Response to "A Beacon of Emotional Resilience in a Storm of Mistreatment?".

deserved. Recipients who attribute the mistreatment to a noninternal cause (ie, an ineffective teacher or suboptimal learning environment) may feel guilt or humiliation but do not necessarily experience shame. Thus, the emotional outcome of the mistreatment must be analyzed to determine if particular treatment is “shaming.” The ability to receive mistreatment and not experience shame may actually constitute a form of emotional resilience. In the study by McMains et al, residents’ responses to the mistreatment suggest the presence of constructive responses to mistreatment. Over half of residents reported self-improvement and reaching out to others in response to the mistreatment, both of which are associated with constructive, prosocial guilt responses. Conversely, respondents also reported keeping the event a secret, reaching out to colleagues less frequently, feeling professionally isolated, and experiencing depression, each of which implies a damaging shame response. Thus, the data that McMains et al collected suggest the presence of both damaging shame responses and constructive guilt responses in the face of mistreatment. As such, it is both bleak and encouraging. It is bleak because of the high rate of reported mistreatment, which is consistent with rates previously reported, and its tendency to cause shame. However, the emotional resilience woven into the results is encouraging. Research is needed to further characterize how learners experience shame, what influences its occurrence, and the outcomes with which it is associated. This should be accompanied by equally important research into what constitutes and influences emotional resilience in the face of learner mistreatment. Eradicating mistreatment in medical education will take time, but characterizing the underlying emotions and promoting resilient responses can and should begin immediately.