Building resilience in emergency medicine

In this podcast I am joined by Rick McKnight PhD author of Victim, Survivor, Navigator and Curt Woolford MA E-RYT.  Rick, Curt, and I held a Workshop/Retreat for my Department last month with the goal of building resilience using mindfulness techniques.

The basic approach we took was to have all participants take a Maslach-Burnout Inventory and begin using a few apps (Mood Meter, Provider Resilience) before the retreat. The day of the retreat we started with a review of the groups Maslach-Burnout Inventory and then each individual opened the envelope with their results. It had a fairly powerful attention getting effect. We then moved to various small group sharing and transitioned to Mindful Resilience Training specifically focusing on individual based techniques (e.g. meditation, breathing exercises, etc). Finally, we created workshop like approach to identify best practices for Team Resilience. Four specific scenarios were discussed that typically result in interpersonal stress on teams in the Emergency Department (a few examples – an angry patient confronts a colleague, a difficult patient keeps calling for help, a colleague is not seeing enough patients or carrying an appropriate load, a rude consultant, a colleague appears to becoming distressed dealing with a violent patient). What should our response be? How would we want our colleagues to respond if it we were in distress, being attacked, treated rudely etc? This generated a lot of great discussion.

In the podcast we reviewed some of the important take home themes from the retreat. Social connectivity and a sense of not being alone in feelings of stress goes a long way to restoring a sense of balance and calm. Resilience is not about hardening you to be resistant to stress, resilience is about developing the attributes that make you and your team someone who thrives in stressful environments. Choosing to navigate the challenges and stress that EM has to offer leads to a much better outlook and a happier and enjoyable practice. Remaining a victim at worst or a survivor at best is not the path to a satisfying relationship with the practice of EM.

Finally we take a look at this brand new paper Psychological Skills to Improve Emergency Care Providers’ Performance Under Stress.This papers develops the BTSF (Breath, self Talk, See (mental rehearsal), Focus with trigger word) mnemonic that is discussed at EMCrit and is specifically focused on high stakes performance. Somewhat different from our retreat topic, but still the same technique.

Just for fun – here are some of my favorite self talk, trigger word performance enhancing practices from the movies!

Inner Space – a fun favorite from way back when that has one of favorites “Zero Defects”

For the Love of the Game – the story of Billy Chapel – “Clear the Mechanism” dramatizes how weirdly personal a trigger word can be – and how effective. They say many of the great athletes had the ability to focus and eliminate distractions. This scene is perfect for EM physicians because I think on just about every shift I am trying to concentrate on something while being heckled (okay – distracted) by someone who thinks I need to do something else (get a phone call, hear about a case, read an ECG, get them food, the list goes on…).

Enjoy the podcast and leave your comments on how you build resilience personally and with your teams!!!

After the podcast, Rick, Curt and I headed out to our local Japanese BBQ and finished our meal with ‘smores – now that’s resilience building!