Resilience – 10 Steps

RESILIENCE 10 STEPS

These 10 steps are based on an article written by the American Psychological Association. It was adapted by Iain Lamb (Scotland Deanery SE region) to underpin workshops for trainers who felt that trainees were becoming less resilient. I’ve noted in blue some of the ways I’ve tried to help struggling trainees in my patch – some are mentioned in more detail in other attachments. A significant number of trainers gave feedback that the workshops had been relevant to them and had been helpful.

1: Make Connections

Good empathic relationships with close family members, friends or others are important and help build social resilience. (Ensure the trainee knows what empathy and rapport really mean. Get them to regularly swap shoes when thinking about others positions).   Accepting help and support from those who care about you and will listen to you strengthens resilience. Some people find that being active in civic groups, faith-based organizations, charities or other local groups provides social support and can help with reclaiming hope. Assisting or offering acts of kindness to others builds a positive emotional bank account. Help a trainee build resilience by offering the right culture and learning environment with good role modelling.

2: Be positive and think solution not problem

When you are lacking in resilience you will often see and be stuck in thinking about the negatives. Remind yourself of the positives – you will not have reached this stage in your career without some positives – in your life and work. Write the + down and keep writing until you have more than 3 to 1 + to – ratio.

3: Accept That Change Is a Part of Living

Goals may need to adapt to changing situations. Accepting the circumstances that cannot be changed can help you focus on circumstances that you can alter. Be proactive (1st effectiveness habit) not reactive – the circle of influence. (Think motivational interviewing, the pros and cons of change or no change, the Likert scale of how motivated or confident you are and the cycle of change.)

4: Identify your Goals

Develop some realistic (for example SMART) goals. Do something regularly — even if it seems like a small accomplishment — that enables you to move toward your goals.  Small steps that move in the direction you want to go (Consider using 2nd effectiveness habit which is Begin with the end in mind to help look at long term goals. For example “What kind of doctor would you like to be in 5 years time?” Even though all have the same CCT goal of passing the exam there will be different motivations if you plan to be a partner or a retainer or an OOH doctor etc) – “What’s one thing I know I can accomplish today that helps me move in the direction I want to go?” It’s not just about bouncing back but bouncing forward! 

5: Be decisive

As much as you can take decisive actions, rather than detaching completely from problems and stresses by avoidance and wishing they would just go away. Base decisions on personal values and beliefs – e.g. use logical levels.

If a trainee is struggling with uncertainty and the swampland of GP explore complexity theory with them. To help with decision making use experiential and problem based learning. Make sure there is plenty non judgmental feedback to develop skills.

Cope and thrive!

6: Self-Discovery and learning

Use experiences as learning opportunities. Reflect and ask yourself non judgmental awareness raising questions, be curious and keep learning. This will be even more effective if you also discover other perspectives by working in a group of peer learners.

If a trainee is struggling to reflect help them by using PUNS and DENS or Discomfort logs (theirs and yours). Do joint surgeries – either being actively observed or observing with feedback.

7: Develop self efficacy – see more detailed handout

Through mastery experiences and performing tasks successfully especially if it is reinforced by positive feedback. Social Modelling and seeing people similar to oneself succeed. (ERP helps with this) By persuasion to believe that you have the skills and capabilities to succeed. And by creating the right learning environment and preparing learners to manage their Psychological responses and preparedness for the challenge we can help reduce their stress levels or low mood when facing difficult situations

8: Keep Things in Perspective

Try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion. Use flexible rather than rigid thinking. Helped by the mentoring part of a trainer’s role. (A small book by a former GP course organiser and student mentor may be useful – “Medical Mentoring” by David Jeffrey)

9: Optimism, happiness and humour

The evidence shows that optimism leads to happiness and this has significant effects on health, well being and improved life expectancy. There are benefits to maintaining humour through mental well being but also physiological improvements.

The issue is that many trainees (people in general) are pessimistic in the face of adversity, develop negative beliefs and the negative consequence is that performance suffers. For example a patient gets angry with a trainee in a consultation (adversity), this leaves the pessimist in them with the (belief) that they are poor at consulting with patients and the (consequence) is that they expect to (and increasingly do) consult badly. That is an ABC – help by adding a “d” and looking to dispute that is the correct belief to follow that adversity. (For example to identify that whilst the patient was angry it was because you were rightly refusing to prescribe a drug that might do them more harm than good) (In other words bring out the optimist in them.

Happiness has been described as pleasure with meaning. Trainees can need reminded of medicine’s meaning for them and the reasons why they wanted to be a doctor and GP in the first place.

10: Take Care of Yourself

Pay attention to your needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly and build up biological resilience. Get outside. Have short mental relaxation breaks. (The 7th habit is “sharpen the saw” – but also the 3rd habit of good management of time helps stop a build up of overwhelmed and reactive behaviour).  Use the time management matrix for those who way they can’t take care of themselves because of lack of time.

Underpinning all of these is that there is evidence that positive mental training is of help – see separate attachment. Others find that mindfulness or cognitive behavioural therapy for example has been on help. If there is unprofessional or selfish behaviour as compared to the standards of the college or GMC, or as calibrated against the competencies and their peer’s performance then that has to be addressed.

Many doctors struggle to maintain resilience and avoid burnout during their career. We can try and prevent this by being aware of our own vulnerability and building up mental, biological and social resilience in ways that suit our personality and life situation.

Iain Lamb – updated 2016