1. Error is the raw data of learning: developing resilience in the face of setback Louise Davis Richard Canter

2. This session What is resilience? Does it matter in healthcare settings? Can we measure resilience? Is resilience in healthcare less than it used to be? Can resilience be developed? What can educational systems offer in terms of improving resilience? TASK How would would you develop processes to improve resilience in your trainees?

3. Does it matter in healthcare?

4. GMC recommendation 2014 Making emotional resilience training an integral part of the medical curriculum

5. What is resilience? Discuss in pairs for 2 mins what is resilience?

7. What is resilience? Psychological resilience is defined as an individual's ability to properly adapt to stress and adversity. – Resilience should be considered a process, rather than a trait to be had Stress and adversity – family or relationship problems – health problems – workplace and financial stressors

8. The word bouncebackability was first coined by Iain Dowie whilst he was manager of Crystal Palace football club famously described his team as showing '… great bouncebackability'.

9. What is resilience? Studies show that there are several other factors which develop and sustain a person's resilience – The ability to make realistic plans and being capable of taking the steps necessary to follow through with them – A positive self-concept and confidence in one’s strengths and abilities – Communication and problem-solving skills – The ability to manage strong impulses and feelings

10. Most important factor The primary factor in resilience is having positive relationships inside or outside one's family. – It is the single most critical means of handling both ordinary and extraordinary levels of stress.

11. Does it matter in healthcare ? An applied literature search – in education, ethics, psychology and sociology ‘What is resilience and what might it mean for professional development in medical education?’ Howe A, Smajdo A & Sto¨ckl A. Towards an understanding of resilience and its relevance to medical training Medical Education 2012: 46: 349–356 doi:10.1111/j.1365-2923.2011.04188.x

12. Does it matter in healthcare? Resilience includes following: – self-efficacy, self-control, ability to engage support and help, learning from difficulties, and persistence despite blocks to progress Known to be qualities in clinical leaders Much of what we regard as good practice in modern medical education, support the development of resilient processes Howe A, Smajdo A & Sto¨ckl A. Towards an understanding of resilience and its relevance to medical training Medical Education 2012: 46: 349–356 doi:10.1111/j.1365-2923.2011.04188.x

13. Can we measure resilience? Systematic review of papers on resilience identified 19 resilience measures found – 4 were variations of a single measure leaving n=15 No “gold standard”, – “questionable theoretical adequacy of many of the scales used” Overall 3 were found to be “the best”. – Lack of validation statistics Windle et al. A methodological review of resilience measurement scales. Health and Quality of Life Outcomes 2011, 9:8 http://www.hqlo.com/content/9/1/8

14. Does informal resilience training already exist on your training programmes?

15. Are support structures less than they used to be? Argued that “having positive relationships inside or outside one's family” single most important factor in resilience Working hours directives and pressures of service mean that hospitals and primary care are more lonely places than they used to be. Morbidity and mortality meetings given way to governance meetings

16. How would you develop resilience in your training programmes? Discuss Flip chart Collect ideas Consolidate Send round to others

17. Can resilience be developed? Maintain good relationships both inside and outside of work Avoid seeing crises as unbearable problems Accept what cannot be changed Develop realistic goals Take decisive actions where needed Look for opportunities for self discovery Develop self confidence Take a longer term perspective on problems Maintain a hopeful outlook and visualize what you wish Take care of oneself mentally and physically eg exercise American Psychological Association

18. Identifying your self help SSRIs S trategies – Practical things we do eg asking for help, using problem solving approaches, meditation, attention to diet and expercise S trengths – Draw on our own courage, determnination, sense of humour, flexibility, ability to communicate R esources – Support and guidance from friends, mentors, self help books, support groups, telephone helplines I nsights – Ideas, perspectives, sayings we find useful eg “I can’t, we can”, a journey approach to change, seeing setback as data for learning. Johnstone C. (2010) Find Your Power. Permanent Publications website hhtp://chrisjohnstone.info

19. Video! From Monty Python and the Holy Grail Search on youtube for clip of the Black Knight If you want to watch it again!