Abstract
Medical and health professions education should give attention to faculty and student wellbeing and create a supportive curriculum and teaching–learning process to assure the achievement of competency and readiness of graduates. This chapter highlights that the students, faculty, patients, and other human enterprises are the center of the process. Relevant theories and practices on resilience, burnout, and wellbeing will be discussed comprehensively in the medical and health professions education context in general and in a hierarchical-collectivist cultural context. Resilience or perseverance is the ability of an individual to respond to stress healthily and adaptively so that people may ‘bounce back’ from challenging circumstances and even become more robust in the process. On the other hand, the failed adaptation will result in burnout. The balance between resilience support and burnout prevention is believed to promote wellbeing. The concept is highly relevant to the vision of creating future medical and health professionals and in any efforts involving current students and faculty. In addition to individual processes and development, resilience is influenced by the learning environment. The socialization process within the education milieu allows students and faculties to stay motivated in achieving their goals, prevent burnout and keep developing their personal and professional identity. Studies show that interventions on the individual without paying attention to the learning environment are not adequate. The keys to nurturing and humanistic learning environment which supports resilience are at the individual, interpersonal, and organization/system levels in which culture is embedded. This chapter will also describe that positive role-modeling and mentoring can create the expected learning environment in hierarchical and collectivist cultural context.
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References
Aultman JM (2005) Uncovering the hidden medical curriculum through a pedagogy of discomfort. Advan Health Educ Theory Pract 10:263–273
Armyanti I, Mustika R, Soemantri D (2020) Dealing with negative role modelling in shaping profssional physician: an exploratory study. J Pakistan Med Educ 70(9):1527–1532
Bandura A (1989) Social cognitive theory. In: VASTA R (ed) Annals of child development, vol 6. Six theories of child development. JAI Press, Greenwich CT
Billings ME, Lazarus ME, Wenrich M et al (2011) The effect of hidden curriculum on resident burnout and cynicsm. J Grad Med Educ 3(4):503–510
Boor K, Van Der Vleuten C, Teunissen P et al (2011) Development and analysis of D-RECT, an instrument measuring residents’ learning climate. Med Teach 33:820–827
Branch WT (2015) Teaching professional and humanistic values: Suggestion for a practical and theoretical model. Patient Educ Couns. 98:162–7
Breda AD (2018) A critical review of resilience theory and its relevance for social work. Soc Work 54:1–17
Brydges R, Manzone J, Shanks D (2015) Self-regulated learning in simulation-based training: a systematic review and meta-analysis. Med Educ 49:368–378
Caleon IS, Wui MGL, Chiam CL (2017) Personal strengths and perceived teacher support as predictors of Singapore students’ academic risk status. Educ Psychol 37:983–1000
Clauss-ehlers CS (2008) Sociocultural factors, resilience, and coping: support for a culturally sensitive measure of resilience. J Appl Dev Psychol 29:197–212
Clauss-ehlers CS, Yang YTT, Chen WCJ (2006) Resilience from childhood stressors: the role of cultural resilience, ethnic identity, and gender identity. J Infant, Child Adolesc Psychoth 5:124–138
Cruess RL, Cruess SR, Boudreau D et al (2015) A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med 90(6):718–725
Dianti NA, Findyartini A (2019) The relationship between type of motivation and burnout in medical student during transition from preclinical to clinical stages in Universitas Indonesia 2018. E-J Kedokteran Indonesia 7(2):115–121
Duckworth AL, Peterson C, Matthews MD et al (2016) Grit: perseverance and passion for long-term goals. J Pers Soc Psychol 92:1087–1101
Dunn LB, Iglewicz A, Moutier C (2008) A conceptual model of medical students’ well-being: promoting resilience and preventing burnout. Acad Psychiatry 32(1):44–53
Dyrbye LN, Thomas MR, Harper W et al (2009) The learning environment and medical student burnout: a multicentre study. Med Educ 43:274–282
