Although the world is full of suffering, it is full also of the overcoming of it.
—Helen Keller, “Optimism” 1
The COVID-19 pandemic has stormed on for more than 2 years, mercilessly causing the deaths of millions of people and negatively affecting the lives of billions of others globally. 2 Among those who have died are many members of the academic medicine community, including students of the health professions and sciences. We have lost patients, colleagues, mentees, and friends. Many of us have experienced illness, uncertainty, disillusionment, and helplessness as the coronavirus has surged, mutated, and swept its way throughout the world.
The people of academic medicine have also witnessed the erosion of trust in medical care, health systems, and the biomedical sciences in an increasingly divided society. Health disparities and inequities that fall unjustly along racial, socioeconomic, and geographic lines have been more starkly unveiled. We have seen more hate crimes and cared for more who have been victimized, and more of us have ourselves been directly targeted. 3 As the acute stresses of the pandemic have stretched to become chronic stressors, grief and physical and emotional fatigue have become commonplace. Congress took note, and in March 2022, passed the Dr. Lorna Breen Health Care Provider Act, 4 acknowledging the distress and difficulties within the health care workforce.
Under these adverse circumstances, the people of academic medicine have persevered, continuing their work, safely and effectively, in laboratories, clinics, classrooms, communities, and conference rooms. Extraordinary breakthroughs in science, clinical medicine, and public health have helped to lessen the full impact of the pandemic. Vaccines and boosters and safety precautions have allowed adaptation to the wily, ever-changing virus. Our society has much more fully acknowledged health disparities and is working, albeit reluctantly and late, to bring about greater health equity. 5 Academic medicine, the health professions, and health care systems are evolving to address the challenges of the past, present, and future, as illustrated by several articles appearing in this issue. 5–9
The effects of the immense and multifaceted experience over these past few years will be felt through lifetimes and generations as a kind of shared trauma—a trauma that has revealed tragedy and vulnerability as well as heroism and strength. 10 Academic medicine, and all other areas of society, will be changed due to the COVID-19 pandemic.
Trauma and Well-Being
Insights regarding psychological trauma and support for professional well-being are illuminating as we in the health professions look to the future. Although there is certainly reason for hope and optimism, acknowledging the hurt in what we have been through together will help us to move through the experience constructively. With the loss of life, widespread exhaustion amongst members of the health professions, and the “great resignation” affecting the health care workforce, the peril is clear. Our challenge is to use this experience of shared trauma to bring forward personal growth, a sense of purpose, and new scientific discoveries to lessen suffering. Insights drawn from fields of study relevant to psychological trauma and professional well-being may also inform strategies and operations that strengthen organizations and systems themselves, along with the individuals within them.
The literature on psychological trauma from the disciplines of psychiatry and psychology, for example, reveals that people who face adversity are not always affected negatively by the experience. Moreover, people who undergo very significant trauma do not always manifest serious subsequent symptoms. Those who have encountered adversity or who have recovered from significant trauma may feel a sense of strength and self-discovery, perceive more meaning in their lives, feel a deepened sense of attachment to others, and demonstrate greater generosity and altruism toward others. 11
On the other hand, evidence from studies of children, adults, elders, and distinct and special populations suggests that many individuals who experience severe trauma, and nearly all individuals who undergo chronic trauma, arrive at a point where they have reduced coping ability, narrowed lives, and overt symptoms. 11,12 It is not uncommon for individuals who have survived trauma to feel and act differently; to have a diminished sense of connection with others; to feel reduced self-efficacy; to encounter heightened challenges in managing emotions; to feel new forms of distress, numbness, or irritability; and to experience cognitive errors. Some individuals have trouble with remaining calm and focused or getting restful sleep. Some may turn to substances in their struggle with these problems, and others may begin to develop more serious physical and mental health issues requiring treatment. Concomitant challenges, such as relationship issues, financial stresses, or newly emerging health issues, can trigger or worsen these concerns.
Clearly, trauma can trigger growth and it can create vulnerability. Sometimes both. Trauma also is not time-bound. Wise, experienced clinicians who have cared for individuals who have survived extreme hardships observe that past trauma shapes an individual’s sense of the present. Time alone does not heal. 13 Indeed, time itself is different in trauma’s wake. As noted by Van der Kolk, “Trauma is not the story of something that happened back then, it’s the current imprint of that pain, horror, and fear living inside people.” 14
Taken together, these insights help us remember that people will respond differently to the difficult experiences of the past few years. The negative effects of the trauma typically will not disappear if they are ignored or remain unaddressed; fortunately, positive changes in the wake of trauma can be nurtured to endure, helping to define who we are in part through what we have faced, survived, and overcome.
Evidence regarding professional well-being may help us as we endeavor to restore strengths and enable adaptation amongst our colleagues, our learners, and ourselves in academic medicine. 15,16 The well-being literature in the health professions emphasizes contextual and individual factors that foster resilience. Contextual factors include a positive organizational culture; activities that help lessen isolation; opportunities for mentorship, peer support, and intellectual stimulation; access to resources; and efforts to enable work–duty flexibility and reduce financial stresses. 17,18
A recent report of the Association of American Medical Colleges 17 reviewed best practices for wellness programs within health care institutions, reinforcing many of these ideas. Recommendations to help organizations promote a culture of well-being include, for example, identifying well-being as a core competency for all health professionals; embedding champions to coordinate well-being efforts; providing training, resources, and dedicated funding to well-being efforts; and conducting ongoing assessments of individual well-being and program effectiveness.
