Surgical Resident Errors Trigger Debilitating Shame Varying by Specific Error Type

Errors committed during surgical training act as identity-relevant experiences that trigger immediate, intense, and debilitating shame among general surgery residents, according to a qualitative investigation published in Global Surgical Education. The findings demonstrate that although global self-assessments of personal inadequacy arise across all categories of error, the specific dimension of the self that feels threatened varies systematically depending on the nature of the mistake.

The study addresses an ongoing well-being crisis across the surgical profession, where rates of altered mental health continue to rise over the course of residency training. While previous observations have documented that experiencing a recent error correlates with measurable declines in resident well-being, the precise mechanisms driving this distress have remained unclear. Researchers approached this question by examining shame—conceptualized as a global negative self-assessment—as a novel framework for understanding the emotional consequences of clinical mistakes.

To investigate these dynamics, researchers recruited 12 general surgery residents between July and November 2025 using a combination of convenience, snowball, and purposive sampling strategies. Each participating resident completed a written reflection detailing their personal experiences of shame, followed by an hour-long semi-structured interview designed to explore those events in depth. The research team subsequently analyzed the collected qualitative data using hermeneutic phenomenology to construct a detailed description of residents’ shame responses in the aftermath of errors.

Analysis revealed that four distinct classes of error prompted shame responses during residency: technical errors, judgment errors, normative errors, and quasi-normative errors. Across each category, residents experienced shame as an acute, overwhelming reaction characterized by comprehensive self-judgments of inadequacy. However, the exact psychological vulnerability exposed by the mistake depended directly on the error category involved.

Specifically, the authors found that distinct errors challenged different foundational components of surgical identity. Technical errors directly threatened perceptions of manual and operative skill, while judgment errors called into question a resident’s clinical reasoning.

The investigation also observed that the trajectory of shame is heavily shaped by community engagement and cultural norms rather than following an inevitable course. Formal institutional mechanisms such as Morbidity and Mortality conferences regularly process technical and judgment errors, whereas informal communication channels bear the burden of addressing normative and quasi-normative mistakes. The authors concluded that surgical training programs can prevent residents from being defined by their errors by fostering psychological safety, constructive feedback, reflective practices, and learning-focused institutional responses.

However, because the study relied on a qualitative cohort of 12 general surgery residents gathered through convenience, snowball, and purposive recruitment between July and November 2025, the findings offer rich descriptive insight into experiential patterns rather than quantifiable statistical incidence across all surgical residency programs.

The authors highlighted a critical institutional divergence in how training programs manage different categories of mistakes. While established clinical forums such as Morbidity and Mortality conferences offer structured venues to evaluate technical execution and operative judgment, surgical departments currently lack equivalent formal avenues to address breaches of normative conduct or quasi-normative belonging.

Crucially, Thornton and colleagues emphasized that debilitating shame is not an inevitable outcome of surgical training errors.

Subject of Research: General surgery residents' experiences of shame following clinical errors during surgical training

Article Title: Error and shame: a qualitative investigation of general surgery residents experience of shame following error

Article References: Thornton, S., Korenek, S., Greenberg, J., & Bynum, W. (2026). Error and shame: a qualitative investigation of general surgery residents experience of shame following error. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 212. https://doi.org/10.1007/s44186-026-00627-y

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00627-y

Keywords: general surgery residents, surgical training, shame, medical error, hermeneutic phenomenology, technical errors, judgment errors, normative errors, quasi-normative errors, resident well-being, morbidity and mortality conferences, psychological safety, constructive feedback, surgical education, qualitative investigation, professional identity, semi-structured interviews