Latest / The Mastery Project Podcast / Stoicism for Healthcare Students: 6 Practices for Handling Setbacks Without Burning Out
Transcript
- Dr. T-Michael Dougherty, Ed.D.: Despite what you might have heard or even experienced, it is possible to get through a demanding academic program and actually enjoy the life you're living along the way. Medical school, PT school, nursing school, these programs ask a great deal of you over an extended period of time. You have to sustain your effort while meeting requirements that you don't get to set yourself. You might be putting in the hours without seeing the improvement that you want. Other students seem to be catching on to things faster than you do. You fail a practical exam one day or a skill competency checkoff, and now you have to pass the retake to stay on track. During one of your clinical rotations, you struggle with something that you could do easily back in the lab. Now, you need to understand what went wrong, but you're also starting to question whether you'll ever be able to do this reliably with real patients or not. Meanwhile, you're trying to cover your expenses, you're trying to keep up with your family responsibilities, and still somehow get enough sleep to be able to function from day to day. You've cut back on your exercise, socializing, and even time with people that you care about. Even when you're taking a break, you feel guilty because there's something that you could or should be studying. You may still want the career you're working toward, But you're beginning to wonder whether or not you can keep managing everything that it takes to finish the program. And that's what I want to address in this episode. I'm Dr. T-Michael Dougherty, and this is the Mastery Project Podcast, where we explore the research and evidence that support the pursuit of mastery and motivation, learning, leadership, resilience, and habit formation. So, how do you respond when your effort isn't producing the results that you need? How do you handle criticism and disappointment without spending an entire day attacking yourself over it? How do you recognize when you need to change your approach or ask for help? Some principles from Stoicism offer useful ways to work through some of those questions. And if you're not familiar, Stoicism is an ancient philosophy that concerns how we judge situations, how we act, and how we meet our responsibilities. To other people. The teachings of Epictetus and the writings of Seneca and Marcus Aurelius address difficult circumstances and uncertain outcomes. We're going to look today at six concepts and explain how to use them in healthcare education. We'll also discuss the concept of the inner citadel, which is a way of recalling these principles when you're under immense pressure. The research on teaching stoicism to healthcare students is limited. These are practices that you can try rather than methods proven to prevent burnout or ensure that you're going to finish your degree. So we'll look at what researchers have actually tested. The purpose here is to help you respond to problems in your program while protecting your health. and maintaining the relationships and interests that are important to you. So let's begin with the idea that you've probably heard most often. Focus only on what you can control. That advice needs a bit of an explanation when your program sets your schedule, assigns the work to you, and determines the requirements that you must meet for moving forward. Beginning of his handbook, Epictetus distinguishes what is up to us from what isn't. He includes our judgments and choices among the things that are up to us. Our reputation and other external circumstances belong on the other side of that equation. Those things are not up to us. And for a student, a useful application is to identify the actions that you can take without expecting that those actions are going to. Guarantee a result. So if you're struggling with learning a clinical skill, you can ask your instructor what needs improvement. You can request supervised practice and work on the specific problems that they identify for you. That can improve your chances of passing the next assessment, but it does not guarantee a pass. You still have to demonstrate the required performance and someone is going to have to evaluate it. An instructor's assessment here matters. And because it can affect your grade and whether or not you progress in your program. Now, of course, you care what they think about your performance, but if you keep trying to guess what they want from you, you may spend hours worrying without learning what you actually need to change. So ask for clear expectations. What are you being assessed on? Where does your performance fall short? What do you need to demonstrate in order to meet the standard that they're holding you to? If the feedback is too vague for you to use, ask for a specific example and an explanation of what you could do differently. If you believe you're being treated unfairly, document what happened and raise the concern with your clinical coordinator or your program director. And definitely follow your program's processes for requesting a review. You cannot guarantee that someone will respond fairly to you. But you can ask for clarification, you can seek supervision, and you can request that a concern be reviewed. You may still feel anxious or angry while doing those things, and you don't have to resolve the feeling even before you ask for help. This distinction is also important when you try to judge your own performance on things. Working hard does not guarantee success in anything, and a disappointing result. Needs review and examination. Did you prepare adequately? Were the requirements for you clear to you? What needs to be improved? Did you have the instruction and support that you needed? You can take responsibility for your decisions and actions while recognizing problems that require someone else's help. And