commentaries 345
Teaching and learning resilience: a new agenda
in medical education
Patricia Tempski,1 Milton A Martins1 & Helena B M S Paro2
Reading the article on resilience by
Howe et al.1 brings to mind a pic-
ture of palm trees curving in the
wind and returning to their original
positions. Palm trees face adversity
over time without deforming, an
image that seems to depict the
meaning of resilience. Just like
palm trees, we need resilience to
face the challenges with which life
confronts us.
The term ‘resilience’ has been
imported from the language of
physics and is used to designate the
capacity of a material or body to
suffer stress or the imposition of
external pressure and return to its
original state without becoming
deformed after the stimulus of the
stressor is withdrawn. In a transdis-
ciplinary context, this term is also
used in physiology and psychology
to refer to a person’s capacity to
resist adversity without developing
physical, psychological or social
disabilities.2
Just like palm trees, we need resilience to
face the challenges with which life
confronts us
Resilience is an emotional compe-
tence and can be considered as a
virtue or behaviour to be acquired
and improved. It consists of cogni-
1
São Paulo, São Paulo, Brazil
2
Uberlandia, Minas Gerais, Brazil
Correspondence: Professor Helena Paro,
Health Sciences, Federal University of
Uberlandia, Avenida Pará 1720, Uberlandia,
Minas Gerais 38400902, Brazil. Tel/
Fax: 00 55 34 3218 2389; E-mail:
helenaparo@terra.com.br
doi: 10.1111/j.1365-2923.2011.04207.x
ª Blackwell Publishing Ltd 2012. MEDICAL EDUCATION 2012; 46: 343–348
tive processes that encompass at
least four dimensions: self-efficacy;
planning; self-control, and com-
mitment and perseverance.3
Being resilient does not mean
being indestructible, but being able
to deal with life events, meet prob-
lems as opportunities for personal
growth, and recognise problems,
limitations, and personal and col-
lective resources. It also means
being able to organise strategies
through self-reflection, creativity,
optimism and humour, being flex-
ible and able to act with responsi-
bility and ethical awareness.2–4
In recent years, the term ‘resil-
ience’ (from the psychological
perspective mentioned by Howe
et al.1) has been assimilated by
the health sciences and associated
with better outcomes in health
promotion, well-being and quality
of life.2,3 In this context, resilience
may be potentially linked to
improved academic and
professional performance.
Being resilient means being able to act
with responsibility and ethical awareness
As we know, professional compe-
tence extends beyond technical
knowledge. It encompasses abilities
and attitudes that allow one to
show effective team-working abili-
ties, leadership, communication
skills, empathy, self-control and
metacognition. These emotional
competences are considered
essential within the international
agenda of professionalism because
they represent an attempt to
rescue values and humanism in
medical practice.
In this context, medical schools
should seek to provide students
with a holistic education and
should focus on providing oppor-
tunities for the development of
emotional competences within
their curricula.5,6
Although Howe et al.1 observe that
interventions to develop resilience
are ‘best delivered as a managed
process‘,1 we might ask ourselves
how we teach (and learn) emotional
competences such as resilience.
What are the most appropriate
learning strategies? Are we evaluat-
ing our strategies with appropriate
measures? Are we using these resil-
ience measures for ‘formative
reflection and discussion’1 of the
construct with our students? What
are the impacts of our strategies in
the academic community?
How do we teach (and learn) emotional
competences such as resilience?
We strongly believe the answers to
some of these questions lie in
transformative education. During
medical training, we all (students
and professors!) learn, acquire and
improve emotional competences.
If we understand education as a
process with cognitive, ethical,
historical and socio-cultural dimen-
sions that emerge in a dialectic and
dialogic relationship between lear-
ner and teacher, both can be con-
sidered as unfinished beings under
continuing individual and collective
development. Within the sociologi-
cal and ethical dimensions of
resilience, education may be trans-
formative for both students and
professors: the one who learns also
has something to teach.7
345
commentaries
During medical training, we all learn,
acquire and improve emotional
competences
There may be different ways to teach
and learn emotional competences
during medical training. Accord-
ingly, different students learn dif-
ferent things, at different times and
for different reasons. The literature
presents a wide range of learner-
centred and reflective experiences
(pedagogic theatre, role-play, simu-
lations, positive role modelling, video
feedback, portfolios and mentoring)
as means of developing students’
emotional competences. These
strategies seek reflection on practice
as alternatives to students’ change in
(or acquisition of) attitudes.
All these strategies and techniques
will only be effective if we precisely
establish how opportunities for
learning are planned, managed and
evaluated. In this context, validated
resilience measures such as the
Resilience Scale1,8 may be useful
evaluation tools for future research.
Providing an effective learning
environment for the development of
resilience is a challenge upon which
we must focus the medical education
agenda; otherwise our strategies will
be nothing but intentions.
Shining light on competence
Brian Jolly
The competency-based medical
education movement has generated
Melbourne, Victoria, Australia
Correspondence: Brian Jolly, Health Workforce
Education and Assessment Research,
Monash University, PO Box 15,
Melbourne, Victoria 3800, Australia.
Tel: 00 61 3 9905 0067; E-mail: brian.jolly@
monash.edu
doi: 10.1111/j.1365-2923.2011.04203.x
346
At this point, we might examine
ourselves as models of resilience
and even reflect upon whether we
really are concerned about this
educational objective. In addition,
we might ask whether our practices
favour the development of resil-
ience or other emotional compe-
tences in our students.
Providing an effective learning environ-
ment is a challenge upon which we must
focus the education agenda
Discussion about resilience in
medical education refers not only
to professional development, but
also to human growth. We under-
stand the article by Howe et al.1 as a
starting point to stimulate discus-
sion in medical education that
seeks to establish a new dialectic
synthesis in our educational prac-
tice. By fostering transformative
educational approaches in medical
school, we will certainly achieve
competent and humanistic profes-
sionals. After all, we need doctors
who are able to transform reality.
REFERENCES
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utterance in the corridors of the
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was seen as a threat to the
integrity of disciplines steeped
in reverence for academic self-
determination. It also challenged
ª Blackwell Publishing Ltd 2012. MEDICAL EDUCATION 2012; 46: 343–348
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medical training. Med Educ
2012;46:349–56.
2 Tempski P. Evaluation of quality of
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academics’ respect for freedom
of thought and action. Finally,
many thought that by reducing
academic and professional
expertise to a set of behavioural
specifications, they would capitu-
late to the techno-rationality
appropriate to vocational institu-
tions that train, for example,
electricians, builders and surveyors.