Find yourself a Failure Friend

The article « Failing Up and Failing Better » by Sara Gray published on CanadiEM on Nov 22, 2017 outlined 5 Steps « to fail up ». The premise of the article is that failure is inevitable, so let’s accept failure and learn to fail.  The author outlined 5 principles of failure which included: 1) accepting failure, 2) breaking the silence, 3) excellent self-care, 4) learn and teach about it and 5) taking care of each other.

These principles are incredibly important as we progress further into our medical training. Take a look at this article for more information: https://canadiem.org/failing-failing-better/

It is so important to know how to support one another and debrief.

A few key pointers on learning how to debrief:

  1. Ask for permission: friends and peers may be going through a similar learning process. Debrief is most effective when friends/peers have the time to listen. Friends want to be able to listen and be present but it’s difficult to do so if they’ve had a challenging day themselves.
  2. Just the facts: Outline the story in it’s entirety to provide context to your listener. Provide your listener with context and an understanding of the situation. This allows a   “set-stage” for your emotions, and your thoughts.
  3. Express emotion: There is strength in vulnerability, and finding someone that can be your “failure friend” is key. Take the time to be honest with yourself and to find someone you can truly be 100% honest with.
  4. Learning, not finger pointing: Once you’ve processed all the facts, the emotions, reflecting on your triggers, your stressors and learning from the experience will facilitate the learning.
  5. Be present: We should aim to support, and be present, as we would expect to be supported from our own friends and colleagues; let’s be present and open-minded.

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Burnout isn’t a dirty word

Note: You can see our blog post defining burnout and its symptoms here, and a post on one strategy to cope with it here

In pre-clerkship, I would have told you that I would be able to recognize burnout in myself and my colleagues when it happened. Because, of course, based on the statistics, it would happen to some of us someday! I would have told you that there are many things that can be done to mitigate burnout, and that I, of course, would do them. Get a good night’s sleep, go home when you’re told to go home, make sure you’re eating right, take time for yourself. The thing is, clerkship came, and it just wasn’t that simple. With CaRMS hanging over our heads, we didn’t say no when we didn’t have the energy. We said it’s okay, I don’t mind staying when our preceptors suggested we go home after ten hours at the hospital. We didn’t get eight hours of sleep, we missed meals, we missed workouts, and either missed or were half present during time with friends and family. We filled our “free time” with studying, research projects, and other extracurriculars. We sometimes did, but definitely didn’t always, take the time to unpack complex emotions or debrief after the first time we were part of a code, or a patient died, or we observed a medical error with awful consequences.

We did talk about it. We discussed how difficult it was. We knew, and we tried to take better care of ourselves. We continued to remind each other why we are doing what we are doing. For the record, I don’t think burnout dominated our experience of clerkship. I think most of us would agree that clerkship was an incredibly rich, unique, amazing experience that we feel privileged to have undergone. I do think though that many (most?) of us experienced symptoms of burnout at some point or another during clerkship.

I didn’t notice my own symptoms at first, because they didn’t come out in the clinical setting. Maybe my patients were affected to some degree, but I actively worked to prevent that. I carefully monitored my thoughts and feelings towards patients to ensure that I wasn’t feeling compassion fatigue. What I didn’t realize, however, was that compassion fatigue can manifest in your personal life too. For me, it shone clearly through in the way I treated my family, friends, and partner. After a long day of seeing suicidal or psychotic patients in the emergency department, or listening to and empathizing with oncology patients, or even just seeing coughs and colds on an urgent care shift, I had nothing left. When my partner, parent, sibling, or friend needed someone to just empathize, something that had always been one of my best qualities, I didn’t have the energy to listen. I found myself annoyed with the people I loved for burdening me with more problems, when all I’d done all day was listen to other people’s.

