1. Promoting Resident Wellness Through Better Stress Management Margaret Rea, Ph.D. GME Counselor UC Davis School of Medicine

2. Why are We Concerned if Residents are Not Managing Stress Well?

3. July September NovemberJanuary The Evolution of the Resident

4. We Want to Avoid: Physical Changes Emotional changes Maladaptive responses Poor Patient Care

5. Bad Equation High demands of work + Perfectionism + Feelings of lack of control + Few Rewards = STRESS

6. We Want to Avoid Burnout:

7. Emotional exhaustion Depersonalization Feeling inefficient on the job

8. Emotional Exhaustion= Feeling emotionally overextended and exhausted by work

9. Depersonalization= Unfeeling and impersonal response to one’s efforts

10. Feeling Inefficient= Incompetent

11. We Want to Protect Against: Depression Anxiety Substance Abuse

12. We Want You To: Maintain meaning and satisfaction with your job Maintain and or get back some of the energy and enthusiasm that brought you to medicine Maintain a personal life and achieve some balance between work and home

13. What Can We Do To Assist You? We can’t make the stress of residency disappear, but we can try to assist you in achieving some balance so you can maintain your physical and psychological health

14. How do we do that? Can we do that?

15. We Do Not Want To Cause More Stress with Stress Management

17. What Techniques Do you Currently Use to Promote Wellness?

20. Unhelpful Stress Management Techniques Escape through drugs and alcohol Short cuts at work: lying, dumping: “Its pending” Overeating/under eating Taking out on others: colleagues, students Acting out at home

21. Can Residents Really Use Typical Stress Management Techniques?

22. Can Residents Modify Their Style and Consider Wellness Obsessive traits High to unrealistic expectations of self “Addiction” work Competition to do better than others Stress is a motivator

23. Life Curriculum for Residents Duke University: ERASE E xercise Relaxation Activities Supportive Relationships Emotional Expression

24. Exercise: Can Residents Really do This?

27. Exercise Options for Residents Hospital Stairs Walk around hospital Hospital Gym: Rooms 7148 and 7156- Code 541 Equipment at home 24 Hour Gym Ramp

28. Relaxation Deep breathing Muscle relaxation Meditation Imagery/Visualization Mindfulness

30. Meditation Focus on: Sound Image Phrase Breathing

31. Time Outs I pod/CD- (only for time out) Power nap Social Interlude: call a friend,call home, grab coffee with fellow resident Walk the perimeter or ramp Library

32. Enjoyable Activities: Can You Remember Any? Try to remember what used to be enjoyable Try and find a concrete hobby that can balance chaos of the hospital

33. Support Systems !!!!!!!!!! Reach out to family and friends Keep personal relationships intact A short phone call can help Form alliances with other residents Consider counseling, even one session

34. Emotional Expression Expressing emotions in safe and appropriate way leads to better coping with family, friends, counselor Keep a journal Touch base with seniors and supervisors ISOLATION=POOR OUTCOME

35. Why Consider Counseling Venting to someone helps Practice stress management skills Problem solve One session or continuing Regular or intermittent

38. Mental Traps Keeping You From Counseling Fear of exposure to fellow residents, colleagues, patients Fear it is not confidential “I can heal myself” Fear failure

39. Avoid Trap “If I admit I am struggling THEY will figure out I really don’t belong, I can do it”

40. What Else Can Help?

41. Reframing World View: You Have a Choice We often can’t change the reality, but we can change how we think about it We can take control of how we respond to events We can adopt more helpful interpretations

43. Realism not perfectionism Embrace the challenge and opportunities Avoid victim interpretation

44. “They are out to get me, they are dumping on me, they are slamming me” vs. “It is a bad night, how can I make things work”

45. Avoid the Trap of “Service PTSD” You begin re-living a bad service or ward experience You then predict it will happen again You become pre-occupied, expecting worse You walk in with heightened arousal and stress

46. Avoid the Victim Role at Home If you arrive home feeling abused, your family will often respond negatively They want your presence so be present

48. Take Charge of Your Wellness: Be Mindful!!!!!

49. Eat Laugh Take a Time Out Communicate Get Support, Reach Out Take Care of Each Other