Author Archives: Melissa Young

The True Meaning of Resilience

The True Meaning of Resilience

I have had the great privilege of working with some of the top psychologists in the resilience field including Drs. Karen Reivich and Andrew Shatte who authored the book the Resilience Factor. I had the unique opportunity to develop three online resilience programs with them that improved the lives of thousands of people across the United States and beyond. I learned from them that resilience is a complex web of seven factors that give us the ability to recover in the face of adversity and includes:

  1. Emotion Regulation: the ability to control one’s emotions in the face of adversity and to remain goal focused.
  2. Impulse Control: the ability to control one’s behavior in the face of adversity and remain goal focused.
  3. Causal Analysis: the ability to accurately and comprehensively identify the causes of one’s adversities and generate effective solutions.
  4. Self-Efficacy: one’s sense of mastery over adversity, challenges, and opportunities.
  5. Realistic Optimism: a reality-based belief that the future is positive.
  6. Empathy: the ability to read the verbal and non-verbal cues of others to estimate their mental state and emotion.
  7. Reaching Out: the ability to deepen relationships with others and to take on new challenges and opportunities.

For almost 15 years I have practiced the resilience skills they taught me and have boosted my ability to overcome minor day-to-day adversities, steer through life’s challenges, and even bounce back from major adversities. But recently in a four-day period, I learned more about resilience than I had in the previous 15 years. It was during my trip to Ethiopia where I learned the true meaning of resilience.

I had been invited to Ethiopia by the American College of Obstetricians and Gynecologists and the Ethiopian Ministry of Health to teach healthcare providers about curriculum development and e-learning. I was asked to conduct a 36-hour seminar over four days.

The first day of the course, one of the participants—an Ob/Gyn—arrived to the program an hour late and was very apologetic. I later found out that she had been dealing with a maternal and fetal mortality all night. A patient in the Ethiopian public health system had been laboring for several days at home but could not get to a hospital. She was finally taken to the hospital after she had a uterine rupture and her baby was expelled into the abdominal cavity. Both mother and baby died on the way to the hospital. I am also an Ob/Gyn but have never had a maternal mortality in my entire career. I would imagine if I had one, it would have a very traumatic effect on me that might require weeks or even months for me to process. But not this Ethiopian physician. She was a bit tired because she had been up all night, but she was poised and ready to learn. After all, she had seen her share of maternal mortalities since sub-Saharan African countries have the highest maternal mortality rates in the world. I began to realize how different her experiences and perspectives were from mine and that her resilience was far greater than mine.

After the first day of the seminar, the participants were truly engaged and excited to learn. The group started building this palpable sense of comradery and I began to experience their beautiful spirit and character first-hand. Through our conversations, I began to realize that they were beyond a doubt the most resilient people I had ever met. That realization would be confirmed just a few hours later.

Mid-afternoon on the second day of the course, we took a 15-minute break. We all congregated in a foyer in the conference hotel for coffee and tea and were having deep discussions about the educational needs for healthcare providers in Ethiopia. We were in one of the nicest hotels in Ethiopia and you could look up to the overcast sky through a glass roof over 20 stories above. Unbeknownst to us, there were some workers on the roof doing repairs that day.

We all heard it at the same time: what sounded like sonic boom coming from above. As we looked up toward the noise, we saw large chunks of concrete and glass shrapnel from the roof barreling down toward our group. Everyone scattered out of instinct to get out of the way. Some of the course participants were hit by pieces of glass and injured. We immediately went from student/teacher mode to healthcare provider mode. We triaged the injuries and sent three people to the local hospital.

We quickly found out that there was a worker accident on the roof that caused the collapse of a small section.  When I surveyed the foyer area after the situation was under control, I realized that the table where I was drinking coffee and sharing insights during the break had been cut in half by a large chunk of concrete. I took a picture of the table that had been destroyed and thought to myself, “What if…”

We decided to take the rest of the day off from the conference, but we wanted to be together and process what we had just experienced. We moved to another area of the hotel and sat in a circle talking about the people who were injured and wondering how they were doing. We told stories of some of the worst things that have happened to us in our lives, and that seemed to be somewhat calming for the group. I quickly began to realize that this group is inundated day after day with some of the greatest poverty and harshest conditions on the planet, but somehow approach life with vigor, enthusiasm, and hope.

As we continued to share our stories, we began forming a bond closer than I could have imagined. We were from different cultures, different countries, almost different worlds. But in the end, we were all caring human beings who had gone through the same traumatic experience.

We were heartened to hear that the injured participants were released from the hospital. They came back to the course with bandages covering different parts of their bodies but participated fully as if nothing had ever happened. At the end of the course, we each expressed how grateful we were to have shared our time and experiences with one another.

A few months have now passed since my trip, but I reflect on it often. I truly believe I am a better person as a result of my experiences in Ethiopia. I am already looking forward to going back there again soon to see my new friends who have taught me the true meaning of resilience.

Please let me know if there is anything I can do to help you and your department 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 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 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/

Wellness Can’t Wait

Wellness Can’t Wait

Burnout syndrome (BOS) is a serious epidemic that is adversely affecting between 40 to 75% of our healthcare trainees and professionals. Up to 12% of doctors with BOS express thoughts of suicide, and the rate of completed suicide in medical trainees is double that of the general population. In fact, we are losing almost 400 healthcare providers a year to suicide. This is comparable to losing the number of students in an average size medical school every year. We must address the issues of BOS now, before we lose anymore healthcare providers to suicide.