you need to understand what contributed to the result before you decide what you should change. Now, sometimes your options are limited. If you need paid work to cover your bills, you simply can't decide to have more time for the program. Ask about financial assistance or scheduling options and discuss whether your current commitments are manageable with someone who understands the program's requirements. Those conversations may not resolve every constraint that you're experiencing, but they can help to establish what assistance is available and what options are realistic. The question is specific though. What action could help with the problem that I'm facing? And who needs to be involved here? the second concept we want to examine concerns the conclusions that you draw from difficulty. Failing an assessment tells you that you did not meet a requirement on that particular assessment. It may in fact have some serious consequences for you academically, but you need to find out what went wrong and what your program requires next. But I failed this assessment and I'm not capable of completing this program are very different statements. The first describes a result. The second is a conclusion about your ability to finish the program. That conclusion requires more information than just a single result could ever provide. Epictetus advises examining an impression that you have before you accept it. The Stoic term for accepting it is called assent. Now, in this context, that means treating your initial interpretation of something as true or a verifiable fact. You can practice this by identifying what happened, then trying to identify what you concluded from it. What was the result? Which requirement in the process wasn't met? What did the feedback actually say? And then ask what you've added. Have you concluded that improvement is impossible? That everyone else around you is capable of this and you just simply aren't? That one instructor's criticism means that you should leave healthcare altogether? You can write the result and the conclusion separately if you're having trouble distinguishing between them. So for example, I missed a required safety step during the checkoff, identifies a problem that you clearly need to address. But I'll never be safe with patients predicts your future performance. You need to correct the misstep, obviously, and demonstrate that that correction has taken place. The mistake alone does not establish that you can never improve. And if you're comparing yourself with classmates, just remember that their apparent confidence does not tell you how well they understand the material or what help they themselves need. Use the assessment criteria and the feedback to evaluate your performance objectively. Now, your conclusion may still identify a serious concern. Repeated failures, difficulty despite additional instruction, or a pattern of unsafe performance require attention for sure. Discuss those facts with faculty and find out what options that you have available to you. The practice that we want to follow here is to make your conclusion fit the information that you actually have in front of you. You don't need to pretend that the setback is somehow insignificant, and you don't need to decide your entire future before you understand it completely. Seneca also distinguished involuntary initial reactions from the anger that often develops afterward. Feeling embarrassed or upset does not mean you fail to use these ideas properly. The initial feeling can occur before you've even had time to consider the situation. But once you can review it, Examine what happened and try to decide how to respond appropriately. If the facts indicate mistreatment, include that in your assessment and seek support for that. Examining your judgment does not require assuming that your attitude was the cause of the problem. The third concept is anticipating difficulty before it arrives. You may have this called premeditatio malorum, thinking ahead about adversity. Epictetus gives the example of going to a public bath. He advises anticipating the ordinary disruptions that normally occur there, including people pushing or behaving poorly, and trying to remember how you intend to conduct yourself. Now, for a student, the application of this is to identify a difficulty that you already encounter regularly and decide how you'll respond when it happens again. If you tend to become defensive when receiving feedback, decide in advance that you're going to hear the explanation before you respond. If you don't understand the criticism, ask for an example and what the instructor wants you to do differently. Before an assessment, you might decide that if an instruction is unclear, you'll ask for clarification before proceeding. Whether the evaluator can answer depends on the assessment rules, of course, but asking allows you to establish that rather than guessing. The useful part here is the response that you've identified. And once you have it, go ahead and stop the exercise. Repeatedly imagining failing or being dismissed or even disappointing your family does not add to a plan. If considering possible difficulties increases that kind of worry or anxiety, go ahead and leave that practice out. You can prepare by reviewing the requirements and asking questions without imagining frightening outcomes. There is some research on teaching related practices to healthcare students, and it's important to explain what those studies involved. study published in 2022, researchers had 24 third-year medical students complete a guided stoic diary over the course of 12 days. These exercises included anticipating difficulties, examining thoughts and emotions, and considering patients' perspectives. Students spent an average of about 23 minutes a day on This training. And their questionnaire scores for resilience and empathy increased immediately afterward. In interviews two months later, students described finding contingency