Six Stoic Practices for Setbacks in a Healthcare Program

Two research teams have tested whether teaching Stoic philosophy changes how healthcare students handle their programs, and the results are modest. Dr. Megan E. L. Brown and colleagues at Hull York Medical School had 24 third-year medical students complete a guided Stoic diary over 12 days, spending about 23 minutes a day on it, and measured resilience and empathy before and after (Brown et al., 2022). Both scores rose. There was no comparison group, and the students completed the exercises while the COVID-19 pandemic had suspended their clinical placements, so the study cannot show that the exercises caused the change or that it would hold up during clinical work. Amirhossein Boostani and colleagues at Birjand University of Medical Sciences in Iran then conducted a randomized trial with 74 nursing students. Students who listened to eight half-hour podcasts on Stoicism showed no benefit on self-compassion or on uncaring attitudes compared with students who received nothing (Boostani et al., 2026). Neither team measured burnout or whether students stayed in their programs.

The practices below come from the Stoic texts themselves, from Epictetus, Seneca and Marcus Aurelius. The two studies do not establish that these practices prevent burnout. They can be tried one at a time against a difficulty you are actually having, and judged by whether they help you decide what to do next.

Identify the actions available to you.

“Focus on what you can control” is the advice most people have heard, and it needs explaining when your program sets the schedule and decides what counts as passing. At the start of the Enchiridion, Epictetus separates what is up to us, which includes our judgments and choices, from what is not, which includes our reputation and most external circumstances (Epictetus, ca. 125 CE/1877, section 1). For a student, a workable application is to identify the actions you can take without expecting them to guarantee the result.

If you are struggling with a clinical skill, you can ask your instructor what needs to improve and request supervised practice on the specific problems they name. That raises your chances of passing the retake. It does not guarantee a pass, because someone else evaluates the performance. If the feedback is too vague to use, ask for an example and for what you should do differently. If you believe you are being treated unfairly, document what happened and raise it with your clinical coordinator or program director through the program’s review process. You cannot make someone respond fairly. You can ask for clarification, request supervised practice, document what happened, and ask for a review, and you can do all of that while still feeling anxious or angry about the situation.

The same distinction applies when the constraint is money or time. If you need paid work to cover your bills, you cannot simply decide to have more hours for the program. You can ask about financial assistance and scheduling options, and you can discuss whether your current commitments are manageable with someone who knows the program’s requirements. The question is specific: what action could help with the problem in front of me, and who needs to be involved?

Separate the result from the conclusion you draw from it.

Failing an assessment tells you that you did not meet a requirement on that assessment. It may have serious consequences, and you need to find out what went wrong and what the program requires next. But “I failed this checkoff” and “I am not capable of finishing this program” are different statements. The first describes a result. The second predicts your future, and it needs more information than one result can supply.

Epictetus advises examining an impression before accepting it as true; the Stoic term for that acceptance is assent (Epictetus, ca. 108 CE/1916). In practice, write down what happened and what you have concluded from it as two separate lines. “I missed a required safety step during the checkoff” names a problem you have to correct and then demonstrate. “I will never be safe with patients” is a forecast, and the missed step alone does not support it. If you are comparing yourself with classmates, their apparent confidence tells you nothing about how well they understand the material or what help they are getting.

Seneca made a related distinction between the involuntary first reaction, the flush of embarrassment or anger, and the anger that develops once a person dwells on the event (Seneca, ca. 45 CE/1889a). Feeling upset after criticism does not mean the practice has failed. You feel the first reaction before you have had time to think; the examination comes afterward, once you can review what was actually said. If that review shows mistreatment rather than a mistake, include that in your assessment and seek support. Examining your conclusion does not require assuming that your attitude caused the problem.

Decide in advance how you will respond to a difficulty you expect.

Epictetus illustrates this with a trip to the public baths: expect the splashing and shoving that happen there, and decide beforehand how you intend to conduct yourself (Epictetus, ca. 125 CE/1877, section 4). The practice is often called the premeditation of adversity. For a student, it means taking a difficulty you already run into and choosing your response before it happens again.

If you tend to become defensive during feedback, decide that you will hear the full explanation before you respond, and that if you do not understand the criticism you will ask for an example. Before an assessment, decide that if an instruction is unclear you will ask for clarification before proceeding. Whether the evaluator can answer depends on the assessment rules, but asking settles the question instead of guessing.

The useful part of this exercise is the response you identify. Once you have it, stop. Repeatedly imagining failing or disappointing your family adds no plan. If rehearsing possible difficulties increases that kind of worry, leave this practice out and prepare by reviewing the requirements and asking questions instead. The medical students in Brown’s study described this kind of contingency planning as one of the parts they found most useful, which is a report of their experience rather than evidence that it improved their performance.

Revise the plan when circumstances change.

Marcus Aurelius describes acting “with a reservation”: you commit to an action while recognizing that circumstances may prevent you from completing it (Marcus Aurelius, ca. 170 CE/1862, 6.50). This is often called the reserve clause. In practical terms, you plan to do something and remain willing to change the plan when the conditions change.

On a clinical rotation, you may plan to complete a required competency with your supervisor during a particular week. If the right patient or procedure never appears, you still need to meet the requirement, and you cannot create the opportunity yourself. The next action is to explain the problem to your supervisor or clinical coordinator and ask how to arrange another approved opportunity: whether there is an alternative and what process applies. The original plan was to complete the competency that week. The revised plan is to find out how the requirement can still be met.

The same principle covers larger disruptions. If illness or family responsibilities make your schedule unmanageable, ask the program what options exist and what a reduced load or a leave of absence would mean for your progression before you decide. Your original intention to finish on a particular date does not tell you which option is now workable. You can investigate the options while still feeling disappointed about the delay.