Dyrbye LN, West CP, Satele D et al (2014) Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med 89:443–451
Dyrbye LN, Shanafelt T (2016) A narrative review on burnout experience by medical students and residents. Med Educ 50:132–149
Felaza E, Findyartini A, Mustika R et al (2020) How motivation correlates with academic burnout: study conducted in undergraduate medical students. Educ Med J 12(1):43–52
Findyartini A, Hawthorne L, McColl G, a., (2016) How clinical reasoning is taught and learned: cultural perspectives from the University of Melbourne and Universitas Indonesia. BMC Med Educ 16:185
Findyartini A, Utami DB (2018) Development of clinical learning environment measure in the undergraduate medical program. Adv Sci Lett 24:6097–6108
Greviana N, Mustika R, Soemantri D (2020) e-Portfolio system development for undergraduate clinical dentistry: an action research study. Padjadjaran J Dent 32(2):91–100
Gruppen L, Irby D, Durning S et al. (2018) Interventions designed to improve the learning environment in the health professions: a scoping review. MedEdPublish 7(3). doi:https://doi.org/10.15694/mep.2018.0000211.1
Gunnestad A (2006) Resilience in a cross-cultural perspective: how resilience is generated in different cultures. https://www.immi.se/intercultural/nr11/gunnestad.htm. Accessed 12 Feb 2020
Hafferty FW (1998) Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med 73:403–407
Haider SI, Snead DRJ, Bari MF (2016) Medical students’ perceptions of clinical teachers as role model. PLoS ONE 11:e0150478–e0150478
Haizlip J, May N, Schorling J et al (2012) Perspective: the negativity bias, medical education, and the culture of academic medicine: why culture change is hard. Acad Med 87:1205–1209
Harden RM, Lilley P (2018) The eight roles of the medical teacher: the purpose and function of a teacher in the healthcare professions. Elsevier Health Sciences
Hochberg MS, Berman RS, Kalet AL et al (2013) The stress of residency: recognizing the signs of depression and suicide in you and your fellow residents. Am J Surg 205(2):141–146
Hofstede G (2001) Culture’s consequences: Comparing values, behaviours, institutions, and organisations across nations. 2nd edition. Thousand Oaks, CA: Sage
Hopkins L, Saciragic L, Kim J et al. (2016) The hidden curriculum: Exposing the unintended lessons of medical education. Cureus 8(10):e845
Horton ME (2019) The orphan child: humanities in modern medical education. Philos Ethics Humanit Med 14:1–6
Howe A, Smajdor A, Stockl (2012) A towards an understanding of resilience and its relevance to medical training. Med Educ 46:349−356
Huey CWT, Palaganas JC (2020) What are the factors affecting resilience in health professionals? A synthesis of systematic reviews. Med Teach 42(5):550–560
Irby DM (1986) Clinical teaching and the clinical teacher. J Med Educ 61:35–45
Isba R, Boor K (2011) Creating a learning environment. In: Dornan T, Mann KV, Scherpbier A, Spencer J (eds) Medical education: theory and practice. Churchill Livingstone, London, pp 99–114
Ishak W, Nikravesh R, Lederer S et al (2013) Burnout in medical students: a systematic review. Clin Teac 10:242–245
Jarvis-Selinger S, MacNeil KA, Costello GRL et al (2019) Understanding professional identity formation in early clerkship: a novel framework. Acad Med 94(10):1574–1580
Jochemsen-van der Leeuw HGAR, van Dijk N, van Etten-Jamaludin FS et al (2013) The attributes of the clinical trainer as a role model: a systematic review. Acad Med 88:26–34
Kemp S, Hu W, Bishop J et al (2019) Medical students well-being: a consensus statement from Australia and New Zealand. BMC Med Educ 19:1–8
Keyes CL (2007) Promoting and protecting mental health as flourishing: a complementary strategy for improving national mental health. Am Psychol 62:95
Kilty C, Wiese A, Bergin C et al (2017) A national stakeholder consensus study of challenges and priorities for clinical learning environments in postgraduate medical education. BMC Med Educ 17:226
Kushner RF, Kessler S, McGaghie WC (2011) Using behavior change plans to improve medical student self-care. Acad Med 86(7):901–906
Kusurkar RA, Ten Cate TJ, Van Asperen M et al (2011) Motivation as an independent and dependent variable in medical education: a review of the literature. Med Teach 33(5):e242-262
