Effective coping strategies are of great importance for trainees actively navigating the challenges and stresses of graduate medical education (GME). Although there is increasing emphasis on the concept of emotional intelligence (EI) in medical curricula, the range of behavioral skills learned in typical EI training may not be sufficient when dealing with extreme stress – something that healthcare students in general, and GME trainees as a subset, continue to struggle with. Under the conditions of extreme stress, multiple competing priorities and high cognitive load, even those with excellent command of EI skills may not be able to universally maintain sufficient emotional control. This, in turn, exposes a significant opportunity for further understanding and development in this dynamically evolving area of investigation. Increasing amount of research suggests that a unique skill set exists, known as ‘coping intelligence’ (CI), that may help fill the gap under the conditions of extreme stress and significantly elevated cognitive load. This chapter will discuss CI as a unique and novel concept, further exploring the possibility of introducing this new construct into the realm of GME.

The coronavirus disease 2019 (COVID-19) pandemic has created numerous risk factors for families and children to experience toxic stress (TS). The widespread implementation of lockdowns and quarantines contributed to the increased incidence of domestic abuse and mental health issues while reducing opportunities for effective action, including social and educational interventions. Exposure to TS negatively affects a child’s development which may result in a lasting impact on the child’s life, as measured by tools, such as Adverse Childhood Experiences (ACE) score. When TS becomes highly prevalent within a society, it may develop into a health security threat, both from short- and long-term perspectives. Specific resources to combat the pandemic have been put in place, such as COVID-19 vaccines, novel therapeutics, and the use of telemedicine. However, the overall implementation has been challenging due to a multitude of factors, and more effort must be devoted to addressing issues that directly or indirectly lead to the emergence of TS. Only then can we begin to reduce the incidence and intensity of pandemic-associated toxic stress.

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