This differs from the previous practice. Anticipating a difficulty gives you a response to a foreseeable problem. The reserve clause reminds you to reconsider the plan when something you did not foresee prevents it.

Review your conduct alongside your results.

The Stoics put character at the center of a good life and described it through four virtues: wisdom, justice, courage, and moderation (Seneca, ca. 65 CE/1925). For a healthcare student, these give you a second set of questions to ask alongside your grades. Are you accurate about what you know and do not know? Are you treating patients and classmates with respect? Are you accepting responsibility for mistakes? Are you asking for help when you need it?

Courage can mean saying “I don’t understand this” while someone is evaluating you. Wisdom includes recognizing when you should not decide alone and need supervision. Moderation includes holding an angry response long enough to decide how to raise the concern properly. These are contemporary applications of the virtues, and they are behaviors you can work on while your clinical competence is still developing. Evaluations may assess them too, but between evaluations you can notice them yourself: using feedback to correct a mistake, or requesting supervision when you were unsure. Those actions belong in an accurate account of your progress even on a day when another part of your performance fell short. They do not cancel a failed requirement.

Some experiences have nothing to do with grades. Encountering serious illness or a patient’s death can be upsetting, and other people’s composure tells you nothing about what they feel. Being affected by a patient’s death does not by itself show that you are unsuited to healthcare. Ask your supervisor about debriefing and support, and get help if the experience continues to trouble you.

Stoic ethics also covers your responsibilities to other people, and your family and friends remain part of your life during the program (Marcus Aurelius, ca. 170 CE/1862, 9.1). You may have moved away from home or have far less time with them. Passing your courses does not prevent loneliness. Schedule time to call someone you are close to, and if the workload is making you withdraw, say so and agree on a realistic way to stay in touch.

Your own health belongs here as well. If guilt appears whenever you rest, ask what actually has to be done and by when, and identify your next work period rather than assuming every free hour must go to studying. If the demands genuinely leave no time to sleep, that is a problem to raise with someone who can help you assess your options. If you do have time to rest, use it. Feeling guilty about stopping does not establish that stopping is irresponsible.

End the evening review once you have a next action.

Seneca describes examining his conduct at the end of each day, a habit he credits to the philosopher Sextius: what needs correcting, what he could have done differently, and a willingness to forgive the fault while naming the change (Seneca, ca. 45 CE/1889b, Book III, section 36). For a student who spends evenings replaying an embarrassing moment without reaching a decision, this can become a short, bounded review.

Begin with something specific you did well or want to continue, including asking for supervision when you needed it, whether or not anyone praised you for it. Then identify one thing that needs correcting, using the feedback you received and the facts you know: what happened and what has to change. Record relevant conditions too. If the instructions were unclear or support was unavailable, that belongs beside your own actions, because it tells you who needs to be involved in the fix. Finally, choose the next action and when you will take it. If you did not understand the feedback, the action may be asking the instructor for an explanation before your next practice session.

Once the action is chosen, the review is over. Write it down so you have a record. If you return to the experience later, ask whether you have remembered anything new. If so, decide whether it changes the action. If not, remind yourself what you already decided and go back to your evening. Repeating an insult about yourself does not supply another correction.

Some experiences need more than private reflection. A distressing patient encounter may call for a debrief with your supervisor, and a safety concern goes through your placement’s reporting process. Mistreatment may require a report and support through the program. If anxiety or persistent low mood is interfering with daily life, or you have stopped enjoying things you used to enjoy, speak with a counselor or a healthcare professional. Good grades do not mean the distress can be ignored.

A pause before you respond.

Marcus Aurelius describes returning briefly inward to principles he understands and then going back to his work (Marcus Aurelius, ca. 170 CE/1862, 4.3), and elsewhere he compares a mind governed by reason to a citadel (Marcus Aurelius, ca. 170 CE/1862, 8.48). The phrase “inner citadel” comes from those passages. The practical version is a short pause to recall one principle before choosing your next action. It does not mean becoming unaffected by exhaustion or by other people’s behavior.

After difficult feedback, pause before responding. Ask what the instructor actually said and whether you have added a conclusion they did not make. Then identify what you need to ask or do. Often the answer is that you do not yet know which part of your performance needs correcting, and the next action is to ask. You can do that while still upset. The pause uses two of the practices above, examining the conclusion and identifying an available action, and it is a way of remembering them during the conversation itself.

The one thing to do.

Choose one practice that matches one difficulty you are having now, and leave the others alone. If unclear expectations have you guessing, write down specific questions for your instructor and ask them this week. If every setback makes you question whether you can finish, write the result and the conclusion on separate lines the next time one happens. If a plan has just fallen through, write down the requirement that still has to be met and the person you need to ask about meeting it. If you spend evenings criticizing yourself, try the bounded review tonight and end it as soon as you have a next action and a time for it.

Judge the practice by whether it helps you understand the problem and do something useful about it. If it turns into another way to criticize yourself or increases repetitive worry, stop and ask for guidance. If what you are dealing with is pressure to look unaffected, the post on real toughness picks up there.

What this does not show.

Two studies, one small and without a comparison group and the other finding no measurable benefit, are not a basis for claiming that Stoic practice prevents burnout or keeps students in their programs. Neither study measured those outcomes. Both tested a package of exercises rather than any of the six practices on its own, so nothing here has been shown to work separately. The applications to checkoffs and clinical placements are my adaptations of the ancient texts for a modern student. They are not reports of particular students, and they are not the Stoics’ own claims.

The practices also have a boundary. They are for deciding how to respond to a difficulty, and they leave room for asking for support and for recognizing that the conditions themselves need attention. If the workload truly leaves no time to sleep, or you are being mistreated, no evening review will fix that, and the conversation needs to happen with the program.