Kusurkar RA, Croiset G, Galindo-Garré et al. (2013) Motivational profiles of medical students: association with study effort, academic performance, and exhaustion. BMC Med Educ 13:1−8
Lawrence C, Mhlaba T, Stewart K, Molestsane R (2017) The hidden curricula of medical education: a scoping review. Acad Med 93(4):1
Ledesma J (2014) Conceptual frameworks and research models on resilience in leadership. SAGE Open 4(3):2158244014545464
Lee E, Hannafin MJ (2016) A design framework for enhancing engagement in student-centered learning: own it, learn it, and share it. Educ Tech Res Dev 64:707–734
Lo D, Wu F, Chan M et al (2018) A systematic review of burnout among doctors in China: a cultural perspective. Asia Pac Fam Med 17:3
Lyndon MP, Henning MA, Alyami H et al (2017) Burnout, quality of life, motivation, and academic achievement among medical students: a person-oriented approach. Perspec Med Educ 6:108–114
Marlina M, Findyartini A (2020) Content validity of burnout measurement of medical teacher in Indonesia. E-J Kedokteran Indonesia 8(1):23–30
Martimianakis MA, Hafferty FW (2016) Exploring the interstitial space between the ideal and the practised: humanism and the hidden curriculum of system reform. Med Educ 50:278–280
Maslach C, Jackson SE, Leiter MP (1996) MBI: The Maslach Burnout Inventory: Manual. Consulting Psychologists Press, Palo Alto, CA
Miller-Matero LR, Martinez S, Maclean L et al (2018) Grit: a predictor of medical students performance. Education for Health 31:109–113
Nishimura Y, Miyoshi T, Obika M et al (2019) Factors related to burnout in resident physicians in Japan. Int J Med Educ 10:129–135
Nordquist J, Hall J, Caverzagie K et al (2019) The clinical learning environment. Med Teach 41(4):366–372. https://doi.org/10.1080/0142159X.2019.1566601
Ofri D (2017) Medical humanities: the Rx for uncertainty? Acad Med 92:1657–1658
Pacifico JL, van der Vleuten CPM, Muijtjens AMM et al (2018) Cross-validation of a learning climate instrument in a non-western postgraduate clinical environment. BMC Med Educ 18:22
Passi V, Johnson N (2016) The impact of positive doctor role modeling. Med Teach 38:1139–1145
Passi V, Johnson N (2016) The hidden process of positive doctor role modelling. Med Teach 38:700–707
Pellegrino ED (2006) Toward a reconstruction of medical morality. Am J Bioeth 6(2):65–71
Pinalla S, Pander T, von der Borch P et al. (2015) 5 years of experience with a large-scale mentoring program for medical students. GMS J Med Educ 32(1):Doc5
Quirk M, Chumley H (2018) The adaptive medical curriculum: a model for continuous improvement. Med Teach 40(8):786–790
Rattrie LTB, Kittler MG, Paul KI (2020) Culture, burnout and engagement: a meta-analysis on national cultural values as moderators in JD-R theory. Appl Pscyhol Int Rev 69(1):176–220
Ross MT, Cumming DA (2013) Peer assisted learning. Dent JA. Elsevier, Harden RM. Practical guide for medical teachers. Churchil Livingstone, pp 134–141
Ryff CD (1989) Beyond ponce de leon and life satisfaction: new directions in quest of successful ageing. Int J Behav Dev 12:35–55
Sambunjak D, Straus SE, Marusic A (2010) A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. J Gen Intern Med 25(1):72–78
Savicki V (2003) A cross-cultural study of burnout and job roles. Soc Work Europe 10(1):41–48
Schönrock-Adema J, Bouwkamp-Timmer T, Hell EAV et al (2012) Key elements in assessing the educational environment: where is the theory? Adv Health Sci Educ Theo Pract 17:727–742
Schaufeli WB, Leiter MP, Maslach C (2008) Burnout: 35 years of research and practice. Career Dev Int 14(3):204–220
Schaufeli WB, Bakker AB (2004) Job demands, job resources, and their relationship with burnout and engagement: a multi-sample study. J Organiz Beh 25:293–315
Schaufeli WB (2017) Burnout: a short socio-cultural history. In: Neckel S, Schaffner AK, Wagner G (eds) Burnout, fatigue, exhaustion: an interdisciplinary perspective of a modern affliction. Springer Nature, Switzerland
Scheepers RA, Emke H, Epstein RM et al (2020) The impact of mindfulness-based interventions on doctors’ well-being and performance: a systematic review. Med Educ 54:138–149
Sheehan D, Jowsey T, Parwaiz M et al (2017) Clinical learning environments: place, artefacts and rhythm. Med Educ 51(10):1049–1060
Soemantri D, Herrera C, Riquelme A (2010) Measuring the educational environment in health professions studies: a systematic review. Med Teach 32(12):947–952
