By Daniel Cabrera (@CabreraERDR)

When I reflect on my life as a learner and as an educator, there are several things I wish I learned in medical school and that I hope I can teach to our students. Among them, is the concept and the praxis of grit or resiliency. I didn’t realize about the importance of resiliency until late in medical school, where I started to realize that people who actually make it in life are people who have the mental toughness, emotional skills and the physical ability to conquer daily adversity.

Resilience is a buzz word in many disciplines, including psychology, management and education. While a growing body of research is trying to understand its nature and mechanics, there are a lot of controversies about what the phenomenon really is and particularly if is a skill that can be taught.

Among the main questions about resilience is whether it is a personality trait shaped by genetic makeup and the environment or whether it is a cognitive skill that can be taught. Several resiliency building programs currently exist (with a spectrum of participants ranging from young children to active military personnel), most of them based on the Penn Resiliency Program.

Why think about resiliency?

As Clinician Educators, we should consider resilience because of the alarming rate of burnout and abandonment of the healthcare workforce in recent years. Most authors tend to believe that our inability to cope with the multiple conflicts of work and life is the leading cause of this schism. A robust set of skills to deal with the intrinsic and extrinsic stressors is critically important. I would suggest that resilience is a protective factor against dissatisfaction and burnout. We need to understand what resiliency is and is not, apply it in our lives and teach it to our students.

What are the key characteristics of resilience?

No one is completely sure with several schools of thought describing different core characteristics of resiliency. In an attempt to organize the current theories, I suggest the following three major domains:

Ability to recognize the circumstances

Ability to provide a raison d’etre

Ability to adapt and react

The first and most important trait of resiliency is the ability to make realistic sense of the environment and to prevent a biased, emotionally-negative interpretation of the current circumstances. Mentally tough people are able to dispel the unrealistic beliefs about adversity; they understand that the emotional consequences of adversity are a function of the interpretation of the situation and not the actual event. Resilient people are realistic and optimistic at the same time, they recognize the adverse situation and try to read it through the prism of the most likely scenario, discarding extremely positive or negative possibilities, which are largely improbable. They know that failure is a dichotomist outcome with an opportunity. They choose to follow the opportunity.

The second trait that defines resiliency is the ability to find meaning, a reason to be or raison d’etre in the midst of adversity. The meaning serves as motivation and allows people to re-adjust their expectations. Further planning of their objectives can lead to more transcendent goal. This goal can be as practical as a grade on a test or as ethereal as true happiness. This raison d’etre provides persistence, but is important that this persistence is linked to a low-anxiety temperament (composure), otherwise minor and major setbacks in the quest for the goal have the opportunity to create significant emotional distress. This trait may largely be influenced by personality.

The third trait is the ability to adapt and react. Understanding adversity and being able to persist is only positive if the person is able to take action. This trait involves discipline, ingenuity and determination; the discipline to craft an action plan, the ingenuity to adapt this plan to the constrained resources available and the determination to carry it out. This is adaptation too, as carrying out a plan with unlimited resources is far easier than adapting to the constraints given by time and resources.

Further Reading

Coutu D. How Resilience Works [Internet]. Harvard Business Review. [cited 2015 Apr 10]. Available from: https://hbr.org/2002/05/how-resilience-works

Dunn LB, Iglewicz A, Moutier C. A conceptual model of medical student well-being: promoting resilience and preventing burnout. Acad Psychiatry. 2008 Feb;32(1):44–53.

Howe A, Smajdor A, Stöckl A. Towards an understanding of resilience and its relevance to medical training. Medical Education. 2012 Apr 1;46(4):349–56.

Tempski P, Martins MA, Paro HBMS. Teaching and learning resilience: a new agenda in medical education. Medical Education. 2012 Apr 1;46(4):345–6.

Seligman MEP. Building Resilience [Internet]. Harvard Business Review. [cited 2015 Apr 14]. Available from: https://hbr.org/2011/04/building-resilience

Edmondson AC. Strategies for Learning from Failure. 2011 Apr 1 [cited 2015 Apr 14]; Available from: http://www.hbs.edu/faculty/Pages/item.aspx?num=40142

Photo: Salim Fadhley from Flickr. Used under Creative Commons License CC2.0