Resiliency and Learning: Implications for Teaching Medical Students and Residents

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Resiliency and Learning: Implications for Teaching Medical Students and Residents

Overview: The 2011 Symposium on the Science of Learning: Implications for Medical Education from the Neurosciences and Social Sciences will pose the question, “How do we maintain resiliency during stressful experiences?” Recent studies document high rates of depression and burn-out among medical students, residents in a broad spectrum of specialties, and physicians in practice. Drs. George Everly (Rockefeller University) and Bruce McEwen (Johns Hopkins School of Public Health), both distinguished scholars, will present research on the impact of stress on the brain, factors contributing to resiliency, and evidence that resiliency can be taught. They will describe interventions that change brain function and foster resiliency.

Speakers:

Bruce S. McEwen, PhD
Alfred E. Mirsky Professor
Head, Harold and Margaret Milliken Hatch
Laboratory of Neuroendocrinology
The Rockefeller University

Protective and Damaging Effects of the Mediators of Stress and Adaptation: Central Role of the Brain

Overview: The brain is the central organ of stress because it interprets what is stressful and also determines behavioral and physiological responses.  Besides major life events, the aggravations of daily life elevates activities of physiological systems so as to cause some measure of wear and tear (“allostatic load”),  that reflects not only the impact of life experiences but also of genes;  individual life-style habits reflecting items such as sleep quality and quantity; diet, exercise and substance abuse;  adverse early life experiences that set life-long patterns of behavior and physiological reactivity; and exposure to toxic agents in the environment.  Hormones associated with stress and allostatic load protect the body in the short-run and promote adaptation (“allostasis”), but in the long run overuse and dysregulation of allostasis causes changes in the body and brain that lead to disease. The brain is  a target of stress and the hippocampus was the first brain region besides hypothalamus to be recognized as a target of glucocorticoids.  Stress and stress hormones produce both adaptive and maladaptive effects on this brain region throughout the life course. Early life events influence lifelong patterns of emotionality and stress responsiveness and alter the rate of brain and body aging.  The amygdala is an important target of stress and is important in fear and strong emotions and the prefrontal cortex is involved in attention, executive function and working memory.  The hippocampus and amygdala show opposite response to repeated stress, involving remodeling of dendrites, whereas the prefrontal cortex shows both types of responses. Hippocampal and medial prefrontal cortical neurons become shorter and less branched and dentate gyrus neurogenesis is suppressed by repeated stress, whereas amygdala and orbitofrontal cortical neurons show signs of hypertrophy after repeated stress.  Repeated stress promotes impairment of hippocampal-dependent memory and enhances fear and aggression, as well as impairing attention set shifting, a form of executive function that indicates cognitive flexibility.   Translational aspects of these findings will be presented.

Bruce S. McEwen, Ph.D., is the Alfred E. Mirsky Professor and Head of the Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology at The Rockefeller University. He is a member of the US National Academy of Sciences, the Institute of Medicine, the American Academy of Arts and Sciences and a Fellow of the New York Academy of Sciences.  He served as Dean of Graduate Studies from 1991-3 and as President of the Society for Neuroscience in 1997-98.  As a neuroscientist and neuroendocrinologist,  McEwen studies environmentally-regulated, variable gene expression in brain mediated by circulating steroid hormones and endogenous neurotransmitters in relation to brain sexual differentiation and the actions of sex, stress and thyroid hormones on the adult brain.  His laboratory discovered adrenal steroid receptors in the hippocampus in 1968.  His laboratory combines molecular, anatomical, pharmacological, physiological and behavioral methodologies and relates their findings to human clinical information. His current research focuses on stress effects on amygdala and prefrontal cortex as well as hippocampus, and his laboratory also investigates sex hormone effects and sex differences in these brain regions.   In addition, he served on the MacArthur Foundation Research Network on Socioeconomic Status and Health, in which he helped to reformulate concepts and measurements related to stress and stress hormones in the context of human societies.  This led to the concept of “allostatic load” that describes the wear and tear on the body and brain from chronic stress and related life style behaviors that lead to dysregulation of physiological stress pathways that are normally protective.  He is also a member of the National Council on the Developing Child which focuses on healthy brain development as a key to physical and mental health.  He is the co-author of book with science writer Elizabeth Lasley for a lay audience called “The End of Stress as We Know It” published in 2002 by the Joseph Henry Press and the Dana Press and another book with science writer Harold M. Schmeck, Jr. called “The Hostage Brain” published in 1994 by The Rockefeller University Press.

 


George S. Everly, Jr, PhD
Department of International Health
Bloomberg School of Public Health
Johns Hopkins University
Baltimore, MD

The Core Elements of Psychological Resilience: From Children to Navy SEALs

When subjected to trauma, on average only about 9 -25% of individuals develop extreme stress reactions and depression. For years we have endeavored to understand mechanisms of pathogenesis. The time has come to focus equal energies on mechanisms of resilience. Using investigative methodologies ranging from structural modeling equations to focus groups, this presentation will discuss what appears to common themes of human resilience.

George S. Everly, Jr, PhD, ABPP is Associate Professor (parttime) of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine and Professor of Psychology at Loyola University Maryland. He is a faculty member of the Johns Hopkins Public Health Preparedness Programs at the Johns Hopkins Bloomberg School of Public Health. Dr. Everly is a Fellow of the Academy of Psychosomatic Medicine and a Fellow of the American Psychological Association. He was formerly Senior Advisor on Research to the Office of His Highness the Amir of Kuwait after the Gulf War and has been an adjunct faculty member for the FBI National Academy and the Federal Emergency Management Agency. He has given invited lectures in 22 countries on six contimemts. Dr Everly is the author of numerous books on stress, psychological trauma, and human resiliency. His book The Resilient Child won Foreword Magazine's Gold Medal for Book of the Year.
 

Recommended Journal Articles:

McEwen, Bruce S. Gianaros, Peter J. Stress - and Allostatis-Induced Brain Plasticity. 2001. Annual Review of Medicine.

McEwen, Bruce S. Protective and Damaging Effects of Stress Mediators. 1998. New England Journal of Medicine.

McEwen, Bruce S. Boyce, Thomas. Shankoff, Jack P. Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention. 2009. Journal of American Medical Association.


Accreditation: Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Harvard Medical School designates attendance at this activity’s workshops for a maximum of 3 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.