Skip to main content

Strengthening Resilience in Medical and Health Professions Education: The Dynamic Interaction of Culture, Humanistic Environment, and Positive Role Modelling

  • Chapter
  • First Online:
Challenges and Opportunities in Health Professions Education

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Aultman JM (2005) Uncovering the hidden medical curriculum through a pedagogy of discomfort. Advan Health Educ Theory Pract 10:263–273

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    PubMed  PubMed Central  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • Branch WT (2015) Teaching professional and humanistic values: Suggestion for a practical and theoretical model. Patient Educ Couns. 98:162–7

    Google Scholar 

  • Breda AD (2018) A critical review of resilience theory and its relevance for social work. Soc Work 54:1–17

    Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    Google Scholar 

  • Clauss-ehlers CS (2008) Sociocultural factors, resilience, and coping: support for a culturally sensitive measure of resilience. J Appl Dev Psychol 29:197–212

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    Google Scholar 

  • Duckworth AL, Peterson C, Matthews MD et al (2016) Grit: perseverance and passion for long-term goals. J Pers Soc Psychol 92:1087–1101

    Google Scholar 

  • 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

    PubMed  Google Scholar 

  • Dyrbye LN, Thomas MR, Harper W et al (2009) The learning environment and medical student burnout: a multicentre study. Med Educ 43:274–282

    PubMed  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • Dyrbye LN, Shanafelt T (2016) A narrative review on burnout experience by medical students and residents. Med Educ 50:132–149

    PubMed  Google Scholar 

  • 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

    Google Scholar 

  • 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

    PubMed  PubMed Central  Google Scholar 

  • Findyartini A, Utami DB (2018) Development of clinical learning environment measure in the undergraduate medical program. Adv Sci Lett 24:6097–6108

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    CAS  PubMed  Google Scholar 

  • Haider SI, Snead DRJ, Bari MF (2016) Medical students’ perceptions of clinical teachers as role model. PLoS ONE 11:e0150478–e0150478

    PubMed  PubMed Central  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    Google Scholar 

  • 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

    PubMed  Google Scholar 

  • Hofstede G (2001) Culture’s consequences: Comparing values, behaviours, institutions, and organisations across nations. 2nd edition. Thousand Oaks, CA: Sage

    Google Scholar 

  • Hopkins L, Saciragic L, Kim J et al. (2016) The hidden curriculum: Exposing the unintended lessons of medical education. Cureus 8(10):e845

    Google Scholar 

  • Horton ME (2019) The orphan child: humanities in modern medical education. Philos Ethics Humanit Med 14:1–6

    Google Scholar 

  • Howe A, Smajdor A, Stockl (2012) A towards an understanding of resilience and its relevance to medical training. Med Educ 46:349−356

    Google Scholar 

  • 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

    PubMed  Google Scholar 

  • Irby DM (1986) Clinical teaching and the clinical teacher. J Med Educ 61:35–45

    CAS  PubMed  Google Scholar 

  • 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

    Google Scholar 

  • Ishak W, Nikravesh R, Lederer S et al (2013) Burnout in medical students: a systematic review. Clin Teac 10:242–245

    Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    Google Scholar 

  • Keyes CL (2007) Promoting and protecting mental health as flourishing: a complementary strategy for improving national mental health. Am Psychol 62:95

    PubMed  Google Scholar 

  • 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

    PubMed  PubMed Central  Google Scholar 

  • Kushner RF, Kessler S, McGaghie WC (2011) Using behavior change plans to improve medical student self-care. Acad Med 86(7):901–906

    PubMed  PubMed Central  Google Scholar 

  • 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

    CAS  PubMed  Google Scholar 

  • 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

    Google Scholar 

  • Lawrence C, Mhlaba T, Stewart K, Molestsane R (2017) The hidden curricula of medical education: a scoping review. Acad Med 93(4):1

    Google Scholar 

  • Ledesma J (2014) Conceptual frameworks and research models on resilience in leadership. SAGE Open 4(3):2158244014545464

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    PubMed  PubMed Central  Google Scholar 

  • 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

    Google Scholar 

  • Marlina M, Findyartini A (2020) Content validity of burnout measurement of medical teacher in Indonesia. E-J Kedokteran Indonesia 8(1):23–30

