Building Personal Resilience Amy Markese, MD Michelle Meglin, MD
You may be thinking, physicians are the most resilient people I know. They have survived years of grueling training, overcome barriers and most recently adapted to the COVID-19 pandemic. We know physicians experience burnout. The skills we needed to survive may not be the skills we need to thrive. We select trainees with character traits that will make them good physicians, but may also predispose them to burnout.
You may be thinking, the system is the problem and we should really focus on advocacy, dismantling systemic racism, healthcare reform, etc. If we are waiting until our world or our jobs are perfect to be happy, we may be waiting forever. We can fight for justice and progress while also learning skills to improve our own happiness.
Interventions to Build Personal Resilience • Vulnerability • Values Clarification • Shame Resilience • Self Compassion • Mindfulness
Vulnerability • “The emotion we experience in times of uncertainty, risk and emotional exposure.” • “Vulnerability is not winning or losing. It’s having the courage to show up when you can’t control the outcome.” Brown B. Dare to Lead. New York, NY: Penguin Random House; 2018
Examples of Vulnerability • Uncertainty • Not knowing the answer/what to do • Asking for help • Sharing an unpopular/uncommon viewpoint • Showing or talking about emotions • Admitting failure, shame, fear, etc. • Trying something new • Giving or receiving negative feedback Brown B. Dare to Lead. New York, NY: Penguin Random House; 2018
Brown B. Dare to Lead. New York, NY: Penguin Random House; 2018
What are values? Why do values matter? Values mediate our Principles or standards behavior, at both the of behavior; one’s individual and societal judgement of what is level… important in life A way of being or … and when we are not believing that we hold honoring our values, most important burnout can result
Values Clarification
Values Clarification – Breakout • Take turns introducing yourself (name, institution) • Share in your small group ▫ Why did you choose these 2 values? ▫ What barriers you face when it comes to honoring your values ? ▫ Which barriers are in your control? Which are not?
What is Shame? • “Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of acceptance and connection.” • During your medical career, have you ever felt deficient, flawed and/or unworthy? Brown B. Shame resilience theory: A grounded theory study on women and shame. Families in Society: The Journal of Contemporary Social Services 2006; 87:43-52. Brown B. Dare to Lead. New York, NY: Penguin Random House; 2018.
Shame Guilt • “I am bad” • “I did something bad” • View our actions as a reflection • Assess if our actions line up with of our self worth our values using self compassion • Lacks self compassion and • Drives meaningful change empathy • Adaptive • Self destructive, maladaptive • We all experience it • We don’t like talking about it • The less we talk about it, the more control it has Brown B. Shame resilience theory: A grounded theory study on women and shame. Families in Society: The Journal of Contemporary Social Services 2006; 87:43-52. Brown B. Dare to Lead. New York, NY: Penguin Random House; 2018. Bynum WE, Artino AR, Uijtdehaage A, Webb AM, Varpio L. Sentinel Emotional Events: The Nature, Triggers, and Effects of Shame Experiences in Medical Residents. Academic Medicine: 2019; 94:85-93 .
Boehm K, McGuire C, Boudreau C, Jenkins D, Samargandi O, Al-Youha S et al. The Shame – Blame game: Is it still necessary? A national survey of shame-based teaching practice in canadian plastic surgery programs. Plastic and Reconstructive Surgery - Global Open 2019; 7:e2152.
Shame Resilience • Critical awareness • Self compassion • Empathy • Connection • Talking about shame https://www.youtube.com/watch?v=TdtabNt4S7E Brown B. Shame resilience theory: A grounded theory study on women and shame. Families in Society: The Journal of Contemporary Social Services 2006; 87:43-52. Brown B. Dare to Lead. New York, NY: Penguin Random House; 2018.
Self Compassion Wishing for oneself to be free of suffering Mindfulness → Over-identification Common humanity → Isolation Self-kindness → Self-judgement Neff, K. Self Compassion. New York, NY: Harper Collins; 2011.
