Association of Grit and Shame Based Learning on Burnout in Surgical Training: A Single Institution Analysis

Rawan ElAbd; Lucy Pu; Caroline Esmonde-White; Hassan ElHawary; Joshua Vorstenbosch; Dino Zammit

doi:10.1016/j.jsurg.2025.103583

Association of Grit and Shame Based Learning on Burnout in Surgical Training: A Single Institution Analysis

J Surg Educ. 2025 Jun 27;82(9):103583. doi: 10.1016/j.jsurg.2025.103583. Online ahead of print.

Authors

Rawan ElAbd¹, Lucy Pu², Caroline Esmonde-White³, Hassan ElHawary³, Joshua Vorstenbosch³, Dino Zammit³

Affiliations

¹ Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Qc, Canada; Division of Plastic and Reconstructive Surgery, Jaber AlAhmad Hospital, Surra, Kuwait. Electronic address: rawan.elabd@mail.mcgill.ca.
² School of Medicine, McGill University, Montreal, Qc, Canada.
³ Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Qc, Canada.

PMID: 40580606
DOI: 10.1016/j.jsurg.2025.103583

Abstract

Introduction: Shaming in surgical training refers to the use of humiliation, belittlement, or derogatory remarks towards surgical trainees.

Objectives: The objective of this study is to assess the prevalence of shame-based learning (SBL) and its association with grit in surgical training.

Design/setting/participants: A cross-sectional questionnaire was distributed amongst surgical residents at McGill University in May 2024, covering: (1) demographics, (2) SBL experience, (3) Professional Fulfillment Index burnout scale, and (4) Short Grit 8-item Scale.

Results: Seventy-six residents (55 males) completed the survey (35% response rate). Seven percent believed SBL is necessary for training in their field. A total of 78% observed a colleague shaming a junior and 89% observed a staff shaming a resident. Seventy-five percent were shamed, mostly by attending staff (93%) or senior resident (61%). Shaming was mostly due to giving a wrong answer when asked (54%) and most often occurred in the operating room (80%). It resulted in loss of self-confidence (63%), depression or anxiety (37%), and professional isolation (33%). Most residents dealt with the situation by keeping it to themselves (59%). Four percent considered suicide in the past year. Being shamed and observing colleagues shaming juniors were associated with higher burnout scores and less professional fulfillment (p < 0.05). SBL was associated with higher burnout scores (p < 0.05), which was associated with thoughts of suicide (p = 0.013). High grit was protective against burnout (p = 0.004) and associated with increased professional fulfillment (p = 0.003).

Conclusions: SBL is still commonly practiced in surgical training programs despite most trainees not believing it is necessary. SBL is associated with higher burnout scores and thoughts of suicide. Conversely, higher grit scores are protective against burnout. The findings of this study highlight the need of fostering a positive learning environment for surgical trainees to increase work satisfaction and performance, to the benefit of learners and patients alike.

Keywords: burnout; grit; shame-based learning; shaming; surgical training.