Exploring how pediatric supervisors conceptualize the optimal stress zone for resident learning

INTRODUCTION: Educators often view stress as a threat to learning, yet under the right conditions it may enhance it. Ideally, supervisors identify an optimal stress zone that supports learning, an ability that likely depends on how they conceptualize the stress-learning relationship. Our study explores how supervisors conceptualize this optimal stress zone and the factors that shape it.

METHODS: Using constructivist grounded theory methodology, we interviewed pediatric supervisors who were nominated by residents for their ability to use stress to support learning. We analyzed the interviews through open and focused coding, with regular team discussions to develop categories and a theoretical model.

RESULTS: Participants described a curvilinear relationship between stress and learning, conceptualized as a four-zone Stress-Learning Model: comfort, optimal stress, caution, and crisis. Learning was perceived to peak in the optimal stress zone, where stress is manageable and shaped by individual, situational, and supervisory factors. The "tipping point" between caution and crisis marked a sharp decline in learning and wellbeing but was difficult to recognize.

DISCUSSION: Pediatric supervisors believe there is an optimal stress zone for learning but find it difficult to identify. Our findings suggest supervisors do not view stress as inherently harmful, but as a force that can enhance learning.