How resilient are doctors and can resilience skills be taught? Dr Beatrice Downie Leadership Fellow

How resilient are doctors and can resilience skills be taught? Dr Beatrice Downie Leadership Fellow

Declaration of Interest Health Education England working across the North East and North Cumbria Marsden Rock South Shields #LeadersHealth17

Aims Understand and describe resilience in doctors. Evaluate the role of training to enhance resilience skills. Understand the benefits to workplace culture of promoting resilience. #LeadersHealth17

When I needed Resilience! Moving from the Midlands to the North East Staff shortages - Sickness - Research - Relocation Specialty Exams Organising my Wedding Working in a Transplant Centre #LeadersHealth17

Resilience what is it!? The ability to bounce back from tough times, or even triumph in the face of adversity: to develop tenacity, but not at the expense of reason (Clarke + Nicholson, 2010) #LeadersHealth17

Bouncing back Recovering from setbacks Dynamic process Resilience Flexibility Learning from Adversity Avoiding destructive coping mechanisms Adaptability Managing Change Sustaining health and energy #LeadersHealth17

Resilient Behaviours Realistic optimism (Siebert, 2005) Accurate assessment of situations (Reivitch + Shatte, 2002) Self-efficacy (Reivitch & Shatte, 2002, Connor & Davidson 2003) #LeadersHealth17

Wellbeing The state of being comfortable, healthy, or happy (Oxford dictionary) Resilience is key to maintaining wellbeing. Low staff wellbeing linked to poor patient outcomes. #LeadersHealth17

Why do doctors need resilience? Exams Mental Health Physical demands Assessments Workload Family Expectations Emotional labour #LeadersHealth17

Burnout Emotional exhaustion, depersonalization (i.e., treating patients as objects), and feelings of worthlessness (Krasner, 2009) Higher rates of burnout associated with lower resilience in doctors (Cooke, 2013) #LeadersHealth17

Stress Response Curve

How Resilient are doctors? #LeadersHealth17

Assessing Resilience in Doctors Aims - to understand resilience in doctors in the NE - to explore factors affecting doctors resilience #LeadersHealth17

Connor Davidson Resilience Scale (CDRISC25) Validated psychology scale 25 questions Score 0 100 0 100 Less Resilient More Resilient Ref: Connor K.M, Davidson J.R.T, (2003), Development of a new resilience scale: the Connor-Davidson Resilience Scale (CDRISC), Depression and Anxiety, 18: 76-82. Use of scale requires purchase of licence.)

Method Group 1 Trainee Doctors Group 2 Senior Doctors (Educators) Group 3 Non Doctors n = 1,422

*Unpublished data Do these factors influence Resilience? Demographics + Protected Characteristics Age Sex Gender Disability Ethnicity Religion Marital Status Sexual Orientation Pregnant/Parental Leave Job Role Training Grade Specialty Workplace Factors Trust Hospital Site Part Time or Full Time Out of Programme

Results Trainees Doctors Senior Doctors Non Doctors CDRISC Score (mean + Sd) 69.17 ± 12.07 71.10 ± 10.94 71.27 ± 12.38 Response Rate 25% (n = 763/ 3,027) 20% (n = 578/ 2,866) 58% (n = 81/ 140) *Unpublished data

Results Regression analysis and model of best fit Predictor Coefficient P-value 95% CI Marital Status Full Time 3.90 2.78 Religious Belief 3.02 < 0.0001 1.74 4.32 <0.05 <0.01 0.93 6.87 0.70 4.86 3.21 < 0.0001 1.95 4.47 *Unpublished data

No effect } Grade Specialty Trust Hospital Site Sex Age Disability Sexuality Gender status Pregnant or on parental leave Out of programme *Unpublished data

*Unpublished data Is there a demand for resilience training? Questionnaire given to doctors at teaching days Medical Specialties, GP, Paediatrics N = 66 / 140 Mean age 32yrs

Results 74 % are aware of resilience 95 % think there is a role for Resilience training 83 % think all doctors should have resilience training Preferably early in training 9 % have attended training *Unpublished data

Is there a culture that values Doctors wellbeing and encourages them to look after their mental and physical health? Other Yes No (80%) *Unpublished data

During your training have you ever felt you are experiencing burnout? 65% No. of respondents 45 40 35 30 25 20 15 10 5 0 Yes No other *Unpublished data

