which verge on uncivilised can ever be considered conducive to learning. It is a communal feeling amongst students – that mentors who inspire and foster a positive and safe learning environment facilitate true personal and professional development.

A key element of placements during the latter years of medical school is the synthesis of connections between theoretical understanding and clinical signs in practice. As such, I recall a poignant clinical encounter during a plastics clinic, where a patient was diagnosed with late stage melanoma: ‘It was saddening to learn that the patient was likely to pass away…palpating his enlarged axillary lymph node made this realisation ever more apparent.’ Throughout this consultation, the patient’s wife frequently shared teary and desperate eye-contact with me. Indeed, I felt sheer helplessness at the inevitability of her situation. But I also began to imagine the toll of the countless episodes of bad news a medical professional is expected to deliver over the course of their career. Is it not gravely hypocritical how often we are reminded to consider patient fear and insecurity, but that the medical culture seldom supports shame-ridden healthcare workers, relentlessly exposed to emotional and physical challenge? If left unaddressed, does it not begin to erode our patient empathy? Perhaps, also our very selves?

At this stage in my training, I still have so much growth to do as a healthcare worker. Nonetheless, as I enter my penultimate year of medical school, I feel grateful to harness the benefits of reflection, so that it is not merely a prescribed assessment of my professionalism, but a vital tool for my overall wellbeing and development.


*Anki – flashcards based on active recall and spaced repetition learning methods which are often used by medical students.


Natasha Syed – 4th Year Medical Student, University of Exeter

30th October 2023


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