When I say ... stress
Joy R Rudland
& Tim J Wilkinson
In recent years, the deﬁnition of stress has become
confused. Stress is a force, not an outcome. A
stressor is something that applies stress to a person.
Strain is a term used in mechanics to describe
deformation in a structure due to stress applied. In
humans, strain equates to changes (biological or
physiological) that occur as a result of stress. Stress
does not mean distress.
Stress (or a stressor) applied to an individual can
have three outcomes with respect to performance:
performance may improve, deteriorate or remain
With respect to the emotional element,
an individual may become distressed, positively
invigorated and challenged, or the stress applied
can have no discernible effect. The relationship
between strain and a positive or negative outcome
with respect to performance is unclear. There is a
general muddle in the literature regarding the
emotional outcome related to a stressor and the
potential performance outcome.
Although many studies report stressors as having a
negative outcome on performance or well-being,
there have also been several studies indicating the
beneﬁts of stress in the workplace,
performance and academic achievement.
An individual’s response to stress can be inﬂuenced
by many things, including personality traits, coping
skills and coping reserves. Furthermore, belief in
the value of stress can have an impact on the
outcome; if a person believes that stress is beneﬁcial
for their health then invariably it is.
ﬁndings also suggest that reappraising the value of
stress can have positive physiological effects.
If an individual is exposed to a stressor they can
experience harm (for example by being bullied),
see the stressor as a threat, or see it as a challenge
to be met.
If an individual response to a stressor is
positive this is known as eustress,
However, much of the research has been hindered
by lack of a clear measure of eustress. It is even
unclear whether distress and eustress are on the
same spectrum or are different constructs.
In the educational sphere there are at least three
distinct types of stressors, the learning expected
(learning gap), the environment in which the
learning takes place, and the individuals that
inﬂuence the learning, hopefully the teachers. In
this context, the educational concept of cognitive
loading in working memory may be analogous to
the impact of stressors. Cognitive load is deﬁned by
the inherent difﬁculty of the learning, how germane
the learner perceives the learning to be and
Determining the perception of
the stressor (load) may be a complex interplay
between these three components. ‘Inherent
difﬁculty’ pertains to the learning gap, what the
learners know and what they think they need to
know. Assuming the learning (stressor) is germane
but load is high due to intrinsic difﬁculty then a
response may be inﬂuenced by extraneous factors,
whether positive or negative. Extraneous factors act
to hinder or encourage learning. This may include
a familiar or unfamiliar learning environment, the
workplace where the priority is learning or service
commitment, the unspoken mores of health
professionals and teachers who may exhibit
desirable or undesirable teaching behaviours.
Depending on the load, the same learning task
Wellington, New Zealand
Christchurch, New Zealand
Medical Education 2018: 52: 692–693
Correspondence: Joy Rudland, Educational Development and Staff
Support, University of Otago, Wellington, New Zealand.
Tel: +640 2712 9305; E-mail: firstname.lastname@example.org
692 ª 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education;
MEDICAL EDUCATION 2018 52: 692–693
when i say