The Resilient Trainee
A Leaders Priority
Miss Shazia Hafiz (Chair)
Dr. Shirley Remington
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Patient Encounters
Working with Colleagues/Staff
Workload & Burnout
Exams/Courses/Presentations
Work: Life balance
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Do trainees want to be resilient?
• Bounce back
• Emotional stability
• Clinically Sound
• Balanced
• Unafraid
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Workshop
4 scenarios: 10 minutes to discuss your approach to these trainee
Feedback: 10 Minutes
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Scenario 1
Career Resilience
Work: Life Balance
An FY2 doctors has just rotated onto your firm.
They are worried about applying for core training.
They feel overwhelmed by the workload involved in applying- including
going over their answers for the interviews, revising their clinical knowledge and
preparing their portfolio and they are worried its all becoming too much.
They briefly also mention about concerns about medicine being right career:
‘If I can’t cope with this stress now, how on earth will I manage in future :working
clinically, preparing for more interviews & exams and not to mention I’m currently in
the middle of buying a house and trying to put money aside to get married next year
and trying to just live’
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Scenario 2
Working with Colleagues
A female ST3 has started on a surgical firm as her first rotation in
august. She is always smartly dressed, professional and works hard.
She has been sensing some negativity from the nurses on the ward.
She senses she is being undermined during the ward rounds and via
non-verbal actions.
As a registrar she remains professional however she voices to a more
senior registrar (an ST8) that she does not understand what she has/is
doing wrong? Why won’t the nurses work with rather than against
her?
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Debriefing Checklist
• Debriefing as a team encourages transparency
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Scenario 3
Post-Traumatic/Emotional Resilience
A multiple vehicle RTA has been referred as trauma call into A&E Resus
The FY2 doctor was on during the night shift - 3 young adults were severely injured, a child
had cardiac arrest at the scene and had a further period of CPR on arrival but now died and
some of the injured required transfer to ITU.
The FY2 was involved in as part of the child’s resuscitation process, as well as managing the
some of the other cases with the team.
A few days later they approach you and say they can’t get the events of the evening out of
their mind-they found it difficult t that the child died despite efforts to resuscitate and
wonder if they could have done more.
How can you guide this trainee?
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Transition cycle- Williams 1999
Scenario 4
Professional Resilience
A medical ST6 has been called to coroners court.
A patient died during a night shift following an acute UGI bleed. The case
caused some tension in the trust as it was unclear whether medics or
surgeons manage these patients.
Management was delayed due to the confusion. The medical trainee
reviewed the patient when he was acutely deteriorating and managed them
as per pathway however the patient passed away during the endoscopy
procedure.
He is very anxious and has approached you about guidance on how to
approach this situation. He has become doubtful of his own practice since the
incident which has been logged as an SAE at the trust
How do you guide/support?
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How do Seniors support Resilience in
trainees?
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Compassion
Safe Space
Mentoring
Skills:
Change &
Conflict
@NHS_HealthEdEng
Education to enhance resilience
- after Baron and Howe
• Content - ethical dilemmas, causes of error
• Process - building exposure to difficulties, simulations,
increasing autonomy
• People - role models, patients, each other
• Understanding why - link to professionalism and
leadership
• Reflective Practice - reduces risk burnout
• Understanding how we think - Thinking fast and Slow –
Daniel Kahneman
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Feedback
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Losada ratio
Positive/Negative
Passive/active
Constructive/Destructive
Pendleton
• Hall 2005 goal set, objective success, subjective
success(recognition by self),identity change and new
goals
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Four steps to resilience on
organisations
1.Need senior leadership support
2.Build safe and secure work environments – find out how your team are
really feeling, get them to focus on what they have achieved and are
pleased with, and what they want to focus on. Celebrate success
3.Encourage employees to embrace tips to increase effectiveness:
Spend the first 90 minutes on the most important thing
Set 2 or 3 priorities at the end of one day for the next
Keep a to do list
Encourage people to monitor their moods
4.Develop policies and procedures that encourage employees to build
resilience and have senior leaders lead by example – breaks, exercise….
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SCARF Model for working
together – Rock
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S –status recognition –perceived threats
C-certainty-knowing what is required of you
A-autonomy-control – which would you prefer
R- relatedness-cliques
F-fairness
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Quick Wins
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Take aways
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3 good things a day
Acts of random kindness
7 minutes exercise
4 times 4 breathing exercise
Do something new
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4 deep breath techniques
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4x4x4x4x4
Breath in through your nose filling up your belly for 4
seconds
Hold for 4 seconds
Exhale through your mouth for 4 seconds
Hold for 4 seconds
Repeat x 4
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Well-being exercise
 Write down 3 things that went well in last day
 Why were they positive?
 Discuss with partner
After Seligman
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Learn a skill , Develop a habit ,change behaviour
Change for Life
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Future Planning
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SWOT
ACTION PLAN – challenging –negative self view
and really using SMART objectives
-Specific enough? Measurable? Attainableenough stretch? Relevant-reinforce positive?
Time-how limited
Long Term goals
Attitude and perspectives
valuing what you do as a
doctor, maintaining
interest in the job,
developing self-awareness
and accepting your own
limitations
Balance and prioritisation
setting limits, work life
balance and looking after
and valuing yourself,
taking effective
approaches to CPD
Organisation of your
work environment
good management,
having good staff,
effective systems at work
Supportive relationships
positive personal
relations, effective
professional relationships
and good communication
“The greatest glory in living
lies not in never falling,
but in rising every time we fall.”
Nelson Mandela
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Bounce back, Be flexible & flourish
Useful Trainee Resources
• Faculty Medical Leadership and Management
website
• Kings Fund
• DAPS Global
• Health Foundation
• IHI open school modules
• Leadership Academy – Edward Jenner
programme
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On line resources
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Free on line test for resilience quotient https://www.testyourrq.com/
Martin Seligman on resilience https://www.youtube.com/watch?v=e0LbwEVnfJA
Sven Henson Resilience – slides http://www.slideshare.net/sfmardon/sven-hansen-elf-12resilience-presented-at-education-leaders-forum-2012
Sven Henson Leadership and resilience - https://www.youtube.com/watch?v=4UCuX-Y1jpk
Sven Henson longer talk on resilience https://www.youtube.com/watch?v=Ka0LeDubU3k
Developing resilience – CIPD guide for practitioners http://www.cipd.co.uk/hrresources/guides/developing-resilience-evidence-guide.aspx
Steve Peters on Chimp Management https://www.youtube.com/watch?v=R-KI1D5NPJs
Questionnaire for signature strengths https://www.authentichappiness.sas.upenn.edu/home for
signature strengths for the VIA Survey of Character Strengths ( not the brief strengths test)
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