Author Archives: Barrie Maylott

Resilience Training is the Key to Wellness Initiatives

Over the last six months, I have had the opportunity to interact with over 300 residency programs and medical schools about wellness of their trainees. A vast majority of program directors and faculty expressed how over half of their residents and over a third of their medical students had at least one component of burnout syndrome. More than a dozen residency program directors confided in me that they had a recent resident suicide in their institutions.

So, you can imagine I was somewhat surprised that many programs and institutions still don’t incorporate proactive training like resilience exercises in their wellness initiatives. I believe that resilience training should be an integral component of ALL wellness initiatives. As resilience expert and author of The Resilience Factor, Dr. Andrew Shatte said, “More than education, more than experience, more than training, it is RESILIENCE that determines who succeeds and who fails.” Resilience empowers residents and medical students to overcome obstacles and challenges, steer through day-to-day adversities and bounce back from major setbacks. Resilience proactively builds the critically important skills necessary to help prevent burnout and depression. Cognitive behavioral therapy (CBT) research shows that everyone is capable of becoming more resilient if they have willingness to change – a process that begins with self-exploration.

Building resilience takes deliberate practice beginning with learning the “A-B-Cs” of cognitive therapy. Most people think that there is a direct connection from an adversity (A) to a consequence (C) that cannot be controlled. Can an adversity occur that automatically leads to a consequence? The answer is no! There is always a belief (B) or thought process in between the A and C that has a direct impact on the resulting consequence (the feelings, behavior and actions). If an A led directly to a C, everyone would react to an adversity in the exact same way. But that is of course not how it happens. Everyone reacts differently because everyone has unique thinking processes and patterns.

Let me illustrate how different Bs can lead to unique Cs in an example below.

A= Adversity (Stressor)

Example: You are on-call and you are getting paged every few minutes about another patient being admitted to your service. This is turning out to be the busiest call you have ever had.

B= Belief (Thought Process)

Example 1: “I cannot deal with this and I am not confident things will work out; there will be so many patients that I’ll make mistakes. A patient will die and that will be the end of my medical career.”

Example 2: “Yes, there are a lot of patients at once, but I can ask for help and do the best I can. I can learn new organization skills to handle this challenge, because it is not unlike what I have done before. This on-call night will be one I will remember, and it’s going to turn out just fine.”

C = Consequences (Feelings or Behaviors)

C resulting from the belief in example 1: The trainee is highly stressed and takes a disorganized approach to the on-call challenge. This distressful consequence is a result of a type of cognitive distortion known as catastrophizing where one assumes the worst, most catastrophic outcome possible rather than assuming the most likely (a more neutral or positive) outcome.

C resulting from the belief in example 2:  The trainee is more likely to appropriately cope with the situation with an acceptable stress level and creative use of support services for processing patient admissions. Note how the thought content invokes reason and problem solving, unlike the dysfunctional, stress-inducing thought-stream in the first example.

Now you can understand how the A-B-C model can help explain how we react to different types of adversities. As trainees get more in tune with their thinking, they might detect some emerging patterns. They may begin to realize that there are some consistent connections between their B and C as described in the table below.

Beliefs (B) Consequences (C)
Violation of your rights Anger
Real world loss or loss of self-worth Sadness, depression
Violation of another’s rights Guilt
Future threat Anxiety, fear
Negative comparison to others Embarrassment

This understanding leads to insights in their thinking patterns. This creates opportunities for trainees to change their thinking patterns to improve their consequences or outcomes.

Teaching oneself to adopt new ways of thinking is not only possible based on cognitive behavioral methods, but also based on the neurophysiologic model of resilience. Research on post-traumatic stress, depression, and differences in resilience teach us that improved coping is related both to neuroplasticity and to developing new neuropathways and different, more adaptive and helpful ways of viewing stress. The overall objective of resilience skill-building is to harness one’s innate cognitive flexibility, leading to the ability to reappraise negative situations.

As Henry Ford said so clearly and succinctly, “Whether you think you can, or you think you can’t – you are right.”

In the CoreWellness program, there are several proactive resilience skill-building exercises for residents and medical students to help them better deal with adversities and improve their consequences resulting in more realistic and optimistic beliefs. In this way trainees learn to not only survive their training, but to actually grow and flourish both professionally and personally.

Please let me know if there is anything I can do to help you, your department, or your institution build resilience. You can reach me at info@casenetwork.com. I look forward to interacting with you.

