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Responding to Stress and Adversity

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“Medical school is stressful. There’s no way to avoid that. Like a booth at the carnival, med schools have gotten pretty good at putting pockets of stress under coconut shells, and mixing them around, but the stress is still there.”

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Observation: You can’t learn how to respond to stress and adversity, without experiencing stress and adversity.

Related mini-observation: There’s no way to remove stress and adversity from medical school.

I know, I know, there should probably be a picture of “Captain Obvious” just after the above statement. But, the fact that something’s obviously true does not mean I’ll accept it, and it definitely doesn’t mean I’ll remember it. (By the way, having people in your life to remind you of the true things when you forget is one of the best reasons I know to live in community). On an intellectual level, we know that learning to respond to stress only comes from being in stressful situations, and yet, on an experiential level, we hope we never find out for sure. Because, in this case, learning can only come through experiencing hard things. Often times we structure our lives to avoid pain, to side-step hardship, to go around difficulty. We’re like the dog who hates water but must get a bath. We hear the faucet turn on, and we hide. We see the water and start to whimper. We get closer to the water and squirm, fighting to get free. In our last desperate attempts, we will even lash out and bite. All to avoid getting wet.

Med schools have been focused on student health and wellness a lot lately, and there’s good reason for it. Reading the statistics about stress, burnout, suicidal ideation, increased cynicism, alcoholism, and drug use among medical students is alarming. Seeing it happen in real people whose names you know and who are in your educational care, keeps you from sleeping so good. In response to these trends, medical schools have changed. Pass/Fail grading; dropping class attendance requirements; reducing student clinical obligations on weekends and holidays, and more have been implemented to keep back the kudzu of dysfunction and emotional strain that seems to be creeping faster into our students’ experiences. Sounds great. Sounds noble. And, in many ways it is. There’s a problem though. Too often we’ve removed many of the causes of stress and adversity for students, instead of coaching them in how to move through the stress and adversity they experience.

Here’s the thing: Building resiliency is not a theoretical exercise. As an idea, it can be taught. As a skill, it must be developed in real circumstances. If you spend yourself studying and don’t make the grade you want, or fail an exam, you are building skills that can help when you do all you can for a patient, and they die anyway. Yes, the circumstances are dramatically different. The skill, however, is the same.

Medical school is stressful. There’s no way to avoid that. Like a booth at the carnival, med schools have gotten pretty good at putting pockets of stress under coconut shells, and mixing them around, but the stress is still there. We can take it from one area - move to pass/fail grading; but it will pop up in another area - more emphasis on Step 1 scores. This phenomenon used to bug me, a lot. Now, I’m grateful for it. Taking away stress and adversity is the last thing we need to do. Coaching, teaching, talking with students about
how to deal with the stress and adversity they face, that’s what we should be doing.

It’s so obvious it only took me three, okay four years to realize.

Jason Noah, M.Ed.
Program Director for Student Success, Medical Student Services
University of Alabama at Birmingham School of Medicine

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