Compassionate resilience in medical education. Dr KE Leedham-Green

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Tyler Wiggins
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1 Compassionate resilience in medical education Dr KE Leedham-Green

4 Resilience Wellbeing vs burnout Quality of caring Compassion vs detachment Quality of care Safety vs inattention

5 Responses to stress Unhealthy Withdrawal, disengagement Avoidant coping: e.g.alcohol Unsustainable Survival tactics e.g. TV, books Destructive if habitual Healthy Mindful practice Compassionate resilience Constructive engagement Epstein, 2014

6 The good, the bad and the resilient Positive values Service Altruism Knowledge Caring Empathy Competence The dark side Over-commitment Perfectionism Hiding errors Need for certainty Personal distress Distancing Neglecting self Compassionate resilience Balance Knowing limitations Engagement Compassionate action Gratitude and appreciation Self-care Self-compassion Reflective self questioning Epstein, 2014

8 That poor woman (sympathy) After you you look exhausted! (compassion) I can understand why everyone is pushing (empathy) We shouldn t push (moral reasoning) What do we mean by compassionate resilience?

11 Don t push! I just don t care anymore (burnout) No-one is watching me and I ll never see any of these people again (disengagement) I will be late if I don t get on this train (distress) Well, everyone else is pushing so why not me? (poor role modelling) The environment, burnout, distress, disengagement and poor role modelling make compassionate care harder to achieve.

12 Selfactualisation Becoming a competent, confident, communicative, compassionate, caring doctor The need for selfesteem Feedback, progression, achievement, feeling challenged, making a difference The need for love/belonging Longitudinal relationships with peers, teachers, places, patients The need for security Sufficient control over areas of responsibility, fair assessment, sufficient resources for all Physiological needs Sleep, food, exercise, time for self-care Adapted from Maslow, 1954

13 How resilient do you feel? Go vote Go to and use the code

15 EPSTEIN S 5 HYPOTHESES OF COMPASSIONATE RESILIENCE

16 Compassion requires resilience to be present with suffering

17 Compassion for others is facilitated by compassion for oneself

18 Resilience is a capacity that can grow

19 Wellbeing is about engagement not withdrawal

20 Mindful practice is a group activity

21 The new curriculum Emphasis on Primary care Psychological health Long-term conditions Health promotion and disease prevention Longitudinal relationships Clinicians, places, peers, patients

22 Workshop activities 3 Scenarios 1. The clinical workplace learning environment 2. Self-care and compassion 3. Mindful practice Critical thinking exercise What questions do we need to ask? What are some ideas for addressing that? What is the evidence What else might work What are the potential issues with that? What next? How can I make this happen? Who, what, when by, how

23 Clinical workplace learning Scenario 1 I don t think I could work here. Everyone seems so stressed and grumpy. How could I balance this level of work with my other goals in life, such as starting a family? I want to make a difference to my patients, this just feels like tick-box medicine with QOF being the only outcome that matters. environment Personal control? Teamwork? Environment? Workload? Critical thinking exercise What questions do we need to ask? What are some ideas for addressing that? What is the evidence What else might work What are the potential issues with that? What next? How can I make this happen? Who, what, when by, how

24 Self-care and compassion Scenario 2 I ve failed my formative OSCE. I worked so hard, I must be useless. I couldn t sleep last night and the coffee machine s not working. I ve had enough, I feel so low, I m going home to get drunk. Recognising moments of vulnerability? Providing peer support? Modeling self-care? Appreciative enquiry? Critical thinking exercise What questions do we need to ask? What are some ideas for addressing that? What is the evidence What else might work What are the potential issues with that? What next? How can I make this happen? Who, what, when by, how

25 Mindful practice Scenario 3 I was so busy trying to get through everything that I didn t notice what was really going on with that patient. I d like to talk about it with someone but I m too embarrassed. I don t think it shows me in a very good light. Recognising and discussing emotions Noticing and acting Slowing at critical moments Honest, attentive reflection Critical thinking exercise What questions do we need to ask? What are some ideas for addressing that? What is the evidence What else might work What are the potential issues with that? What next? How can I make this happen? Who, what, when by, how

26 Conclusions and take-home messages Thank you

27 Clinical workplace learning environment audit Measuring the learning culture of the clinical workplace Jennifer Newton, Brian Jolly, Amanda Henderson Incorporates student and staff perspectives. Likert scale domains: collegiality, teamwork, being valued, respect, university values (orderly structure, knowledge generation, critical reflectiveness) workplace values (efficiency, doing the work, patient outcomes, orderly chaos) Example questions Staff help each other to get the job done Changing practice in this workplace is difficult It is clear that my work is important to the success of this workplace People consider colleagues feelings I am encouraged to try new things Workload allocations are carefully planned

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