planning and reflection very useful. But there was no comparison group. The students also completed the training while their clinical placements were suspended during the COVID 19 pandemic. The study therefore can't establish that the exercises caused the score increases or that the increases would continue during clinical training. And the follow-up interviews did not repeat those outcome questionnaires. A randomized study published in 2026 assigned 74 nursing students to a stoicism training program or a group that received no intervention at all. The training include eight weekly half-hour podcasts, quizzes, and written scenarios. researchers measured self-compassion, which concerns how people respond to their own difficulties, and callous, unemotional traits, which include uncaring attitudes and reduced emotional responsiveness. statistically significant benefits on either measured outcome compared with the control group. And neither study established that stoic training reduces burnout or prevents students from leaving their programs. They also tested packages of practices rather than each of the six concepts separately. You can try a practice because it gives you a specific way to address a difficulty and assess whether it helps you identify a useful response or not. The fourth concept that we want to talk about concerns what you do when your plan cannot be completed as you intended. Marcus Aurelius describes acting with a reservation, and this is often called the reserve clause. You intend to pursue an action while recognizing that circumstances may prevent you from completing it. In practical terms, you plan to do something and remain willing to revise the plan if the conditions change. During a clinical rotation, for example, you may plan to complete a required competency with your supervisor one day. And if the appropriate patient or procedure is unavailable, you still need to meet the requirement, but you can't create the opportunity for yourself. So your next action is to explain the problem to your supervisor or clinical coordinator and then ask how to arrange another approved opportunity. Find out whether there's an alternative, whether the deadline can change, and what process that you might need to follow. You cannot just assume that an exception will be granted. The original plan was to complete the competency at that specific time. But when the opportunity became available, the next plan was to establish how you could meet the requirement anyway. That is different from preparing for a difficulty that you expect. Anticipation gives you a response to a foreseeable problem. The reserve clause reminds you to reconsider your plan when circumstances prevent the intended action. You can apply that same principle to larger disruptions. If illness or family responsibilities make your current schedule unmanageable, speak with the program about the available options. Establish the consequences of a reduced workload or a leave of absence before you make a decision. Your original intention to finish on a particular schedule doesn't tell you which option is now workable. You need current information about the program and your circumstances. You may be disappointed about the delay, but you can still investigate the options while feeling disappointed. Now, the fifth concept that we want to discuss is virtue. The Stoics put moral character at the center of a good life and described it through wisdom, justice, courage, and moderation. And for a healthcare student, this gives you another set of questions to consider alongside your grades. How are you acting? Are you being honest about your knowledge and the limitations placed upon you? Are you treating people respectfully? Are you accepting responsibility for mistakes and seeking appropriately help when you encounter them? Courage can mean acknowledging that you don't understand something while somebody is evaluating you. Wisdom includes recognizing when you're not qualified to decide something alone and you require guidance or supervision. Justice concerns how you treat other people, including patients and your classmates or future colleagues. Moderation includes restraining an angry response just long enough to decide how to raise your concern more appropriately. These are contemporary applications of the stoic virtues, and they're behaviors that you can work on while you're developing your professional competence. Grades and clinical evaluations matter, of course. and they may assess these behaviors as well as knowledge and skills. But between evaluations, you can also recognize specific progress for yourself. Did you use feedback to correct a mistake? did you recognize uncertainty and request supervision? Did you explain something clearly to a patient within your student role? Those actions are part of becoming a responsible healthcare professional. Notice them even on a day when another part of your performance needed improvement. They do not cancel a failed requirement, but they belong in an accurate review of your actual progress. There are also experiences for which a grade is not the relevant concern. Encountering serious illness or patient death can be very upsetting. Other people around you may continue working while you're still trying to understand your own reaction to what just happened. Their outward behavior does not tell you what they're feeling. Being affected by a patient's death does not, by itself, establish that you're unsuited for health care. Speak with your supervisor about debriefing and support when this occurs. You need guidance about your responsibilities and help processing the experience if it continues to trouble you. Stoic ethics also concerns our responsibilities to other people. Your family and friends. Remain part of your life even while you're in your program. And you may move away from home or have much less time with them. Passing your courses and getting along with your classmates do not prevent loneliness or