BOS is defined as the prolonged, psychological response to job-related, interpersonal stressors. BOS occurs when occupational demands exceed one’s ability to cope, and is characterized by three measurable domains:

  1. Emotional Exhaustion: feelings of emotional and physical depletion.
  2. Depersonalization: a sense of indifference, detachment, or negative, cynical feelings toward patients and/or co-workers.
  3. Lack of Personal Efficacy: a decreased sense of personal accomplishment.

Occupational stressors leading to BOS accumulate during the preclinical training years, finally reaching a critical point during the later years of medical school or shortly after starting residency. Without improved coping ability during the first months of internship, as the workday becomes longer and patient responsibility increases, those more susceptible to BOS struggle to put present-day challenges in perspective. They may lose sight of the greater goal of graduating residency and going into practice.

Burnout may seem to be a purely personal issue, but in medicine that is not the case. The enormous burden that residents and medical students on rotation undertake to maintain patient quality-of-care could result in BOS with detrimental effects on the trainees’ personal lives and professional development. However, burnout also leads to negative ramifications for patients.

Professional Consequences

  • gaps in professionalism, including callous attitudes or overt hostility toward patients and co-workers
  • lack of career satisfaction
  • early retirement or leaving the profession

Personal Consequences

  • strained relationships, marital separation, or divorce
  • depression and anxiety
  • suicidal ideation/completed suicides

Patient Consequences

  • increased medical errors
  • less patient satisfaction with quality of care

I am presently at the AAIM meeting in Philadelphia and have had the opportunity to meet with dozens of residency program directors and discuss their departmental wellness initiatives. During those discussions five program directors confided in me that their programs have been devastated by recent resident suicides. Three out of five stated they did not see it coming. In contrast, other program directors told me that their residents were doing just fine and did not really need a wellness initiative. But how do they know? How do they be assured that they won’t be the next program director devastated by a resident suicide and dealing with the guilt that they did not do enough?

So when I say, “Wellness can’t wait!” –  I mean it literally.

Jeffrey Levy, MD
CEO, CaseNetwork
Author of CoreWellness: A Physician Wellness program

About CaseNetwork

CaseNetwork is a technology enhanced medical education company and the developer of CoreWellness: A Physician Wellness program – a 24 module online program that provides the tools needed for residents and medical students to overcome adversities, build resilience, improve wellness, and thrive. CaseNetwork also 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 www.casenetwork.com.

Education Philosophy: Part 2

After 30 years of innovations in medical education and training and conducting hundreds of live and online programs, I have gained some important insights into effective strategies that make educational programs more successful. I would like to share a few of these with you.

Blended Education Solutions
Medicine requires more complex education and training strategies than other disciplines due to the need to integrate cognitive (knowledge), technical (psychomotor/procedural), and nontechnical (e.g., communication, collaboration, professionalism, and management) skills within limited work hours. All learners, independent of learning styles and background knowledge and experiences must meet or exceed high level standards determined by government, medical societies, and regulatory/credentialing boards.

In my experience this is best accomplished by providing a blended solution education model that promotes interactivity and limits traditional lecturing. The blended solution model builds pre-knowledge through e-learning, so the adult learner comes to live meetings with a higher level of understanding and knowledge. Live meetings are reserved for “flipped classrooms” (facilitated discussions rather than teacher-directed lectures) and the training of technical and non-technical skills.

Contextualized Learning
Providing precise and directed information in the moment the learner needs it to build context around the present learning experience. This technique also ties information to past learnings and experiences to build “scaffolding” or “schema”.

Formative Feedback
Providing immediate feedback regarding decisions or actions within an education and training program. An emphasis on the avoidance, recognition, and management of errors fosters more efficient and effective implementation of learnings into clinical/surgical practice.

Information Reinforcement
Providing multiple “educational touch points” improves retention and provides opportunities for continued knowledge growth as experience increases.

Proficiency-based Progression
The process starts with deconstruction of a procedure into its component parts (task deconstruction). The learner can then undergo deliberate practice to perform a single task to a high-level benchmark set by experts. Once a single task is mastered (proficiency), other tasks increasing in difficulty and complexity (progression) are practiced and mastered. These tasks can be conducted in dry labs, wet labs, or simulation settings.

Procedure Practice
Once all of the component tasks from a particular procedure are mastered, they are reintegrated so the entire procedures can be practiced, mastered, and assessed. Such teaching should focus on the correct execution of the procedure, forward planning, decision making and error detection. This method improves safety and outcomes for full procedures. Procedures should be accomplished in a laboratory setting first (animal, synthetic, cadaver, or simulator models) before attempting them on a live patient. Appropriate mentoring/coaching should be included for the first several live cases to ensure successful procedure completion and patient outcomes before granting privileges for independent practice.

Team Training
Communication, collaboration, and professionalism are important components of any clinical, procedural, or surgical interaction and should be a critical part of any education and training program.

Social networking
Incorporate social networking using a peer-to-peer style of education into educational programs to improve learner engagement, retention, personalization, and application of materials.

Train-the-Trainer
Trainers should receive standardized training including learning theory, communication skills, and debriefing methodologies before being allowed to serve as a trainer. It is expected that the trainer is an expert in the subject matter, tasks, and procedures being trained. It is optimal to create opportunities for trainers to become ongoing mentors (or develop an additional long-term mentoring system possibly through telementoring) to continue to provide support to the trainee as his or her practice increases in complexity over time.

Metrics and Assessments
Create unambiguous metrics to assess a learner’s knowledge and skills in the most objective and reproducible manner. Binary metrics are preferred over more subject Likert scales.

Ongoing Tracking of Performance and Outcomes
The value of the education and training programs can only be evaluated and improved if data is collected regarding long-term clinical performance and patient outcomes. These measurements are for quality improvement opportunities and training remediation and should not be collected/analyzed for punitive purposes.

Jeffrey Levy, MD
CEO, CaseNetwork