Development of a “Stress in Medicine” Education Module: Learning from the Aviation Industry

Anne Gunderson GNP, and Dave Mayer MD

University of Illinois Chicago College of Medicine


The aviation industry designed and implemented assessment and training programs to improve employee attitudes and performance in the areas of leadership, interpersonal communications, teamwork, stress management, conflict resolution, and decision-making. The goal of this project was to develop and implement curricular modifications at the University of Illinois at Chicago College of Medicine (UIC COM), utilizing the aviation model, to increase medical student proficiency in these non-cognitive and social skills shown to improve patient safety.

The objective of the initiative funded by the U.S. Department of Education was to create and implement a three year longitudinal program similar to the aviation educational modules; validate the results of learning in simulated team exercises; and demonstrate the curricular effectiveness through assessment of students’ recognition of the importance of these non-technical skills in medical practice, and eventually the translation of these skills to clinical practice.

The first M1 learning module developed and piloted was “Stress in Medicine”. Historically, plenary content delivered in the Essentials of Medicine (ECM) course was not linked to small group activity, nor did faculty members participate in preparation prior to facilitating small groups. For this inaugural module, faculty preparation was held immediately before the plenary session and the small group session followed the plenary. Faculty facilitators were required to participate in preparation, plenary and small group; students were required to attend the plenary and small group.

The plenary capitalized on the use of an interactive large group discussion for students to begin thinking critically about the physiology of stress, signs of burnout, and how stress can impact a physician’s attitudes, job performance and patient outcomes. During the small group, students participated in an airplane hijacking simulation designed to continually increase stress levels of the students during the simulation. Stressors included introduction of “bombs” on the airplane requiring time limited dismantling; murder of the pilot; and a passenger suffering a cardiac arrest. Intensive debriefing focused on personal and team reactions to stress and impact on performance. Student assessments and module evaluations completed by faculty and students were extremely positive regarding the integration of aviation training methods into the medical curriculum.

“The contents of this article were developed under a grant from the Fund for Improvement of Postsecondary Education, U.S. Department of Education.

However, these contents do not necessarily represent the policy of the Department of Education and you should not assume endorsement by the Federal Government.”