A guest blog by Dr Natasha Yates.
“She doesn’t have what it takes to be a surgeon”
“He can’t handle the pace of the Emergency Department”
The medical students to whom these statements were addressed felt backed into a corner. Should they fight hard to prove them wrong? Or take this as feedback that they should pursue a different speciality…or even career?
There has been a longstanding tradition in medicine of teaching through shame. The idea seems to be that if you embarrass someone (especially in public) they will be motivated to learn/achieve/perform. Those who utilise this technique are often the products of it themselves.
Thankfully this is no longer seen as best practice within medicine, especially as there is ample evidence to show that it is simply not an effective teaching method. There is also growing concern over the mental health and wellbeing of our junior colleagues, and as a profession we need to focus on helping, not humiliating them.
That said, medicine is a tough job. It’s not for the faint-hearted. We expect incredibly high standards of ourselves as a profession, as does the community that we serve. There are many aspects of our work that require extra-ordinary input from us: it is physically, mentally, emotionally, psychologically and socially incredibly demanding. Many would say that being a doctor is a vocation or calling, and not “just a job”.
Medical education in the 21st century wrestles with how to help train medical students to be more than ‘mechanics who fix bodies’. Now, more than at any other time in history, we have access to incredible volumes of knowledge with just a few clicks. The need for teaching to be primarily about transferring knowledge (which was the bulk of medical education in previous centuries) has therefore diminished. Following the lead of the aviation industry, we have increasingly recognised the important role that human factors (often called “non-technical skills” or “soft skills”) play in our work, and have introduced teaching around subjects like communication, teamwork, and leadership.
One of these non-technical skills is that of resilience. Educators in Australia from kindergarten to high school are focussing on intentionally building resilience training into their teaching programs. There is a sense in the wider community that the millennial generation lacks resilience, and it is not uncommon to hear them being criticised by older generations for being too pampered/protected/soft. I have heard teenagers and young adults push back, saying “not the ‘R’ word again?”. Indeed it must be tiring and even demeaning to hear how you lack resilience, how you need to toughen up, how you have it so easy and don’t appreciate the opportunities you’ve been given.
Another view in education circles is that it is unfair to tell students they need to be more resilient. They are growing up in a confusing, demanding and sometimes toxic environment. The last thing they need is to be told that they are part of the problem. Instead of focusing on building resilience in individuals, this view holds that we should be challenging and changing the noxious systems and hierarchies that are crushing those individuals. I will discuss this more in a later blog. Let’s focus for the moment however on what (if anything) can be done to help build resilience in individual students.
The first question most people have when they start to think about this is, “Can resilience be learnt and developed, or is it just something you have?”. In other words, is it nature or nurture? Born or bred?
Before exploring that question, it is important to clarify what is meant by resilience. There are a variety of definitions in the research literature, all with subtle but sometimes important differences.
One of the most widely held definitions describes resilience as the ability to bounce back after adversity. This may be adequate when talking about non-human subjects (e.g. the resilience of materials, or environments). However humans tend to be changed by adversity and returning to their original form is often highly unlikely, even impossible. This is recognised in definitions which describe resilience as including adaption and even growth through adversity2.
It gets more complicated however: some people believe resilience is a personality trait, others like to think of it as an outcome, and still others as an ongoing process in people’s lives. And regardless of the chosen definition, there is a danger in taking a binary view. By this, I mean we can fall into the trap of thinking that resilience is either present or absent. In reality, it seems that it is a continuum which changes over time and varies across the domains of our lives. For example, someone who is highly resilient at work may not adapt as well in their personal life; a resilient child may not become a resilient adolescent.
I have decided to use Howe’s1 definition of resilience in my own work: “Resilience is a mindset and skill set that can be nurtured into a stronger and more effective attribute”. This definition has features which I believe are important when considering teaching resilience:
- It is recognised as being both behavioural and psychological
- It is dynamic/modifiable
It is also important to note that resilience is universally accepted to be a response to trauma or perceived trauma, or difficulty. Therefore any attempts to help students learn to be more resilient requires exposing them to trauma or difficulty. The challenge for teachers is both “how do I teach this?”, and “how will students learn this effectively?” (Just because we try to teach something does not mean that it is learned!). The best way to find out is to research our teaching to ensure students are actually learning what we hope they are (and not being harmed in the process).
As you can imagine, this makes it a tricky field to teach and research. You can imagine saying to curriculum and ethics committees “We want to put students through deliberate trauma so they can become more resilient.” Understandably they have reservations!
So, can resilience be learnt? This is the question that we set out to answer.
Stand by for the second blog in this series in May 2019.
1. American Psychological Association. The road to resilience. Washington, DC: American Psychological Association; 2014.
2. Howe A, Smajdor A, Stockl A. Toward an understanding of resilience and its relevance to medical training. Med Educ (2012); 46:349-56
Tash Yates is a General Practitioner who also works teaching Medicine at Bond University, Gold Coast, Australia. She is passionate about “non-technical” skills in medicine particularly resilience, empathy and compassion. Her vision is to see non-technical skills valued as highly as technical skills, throughout the healthcare profession.
Her most recent research has been into whether resilience can be learned by medical students, through simulation and deliberate practice.
Writing has always been a passion for Tash, and in her current roles there is no lack of this, for example documenting patient encounters, academic journal submissions, composing curriculum, and more. She recently discovered that writing blogs is a helpful way to share her experiences, thoughts and reflections with a broader audience. As a life-long learner, she invites conversation and feedback on these publications.
You can follow her on twitter @DrTashY and via her blogs.