missing those relationships. Include time to call someone you're close to or spend time with them whenever you can. If your workload is making you withdraw, explain what's happening and discuss a realistic way to try to stay in touch. You don't have to make every conversation with them about your performance in the program. In fact, your own health needs attention too. If guilt appears whenever you rest, ask what actually needs to be completed and by when. Identify your next work period rather than assuming that every available hour has to be spent studying. If the demands of your program genuinely leave you without enough time to sleep or recover, discuss that problem with someone who can help you assess your options. If you do have time to rest, use it. Feeling guilty about stopping does not establish that stopping is irresponsible. And the sixth concept that we want to discuss is an evening review. Seneca describes examining his conduct at the end of each day. He considers what needs correction and how he could respond differently. His account of this includes forgiving a mistake while identifying what should change. For a student, this can become a short review of what you did and what you might need to do next. Is particularly relevant if you spend evenings replaying embarrassing moments without reaching a decision about them. Begin with something specific that you did well or want to continue to do. Asking for supervision when you needed it belongs in that review as well. Whether or not anyone praised you for it. Then identify something that may need correction. Use the feedback that you received and the facts that you have in front of you. What happened? What requirement or responsibility did you fail to meet? What needs to change? Include relevant conditions. If the instructions were unclear to you or support seemed to be unavailable, record that alongside your own actions. You need that information to help you understand the problem and decide who should be involved in addressing it the next time it occurs. And finally, choose the next action and when you'll take it. If you don't understand the feedback that's being given to you, that action might be asking the instructor for an explanation before your next practice session. Once you've identified what needs to happen, end the review. You can write down the action so you have a record to return to. These questions and the stopping point are student adaptations of Seneca's practice. If you return to the practice later, ask whether you've remembered new information. If you have, decide whether it changes the action that you've identified. If you're repeating the same criticism without new information, try to remind yourself what you've already decided to do and return to your other activities. The review should help you understand your behavior and decide what to change. Repeating an insult about yourself does not supply another correction. Some experiences need more than private reflection. A distressing patient encounter from that day may need a debrief with your supervisor. A safety concern requires your placement's reporting process. Mistreatment may require reporting and support through the program. If you're experiencing anxiety, persistent low mood, or loss of enjoyment and it's interfering with daily life, please speak with a counselor or a healthcare professional. Good grades do not mean that distress can be ignored. Marcus Aurelius describes briefly returning inward to principles that he understands, then returning to his activities. Elsewhere, he describes the mind as a citadel. You may have heard this called the inner citadel or an inner sanctuary. For this episode, the practical application is a brief pause to recall a principle before you choose your next action. It does not mean becoming unaffected by grief, exhaustion, or even other people's behavior. After you receive difficult feedback, for example, pause before you respond. ask for clarification about what the instructor actually said and determine whether you've added a conclusion that maybe they didn't make. Then identify what you might need to ask or do. You might recognize that you don't understand which part of your performance needs correction. And the next action is to ask for that explanation. And you can do that even though you still might feel upset. That applies two principles that we've already discussed today: examining your conclusion and identifying an action that you can take. The brief pause is a way to remember them during the interaction. You don't need to introduce all six of these practices at one time. Choose one that fits a difficulty that you've been experiencing recently. If unclear expectations seem to leave you guessing frequently, maybe start with specific questions for your instructor. that you experience makes you question your ability to finish your program, separate the assessment result from the conclusion that you've drawn. If you spend your evenings criticizing yourself, try the review and end it once you've identified your next course of action. Try to pay attention to whether the practice helps you understand the problem and to do something useful about it. If it becomes another way to criticize yourself or increase repetitive worry, stop and seek guidance. Your program still has requirements that you're going to need to meet. These practices can help you decide how to respond when meeting them can become difficult. But they also leave room for asking for support, for changing or modifying a plan, and for recognizing when the conditions themselves may need attention. You're working toward a career that you care about. Your health and relationships matter while you're getting there. Thank you for listening to this episode of the Mastery Project Podcast. If you found this information useful, please share it with a colleague And leave a comment below about something that you might want to hear in the future or how this may help you.