Workplace Environment and Culture Pressures with understaffing lead to culture of service provision and lack of empathy for doctors In a busy stressful environment no one really cares as long as the jobs are done Don t think anyone cares about us except each other - this is getting less too

Resilience Training Mental / cognisance skills Wellbeing 29 Doctors Attended

Toolkit Approach The Circle of Influence Locus of Control ABC Thinking The PERMA Model Positive Thinking 3 gratitudes Using your Strengths and Past Successes #LeadersHealth17

Evaluation 25 20 Do you think this workshop will increase your resilience? 15 10 5 0 N = 29 *unpublished data

Evaluation 2 months post Has this workshop increased your resilience? N = 15 10 9 8 7 6 5 4 3 2 1 0 Yes No Partly *unpublished data

Changes in CDRISC Score 2 months post workshop 14 12 10 Change in CDRISC Score 8 6 4 2 0-2 A B C D E F G H I J K L M N O N = 15-4 -6 *unpublished data

2 months post workshop I have learnt some strategies to deal with stressful circumstances and have had the opportunity to put this into practice The workshop gave us the opportunity to verbalise what is important in maintaining our wellbeing. To me this is extremely important It encouraged me to focus on the stresses in my life which I can influence rather than waste time and energy (and 'let go') when there is little I can do to change the situation. *unpublished data

So what? Individual Patient Organisation Mental health Physical health Burnout Attrition Achieving potential Social/family life Patient satisfaction Quality of care Outcomes Medical error Sickness absence Attrition / staff retention Financial costs Staff Engagement Productivity Patient outcomes Reduce presenteeism

Take Home Message We owe it to ourselves, our colleagues and our patients: To maintain our wellbeing. To focus on developing resilience. To create a culture which supports this and increases engagement. To improve the system in tandem with developing resilience. #LeadersHealth17

Man never made any material as resilient as the human spirit Bernard Williams #LeadersHealth17

Acknowledgements Prof. Namita Kumar Postgraduate Dean at HEE in the North East and North Cumbria Alyson Williamson, Senior Business Manager at Education - HEE in the North East and North Cumbria Bryan Burford Lecturer in Medical Education at Newcastle University Education Team at HEE in the North East and North Cumbria

References 1 Asberg, M, ref. in Williams, M, Penman D (2011), Mindfulness: a practical guide to finding peace in a frantic world, Piatkus: London Beresin, E.V, Milligan, T.A., Balon, R., Coverdale, John, H., Louie, A, K, Weiss Roberts, L., (2016), Physician Wellbeing: a critical deficiency in Resilience Education and Training, Campbell, D (2017), Two-thirds of young doctors under serious stress, survey reveals,(online) accessed at: https://www.theguardian.com/uk-news/2017/feb/11/stressedout-doctors-anaesthetists-survey-nhs Clarke, J., Nicholson, J., (2010) Resilience; bounce back from whatever life throws at you. Connor K.M, Davidson J.R.T, (2003), Development of a new resilience scale: the Connor- Davidson Resilience Scale (CDRISC), Depression and Anxiety, 18: 76-82. Cooke, G (2013) A survey of resilience, burnout and tolerance of uncertainty in Australian General Practice registrars, BMC Medical Education Eley, D S, Cloninger, C, R, Walters, L., Laurence, C., Synnott, R, Wilkinson, D., The Relationship Between resilience and personality traits in doctors: implications for enhancing wellbeing, PeerJ, @NHS_HealthEdEng #insertcampaignhashtag

References 2 Krasner MS, Epstein RM, Beckman H, et al. (2009) Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA ;302:1284 93 Luthar SS, Cicchetti D, Becker B. The construct of resilience: a critical evaluation and guidelines for future work. Child Dev. 2000;71:543 62 Reivich, K., Shatte, A., (2002), The Resilience Factor; 7 keys to finding your inner strength and overcoming life s hurdles, Publisher: Three Rivers Press Royal College of Physicians (2016), Being a Junior Doctor. Royal College of Physicians (2015), Work and wellbeing in the NHS; why staff health matters to patient care. Siebert, A (2005), The Resiliency Advantage, San Francisco: Berrett-Koehler Publishers Zwack J, Schweitzer J. (2013) If every fifth physician is affected by burnout, what aboutthe other four?resilience strategiesofexperienced physicians. Acad Med. ;88:382 9. @NHS_HealthEdEng #insertcampaignhashtag