Can we“teach”resilience? G Kay

What is resilience? “Resilience is the capacity to respond to stress in a healthy way such that goals are achieved at minimal psychological and physical cost; resilient individuals "bounce back" after challenges while also growing stronger” (Epstein et Al, Academic Medicine Mar 2013)

Another definition… “Resilience can be defined as the ability to bounce back from setbacks and keep going in the face of tough challenges. Resilience at work can be described as the capability to maintain high performance and positive wellbeing” (WHO)

Do our trainees have resilience? Looking at personality traits more reliable than assessing single measures of stress or resilience Four personality traits have strong influence: Self Directedness Cooperativeness Harm avoidance Persistence

Self Directedness The ability to regulate and adapt behaviour to the demands of a situation in order to achieve personally chosen goals and values Conscientious Resourceful Goal orientated Accept responsibility for mistakes, learn and move on Associated with internal locus of control

Cooperativeness Accept opinions and behaviours of colleagues Don’t lose sight of own principles but work out solutions to achieve best outcome for all Low cooperativeness might suggest poor communication and lack of empathy

Harm avoidance Personality trait characterized by excessive worrying; pessimism; shyness; and being fearful, doubtful, and easily fatigued Clinicians low in harm avoidance are more decisive and less anxious Ability to accept uncertainty and risk

Persistence Maintaining behaviour with stamina despite frustration, fatigue or discouragement High persistence can be associated with perfectionism which can lead to burnout Aim for healthy level of persistence by identifying and accepting limitations, learning from failures, setting realistic goals

Other aspects of resilience for GPs Attitudes and perspectives – valuing role, maintain interest Frequency of access to positive emotions Balance and prioritisation – setting limits, effective approach to CPD Supportive relationships – personal, professional. Good communication Practice management style – good staff, effective practice arrangements

Discussion points 1. Have you had concerns about a trainee’s resilience? What were the warning signs? How could we identify these trainees early enough to help? 2. How can we help a trainee to enhance their resilience? Any tips from previous experience? What resources might be useful?

So how can trainers help? Awareness of own personality traits Awareness of trainee’s personality traits Less didactic and more self directed learning Help trainees set realistic goals Give feedback appropriately and help trainees respond Giving trainees choice and control of learning Graded exposure to uncertainty and challenges Positive role-modelling Unobtrusive monitoring of well-being Encourage them to look for examples of resilience in others Encourage housekeeping, awareness of burnout etc