Promoting Stress management by residents
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Transcript Promoting Stress management by residents
Promoting Resident Wellness
Through Better Stress
Management
Margaret Rea, Ph.D.
GME Counselor
UC Davis School of Medicine
Why are We Concerned if Residents are
Not Managing Stress Well?
The Evolution of the Resident
July
September
November
January
We Want to Avoid:
Physical
Changes
Emotional changes
Maladaptive responses
Poor Patient Care
Bad Equation
High demands of work
+
Perfectionism
+
Feelings of lack of control
+
Few Rewards
= STRESS
We Want to Avoid Burnout:
Emotional exhaustion
Depersonalization
Feeling inefficient on the job
Emotional Exhaustion=
Feeling emotionally overextended
and exhausted by work
Depersonalization=
Unfeeling and impersonal response
to one’s efforts
Feeling Inefficient=
Incompetent
We Want to Protect Against:
Depression
Anxiety
Substance Abuse
We Want You To:
Maintain meaning and satisfaction with
your job
Maintain and or get back some of the
energy and enthusiasm that brought you to
medicine
Maintain a personal life and achieve some
balance between work and home
What Can We Do To Assist
You?
We can’t make the stress of residency
disappear, but we can try to assist you in
achieving some balance so you can
maintain your physical and psychological
health
How do we do that? Can we do
that?
We Do Not Want To Cause More
Stress with Stress Management
What Techniques Do you Currently
Use to Promote Wellness?
Unhelpful Stress Management
Techniques
Escape through drugs and alcohol
Short cuts at work: lying, dumping: “Its
pending”
Overeating/under eating
Taking out on others: colleagues, students
Acting out at home
Can Residents Really Use Typical
Stress Management Techniques?
Can Residents Modify Their
Style and Consider Wellness
Obsessive traits
High to unrealistic expectations of self
“Addiction” work
Competition to do better than others
Stress is a motivator
Life Curriculum for Residents
Duke University: ERASE
Exercise
Relaxation
Activities
Supportive Relationships
Emotional Expression
Exercise: Can Residents Really
do This?
Exercise Options for Residents
Hospital
Walk
Stairs
around hospital
Hospital
Gym: Rooms
7148 and 7156- Code 541
Equipment
24
at home
Hour Gym
Ramp
Relaxation
Deep breathing
Muscle relaxation
Meditation
Imagery/Visualization
Mindfulness
Meditation
Focus on:
Sound
Image
Phrase
Breathing
Time Outs
I pod/CD- (only for time out)
Power nap
Social Interlude: call a friend,call home,
grab coffee with fellow resident
Walk the perimeter or ramp
Library
Enjoyable Activities: Can You
Remember Any?
Try to remember what used to be
enjoyable
Try and find a concrete hobby that can
balance chaos of the hospital
Support Systems !!!!!!!!!!
Reach out to family and friends
Keep personal relationships intact
A short phone call can help
Form alliances with other residents
Consider counseling, even one session
Emotional Expression
Expressing emotions in safe and appropriate
way leads to better coping with family,
friends, counselor
Keep a journal
Touch base with seniors and supervisors
ISOLATION=POOR OUTCOME
Why Consider Counseling
Venting to someone helps
Practice stress management skills
Problem solve
One session or continuing
Regular or intermittent
Mental Traps Keeping You From
Counseling
Fear of exposure to fellow residents,
colleagues, patients
Fear it is not confidential
“I can heal myself”
Fear failure
Avoid Trap
“If
I admit I am struggling
THEY will figure out I really
don’t belong, I can do it”
What Else Can Help?
Reframing World View: You
Have a Choice
We often can’t change the reality, but we
can change how we think about it
We can take control of how we respond to
events
We can adopt more helpful
interpretations
Realism not perfectionism
Embrace the challenge and opportunities
Avoid victim interpretation
“They are out to get me, they are dumping
on me, they are slamming me”
vs.
“It is a bad night, how can I make things
work”
Avoid the Trap of “Service
PTSD”
You begin re-living a bad service or ward
experience
You then predict it will happen again
You become pre-occupied, expecting
worse
You walk in with heightened arousal and
stress
Avoid the Victim Role at Home
If you arrive home feeling abused, your
family will often respond negatively
They want your presence so be present
Take Charge of Your Wellness:
Be Mindful!!!!!
Eat
Laugh
Take a Time Out
Communicate
Get Support, Reach Out
Take Care of Each Other