Answer to "What is resilience and how can it be promoted?"
Resilience is a commonly used term, both in medical education and more broadly, as it is understandably viewed as a desirable attribute in students; educators want students to be resilient in order to ‘resist’ the various pressures of medical education. However, there is no simple answer to the question ‘What is resilience?’.
We need to be clear what is actually meant by resilience, as the term is used in different ways by different people, often without clear definition or theory. There is also commonly unclarity about how resilience relates to other related concepts, such as stress and well-being.
Although there are multiple perspectives on resilience, it is now generally accepted that resilience is a dynamic process in which individuals use their own and environmental resources to adapt to or manage significant sources of stress, and that resilience therefore varies across an individual’s life course.
One helpful definition reflecting this view comes from Gill Windle: “Resilience is the process of effectively negotiating, adapting to, or managing significant sources of stress or trauma. Assets and resources within the individual, their life and environment facilitate this capacity for adaptation and ‘bouncing back’ in the face of adversity. Across the life course, the experience of resilience will vary.” (Windle, 2011, p.163)
This definition suggests that students can draw on their own internal resources as well as environmental resources to manage difficult situations. This implies that a developmental approach to student support would enable students to develop and best use their resources, within a supportive environment that also provides resources.
Resilience is expected to vary across an individual’s life, and in different contexts, dependent on the available resources and their ability to mobilise them to manage a significant source of stress. Therefore, how resilient a student is will vary across their life, in different contexts, and for different types of stressors.
There are many different potential resources that individuals can draw upon. For example, Schetter & Dolbier (2011) provide a taxonomy of resilience resources, with six main types of resource: personality and dispositional resources (e.g. positive affectivity); self and ego-related resources (e.g. self-efficacy); interpersonal and social resources (e.g. social connectedness); world views and culturally-based beliefs (e.g. spirituality); behavioural and cognitive skills (e.g. relaxation skills); and other resources (e.g. healthy behavioural practices).
Although there may be some resources which cannot be changed or developed (e.g. some aspects of personality), there are many other resources which can be developed, so these aspects should be the focus when identifying the potential strengths of the individual to manage sources of stress.
The definition above provides a start to understanding resilience, but more research is needed within medical education to develop theory around how different resources are used to manage different sources of significant stress.
Schetter CD, Dolbier C.(2011) Resilience in the context of chronic stress and health in adults. Social and Personality Psychology Compass. 5(9):634-52.
Dunn, L. B., Iglewicz, A., & Moutier, C. (2008). A conceptual model of medical student well-being: promoting resilience and preventing burnout. Academic Psychiatry, 32(1), 44-53.
Fletcher, D., & Sarkar, M. (2013). Psychological resilience: A review and critique of definitions, concepts, and theory. European Psychologist, 18(1), 12-23.
Howe, A., Smajdor, A., & Stockl, A. (2012). Towards an understanding of resilience and its relevance to medical training. Medical Education, 46(4), 349-356.
Pangallo, A., Zibarras, L., Lewis, R., & Flaxman, P. (2015). Resilience through the lens of interactionism: A systematic review. Psychological Assessment, 27(1), 1-20.
Teodorczuk, A., Thomson, R., Chan, K., & Rogers, G. D. (2017). When I say… resilience. Medical Education, 51(12), 1206-1208.
Windle, G. (2011). What is resilience? A review and concept analysis. Reviews in Clinical Gerontology, 21(2), 152-169.