Individual factors that foster resilience are many and include engagement in social connection with loved ones; robust self-care and preventive health practices; good nutrition, exercise, and sleep; spirituality; and meaningful work and volunteer activities. 18,19 When needed, temporary emotional support or mental health services can restore health and function across the domains of professional and personal life. Mental health outcomes for more serious trauma-related syndromes are excellent if those syndromes are recognized and treated promptly and appropriately. 12
Looking Ahead—Acceptance and Commitment
We in academic medicine are not immune to the anguish, isolation, and sacrifice that have accompanied the COVID-19 pandemic, nor are our workplaces free of concerns related to safety, morale, turnover, and disruption. And our challenges were great before the pandemic—in 2019, 70,630 people in the United States died by drug overdose, 47,511 people died by suicide, and 37,707 people died by firearm injury. 20 The academic medicine workforce, and the health professions workforce at large, are not arm’s length from the world’s concerns. We are in their midst.
In accepting these realities, we may also commit fully to what matters, using our experience to gain new clarity about our purpose and place in life—and to gather new courage. The aim of academic medicine is to strengthen the health of people and populations and to create a better future for all. We attain this aim by advancing science, clinical care, education, and community engagement and embodying commitments to equity and ethics. This aim matters, and the work we do matters.
We are well positioned to translate knowledge from the biomedical sciences and public health and to animate service, education, and engagement efforts to address the challenges we face as we move into the future. Knowledge translation and hard work led to the unimaginably swift and effective development of vaccines that served to mitigate the ravages of the pandemic. We can use these same approaches to help restore strengths, foster resilience, and enable adaptation for the ultimate benefit of our patients, our learners, our colleagues, and ourselves.
2. World Health Organization. WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int
. Accessed March 14, 2022.
3. Center for the Study of Hate and Extremism. FACT SHEET: Anti-Asian Prejudice March 2020—Center for the Study of Hate & Extremism. https://www.csusb.edu/sites/default/files/FACT%20SHEET-%20Anti-Asian%20Hate%202020%203.2.21.pdf
. Accessed March 14, 2022.
4. Dr. Lorna Breen Health Care Provider Protection Act. Pub L No.117–105, 136 Stat 1118 (2022). https://www.congress.gov/117/plaws/publ105/PLAW-117publ105.pdf
. Accessed April 6, 2022.
5. Todić J, Cook SC, Spitzer-Shohat S, et al. Critical theory, culture change, and achieving health equity in health care settings. Acad Med. 2022;97:977–988.
6. Neelakantan M, Heitkamp NM, Blankenburg R, Frohna JG. The #PedsMatch21 webinar series: Coordinated specialty-level communication during the virtual residency application cycle. Acad Med. 2022;97:1012–1016.
7. Salavitabar A, Popov V, Nelson J, et al. Extended reality international grand rounds: An innovative approach to medical education in the pandemic era. Acad Med. 2022;97:1017–1020.
8. Krohn KM, Yu G, Lieber M, Barry M. The Stanford Global Health Media Fellowship: Training the next generation of physician communicators to fight health misinformation. Acad Med. 2022;97:1004–1008.
9. Blanchard AK, Blanchard JC, Suah A, Dade A, Burnett A, McDade W. Reflect and reset: Black academic voices call the graduate medical education community to action. Acad Med. 2022;97:967–972.
10. Saul J. Collective Trauma, Collective Healing: Promoting Community Resilience in the Aftermath of Disaster. Milton Park, UK: Routledge; 2013.
11. Tedeschi RG, Calhoun LG. Postraumatic growth: Conceptual foundations and empirical evidence. Psychol Inq. 2004;15:1–18.
12. Galovski TE, Nixon RDV, Kaysen D. Flexible Applications of Cognitive Processing Therapy: Evidence-Based Treatment Methods. London, UK: Academic Press; 2020.
13. Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Psychiatric comorbidity of full and partial posttraumatic stress disorder among older adults in the United States: Results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Am J Geriatr Psychiatry. 2012;20:380–390.
14. Van der Kolk B. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Penguin; 2015.
15. Gengoux G, Zack SE, Derenne JL, Robinson A, Dunn LB, Roberts LW. Systems and supports for clinician wellness. In: Professional Well-Being: Enhancing Wellness Among Psychiatrists, Psychologists, and Mental Health Clinicians. Washington, DC: American Psychiatric Association Publishing; 2020;121–152.
16. Gengoux G, Zack SE, Derenne JL, Robinson A, Dunn LB, Roberts LW. Preventive health care strategies: Fostering positive self-care and resilience. In: Professional Well-Being: Enhancing Wellness Among Psychiatrists, Psychologists, and Mental Health Clinicians. Washington, DC: American Psychiatric Association Publishing; 2020;169–190.
17. Pipas CF, Courand J, Neumann SA, et al. The Rise of Wellness Initiatives in Health Care: Using National Survey Data to Support Effective Well-Being Champions and Wellness Programs. Washington, DC: Association of American Medical Colleges; 2021.
18. Gengoux G, Zack SE, Derenne JL, Robinson A, Dunn LB, Roberts LW. Professional Well-being: Enhancing Wellness Among Psychiatrists, Psychologists, and Mental Health Clinicians. Washington, DC: American Psychiatric Association Publishing; 2020.
19. Roberts LW, Trockel M. The Art and Science of Physician Wellbeing. Cham, Switzerland: Springer Nature; 2019.
20. Xu J, Murphy Sl, Kochanek KD, Arias E. Deaths: Final data for 2019. National Vital Statistics Reports. 2021;70:1–92.