Shame and its impacts beyond the west: A mixed-methods study of Japanese medical students

INTRODUCTION: Shame is a deeply uncomfortable self-conscious emotion that can influence learning and identity. Empirical evidence on shame in health professions education is largely derived from Western contexts. We aimed to examine the prevalence of shame experiences among Japanese medical students, their associations with key outcomes, and the contextual meanings. METHODS: From November to December 2025, we conducted a nationwide, cross-sectional, convergent mixed-methods study across eight medical schools. Shame frequency was assessed with an online survey using the Shame Frequency Questionnaire (SFQ), along with burnout and belongingness using previously published scales with validity evidence, and an open-ended item on leaners' shame experiences and impacts. Descriptive statistics and multivariable regression analyses were conducted, along with inductive content analysis of narrative responses. RESULTS: student (i.e. student retaking the entrance exams) experiences. Reported impacts included professional identity formation crisis, sometimes with positive transformation through deliberate self-improvement. DISCUSSION: In this non-Western undergraduate medical education sample, shame experiences were relatively prevalent; varied across learner and institutional characteristics; and were associated with burnout and sense of belonging. Qualitative findings identified examination-centered triggers, Japan-specific experiences, and impacts on developing professional identity. Our findings extend empirical evidence on shame beyond Western contexts and inform future research and educational initiatives to address shame.