1. “The Psychologically Flexible Teacher” Debra A. Gould MD, MPH; Michael J. Aquilino, MS, LMHC Central Washington Family Medicine Residency Program Yakima, Washington

2. Disclosure Deb Gould – author New Harbinger Inc. Publications Michael Aquilino – no disclosures

3. Why? We want to be Great Teachers………..  Create Nurturing Learning Environment  Be Effective  Justice

4. FM Milestone ? PROF 1 – Completes a process of professionalization…….. Level 2 – Recognizes own conflicting personal and professional values. Level 3 – Recognizes that physicians have an obligation to self-discipline and to self- regulate.

5. Goal: Psychological Flexibility Objectives: Learn about Mindfulness & Values-based Action Use Tools for developing Mindfulness & Connecting with Teaching Values Develop Action Plan for dealing with “Difficult Trainees”

6. Case: Lydia - Second Year Resident What next? Complaints - Hospitalized patients complained she was rude. Offended nursing staff with classist comments…… IMG - practiced a short time in home country Significant medical knowledge deficits Older resident Blames others for her poor performance. Has difficulty accepting feedback.

7. ACT- (Acceptance and Commitment Training) mindfulness and acceptance processes enhancing people’s ability to pursue personally valued life goals and actions. in the service of

8. 8 ACTion Plan Teaching Values: Action Steps: 1. 2. 3. Action Steps: 1. 2. 3.

9. Psychological flexibility Core Processes Be Present Connect with Values Acceptance Defuse Changing Self Act on Values

10. Psychological flexibility Be Present Connect with Values Acceptance Defuse Changing Self Act on Values Mindfulness

11. Psychological flexibility Be Present Connect with Values Acceptance Defuse Changing Self Act on Values Values

12. Direction - Not a goal What’s Important to you in how you live your life as a teacher? What are my Values as a Teacher? (Exercise - Retirement Party )

13. Tool: Values Clarification If you were at your own retirement party, what would you like to hear other people say about how you were as a teacher?

14. Teaching Values As a Good Skilled and Principled Advisor I value being: Open Active Listening Think of best interest of resident Think of best interest of patient Aware of my biases Fair Think of best interest of my program

15. TEAMS (private experience) Thoughts Emotions Associations Memories Sensations

16. TEAMS Skill Training: Sit in silence and think about a situation with a resident that troubles you… TEAMS ElementWhat comes up? Thoughts Emotions Associations Memories Sensations 16

17. TEAMS Skill Training: Sit in silence and think about some situation with a resident that troubles you.. TEAMS ElementWhat comes up? Thoughts Emotions Associations Memories Sensations 17 How could she be so insensitive? Who does she think she is? Angry, frustrated, embarrassed. Doctors who treat people like diseases instead of human beings. Feeling out of place in medical school. Tight jaw, Sigh.

18. What do I do next in advising Lydia?

19. 19 ACTion Plan Teaching Values: Action Steps: (Specific, Doable, Self-generated, Accountable) 1. Call her and ask her to meet with me. Acceptance 2. Listen to her side of the story. Be present 3. Describe perceptions of staff and patients. Changing self 4. Give assignment from Crucial Conversations. Values-based Action Action Steps: (Specific, Doable, Self-generated, Accountable) 1. Call her and ask her to meet with me. Acceptance 2. Listen to her side of the story. Be present 3. Describe perceptions of staff and patients. Changing self 4. Give assignment from Crucial Conversations. Values-based Action Open & Active Listener Think of best interest of resident, patient & staff

20. ACT builds Resiliency Mindfulness Present moment awareness Noticing and untangling from internal barriers Strengthening your resilient self Values-based Action Defining your values Mindfully engaging in values-based action Using values as a guide to goals and daily behaviors

21. ACT Resources Association for Contextual Behavioral Science www.contextualpsychology.org/ www.contextualpsychology.org/ New Harbinger Publications www.newharbinger.comwww.newharbinger.com

22. References Lloyd J, Bond FW, Flaxman PE. The value of psychological flexibility: Examining psychological mechanisms underpinning a cognitive behavioural therapy intervention for burnout. Work & Stress, 2013, 27(2):181-199. Wald HS, Anthony D, Hutchinson TA, Liben S, Smilovitch M, Donato AA. Professional Identity Formation in Medical Education for Humanistic, Resilient Physicians: Pedagogic Strategies for Bridging Theory to Practice. Acad. Med. 2015;90:753-760. Biglan A, Flay BR, Embry DD, Sandler IN. The Critical Role of Nurturing Environments for Promoting Human Wellbeing. Am Psychol. 2012 May-Jun; 67(4): 257–271.BiglanFlayEmbryAm Psychol. 2012 May-Jun; 67(4): 257–271.

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