 Jeff
 Jeffrey Levy, MD
CEO, CaseNetwork
Developer of CoreWellness Online for Residents
Author of CoreWellness: A Physician Wellness Program

About Consulting Services

Dr. Jeffrey Levy, author of CoreWellness: A Physician Wellness Program and Dr. Catherine Pipas, author of A Doctor’s Dozen lead a team of physician wellness experts to provide consultative services including train-the-trainer programs for faculty development to improve the faculty’s ability to facilitate wellness discussions and create a culture of wellness. Other longer-term consultative engagements include guiding departments and/or institutions through a step-by-step process to design, launch, measure, sustain and improve their wellness initiatives.

 

Creating a Culture of Wellness

I just returned from the Society of Teachers in Family Medicine (STFM) meeting in Toronto. There was a strong focus on resident wellness at this meeting. As I had the opportunity to speak with dozens of program directors, it quickly became apparent that every residency program is moving toward creating their own “culture of wellness.” Many are at the beginning stages of the process and are struggling with how to design and implement their wellness initiates.

I believe the first step of the process is to accurately define wellness. According to the World Health Organization wellness is as an “optimal state of physical, mental/emotional and social well-being, and not merely the absence of disease.”

I have adopted and subscribe to a much broader definition of wellness provided by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration, which includes eight dimensions of wellness, including:

  1. Physical – recognizing the need for physical activity, healthy foods, and sleep.
  2. Emotional – coping effectively with life and creating satisfying relationships.
  3. Spiritual – expanding a sense of purpose and meaning in life.
  4. Social – developing a sense of connection, belonging, and a support system.
  5. Intellectual – recognizing creative abilities and finding ways to expand knowledge and skills.
  6. Occupational – personal satisfaction and enrichment from one’s work.
  7. Environmental – good health by occupying pleasant, stimulating environments that support well-being.
  8. Financial – satisfaction with current and future financial situations.

Residents certainly have unique circumstances in a very demanding profession, but also have many similarities to the general population. It probably comes as no surprise that adequate sleep, a nutritious diet and exercise, and social connectedness with community, family and friends are important to residents. Why, then, are these obvious self-care practices set aside, postponed, or frankly ignored during the long road through post-graduate training?

Deficits in these basic human needs become risk factors for burnout – an imbalance between work demands and coping ability, which generally continues to worsen throughout medical training. The high prevalence of burnout among post-graduate trainees is, in part, due to deficits in two other dimensions of well-being that are important to address but challenging to nurture.
The first is autonomy that can be described as having a say in shaping one’s learning environment so that it supports well-being as much as clinical education, providing supervision commensurate with a graduated level of independence and responsibility. The second is competence, which is a sense of self-efficacy that increases through training as one accumulates positive experiences of successful patient care resulting from a resident’s knowledge and skills.

To achieve a culture of wellness, a department must:

  • Support a healthy environment that values self-care as a means of maintaining high-quality patient care.
  • Advocate for the adoption of healthy habits in residents’ professional and personal lives.
  • Embrace a nurturing community where seeking help is not discouraged, but rather encouraged.
  • Create an environment where residents feel safe to engage in ongoing dialogue about their challenges and needs.
  • Develop a Wellness Committee that can addresses residents’ needs as well as national/local mandates or requirements.

Does your program have a culture of wellness? If not, please contact me at info@casenetwork.com and we can discuss a step-by-step approach to designing, implementing, assessing and maintaining a culture of wellness.

I look forward to interacting with you.

Jeff

Jeffrey Levy, MD
CEO, CaseNetwork
Developer of CoreWellness Online for Residents
Author of CoreWellness: A Physician Wellness Program

About CaseNetwork
CaseNetwork is a technology enhanced medical education company that delivers competency-focused, case-based education that enables learners to improve their knowledge and comprehension of critical patient situations and disease states. CaseNetwork’s simulated patient encounters integrate evidence-based clinical information with required proficiencies and skills. CaseNetwork’s proprietary platforms include interactive decision making and peer-to-peer problem solving that is conveniently delivered in a browser or on a mobile device for anytime, anywhere learning. The CaseNetwork solution helps healthcare professionals advance their skills and improve competency with the ultimate goal of enhancing patient outcomes. For more information, visit http://www.casenetwork.com.

About CoreWellness
CoreWellness Online is a breakthrough online program from CaseNetwork with 24 modules that provide your residents with the knowledge and practical skills to manage stress and adversities typical of post-graduate training. Residents will learn about burnout syndrome (BOS), improve resilience, and achieve self-awareness through proactive wellness and self-care measures.  This comprehensive program is the first of its kind, designed to help residents cope with the unique demands of the healthcare profession and to better understand the impact stressors have on their cognitive, emotional, and physical well-being. This program provides information to help them not only survive training, but to actually thrive and flourish. For more information go to http://casenetwork.com/markets/corewellness/