System dynamics modeling to understand mental model of public humiliation in medical education

Figures & data

Table 1. Findings from narrative review and preliminary extraction of key variables, interconnections, and main themes.

Paper no.	Author (Year)	Causes and effects of public humiliation and associated aspects	Model variables and connections	Theme
1	Kost and Chen (2015)	Medical educators employ “pimping” with a misunderstanding of a Socratic teaching method. “Pimping” evokes negative emotions and is not conducive to adult learning.	Poor student performance → increase verbal abuse → increase stress	Etiology
2	Belsey (2014)	Student inadequacies are the primary activator for intense questioning.	Poor student performance → increase verbal abuse
3	Seabrook (2004)	Doctors rationalize intimidation with that it helps students learn by exposing their deficiencies and motivating them. It also prepares students for their working lives.	High level of verbal abuse → increase stress → increase drive to learn	Eustress
4	Boghossain (2012)	Teachers understand that Socratic pedagogy induces humiliation and shame in students which results in greater understanding of content.	High level of verbal abuse → Stress → increase drive to learn
5	Kaiseler et al. (2009)	Stress has been linked to enhanced motivation, support-seeking behavior and working harder.	High level of stress → increase drive to learn
6	Webb et al. (1997)	Higher motivation correlates with higher grades.	High drive to learn → increase self-studying time	Motivation
7	Adib et al. (2019)	There is a positive and significant relationship between self-directed learning and academic motivation.	High drive to learn → increase self-studying time
8	Rudland et al. (2020)	Stress can be interpreted as hindering, hence may result in negative effects.	High level of stress → decrease drive to learn	Distress
9	Dyrbye et al.  (2005)	Distress in medical school can lead to cynicism, students’ care of patients, relationship with faculty and ultimately the culture of the medical profession.	Stress → decrease drive to learn
10	Shors (2004)	Acute stress can impede learning and impair performance on spatial learning tasks.	High level of stress → decrease drive to learn
11	Schuchert (1998)	Positive correlation between verbal abuse and lower levels of confidence in students with high and low abilities and high and low levels of assuredness.	Being verbally abused → decrease self esteem	Self Esteem
12	Jirdehi et al.  (2018)	There is a significant relationship between grade point average and educational self-esteem, raising the importance of self-esteem in academic achievement.	High self-esteem → improve students’ performance
13	Arshad et al. (2015)	It was found that there was a significant positive relationship (r = 0.879, p < 0.01) between self-esteem and academic performance.	High self-esteem → improve students’ performance
14	Zimmerman (1995)	Self-efficacy influences students’ learning through cognitive as well as motivational mechanisms.	High self-esteem → increase drive to learn
15	Zeigler-Hill et al. (2013)	Unstable self-esteem was associated with poor academic performance in American undergraduates. Low self-esteem was associated with higher levels of academic disengagement and devaluation for individuals with high levels of self-esteem.	Low self-esteem → decrease drive to learn

Figure 1. Illustrates the iceberg model of systems thinking which was adapted from Ecochallenge with permission.

Figure 2. Illustrates a balancing loop (B1) named “No Pain, No Gain.” The negative arrow indicates inverse relationship while the positive arrows show positive correlation.

Figure 3. Shows the interconnection from two types of stress, illustrated in a balancing loop (B1) named “No Pain, No Gain” and a reinforcing loop (R1) “Stress Overload.”.

Figure 4. Illustrates one balancing loop (B1) named “No Pain, No Gain” and two reinforcing loops (R1) “Stress Overload” and (R2) “The Delayed Side Effect.”.

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