precepting for physician resilience...• permit mistakes while ensuring patient safety. intrinsic...
TRANSCRIPT
Precepting for Physician Resilience
Northern Constellations 2018
Conflict of Interest Declaration: Nothing to Disclose
Presenters: Dr. J. DellaVedova & Dr. K BerstTitle: Precepting for Physician Resilience
We have no financial or personal relationships to disclose
Objectives
• Demonstrate resilience as an essential and teachable skill in residency training
• Apply the promotion of resiliency into day-to-day teaching activities.
• Identify learners who would benefit from increased support and referral for additional assistance
Describe the day or shift during your medical training when you
learned the most
Why were these experiences impactful?
A Tale of Two Learners
Is this resident resilient?
Why or why not?
What may be the problem?
In Small Groups
What is resilience?
Resilience
Stressor
Work intensity
Fatigue
Mortality &
morbidity
Feedback
Error
Personal Issues
LearnGrowAdaptEngage
RetreatAvoid
Burn out
Resilience
• Resilience can only be demonstrated in the presence of a stressor
• Resilience is a skill that can be learned and unlearned over time
• Resilience is unique to particular stressors and not necessarily a personal characteristic
• Resilience depends on environmental factors
• The stressor must not be insurmountable
Resilience
Personal factors
Environ‐mental factors
Stressor factors
Resilience
Resilience
Personal factors
Environ‐mental factors
Stressor factors
Resilience
Experience
Problem‐solving abilityState of physical health
State of mental health
Locus of control
Resilience
Personal factors
Environ‐mental factors
Stressor factors
ResiliencePhysical stressor
Emotional stressorPsychological stressor
Social stressor
IntensityIntensity
Not So Fast…
Personal factors
Environ‐mental factors
Stressor factors
Resilience
Social supports
Formal supports
Resiliency of the system
The Resilient Learner
• Positive attitude• Aims for personal best rather than perfection• Understands limitations• Self-aware• Reflective/mindful/able to focus • Socially connected• Aware of supports
The Resilient Learner
Internal Locus of Control
The Resilient Learner
Internal Locus of Control• Belief that you have control over life events• Actions and degree of effort determine outcomes• Motivation is progress and achievement
The Resilient Learner
Internal Locus of ControlInternals are
• More likely to accept a new challenge• More likely to acknowledge own accomplishments• More likely to accept and implement feedback• More likely to understand limitations (due to ongoing
limit-testing)• Can visualize success
Externals are
• More likely to accept limitations
How Do I Help Others Build Resilience?
Maslow’s Hierarchy of Needs
ThreatThreat
ThreatThreat
ThreatThreat
ThreatThreat
Chronic Stress Curve
Recognizing Breakdown
• Looks tired• Tardy• Inefficient• Incomplete tasks• Unscheduled absences• Unanswered emails• Social withdrawal• Self-doubt• Cynicism and compassion fatigue• Unprofessional or disruptive behaviour
Zones of Teaching
DangerDanger
ChallengeChallenge
ComfortComfort PracticeRegroupConsolidate
StressLearnGrowth opportunity
ExposeObserve
Intrinsic Motivators
• Autonomy• Elicit personal learning objectives• Provide earned and graduated independence• Elicit a commitment to the diagnosis and plan• Discuss rationale• Permit mistakes while ensuring patient safety
Intrinsic Motivators
• Progress/Mastery• Flow the experiences• Create a culture of feedback• Reinforce strengths and highlight progress• “80/20” rule• Losada line
Feedback tips:
• Use specific examples• State observations of behaviours not
assumptions of attitudes• Provide recommendations• Deliver feedback in supportive manner• Detailed enough• Guide toward a concrete action
Intrinsic Motivators
• Purpose• Foster a love of medicine and learning• Avoid cynicism• Encourage mindfulness and reflection
A Tale of Two Learners
How would you approach these residents?
Wellness at NOSM
• WLC• Brief advice• Accommodations and reintegration• Advocacy• Primary care• Curriculum
• EFAP• Counseling and therapy• Hotline