No matter how experienced we are in medicine or business, stress is ubiquitous. In part II of this series, Jim Doorley, PhD, and Jim Naples, MD, draw on their experience teaching performance psychology skills to surgery trainees (residents) to explore how the right kind of stress can build confidence and competence.

During a recent session with surgical residents, we posed an intentionally complex surgical scenario: 

You are operating on a young singer to remove her thyroid gland. Unexpectedly, you encounter bleeding, obstructing your view of the laryngeal nerve (the nerve to the voice box). If the laryngeal nerve is damaged, the singer may lose her voice and experience breathing difficulties, but you must act quickly to stop the bleeding. What do you do?

Most residents understood the key considerations of the case and laid out appropriate action steps. But when asked if they would prefer to hand over the case to a more experienced supervising surgeon, several answered, “Yes.”

A hand-off might sound like the best decision. “Ask your supervisor” or “Consult with a colleague” are quintessential fail-safes. Here though, we are talking about handing over a surgical case completely to another surgeon, when the resident is supposed to be learning how to manage these very challenges. There is no learning without doing, and there is no “experienced surgeon” without… experience. 

Their rationale for handing off the case boiled down to one thing: stress. 

Acute stress makes us want to pull the rip cord, especially when the stakes are high, outcomes are uncertain, and we can envision every potential negative consequence. But in uncertain scenarios, especially when learning, persevering through stress and coming out the other side builds confidence and competence. 

Uncertainty: A breeding ground for stress

The stress felt during surgery, a new client meeting, or a mass layoff is the same stress our hunter-gatherer ancestors felt when a predator ransacked their shelter. Whether threatening to our life, reputation, or economic viability, the biological stress response remains the same. 

Our brains are highly sensitive to many potential threats. To best protect us, mislabeling a true threat as safe is far more costly than mislabeling a safe situation as threatening. Therefore, when presented with uncertainty (a vague email or text, a colleague’s strangely-timed laugh during our presentation), our brains conservatively assume threat rather than safety. This is what the residents experienced in our teaching exercise.

Remember that acute stress does not automatically indicate something is seriously wrong. Stress should serve as a radar detecting important incoming information that demands your attention and energy but may or may not pose a threat. 

Leverage stress to build confidence and competence

Weathering stressful situations at work for a greater purpose teaches us something powerful; we can cope with more than we thought and get the job done even when it feels like we can’t. Bailing out when we feel overwhelmed deprives us of this precious learning. 

Exposure therapy, an effective approach to treat phobias and other anxiety disorders, uses this principle: The stress response will eventually subside after repeatedly confronting our fear and not backing down. This is pivotal. When we back down, our brain learns the opposite – that we cannot cope, and escaping is the only way to be safe and feel better. For our long-term success, the only way out of stress is through it, and toward meaningful goals. Remember this next time you stare down an important task you’ve been avoiding, take the stage to address hundreds of people, or take a calculated risk on a new passion project. 

Help your team bring the positive power of stress to the workplace

Research from Dr. Alia Crum’s lab at Stanford shows that our stress mindset (i.e., whether we believe stress is harmful or helpful) can become a self-fulfilling prophecy. In one of her early studies, employees were told that stress is either debilitating or enhancing via educational videos. The stress-is-debilitating group was told that stress causes illness and increases mistakes at work. The stress-is-enhancing group was told the opposite – that stress can improve immunity, creativity, and performance under pressure. 

Results showed that people's beliefs shaped their reality and, specifically, their performance. Employees who believed stress is enhancing performed better during a high-stress public speaking task, were more open to feedback about their performance, and had lower circulating levels of the stress hormone cortisol. Subsequent experiments with employees from a large finance firm showed that presenting balanced information about stress (potential harmful and helpful effects) and highlighting the importance of stress mindsets leads to even stronger results. In other words, success in the face of stress hinges on our mindset and is a trainable skill. 

Leverage the power of (acute) stress

If you chose to work in healthcare, chances are stress minimization was not a part of your decision. Stress is the tax we pay to do meaningful, impactful work. Better yet, weathering stress is an investment. The more we confront it and persist through it, the more robust our confidence and skills become. Unlike traditional long-term investments, though, stress has the added benefit of quick and sizeable payoffs.

Our stress response was designed to enhance our performance almost immediately, both physically and mentally. You may have benefited from a jolt of stress during that final push before a grant deadline, responding to a patient emergency, or before an important meeting, talk or interview. Would you rather feel a burst of adrenaline in these scenarios or the feeling of waking up from a long nap? This is why we encourage our trainees to accept and even welcome the stress that comes from challenging and consequential work. It is meant to help us. 

Managers are a key part of helping their teams understand the benefits and risks of stress to find a productive balance. Have open conversations with your employees about stress and anxiety. This will normalize the experience and model that this topic is safe. There is no substitute for connecting with your employees in-person on a human level. Help them find meaning in their work and craft their jobs to the extent possible – this will empower them to navigate stress in their own way and optimize their learning from the experience.