I guess what I’m trying to say is, they’re not kidding when they call burnout insidious. The early symptoms probably happen to all of us, at some point, in some way or another. And it’s TOTALLY OKAY to admit it. Burnout isn’t a dirty word. I’d like to say I’ve figured it all out, and that I can impart some sort of wisdom upon you all to prevent it and/or fix it. But I can’t. I don’t know the answer to this problem our profession wrestles with. My friends and I have all changed, in mostly good ways and a few not-so-good ways, from our first year in the clinical setting. It’s been an incredible experience. Now, I’m actively trying to recognize when I’m feeling symptoms of burnout and create a better balance in my life to help me cope with them. I’ll let you know if I come up with something revolutionary. In the meantime, I’ll direct you to www.thehappymd.com , a site I’ve used to learn about burnout and educate my family and friends on what I’m feeling.

 

OMSA Wellness Retreat 2018: Wellness of Mind, Body, Spirit, Emotion

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Click on the follow link to view the Retreat Brochure:

Wellness Retreat Brochure

There is an exciting lineup of speakers and workshops at this year’s retreat.  See the attached brochure for details, where you’ll find options on everything from Yoga and Urban Poll Walking to Mindfulness-based Stress Reduction and Self-Care.  This retreat is open to medical students across Ontario! Mark the registration date on your calendar (March 5 at 5 pm) – it’s first come first serve with limited spots for each Ontario medical school.

Event Date:                  March 23-25, 2018

Cost:                              $90 per student for the entire weekend (incl. hotel & meals)

For more info and to register, check out the OMSA Wellness Retreat page: https://omsa.ca/en/wellness-retreat

 

BEDTIME ROUTINE – not just for kids?

Starting off medical school, I felt very overwhelmed – a combination of excitement, imposter syndrome, and anxiety as everything felt different from undergrad.

This anxiety and worry actually started translating into sleepless nights – I was consumed with these thoughts during the night, and had trouble falling asleep. I realized that I had started using television as a medium to help me fall asleep, watching Netflix to avoid my anxious thoughts.

After a few weeks, I realized how this had become my routine, and how this dependency was unhealthy. So I booked an appointment with my school’s counselling session, and made the conscious effort of having a positive sleep schedule.  

I had never consciously paid attention to my sleep routine before – I would simply sleep whenever I was tired, or had completed the day’s tasks. In fact, I had the perception that bedtime routines are only for kids. But I learned from this journey how important it is to have a routine, training your mind and body for sleep.

Below are a list of things I tried to adopt for a healthy sleep routine, and my experiences related to them.

  1. Setting a specific time

Having a set time to sleep – 12am for me – really made me aware that it was time for bed, and allowed me to prioritize sleep. It was difficult at first to remember to wind up work at 11:45 in preparation for bed, but after a few days, my body was naturally tired around 12am, and I was ready to sleep.  I found that I had less trouble convincing myself to sleep, because my body was naturally inclined to rest at the time. Also, having a set time for bed really pushed me to complete all my day’s tasks before the time, making me more efficient in terms of my daily schedule.

2. Reading a book before going to bed.

04-man-reading-book-in-bedI found this to be extremely relaxing – even reading for 10 minutes before bed had a significant impact on my mindset. I was able to forget about my daily life stressors and immerse myself into the story, which consequently made it easier to sleep. Also, by reading a book instead of watching TV, I was able to avoid being on my laptop, which felt like a break from the daily work. It gave me the sense that work-time was now over, and got me into the mindset for sleep. Also, I was able to avoid the bright light from my laptop right before bed, which may have helped attain a proper sleep as well.

3. Taking deep breaths

I had heard of the benefits that breathing techniques/meditation provides, but only recently experienced it. I decided to breathe in and out for about 3-4 minutes every night before bed, as suggested by the counsellor. I found that this was very relaxing – I was able to concentrate on breathing correctly instead of my anxious thoughts. Also taking deep breaths also triggers a change in the nervous system from ‘sympathetic’ mode – which is what we associate with fight or flight – to ‘parasympathetic’ – or ‘rest and digest’ mode, indicating that I was ready to sleep.
I have stuck to these three activities that I do on the daily – they take only about 15-20 minutes of my time before bed, and have really helped establish consistent, peaceful nights. This inevitably then also helps me start off my day well-rested.  I urge you to try these activities and adopt your own sleep schedule, and notice the dramatic improvement in sleep and mood these simple changes can make.

