commentary

Emotional socialisation and burnout in medicine and the

role of medical educators
Elinor Laws,1 Ray Samuriwo,2,3 Katie Webb4 & Alison Bullock5

The ability to experience, their medical careers, with many

express and regulate emotions concealing or suppressing Emotions have physiological and
in an appropriate manner is challenging emotions. cognitive elements, but are also shaped
fundamental to professional by cultural practices and social
influences
development in medicine.1,2
Historically, medical students Medical students and junior doctors are
were encouraged to display often ill-equipped to deal with the
affective neutrality or detached emotions they encounter There are reports of reluctance
concern as emotional expression amongst medical students and
was perceived to have a junior doctors to disclose their
deleterious impact on patient Emotions have physiological and emotions to senior doctors for fear
care.1,3,4 However, being cognitive elements, but are also of being perceived as fragile,
emotionally neutral in the shaped by cultural practices and incompetent or deviant.9 Yet
challenging situations that arise social influences.6,7 Tam et al.’s emotions and power can be closely
in health care has been linked overview8 of systematic reviews intertwined in medical practice;
to compassion fatigue, stress found that almost 25% of some senior doctors exert their
and burnout.3 In more recent medical students in general and power by acting in ways that evoke
times, the expression of over 40% of medical students in feelings of shame, humiliation and
emotion has come to be seen as Africa are affected by depression embarrassment in their
enabling doctors to provide that is associated with subordinates.9 Whereas the
medical care to patients with sociocultural factors. Efforts to expression of emotion in a
empathy and compassion, and improve medical students’ and medical student or junior doctor
its importance is recognised junior doctors’ emotional may be perceived as a sign of
within medical education.1,2 regulation must consider not weakness, those in more senior
Despite this, recent studies5–7 only practical guidance, but also positions may evoke emotion to
report that medical students and the sociocultural factors that emphasise their own power.
junior doctors are often ill- influence the understanding and Indeed, there are those who
equipped to deal with the expression of emotion in clinical perceive the use of humiliation as
emotions they encounter in practice. The extent to which an effective way of developing
medical curricula equip medical professional attitudes and
students and junior doctors to behaviours in medical students
1
School of Medicine, Cardiff University, and junior doctors, and for others
deal with the emotions they
Cardiff, UK
2
School of Healthcare Sciences, Cardiff encounter in clinical practice is it may be an unconscious learned
University, Cardiff, UK open to debate. Some contend behaviour.9 Additionally, some
3
Wales Centre for Evidence-Based Care, senior clinicians may experience
that the majority of medical
Cardiff University, Cardiff, UK
4
Centre for Medical Education, School of curricula do not have an explicit their own difficulties with
Medicine, Cardiff University, Cardiff, UK focus on how to best manage, emotional regulation and burnout
5
Cardiff Unit for Research and Evaluation in arising from the complex, dynamic
regulate and express
Medical and Dental Education (CUREMeDE),
School of Social Sciences, Cardiff University, emotions.3,5 In addition, little is and rapidly evolving nature of
Cardiff, UK known about how medical clinical practice. However, good
students and junior doctors are medical educators strive to foster
Correspondence: Elinor Laws, School of
Medicine, Cardiff University, Cardiff educated and socialised about emotional competence in medical
CF14 4XN, UK. Tel: 00 44 29 2068 7749; emotions by the health care students and junior doctors
E-mail: lawsem@cardiff.ac.uk professionals they encounter without causing humiliation or
during their training.5 embarrassment.
doi: 10.1111/medu.13787

ª 2019 John Wiley & Sons Ltd and The Association for the Study of Medical Education. MEDICAL EDUCATION 2019 1
commentary

