Resilience and equanimity are essential attributes for physicians, who must face the relentless daily demands and adversities inherent in their craft. Medical educators should cultivate ancient stoic virtues to better prepare students for the realities of their profession.

“Life is difficult” (M. Scott Peck, MD)

Medicine offers a front row seat to the human condition, revealing both its wonders and tragedies, but most often its challenges. Hence, it's concerning to see some medical students not only unprepared for life's vicissitudes but socialized to expect others to provide a psychological shield from them. Those of us in academia are all too familiar with these expectations: trigger warnings and safe spaces are in, while humor and assuming positive intent are out. Yet, reducing stressors in medical education may be counterproductive, because careers in medicine often involve stress and challenge. Hence, this commentary argues that medical schools should rediscover the important role that embracing adversity plays in preparing young physicians for a rewarding but difficult profession.

Generational divides are nothing new. As the saying goes, you know you've reached middle age when you stop complaining about the older generation and start complaining about the younger one. With that proviso in mind, we would contend that students’ sensitivity to stressors has objectively increased over the past 10-15 years, as attributed by scholars to overprotective parenting, risk-adverse schools, addictive devices, and social media. This growing fragility is troubling because our craft requires courage, the assumption of calculated risks, and resilience. The latter is particularly crucial for future physicians, who will spend a career dealing with pain, suffering, disease, and death. In fact, resilience might even be the metaphorical load-bearing wall of medical education, because we are tasked with preparing problem-solvers that will bend but not break. Yet, many of today's students seem unready for the harsh reality of their chosen profession. This may actually contribute to the record levels of burnout and depression being observed among early career doctors. Hence, the need to remind students that friction in life ought not be simply accepted but welcomed, because it's the prerequisite for character development. Horace put it simply: adversity reveals genius, prosperity conceals it.5 Adversity, as psychiatrist M. Scott Peck advises, is no longer a burden once it is accepted. But this is easier said than done.

Humans crave happy endings. In the 17th century, the Anglo-Irish poet and playwright Nahum Tate rewrote King Lear as a comedy. This saccharine version of Shakespeare's greatest tragedy went on for 150 years, which is ironic because Lear is about turmoil as a catalyst for wisdom (“Men must endure/Their going hence, even as their coming hither: Ripeness is all.”). Today, as then, the notion that difficulties don't exist is a self-defeating illusion. Difficulty is written into the contract of life, and, in fact, it fosters character. Unhindered lives are rare and often shallow. Shakespeare writes that, “The current that with gentle murmur glides, Thou know'st, being stopped, impatiently doth rage.” Thus, the key is not to impatiently rage when life's many obstacles are encountered, but instead to adapt with novel solutions, or to adjust expectations. Learning occurs at the point of discomfort, and over time, this process produces wisdom.

History is, of course, replete with those who responded to adversity with courage, resilience, and determination. Many rose to greatness. Verdi, for example, lost a wife and 2 children by the time he was 27. He also suffered a professional setback and considered quitting music. He even contemplated suicide. Yet, resilience and persistence rewarded him with his opera Nabucco, thus relaunching his career.

Ernest Hemingway, whose life abounded with tragedies, believed that life's adversities fostered growth. In A Farewell to Arms he wrote that, “The world breaks everyone and afterward many are strong at the broken places [emphasis added]. But those that will not break it kills. It kills the very good and the very gentle and the very brave impartially. If you are none of these, you can be sure it will kill you too but there will be no special hurry.” It's a dark assessment of the human condition, but those are words all future physicians should hear.

Hemingway's characters often embody the dual imperative of stoicism: never boast when things go well, and never complain when they go badly. Hemingway was a physician's son, and thus it's possible that he might have learned stoicism by following his father on home visits. After all, the ideal physician is a stoic. Osler boiled it down to one word: aequanimitas. Peace of mind might even prompt laughter. Osler—a lifelong prankster with a delightful sense of humor—summed up the cheerful pessimism of the stoic by quipping, “I whistle that I may not weep.”

Yet today's medical students often resent being told that life is unfair. One of us was even ordered not to say it anymore. And so, given this predicament, what solutions can be offered to medical educators? The first, of course, is to acknowledge that we have a problem. Unspoken social pressure, fear of bad evaluations, plus administrative dictates lead many educators to avoid confrontation. Yet, this is a short-sighted, nonvirtuous strategy that only encourages further unreasonable behavior.

At the University of South Florida Health Morsani College of Medicine, we have embraced anti-fragility by introducing our students to stoic philosophy. All incoming freshmen receive a primer on stoicism. We remind them often that life is difficult, and that the world is, at best, indifferent to their fate. It's a rather blunt welcome, and it often elicits a rumble, but it's in full accord with stoic teaching: expect nothing and embrace everything. The psychologist William James even created an equation wherein happiness equals reality divided by expectations. Hence, we can enhance our chance of contentment by either changing our reality or lowering our expectations—the latter being a heck of a lot easier to do. It's a philosophy that puts things in perspective. Marcus Aurelius reminded us in his Meditations that, to build resilience, “begin each day by telling yourself: today I shall be meeting with interference, ingratitude, insolence, disloyalty, ill-will, and selfishness…” And that's okay.

In summary, resilience and equanimity are essential attributes for physicians, who must face the relentless daily demands and adversities inherent in their craft. Medical educators should cultivate ancient stoic virtues to better prepare students for the realities of their profession.