 

The Language of Medicine

I’d like to open with an experience from last week during my Family Medicine clerkship rotation.  A patient (let’s call him John) was next on the list, and my preceptor warned me about a severe language barrier, and that he expected me to take about twice as long as normal for that reason.  So it was with some trepidation that I walked into the room, mentally rehearsing the hand signals and charades that I would have to use.  What a surprise when I walked in and realized the patient spoke my mother tongue: Cantonese.

The look of relief that crossed his face (probably mine as well) was unmistakeable when we both realized this would go a lot better than expected.  What we didn’t realize, however, was that although I was fluent in Cantonese, I was not at all medically literate in Chinese.  Google Translate made more than one appearance as I searched for terms like “sciatica” and “post-nasal drip”.  Although we both laughed about it during the visit, it was bizarre to be both fluent, yet not, in a second language.

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Canada’s medical student population is culturally diverse, and students speak a large variety of languages.  This is, of course, invaluable given the diverse patient population.  However, I encourage medical students to brush up on medical terminology in other languages lest you run into the same experience as I did.  If nothing else, it will win you extra points with your preceptor and with the ward nurses!

There is a hidden bonus to practicing a second (or third) language on the side of medicine: you continue to exercise your mind in different ways yet within medicine, refreshing it from the mundanity of reading Bates’ Clinical Exam yet another time.  Research has shown that speaking more languages puts off the incidence of aging disorders such as Alzheimer’s.  Finally, for the pragmatic and career-oriented students out there, remember that if you speak “medicine” in another language, you make yourself more marketable in competitive fields.  Just a side bonus!

Just Do It

UnknownWhen I sat down with a friend to work on what would become the first provincial suicide intervention workshop for medical students, there were a ton of doubts.  Who would go?  Who would pay for it?  Where would this happen?  The questions kept going.  It was discouraging.

But meeting after meeting, plans slowly fell into place.  We got funding, we got special rates, we got institutional support from the Ontario Medical Association.  Through work and perseverance, we happily launched a successful Applied Suicide Intervention Skills Training workshop that is still making waves now.

Where am I going with this anecdote, you ask?  Well, my message is a simple one: Just Do It.

At few points in your life do you have as much free time as during medical school (sounds weird, but it’s true).  Classes are pass/fail, your clinical work is overseen by a preceptor, and most of us don’t have families to take care of.  Contrast this with our medical future, when work and family begin taking a greater percentage of our lives.  Talking to my peers, many med students fall into the trap of thinking medical school is about work, studying, and then de-stressing.  Rinse and repeat.  As we all know, this is no way to live your life!

Enrich yours and others lives.  If you have an idea for something that could work, be it a quality improvement project, community advocacy, or even putting on an art gala, follow it down that rabbit hole!  We hear stories of students doing amazing things every month, as OMSA posts its Student of the Month blog post.  Bear in mind that there’s nothing inherently separating you from them, save for the audacity of going just one step further than their peers, and another, and another.

I’m not going to belabour the importance of living a balanced life, but I will emphasize the importance of diversifying one’s life.  Like Jack Nicholsen in The Shining would say, “All work and no play makes Jack a dull boy.”

Every day can be a happy one

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5 Simple Steps:

1. Do something nice for another person and ACCEPT it when someone else tries to do it for you. The other day I was sitting at Paediatric Rounds and really wanting coffee but it was 8:03 AM (rounds were probably going to start in a couple of minutes).  My colleague had left the room and I texted him to see if he was getting coffee so he could grab me one as well.  He actually had gone to the bathroom but texted back saying he’d pick up a coffee for me on the way back to Rounds from the bathroom. He made himself late for Rounds and really didn’t have to do that.  I said a million thank-yous. For some reason, we have a hard time accepting nice gestures from others and feel that we should be the ones doing the ‘giving.’ He made my day and I realized that ONE unexpected nice gesture in either direction every day makes the world of a difference. Try it tomorrow.

