By: Nina Honeycutt
As many a medical student and resident can attest, resilience is the wellness topic du jour. It is both prevention and cure for what ails the medical trainee: stress, fatigue, irritability, burnout, depression, anxiety, trauma… You name the challenge and there’s a wellness module, breathing exercise, and journaling prompt to develop resilience and overcome it. This misinterpretation of resilience has not only ignored the already resilient students and residents that make up our medical training system, but has resulted in its designation as a professional competency wholly dependent on the actions of individuals. This individualistic categorization of resilience absolves institutions of responsibility for the wellbeing of their trainees and in turn saddles trainees with the unrealistic expectation that they can fully control their mental and physical health during training.
Resilience is “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress.” A resilient person is able to recover from stressors and move forward from adverse events such that they experience personal growth. To put it another way, the resilient person is not strong in spite of their trials but because of them. The linked article identifies four domains that can strengthen resilience (connection, wellness, healthy thinking, and making meaning). These are valid areas of focus but they are entirely individualistic and ignore the collective responsibility of individuals, organizations, and systems in developing (or impeding) resilience.
So, what does this mean for the medical trainee with yet another resilience module on their to-do list? It means that there is personal responsibility for their own well-being and actionable items to enhance it: getting as much sleep as possible; being intentional about connecting with loved ones; nourishing themselves with healthy food, water, and exercise as they’re able; and limiting the use of alcohol, other substances, and zone out activities to manage distressing emotions. However, two things can be true: an individual can be mindful of all of the above, and no amount of yoga, deep breathing, journaling, or mindfulness can solve the problems of burnout, chronic sleep deprivation, limited access to physical and mental health care, malignant programs, abusive attendings or co-residents, and the compounding stress and trauma associated with medical training and practice.
To be effective, resilience development must encompass systemic change, and the burden of development should be shifted from students and residents to the institutions and systems that educate them. These changes include:
- Removal of mental health treatment history from state licensing applications, such that trainees can access mental health and substance use disorder care without fear of impact on ability to practice;
- Greater financial and practical support that enhances wellbeing, including increased salaries and living stipends, fully paid healthcare premiums for the trainee and their family, and observation of the 80-hour rule; and
- Increased funding for additional resident training spots.
These changes provide students and residents with the capacity to actually practice and develop resilient behavior: students and residents that can access mental health treatment early in a depressive episode can quickly return to their training without detrimental impact on their professional lives; increased trainee spots will strengthen the resident workforce such that the physician shortage problem is mitigated and resident workload is divided across more people; residents that are not financially stressed can begin planning for their financial future and also make choices that enhance wellness such as living in safe, comfortable homes near their hospitals, traveling to see family and friends, and accessing healthy food, exercise, and convenience services that enable them to take good care of themselves. These changes must work in concert to promote a medical training system that fosters resilience.
Resilience is a necessary and achievable character trait, but it cannot develop within a system that discourages and prevents students and residents from strengthening their own resiliency. Until changes are enacted at programmatic, state, and federal levels, resilience for medical trainees will become synonymous with self-care tasks, obligatory training modules, and failed promises about the importance of student and resident wellbeing.
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Nina Honeycutt is a clinical social worker, toddler mom, and resident spouse who has been on the medical training journey for nearly a decade. Her personal experience with medical students, residents, and their families has driven her interest in physician wellness. You can find her on Instagram @the.residents.wife where she shares snippets of training life and thoughts on wellness, mental health, and ways to support trainees and their families.
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Posted on November 23rd, 2020. Follow us on Instagram at (@medical.minds.matter).
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