The Tipping Point
by Sara Lehman, M.D.; Marguerite A. Costich, M.D. | October 27, 2026
Article Citation: Beck J, O’Hara K, van der Schaaf M, O’Brien BC. Exploring how pediatric supervisors conceptualize the optimal stress zone for resident learning. Med Teach. 2026 Jul;48(7):1249-1258. doi: 10.1080/0142159X.2026.2614610.
What is this article about?
This qualitative study explores how supervisors conceptualize the “optimal stress zone” for resident learning. Authors interviewed ten senior residents and 13 attendings who were nominated for their skill in using stress to facilitate learning. They used constructivist grounded theory to build a model.
The resulting Stress-Learning Model describes four zones:
1. The comfort zone, where stress is too low to drive learning or prepare trainees for independent practice.
2. The optimal stress zone, where manageable stress creates ideal conditions for deep learning.
3. The caution zone, where stress nears a threshold that can hinder learning.
4. The crisis zone, where learners shut down or, over time, develop anxiety or burnout.
Learning drops sharply past the tipping point between caution and crisis. Participants recognized that this threshold matters, but they struggled to identify it in real time. Many hesitated to push trainees toward it, both for the learner’s sake and for fear of repercussions to themselves.
Why should you read the article?
It offers a more dynamic, nuanced way of thinking about stress in medical training — not as something to simply minimize, but as a force that can either support or undermine learning depending on how it’s calibrated. The model applies across levels of trainee experience, and it makes a compelling case that supervisors’ comfort with recognizing and responding to stress is itself a teachable skill, not just an instinct some people happen to have.
How can you use this article?
The framework is useful for faculty development and residents-as-teachers curricula. Uncertainty can push educators to put learner comfort ahead of growth. Training supervisors to recognize, name, and deliberately use stress may help them guide trainees into the optimal zone instead of defaulting to the comfort zone.
Learners need a similar reframing. Curricula that help students identify, monitor, and respond to stress can prepare them for clinical work and higher-acuity responsibilities. Narrative medicine and reflective practice suit this well. For example, learners might read first-hand accounts of stressful experiences that fostered growth, then reflect on their own. Structured exercises can also help: learners identify their physiologic, emotional, and cognitive responses to stress. These exercises show learners that discussing stress is encouraged and that, in the right context, stress can fuel engagement and learning.
Review Author: Sara Lehman, M.D., PGY-2, Department of Pediatrics, New York-Presbyterian Morgan Stanley Children’s Hospital and Columbia University Irving Medical Center, New York, NY (Co-authored with Dr. Marguerite Costich, Pediatric Clerkship Director, New York-Presbyterian / Columbia University Irving Medical Center). Organization: Council on Medical Student Education in Pediatrics