Does resilience ever do harm? We say no.

By Rachel Lewin

Today the following quote from Alexander den Heijer caught my eye as I scrolled past it on Instagram:

“When a flower doesn’t bloom, you fix the environment in which it grows, not the flower”

Resilience has been on my mind since I attended the annual meeting of the International Association of Medical Education, where there were many heated discussions about whether calls for greater individual resilience were helping our medical systems or harming the individuals who work within those systems.

One side argues that greater individual resilience is always useful, as it provides learners and clinicians with more tools for navigating stressful work environments. The other side argues that systems need to be corrected so that individuals do not NEED to be resilient—that calling for individuals who are resilient to ever increasing levels of stress is a way of putting band-aids on a failing system.

And so this quote caught my eye. Because, I believe that when a flower doesn’t bloom, we must tend both to the environment and to the flower. We check the environment for the amount of sun, water, and the temperature. But we must also inspect the flower for insects, prune its buds, and talk to it encouragingly.

Here at LAS, we think about resilience from both the environmental and the individual perspective. Our work with learners and clinicians is relational, and focuses on many factors including stressors in high stakes environments. Within our coaching model, our work often considers how our learners can most strategically manage the environmental factors.

For instance, lack of sleep and no time to cook is a fairly standard complaint from both our medical students and our residents. Our coaching plans often begin by scheduling sufficient sleep, and perhaps even helping the student sign up for a meal delivery service. These steps help to manage the environmental factors.

Next, we consider individual resilience. Increasing individual resilience means increasing the skills an individual has that limit the impact of life stress, optimize performance, and ideally decrease the onset of anxiety or depression. Strategies for increasing individual resilience include developing breathing strategies for increased focus and decreased anxiety, practicing meditation, learning communication strategies to manage interpersonal situations effectively, and many others. Coaching plans at LAS include many of these strategies, with particular care taken to target specific strategies to each learner’s particular needs.

Current rates of burnout and suicide among physicians tell us that we need to tackle this problem from all angles. We do need to change the environment—increasing levels of individual resilience will never compensate for overwhelming and unsupportive work environments. But we also need to improve individual resilience so that all of our learners and clinicians are equipped with the most effective strategies to handle the stressors of medicine.