Mindfulness Awareness of one’s own suffering, without trying to change it Suffering occurs in many forms, and may be more discrete than we realize Sitting face to face with a non compliant patient Running late in clinic and missing dinner with your family The physical discomfort Realizing you don’t have the resources you after a long day on call need to help a patient Finding out about an operative complication Sitting through a contentious meeting
Common Humanity Remembering that feelings of inadequacy are shared by most people Understanding that everything happens due to a universe of causes, not exclusively due to “me” and “my mistakes”
Self-kindness Responding to suffering in a warm and understanding manner Which of these phrases have you said I can’t believe I messed up so badly to yourself? I should never have missed that I’m a terrible doctor I don’t deserve to be here Everyone here is smarter/more competent than me I’m so stupid
Self-kindness Responding to suffering in a warm and understanding manner Which of these phrases have you said I can’t believe I messed up so badly to yourself? I should never have missed that I’m a terrible doctor I don’t deserve to be here … envision saying this Everyone here is smarter/more same thing to your competent than me I’m so stupid friend, family, co-worker when they are suffering
Cultivating self-compassion 5 minute self-compassion break
ABC Model • Helpful framework for practicing mindfulness, shame resilience, and self compassion A B C Adversity/ Beliefs/ Consequences Event Thoughts Center for Pediatric Traumatic Stress. Responding to the Coronavirus / COVID-19 Pandemic: Toolkit for Emotional Coping for Healthcare Staff (TECHS). https://healthcaretoolbox.org/images/Toolkit_Emotional_Coping_Healthcare_Staff_-_COVID-19__April_9.pdf
• Identify an event that is upsetting to you right now • Examples: ▫ Recent acts of racism and violence ▫ COVID-19 pandemic ▫ Bad outcome ▫ Overbooked clinic ▫ Having a disagreement with someone you care about ▫ Feeling isolated from family and friends Center for Pediatric Traumatic Stress. Responding to the Coronavirus / COVID-19 Pandemic: Toolkit for Emotional Coping for • There are no right or wrong answers Healthcare Staff (TECHS). https://healthcaretoolbox.org/images/Tool kit_Emotional_Coping_Healthcare_Staff_- _COVID-19__April_9.pdf
• What are you thinking or saying to yourself? • Examples: ▫ I can’t handle this stress. ▫ I am not a good ally/doctor/parent/person/etc Center for Pediatric Traumatic Stress. Responding to the Coronavirus / COVID-19 ▫ This situation has no end. There is no hope. Pandemic: Toolkit for Emotional Coping for Healthcare Staff (TECHS). https://healthcaretoolbox.org/images/Tool kit_Emotional_Coping_Healthcare_Staff_- _COVID-19__April_9.pdf
• Feelings ▫ Anger? Sadness? Worried? ▫ Check in with your body. Are you fatigued? Tense? On edge? • Actions ▫ Do you express theses feelings? Consciously or unconsciously? • Relationships ▫ How has this impacted your relationships with others? Center for Pediatric Traumatic Stress. Responding to the Coronavirus / COVID-19 Pandemic: Toolkit for Emotional Coping for Healthcare Staff (TECHS). https://healthcaretoolbox.org/images/Tool kit_Emotional_Coping_Healthcare_Staff_- _COVID-19__April_9.pdf
ABC Model – Breakout • What thoughts/beliefs came up for you? • Did those thoughts/beliefs result in shame? • What consequences did you notice? • Were you able to be compassionate toward yourself during this exercise? • What strategies have helped you handle adversity or stressful events? Center for Pediatric Traumatic Stress. Responding to the Coronavirus / COVID-19 Pandemic: Toolkit for Emotional Coping for Healthcare Staff (TECHS).
ABC Model – Large Group • Common themes? • What strategies did you discuss? • Did you find this exercise helpful? • General questions or comments? Center for Pediatric Traumatic Stress. Responding to the Coronavirus / COVID-19 Pandemic: Toolkit for Emotional Coping for Healthcare Staff (TECHS).
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