National Academy of Medicine

A Multifaceted Systems Approach to Addressing Stress Within Health Professions Education and Beyond

By Darla Spence Coffey, Kathrin Eliot, Elizabeth Goldblatt, Catherine Grus, Sandeep P. Kishore, Mary E. (Beth) Mancini, Richard Valachovic, and Patricia Hinton Walker
January 30, 2017 | Discussion Paper

TW: suicide

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There are unique stressors faced by health professionals that begin during the educational process and continue throughout training and into practice. While stress is expected owing to the intense nature of the work in health care, the systems in which faculty and health professionals work often intensifies this already stressful environment and can lead to negative mental and physical effects. Stress takes a major toll on individuals and has been reported to increase absenteeism, errors, burnout, and substance use, and it can even lead to individuals quitting the health professions altogether.

Individual and institutional costs in the form of strained personal and professional relationships, lower quality of care, and financial expenses associated with diminished physical health and mental well-being of those caring for the population also occur. The disruption for coworkers who rely on burned-out, stressed, or absent colleagues for their expertise significantly impedes team functioning and further degrades the overall quality of the care. While it is indisputable that the nature of the work in health care causes stress, organizations also bear responsibility for accepting and even creating an institutional culture where stress can be worsened by outdated or negative policies and behavioral patterns. Moral distress can be experienced when there is difficulty obtaining appropriate interventions or care to support patients and families. Further, institutional policies that inhibit inclusivity may create hostility by limiting the diversity of the student body, faculty, and the health profession, themselves; an organizational culture that emphasizes hierarchy over teams and collaboration often creates obstacles to communication, trust, and innovation; and an environment that seems to value measuring the length of clinical appointments and reimbursement over patient quality and safety creates risks and frustrations for everyone. Acknowledgment of the association between stress and working in health and health care has been codified by recent writings expanding the Triple Aim to include a goal to improve the work life of health professionals.


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Suggested Citation

Coffey, D. S., K. Eliot, E. Goldblatt, C. Grus, S. P. Kishore, M. E. Mancini, R. Valachovic, and P. Hinton Walker. 2017. A Multifaceted Systems Approach to Addressing Stress Within Health Professions Education and Beyond. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. doi: 10.31478/201701e

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Disclaimer: The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.