Building Personal ResilienceAmy 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?

Principles or standards of behavior; one’s

judgement of what is important in life

A way of being or believing that we hold

most important

Values mediate our behavior, at both the

individual and societal level…

… and when we are not honoring our values, 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

• “I am bad”

• View our actions as a reflection of our self worth

• Lacks self compassion and empathy

• 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

Guilt

• “I did something bad”

• Assess if our actions line up with our values using self compassion

• Drives meaningful change

• Adaptive

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

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.

https://www.youtube.com/watch?v=TdtabNt4S7E

Self Compassion

Neff, K. Self Compassion. New York, NY: Harper Collins; 2011.

Wishing for oneself to be free of suffering

Mindfulness → Over-identification

Common humanity → Isolation

Self-kindness → Self-judgement

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 after a long day on call Realizing you don’t have the resources you

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 to yourself?

I can’t believe I messed up so badly

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 to yourself?

… envision saying this same thing to your

friend, family, co-worker when they are suffering

I can’t believe I messed up so badly

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

Cultivating self-compassion

5 minute self-compassion break

A

Adversity/ Event

B

Beliefs/ Thoughts

C

Consequences

ABC Model

• Helpful framework for practicing mindfulness, shame resilience, and self compassion

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

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

• There are no right or wrong answers

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

• 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

▫ This situation has no end. There is no hope.

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

• 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?

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). https://healthcaretoolbox.org/images/Toolkit_Emotional_Coping_Healthcare_Staff_-_COVID-

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). https://healthcaretoolbox.org/images/Toolkit_Emotional_Coping_Healthcare_Staff_-_COVID-

References and Resources

• Dare to Lead, Brené Brown (book) and Brenebrown.com

• The mindful path to self-compassion, Christopher K Germer, PhD (book)

• Self-compassion.org, website for Dr. Kristin Neff (includes 5-minute self-compassion break)

• Trauma Stewardship, Laura van Dernoot Lipsky (book & TED talk)

• Values clarification exercise https://www.psychologytoday.com/us/blog/theory-knowledge/201802/personal-value-exploration-experiential-activity

• Writing your personal mission statement https://www.andyandrews.com/personal-mission-statement/

• Full catastrophe living, Jon Kabat-Zinn (book) and https://mbsrtraining.com/about-jon-kabat-zinn/

• Physician resilience and burnout: can you make the switch? AAFP (article) https://www.aafp.org/fpm/2013/0100/p25.html

• Toolkit for emotional coping in the time of COVID19 for healthcare staff

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