precepting for physician resilience...• permit mistakes while ensuring patient safety. intrinsic...

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