2. Reframe the situation. Countless times people say ‘hindsight is 20/20,’ and I always thought it was too cliché.  I still think it’s cliché but it is true that everything is exaggerated in the moment. We tend to forget to put things in perspective and we often forget the potential positive outcomes of a situation.  A family member called me to say he got his car/license taken away for the next 7 days for speeding on the highway.  Some may say that the car/license being revoked maybe saved him from something worse that was going to happen at his destination.  If you don’t see it that way, hopefully you’ll agree with me that this taught a lesson about speeding.  If that doesn’t work, channel your energy towards reminding yourself of the goal of what you were doing and what you are hoping to achieve.  When we are going through medical school, we focus on the preceptor that initially didn’t like us or the test that we failed.  Instead, we should focus on the things we learned overcoming those obstacles.  If that still doesn’t work, remind yourself that someone out there probably has it worse than you and still made it through.

3. Embrace all your emotions.  We frequently equate having an argument with a friend as a ‘bad day,’ or answering a question incorrectly with ‘I know nothing on this rotation.’ Neither is true.  Self-validate your sadness post-argument.  Ask a question or clarify with your team member if you’re frustrated or confused.  Don’t wait for someone else to reassure you of your emotion. Instead, recognize the emotion, which will allow you to have an overall satisfaction with yourself for acknowledging it. Being happy does not mean you can’t be upset for 1 (or more) of the 24 hours of the day.

4. Remember that everyone has a different threshold for “happiness.” Some people want to spend their post-call days being productive and others totally want to chill out. There’s really no correct answer and frankly it doesn’t matter what makes each of us happy so long as we’re doing it.  Social media also skews our perception of this.  It imparts on us that in order to be happy, there’s a formula or some sort of recipe of the balance in your life you must strike.  I’m not saying you should get rid of social media platforms but do not use it as a benchmark of where you should be to achieve happiness.  Find your own balance.

5. If it makes you happy, why question it? I think this was a line on an episode of the The O.C. (my favourite show as a teenager). Similar to my first point, we often try to suppress our happiness especially when we are trying to stay focused or on our “A-game.”  Showing your true personality and doing the things you love will attract people (even if they do or do not share the same interests) because they’re curious about what it is that you’re so passionate about.  Feeling giddy about your interests is not mutually exclusive with being serious.  My friend called me the other night and was telling me that her preceptor on Family Medicine was bonding with her over having the same Aritzia pants. I’m not saying you should buy the same pants as your preceptor, but wear your pants and wear them proudly!

Movement as Medicine

I recently heard that some animals have this ability to physically shake off stress when they go through a fearful situation. It reminded me firstly of course of the Taylor Swift song “Shake it Off” and then also got me thinking about the role that exercise can play in physically shaking off stress. I think one of the challenges of medical school is that there can be a consistent layer of stress throughout, even when I may not feel particularly stressed I may see physiological manifestations of stress such as a new pimple. To help me with this, I have found that movement is key to target stress. Here are some ways I’ve been able to get active that I hope are helpful for you too!

  • Hiking

I find that most cities will surprise you when you go looking for trails; there are so many beautiful trails in Hamilton which I did not expect at all when I first moved here. I have found that going with groups and going at different times of day are great ways to make the same trail feel like a new experience each time. Breaking out the camera is also a great way to capture memories and be observant of animals and plants that you may not have stopped to admire otherwise.

  • Skating

I can barely skate but I love going to Pier 8 Skating Rink! I think the biggest reason is the company of friends, the great music and the view. It’s one of the sneaky ways I get a lot of cardio exercise in without feeling like I’m putting in a lot of effort.