models who are able to articulate contribute to the development of

Good medical educators strive to foster their own emotions in an honest emotional competence in medical
emotional competence in medical and authentic manner have been students. The roles of nurses and
students and junior doctors without reported to convey the importance other health care professionals in
causing humiliation of recognising, dealing with and the emotional socialisation of
expressing emotions to medical medical students and junior
students.5 This suggests that doctors merit further research and
Empirical evidence from the professional socialisation and conceptualisation to inform the
findings of Tam et al.8 and other mentorship play central roles in the development of medical curricula
studies5–7 indicate there is work development of emotional that have a high level of fidelity
to be done to foster emotional well- competence in those working in with the complex nature of the
being and competence in medical medicine. Therefore, it is worth context in which health care is
students, as well as in junior doctors. considering how best to provide delivered.
Health care is inherently complex, medical students and junior doctors
dynamic and multifaceted.6,7 with the mentorship support
Medical students and trainees are necessary to enable them to critically Nurses play a key role in the emotional
said to strive to retain a sense of reflect on and develop their socialisation of medical students and
control in clinical practice, which is emotional competence in practice. junior doctors and in their development
challenging, given the rapidly of emotional competence
evolving nature of health care.7
Recent studies5–7 highlight the need Professional socialisation and mentorship
for a renewed focus on helping play central roles in the development of
medical students and junior doctors emotional competence in medicine REFERENCES
to understand that emotional
responses, such as feeling out of 1 Underman K, Hirshfield LE.
control, are an inevitable part of Professional socialisation and Detached concern? Emotional
mentorship need not be confined socialization in twenty-first century
delivering health care and should
to the medical profession. For medical education. Soc Sci Med
not be repressed or avoided.
2016;160:94–101.
Depression in medical students is example, nurses play a tacit but
2 General Medical Council.
associated with year of study, key role in the emotional Promoting Excellence: Standards for
gender, personal issues, family socialisation of medical students Medical Education and Training.
relationships and health status.8 The and junior doctors and in their London: GMC 2015.
number and nature of the factors development of emotional 3 Bullock A, Fox F, Barnes R, Doran N,
associated with burnout add competence through Hardyman W, Moss D, Stacey M.
credence to the notion5,6 that interprofessional mentorship.10 Transitions in medicine: trainee
medical students and junior doctors Medical students and junior doctor stress and support
require bespoke support to enable doctors are expected to access mechanisms. J Workplace Learn
support from an interprofessional 2013;25 (6):368–82.
them to experience, express and
health care team to improve 4 Gaufberg EH, Batalden M, Sands
regulate their emotions because
R, Bell SK. The hidden
unregulated emotions can influence patient safety and care quality2
curriculum: what can we learn
the quality of the medical care they and, as nurses play a central role from third-year medical student
deliver. Medical schools and in patient care, they are ideally narrative reflections? Acad Med
postgraduate educational placed to facilitate 2010;85 (11):1709–16.
organisations endeavour to provide interprofessional collaboration and 5 Bolier M, Doulougeri K, Vries J,
person-centred well-being and mentorship.11 Interprofessional Helmich E. ‘You put up a certain
mental health support to medical collaboration can also be attitude’: a 6-year qualitative study
students and junior doctors. integrated into medical curricula; of emotional socialisation. Med
However, Tam et al.’s8 findings interprofessional education is Educ 2018;52 (10):1041–51.
universally recognised as a way of 6 Lundin RM, Bashir K, Bullock A,
about prevalences of depression
Kostov CE, Mattick KL, Rees CE,
amongst medical students across the developing positive
Monrouxe LV. ‘I’d been like
world highlight the imperative to interprofessional relationships that
freaking out the whole night’:
improve the emotional support that enhance the quality of care exploring emotion regulation
is provided by senior doctors and through shared learning and based on junior doctors’
other health care professionals in socialisation.12 Interprofessional narratives. Adv Health Sci Educ
clinical practice. Positive role education could therefore Theory Pract 2018;23 (1):7–28.

2 ª 2019 John Wiley & Sons Ltd and The Association for the Study of Medical Education. MEDICAL EDUCATION 2019
 commentary

7 Helmich E, Diachun L, Joseph R, 9 Crowe S, Clarke N, Brugha R. ‘You Medical Education (AMEE), 29–31
LaDonna K, Noeverman-Poel N, do not cross them’: hierarchy and August 2016, Barcelona.
Lingard L, Cristancho S. ‘Oh my emotion in doctors’ narratives of 11 Ma C, Park SH, Shang J. Inter-
God, I can’t handle this!’ power relations in specialist and intra-disciplinary
Trainees’ emotional responses to training. Soc Sci Med collaboration and patient safety
complex situations. Med Educ 2017;186:70–7. outcomes in US acute care
2018;52 (2):206–15. 10 Samuriwo R, Bullock A, Monrouxe hospital units: a cross-sectional
8 Tam W, Lo K, Pacheco J. Prevalence L, Webb K. The hidden hand in study. Int J Nurs Stud 2018;85:1–6.
of depressive symptoms among patient safety – nurses and 12 World Health Organization.
medical students: overview of medical students’ transition to Framework for Action on Inter-
systematic reviews. Med Educ 2019; junior doctor in clinical practice. professional Education & Collaborative
https://doi.org/10.1111/medu. International Association for Practice. Geneva: WHO 2010.
13770 [Epub ahead of print].

ª 2019 John Wiley & Sons Ltd and The Association for the Study of Medical Education. MEDICAL EDUCATION 2019 3