Stenfors-Hayes T, Hult H, Dahlgren LO (2011) What does it mean to be a good teacher and clinical supervisor in medical education? Adv Health Sci Educ Theory Pract 16(2):197–210
Strand P, Sjöborg K, Stalmeijer R et al (2013) Development and psychometric evaluation of the Undergraduate Clinical Education Environment Measure (UCEEM). Med Teach 35(12):1014–1026
Suhoyo Y, Van Hell EA, Kerdijk W et al (2017) Influence of feedback characteristics on perceived learning value of feedback in clerkships: does culture matter? BMC Med Educ 17:69
Tan YS, Teo SWA, Pei Y et al (2018) A framework for mentoring of medical students: thematic analysis of mentoring programmes between 2000 and 2015. Adv Health Sci Edu Theory Pract 23(4):671–697
Theron LC, Liebenberg L, Ungar M (2015) Youth resilience and culture: commonalities and complexities. Springer, Netherlands, Dordrecht
Tse S, Liew T (2004) New Zealand experiences: How is community resilience manifested in Asian communities? E-comm Int J Mental Health Add 2:1–8
Ungar M (2006) Resilience across cultures. Brit J Soc Work 38:218–235
Ungar M (2015) Resilience and culture: the diversity of protective processes and positive adaptation. In: Theron lC, Liebenberg l, Ungar M (eds) Youth resilience and culture: Commonalities and complexities. Springer Netherlands, Dordrecht
van den Berg JW, Mastenbroek NJJM, Scheepers RA et al (2017) Work engagement in health professions education. Med Teach 39(11):1110–1118
van den Berg JW, Verberg CPM, Scherpbier AJ et al (2018) Faculty’s work engagement in patient care: Impact on job crafting of the teacher. BMC Med Educ 18:312
van Houten-Schat MA, Berkhout JJ, van Dijk N (2018) Self-regulated learning in the clinical context: a systematic review. Med Educ 52(10):1008–1015
van Vendeloo SN, Godderis D, Brand PLP (2018) Resident burnout: Evaluating the role of the learning environment. BMC Med Educ 18:54
Vogan CL, McKimm J, Da Silva AL et al (2014) Twelve tips for providing effective student support in undergraduate medical education. Med Teach 36(6):480–485
Wald HS, Haramati A, Bachner YG et al (2016) Promoting resiliency for interprofessional faculty and senior medical students: outcomes of a workshop using mind-body medicine and interactive reflective writing. Med Teach 38(5):525–528
Wartman SA, Combs CD (2018) Medical education must move from the information age to the age of artificial intelligence. Acad Med 93(8):1107–1109
Watts J, Robertson N (2011) Burnout in university teaching staff: a systematic literature review. Educ Res 53(1):33–50
White MK, Barnett P (2014) A five step model of appreciative coaching: a positive process for remediation. In: Kalet A, Chou CL Remediation in medical education: a Mid- Course Correction. Springer Science and Business Media, New York
Williams ES, Konrad TR, Linzer M et al (2002) Physician, practice, and patient characteristics related to primary care physician physical and mental health: Results from the physician work life study. Health Serv Res 37:119–141
Wilson AB, Brown KM, Misch J et al (2018) Breaking with tradition: a scoping meta-analysis analyzing the effects of student-centered learning and computer-aided instruction on student performance in anatomy. Anat Sci Educ 12(1):61–73
Windle G (2011) What is resilience? A review and concept analysis. Rev Clin Gerontol 21(2):152
Wong AK (2011) Culture in medical education: Comparing a Thai and a Canadian residency programme. Med Educ 45:1209–2119
Wright EM, Matthai MT, Warren N (2017) Methods for alleviating stress and increasing resilience in the midwifery community: a scoping review of the literature. J Mid Women’s Health 62(6)
Wright MOD, Masten AS (2015) Pathways to resilience in context. In: Theron IC, Liebenberg l, Ungar M (eds) Youth resilience and culture. Cross-cultural advancements in positive psychology. Springer, Dordrecht
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Findyartini, A., Lee, S.S., Felaza, E., Mustika, R., Greviana, N. (2022). Strengthening Resilience in Medical and Health Professions Education: The Dynamic Interaction of Culture, Humanistic Environment, and Positive Role Modelling. In: Claramita, M., Findyartini, A., Samarasekera, D.D., Nishigori, H. (eds) Challenges and Opportunities in Health Professions Education. Springer, Singapore. https://doi.org/10.1007/978-981-16-7232-3_12
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