  • Swimming

This is another exercise that is really fun for me, and again something that I do because I love it not because I’m a particularly talented swimmer. One of the wonderful things I discovered is that with my student card I had access to the pool at our school and they have fun nights and lane swim in both the shallow and deep end for swimmers of all levels.

  • Going to the Gym

This is an expected example but one that is surprising for me because I used to never make time to go to the gym. I found that once I got started doing my own thing in the gym even if it was a simple routine of treadmill and sit-ups I could feel the benefits in my body and concentration. Even though making time can be difficult even if I miss a workout or several I always find myself back in the gym as soon as I can.

  • Dance

Dance for me is something I got involved in in university and was a great social and as well as physical fitness outlet. One of the best things about dance as well is the show we put on at the end of learning the routines, having the opportunity to perform is it’s own kind of excitement and confidence booster! Even if you’re like me and don’t have any experience there are groups on campus that I found that take on beginners.

What is Burnout Anyway?

Motivation-au-travail-410x218.pngWe always used the words “I’m so burnt out.” No one really defined this for me until one of the speakers at the Wellness Retreat spoke about recognizing physician burnout. For those of you who want a quick summary, here are some resources I found online:

First of all, burnout is chronic and is associated with workplace-related stress.

1) This article talked about the signs and symptoms: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072470/

  • Exhaustion – Being both mentally drained (unable to cope) and physically drained (pain, GI symptoms)
  • Alienation from work-related activities – Finding your workplace increasingly taxing, distancing yourself emotionally from it
  • Reduced performance – Affects everyday tasks at work, being pessimistic about being there, hard to concentrate

2) So what order do these happen in?

This one-pager was useful for categorizing it into stages: http://smhp.psych.ucla.edu/qf/burnout_qt/3stages.pdf

  •  Stage 1: Stress Arousal
    • Ex. Persistent anxiety, persistent irritability
  •  Stage 2: Energy Conservation
    • Ex. Overconsumption of coffee, increased procrastination
  •  Stage 3: Exhaustion
    • Ex. Chronic headaches, wanting to move away from family

3) This PowerPoint made by Dr. Yaman at the University of Pittsburgh was also helpful to clarify how it progresses: www.pitt.edu/~super7/4011-5001/4121.ppt

Dr. Yaman cited a paper by Edelwich et al. (1980) on the five stages of disillusionment

  • enthusiasm -> excited for your job
  • stagnation -> working but becoming detached
  • frustration -> question the value of the job
  • apathy -> defend against frustration
  • intervention -> can occur at any stage to prevent/treat

4) So how do you mitigate the situation?

Dr. Yaman also discusses ways that burnt out physicians can intervene for themselves:

  • self-assessment and determination of stressors
  • specification of life priorities
    • valuing yourself and recognizing that not all demands made upon yourself can be met
  • sharing and expressing feelings
  • alleviating stress at work by focusing on positives and small successes
  • setting goals (daily, weekly, etc.)
  • breaks and variety in daily schedule
  • using a team approach to decrease counter-productiveness

OMSA Wellness Grant Event at Queen’s

Thanks to the OMSA Wellness Initiative Grant, Queen’s Medicine was able hold it’s first (and hopefully annual) Cultural Exchange Night, punnily termed InQBate, on February 16, 2017. It was an evening that highlighted the pluralism of the QMed family. We celebrated our culture and diversity through music, food, language and clothing. We also included an educational component where students of different cultures gave brief overview of their customs, traditions and cultural experiences. This fostered a sense of inclusivity, with the hopes of ultimately mitigating social isolation and strengthening the intercultural connections within our medical school community.

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Given that the event was a potluck, we had a wide array of foods, from Mexican delicacies to tasty Armenian dishes to authentic Indian chai – it was a feast! We had some spontaneous dancing, the application of mehndi (henna) and captivating storytelling of people’s cultural experiences. It was an event that allowed us to share our stories, often of immigration, adversity, triumph and gratitude. It was a wonderful reminder that diversity in culture, religion, ethnicity and other realms add richness to our community that is unparalleled.