Linda Bender, LMSW, BSN, RN Ascension GI Conference March 30, 2019 Improving Physician Wellness Through the ASCO Resilience Skills Program Linda Bender, LMSW, BSN, RN Ascension GI Conference March 30, 2019

Numerous global studies involving nearly every medical and surgical specialty indicate that 1 in every 3 physicians is experiencing burnout at any given time. Shanafelt TD. Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care. JAMA. 2009;302(12):1338-1340.

What is burnout? A work-related stress syndrome that is particularly prominent in human services occupations such as health care. It is NOT an irreversible event but often resolves with an improvement in the work environment consistent with its close occupational alignment. Murali, K., Makker, V., Lynch, J., Banerjee, S. From Burnout to Resilience: An Update for Oncologists. 2018 ASCO Educational Book: 862

Maslach Burnout Inventory – Health Services Score: Three Domains Emotional Exhaustion “I can’t do this anymore!” Depersonalization Signaled by cynicism and sarcasm. Low Personal Accomplishment and Lack of Efficacy “What’s the use? My work doesn’t serve a purpose anyway.” Maslach, C., Jackson, S., Leiter, M. Maslach Burnout Inventory Manual, 3rd Edition, Palo Alto, CA: Consulting Psychologists Press; 1996.

Causes of Burnout The practice of clinical medicine. Your specific job. Having a life. The conditioning of your medical education. The leadership skills of your immediate supervisors. Dike Drummond, MD Physician Burnout: Its Origin, Symptoms, and Five Main Causes. Family Practice Management. 2015 Sep-Oct;22(5):42-47.

In 2016 ASCO decided to partner with palliative care physicians to address burnout and develop methods to help build primary resiliency in medical oncology fellows. What can be done?

RESILIENCE SKILLS PROGRAM The premise: There are skills that can be learned and practiced which can help physicians increase their career satisfaction and well being. The goal: To improve physician wellness in oncology through a proactive, burnout prevention approach. The targeted audience: First year oncology fellows – however, all fellows were invited and encouraged to participate.

RESILIENCE SKILLS PROGRAM Eight one hour sessions. Each session addressed a specific resilience skill. ASCO provided the teaching guide, talking points, and supporting materials. Fellows are encouraged to practice the skills and select specific skills that they are motivated to develop.

WHAT ARE THE RESILIENCE SKILLS? Resilience skills fall into three big categories: Managing your thoughts – Cognitive Behavioral Psychology Managing your attention – Mindfulness Being in touch with the meaning & purpose of your work – Humanistic Psychology

IDENTIFYING AND USING YOUR. STRENGTHS IDENTIFYING AND USING YOUR STRENGTHS *Clinicians are trained to focus on pathology, which can create a spiral of negative thinking. *Identifying and using your strengths can result in positive energy and a sense of well-being. Strengths include: Curiosity, love of learning, open-mindedness, creativity, social intelligence, perspective, bravery, persistence, authenticity, kindness, love, teamwork, fairness, spirituality, appreciation of beauty, leadership, humility, prudence, gratitude, hope, humor, zest, forgiveness.

GETTING INTO YOUR RESILIENCE ZONE- TRACKING YOUR ACTIVATION The habit of being on “automatic pilot” can impair our ability to take in what’s going on around us. When we are at our best, attention is focused, we are taking in data and making thoughtful decisions. Tracking your own activation can help you see patterns in when you feel stress and how you react. Mindfulness practice is a way of paying attention to the present moment in a manner that observes rather than judges. It helps us to notice our emotional reactions and how that affects what we do.

WORKING WITH NEGATIVE THOUGHTS AND COGNITIVE DISTORTIONS Burnout becomes established when clinicians have negative thoughts about themselves that are recurrent and exaggerated. Learning to observe and counteract negative thoughts is an important way to stay resilient. Common cognitive distortions include catastrophizing, overgeneralizing, overpersonalizing, always needing to be right, seeing things in black and white, jumping to conclusions, and discounting positive events.

USING YOUR ATTENTION MINDFULLY “Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, nonjudgmentally”. -- Jon Kabat-Zinn Mindfulness is not about “escape”. It is about paying closer attention to the present moment. An important feature of mindfulness is that one observes thoughts and feelings without doing anything to change them, elaborate on them, stop them, or alter them. Mindfulness practices actually do something that changes the way your brain works and improves your ability to focus and enhances the stability of your mind.

Ten Minute Meditations http://headspace.com http://10percenthappier.com

LIVING WITH YOUR IMPERFECTIONS- PRACTICING SELF-COMPASSION There is a tradition of perfectionism among physicians. Perfectionism, however, can have a dark side, with a tendency to be very judgmental towards oneself or others. Self-compassion is important in increasing resilience. It is important to practice kindness towards ourselves rather than judging ourselves harshly.

FINDING HEALTHY BOUNDARIES Balancing work life and personal life is difficult. Perfectionism is not all bad. Perfectionism can serve us: wanting everything to go just right for your patient is part of being a clinician. However, perfectionism can drive an “always on, always working” mentality that can undermine your personal life. Finding the “good enough” at work can be of service to find more balance in other areas of life.

KEEPING PURPOSE IN VIEW Purpose is a high level goal that is deeply valued and motivating. We can strengthen our sense of purpose by paying attention to the satisfactions we get every day. We can use mindfulness skills to see that meaning is everywhere. Can you think of one thing that you did in the past week which reminds you of the meaning your profession brings to your life?

Making a Commitment

RESOURCE FOR GRAPHS SHOWING BURNOUT STATISTICS: Medscape Oncologist Lifestyle, Happiness & Burnout Report 2019 Leslie Kane, MA, February 20, 2019 https://www.medscape.com/slideshow/2019-lifestyle-oncologist-6011132

PRIMARY RESOURCE FOR TODAY’S PRESENTATION: ASCO RESILIENCE SKILLS PROGRAM 2018-2019