    Google Scholar 

  • 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

    PubMed  Google Scholar 

  • Maslach C, Jackson SE, Leiter MP (1996) MBI: The Maslach Burnout Inventory: Manual. Consulting Psychologists Press, Palo Alto, CA

    Google Scholar 

  • Miller-Matero LR, Martinez S, Maclean L et al (2018) Grit: a predictor of medical students performance. Education for Health 31:109–113

    PubMed  Google Scholar 

  • 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

    PubMed  PubMed Central  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Ofri D (2017) Medical humanities: the Rx for uncertainty? Acad Med 92:1657–1658

    PubMed  Google Scholar 

  • 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

    PubMed  PubMed Central  Google Scholar 

  • Passi V, Johnson N (2016) The impact of positive doctor role modeling. Med Teach 38:1139–1145

    PubMed  Google Scholar 

  • Passi V, Johnson N (2016) The hidden process of positive doctor role modelling. Med Teach 38:700–707

    PubMed  Google Scholar 

  • Pellegrino ED (2006) Toward a reconstruction of medical morality. Am J Bioeth 6(2):65–71

    PubMed  Google Scholar 

  • 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

    Google Scholar 

  • Quirk M, Chumley H (2018) The adaptive medical curriculum: a model for continuous improvement. Med Teach 40(8):786–790

    PubMed  Google Scholar 

  • 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

    Google Scholar 

  • Ross MT, Cumming DA (2013) Peer assisted learning. Dent JA. Elsevier, Harden RM. Practical guide for medical teachers. Churchil Livingstone, pp 134–141

    Google Scholar 

  • Ryff CD (1989) Beyond ponce de leon and life satisfaction: new directions in quest of successful ageing. Int J Behav Dev 12:35–55

    Google Scholar 

  • 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

    PubMed  Google Scholar 

  • Savicki V (2003) A cross-cultural study of burnout and job roles. Soc Work Europe 10(1):41–48

    Google Scholar 

  • 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

    Google Scholar 

  • Schaufeli WB, Leiter MP, Maslach C (2008) Burnout: 35 years of research and practice. Career Dev Int 14(3):204–220

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    PubMed  Google Scholar 

  • Sheehan D, Jowsey T, Parwaiz M et al (2017) Clinical learning environments: place, artefacts and rhythm. Med Educ 51(10):1049–1060

    PubMed  Google Scholar 

  • Soemantri D, Herrera C, Riquelme A (2010) Measuring the educational environment in health professions studies: a systematic review. Med Teach 32(12):947–952

    PubMed  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    PubMed  PubMed Central  Google Scholar 

  • 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

    Google Scholar 

  • Theron LC, Liebenberg L, Ungar M (2015) Youth resilience and culture: commonalities and complexities. Springer, Netherlands, Dordrecht

    Google Scholar 

  • 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

    Google Scholar 

  • Ungar M (2006) Resilience across cultures. Brit J Soc Work 38:218–235

    Google Scholar 

  • 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

    Google Scholar 

  • van den Berg JW, Mastenbroek NJJM, Scheepers RA et al (2017) Work engagement in health professions education. Med Teach 39(11):1110–1118

    PubMed  Google Scholar 

  • 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

    PubMed  PubMed Central  Google Scholar 

  • 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

    PubMed  PubMed Central  Google Scholar 

  • van Vendeloo SN, Godderis D, Brand PLP (2018) Resident burnout: Evaluating the role of the learning environment. BMC Med Educ 18:54

    PubMed  PubMed Central  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • Watts J, Robertson N (2011) Burnout in university teaching staff: a systematic literature review. Educ Res 53(1):33–50

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    PubMed Central  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • Windle G (2011) What is resilience? A review and concept analysis. Rev Clin Gerontol 21(2):152

    Google Scholar 

  • Wong AK (2011) Culture in medical education: Comparing a Thai and a Canadian residency programme. Med Educ 45:1209–2119

    PubMed  Google Scholar 

  • 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)

    Google Scholar 

  • 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

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ardi Findyartini .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

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

Download citation

  • DOI: https://doi.org/10.1007/978-981-16-7232-3_12

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-16-7231-6

  • Online ISBN: 978-981-16-7232-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics