Beyond Kale and Pedicures: Can We Beat Burnout and Compassion Fatigue?

I have been locked out of the seminar room.
 
Peering through the glazing, I can see two dozen operating room nurses in scrubs, milling about inside the auditorium. The space is nearly full, and they are chatting and eating lunch. The session on compassion fatigue and self-care is about to begin, but the door is locked and I can’t get in. I knock once, and then again a little bit louder. They can see me, but no one comes to unlock the door.
 
Problem is, I am the presenter, and this isn’t starting out particularly well.
 
After a few minutes, the caterer, who has just delivered sandwiches to the team, unlocks the door from the inside and whispers to me on his way out: “I’m warning you, it’s worse than high school in there.” It turns out that this group has just learned that all of their summer leave has been cancelled, due to cutbacks, but this session is mandatory, so there they are, steaming mad, and not particularly inspired to discuss sleep hygiene and breathing with me.
 
Luckily, this isn’t my first rodeo, so I am not too rattled. I am also lucky to rarely encounter such hostile audiences, but I do specialize in delivering training to high stress, high trauma-exposed helping professionals: prison guards, child welfare workers, trauma nurses and docs, and so many others who are trying to care for patients and clients in an increasingly challenging and under-resourced climate. But at this point, in 2011, I am starting to ask myself whether what I am teaching them is at all effective.
 
Many of my audiences express growing frustration at working in a system that feels broken, and no amount of kale and yoga can fix that overnight.
 

Have car, will travel

 

I became a compassion fatigue specialist by accident, or rather, by necessity.

I completed my counselling degree nearly 20 years ago and I was very fortunate in receiving first-rate training at Columbia University and at the University of Toronto. Our courses explored issues of multiculturalism, racism, gender bias, addiction, transference, and many other challenging and stimulating topics.

The Columbia program was considered pretty cutting edge, and by virtue of its location and affiliations we had the opportunity to hear from guest lecturers who were truly thought leaders in the field. Once, our class attended a clinical demonstration with the renowned psychologist Dr. Albert Ellis. I didn’t particularly like it – or him, for that matter – but these were invaluable opportunities to learn from the big guns.

Our training invited rigorous self-reflection and an exploration of our own biases and assumptions. However, in spite of all this excellent training, I never once heard any of my instructors mention the concepts of burnout, compassion fatigue (CF), vicarious trauma (VT), secondary traumatic stress (STS) or even use the words “self-care” in any of their lectures.

I also received no training in psychological trauma, except for a brief mention in one lecture. After graduation, I soon discovered that in spite of the great pedigree of my alma maters, I was completely ill-equipped for the real world of mental health counseling.

Crisis work is what drew me to the field. Before pursuing graduate training, I had worked as a volunteer in a hospital emergency ward. We saw it all – multiple vehicle accidents, entire families wiped out by a drunk driver, children who had been harmed by their parents, heart attacks, overdoses. It was intense, sometimes shocking work and I absolutely loved it. Have you ever had this feeling that something is just a perfect fit? You just know? That’s how I felt about crisis intervention.

This was it, the career that had been waiting for me. I am sure that my attraction to crisis work was partly due to my own life history, having been the informal crisis counselor to members of my extended family during my teens, during a dark and tumultuous decade of traumas that befell us. This is not unusual – therapists are often drawn to the field for personal reasons, whether they fully recognize it or not.

Hot Walk and Talk Protocol

Protocol for the Hot Walk and Talk

©2012 Patricia Fisher, Ph.D.

This protocol applies when there has been no physical injury and the person is stable enough in the aftermath to proceed. In the event that the individual has been physically injured or is in shock you would need to follow emergency procedures and get the appropriate immediate medical resources.

This protocol is designed to provide helpful first aid immediately after a team member experiences a particularly distressing or disturbing incident and is undergoing a completely normal stress reaction. This is something either supervisors or peers can offer each other and you will consider what would work best for you in your particular circumstances.

Remember that when we are experiencing a high stress response our body is in the flight, fight or freeze state and we are flooding with stress hormones and all the physical, emotional and cognitive responses that go with that. So, our first response introduces safety and containment for the person.

The following steps in the process are typically helpful:

  1. Go to the individual, ensure that they are physically out of danger, and ask them to come walk with you.
  2. Walk away from the area where the incident occurred and toward a neutral or safe area (if you can get outside that can be even more grounding).
  3. Walk beside them and set a pace that is brisk enough to engage the individual and help them discharge some of the distress… as the walk proceeds you may find that they naturally slow the pace – let them progressively have more control over the pace as the debriefing proceeds.
  4. Bring a bottle of water and have them drink the water as you walk
  5. Let them know that they are safe now and you are here to support them as they move through this absolutely normal response to high stress.
  6. Ask them to tell you what happened in their own words, if they seem stuck in the incident, prompt them to move on with the narrative by asking “and then what happened”. You want to help them move through the whole narrative from beginning to the end – until they get to the present where they are walking with you in safety and are no longer at risk.
  7. After you have gone through this initial debrief you may work in an environment where you are required to complete an incident report. If this is the case, go with the individual and ask them how you can help in completing the report. They may want you to type in the information as they dictate it, or they may simply appreciate your presence while they complete the report.
  8. Remember to remind them to focus on their breathing and open posture to help them deescalate from the stress response – especially after you have stopped walking and may be standing or sitting.
  9. After the initial debrief and report (if required), ask the person what they would find helpful now? Do they want to phone a family member, get a sandwich, take a break, go back to work? They need to have control over their choices while attending to their needs.
  10. Let the individual know that you will remain available to them and encourage them to access addition supports that may be available if they would find them helpful (e.g., Employee Assistance Programs, counselling, other community resources)

Following, and sometimes parallel to, this immediate first aid response, there may be additional steps needed from an institutional perspective. These may include:

  • 􏰃  The debriefer stays with the affected person, and asks a colleague to notify the supervisor about the incident. The debriefer can provide updates to the supervisor as needed.
  • 􏰃  The supervisor speaks with the affected person(s) and assesses whether the person should remain at work following the incident. The debriefer or supervisor assists with making travel arrangements if the affected person is not in a condition to drive home. If the affected person goes home early, the supervisor phones the affected person to ensure that they arrived home safely.
  • 􏰃  The debriefer emails a summary of the incident to the supervisor, based on the information gathered from the affected person. The supervisor may also be responsible for submitting paperwork.
  • 􏰃  The supervisor updates other staff in the office about the incident, as needed.
  • 􏰃  The supervisor works with the affected person(s) to discuss any case management or other relevant

    decisions in relation to the incident.

  • 􏰃  The supervisor will check-in periodically with the affected person and continue to offer support in the weeks that follow.

Unspoken Impact of Trauma on First Responders by Michael V. Genovese

unspoken-trauma-first-responders-michael-genovese

Michael V. Genovese, M.D., J.D., is the chief medical officer of Acadia Healthcare which operates a network of 585 behavioral health facilities with approximately 17,900 beds in 40 States, the United Kingdom and Puerto Rico. As well, he is the Medical Director of the Officer Safety and Wellness Committee of the FBI National Academy Associates. Dr. Genovese is also an advocate for attorneys and first responders seeking treatment for addiction and co-occurring disorders.

Dr. Genovese writes, speaks, teaches and consults widely in the disciplines of pharmacology, neuromodulation and pharmacogenomics. He has kindly agreed to allow us to share his article on the impact of trauma on first responders. 


Bravery is one act, but courage is consistent. And our nation’s first responders are the very definition of courage. Each day, they make the difficult choice to run towards the danger that we run from. In doing so, these officers experience significant trauma, yet rarely have the opportunity to process those experiences before speeding off to the next emergency. 

Science shows that repeated trauma alters the neural pathways and injures the brain. These Post-Traumatic Stress Injuries are linked to startling, yet often unreported, rates of mental health illness, which can manifest into substance abuse or worse. In fact, first responders are more likely to die by suicide than in the line of duty. 

So why are our heroes not receiving the help they need? In my role as medical director of the Officer Safety and Wellness Committee of the FBI National Academy Associates, I’ve met countless officers who have struggled to overcome the trauma experienced in their line of work. Many say they’re expected to be mentally and physically tough, and the stigma around mental health treatment prevails. Admitting they have a problem may cost them their badge – and their identity. 

This is quickly becoming a national crisis, but too many departments are reluctant to admit this crisis exists, much less implement programs to address it. Here are four ways we can change that:

 

Acknowledge mental health injury

Post-traumatic stress is an injury, not a weakness. If a first responder broke his or her leg in the line of duty, treatment would be a no-brainer. We must recognize and treat brain injuries in the same way. 

 

Build resiliency through training

It is not enough to wait until officers are injured. We need to proactively provide training to help officers build resiliency. Resiliency can be learned and can help officers manage the extreme pressure and trauma inherent in the job. 

 

Shift the culture, from the top

Law enforcement agencies must normalize mental health care by proactively offering support services and treatment. This requires a shift in culture which must be led from the top. Support systems can include employee assistance programs, peer support policies and confidential resources, to name just a few.

I am proud to be a part of Treatment Placement Specialists, which provides treatment guidance that reflects the individualized needs of officers. Substance Abuse and Mental Health Services Administration (SAMHSA) also provides excellent resources for mental health treatment.

 

Build pathways back to work

In most professions, overcoming personal challenges, such as depression or substance abuse, is supported and celebrated. But for first responders, the result is often the loss of their job. This severe punishment is unnecessary and leads to further trauma and depression. We need to formalize a pathway back to service, so individuals aren’t penalized for seeking help. 

These are not just academic suggestions. These are practical measures that progressive departments are already taking – and they are working. 

We all know the saying, “To whom much is given, much is required.” When we consider all that is asked of our first responders, we should consider a new phrase:

From whom much is required, much should be given.

We must support those who serve by acknowledging the trauma they experience and providing treatment to address the very real impacts on their health. Will you join me? 

References: 

Genovese, M. (2018, October). How Trauma Causes Alternate Pathways in the BrainRebuilding Officer Resiliency: A Treatment Guide, 4-6.

Heyman, M., Dill, J., & Douglas, R. (2018). Mental Health and Suicide of First Responders [White Paper].

 

Ten Tips for Less Evening Over-Eating with Dr. Deb Thompson

ten-tips-for-less-evening-overeating-deb-thompson

Dr. Deb Thompson is a registered psychologist, certified Integral Master Coach™ and longtime colleague of Françoise’s. They met over 23 years ago while working as clinicians at a University Student Counselling Service and subsequently shared a private practice office for many years.

In this guest blog post, Dr. Thompson share’s tips gained from her many years working with clients in the field of body wellness. You can find out more about Deb on her website or follow her on Facebook. 


As a psychologist/coach and course facilitator specializing in weight wellness, I’ve noticed time and time again how over-eating in the evening is such a common and maddening challenge. I also know this terrain personally, as someone who struggled mightily with food, self-care and weight from my teens to late 30’s.

Are you frustrated by the wheels falling off your wellness bus after work and/or at night despite nourishing yourself fairly well during the day?  

Our Inner Critics can attribute this to weakness, but I encourage your Inner Mentor to get more grounded in knowing that our evening over-eating arises from the perfect storm of being hungry, depleted and/or churning with emotions.  

Here are ten tips for circumventing these vulnerabilities with some new or renewed habits, practices and mindset moves:

 

1. Don’t arrive home ravenous!

Plan and pack or buy a snack for late afternoon because high, high hunger is high, high risk! When our blood sugar is dropping and our bellies are growling, our primal brains direct us to mow down, which can make for chunks of cheddar or handfuls of trail mix that not only derail our dinners, but also our wellness over the long run.

Snacks with some protein, such as whole grain crackers with hummus, a hard-boiled egg or cheese string, almonds with an apple, Greek yogurt or a decaf latte, will stick to your ribs and see you through your commute and transition to home. Higher fiber foods like apples or popcorn can be filling too.

See if eating in a planful way during the late afternoon helps you eat less in the evenings, and thereby, helps you to eat less overall. It almost always does!

 

2. Prep a snack

Alternatively, prepare a snack to be ready for you when you get home — a kindly gift from earlier-more-energetic-you to later-whipped-you!  If you have kids, this can also help you get through what I used to call the “Arsenic Hour” when everyone is hangry.

Cut up veggies or fruits with different healthy dips are handy, as well as helpful for getting in our seven or more recommended daily servings of produce.

 

3. Disrupt your pathway

Aside from a planned snack, don’t mindlessly head to the kitchen as soon as you get in the door or you are off duty for the night. Go to a different room, do something different — even a few minutes of belly breathing, getting into comfies, or washing your face can break the auto-pilot pattern of cruising the cupboards or fridge.

As Viktor Frankl said, “Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.creating the gap is key!

 

4. Take a few minutes to transition

In this space, take a few minutes to transition — after work, change your clothes, put on upbeat or chill music, bring in nice scents with lotions or essential oils, create your own shifting gears ritual…

You may have to train other people to leave you alone for a few minutes, especially if those people are wee ones, but it can be done. You can also create a non-food ritual for exhaling at the end of your second shift… once you are off duty for the evening (more on this in Tip #8).

5. Meal planning for success

A little meal planning and preparation can go a long way to ensure faster and easier healthy suppers on busy work nights… you don’t have to be Martha Stewart, but having veggies ready to stir fry or roast, planned-overs to warm up, a soup or stew or chili in the slow cooker, or a sheet pan dinner ready to assemble in minutes are all golden.

Again, re-frame this as an empathic gift from the person that you are on Sunday afternoons to the person you sometimes become by Tuesday 7pm when you are more depleted, hungry and feeling worn out. Try to keep perfectionism out of the equation to avoid tipping into all-or-nothing thinking or what has been called the “what the hell” phenomenon where we overeat to deal with our emotional frustrations and feelings of self-blame.

Having a sticky note reminder of some quicker-than-take out and healthier-than-cheese-and-crackers options, like scrambled eggs or ready-made soup, is also helpful.  

 

6. Process your thoughts and feelings

The emotional residue of our days often rumbles through us into the evening, and it is so very tempting to soothe, numb and reward with food (and wine!).

One strategy is to use free writing to honour and process thoughts and feelings — set a timer for 7 minutes and write without pausing the pen (or editing — this is a *dump* — not journaling or essay writing!) to help process your day…let it rip, say *anything*… vent, rant, complain, yearn.

When the timer goes, aim to have your Inner Mentor extend kindness and empathy to yourself, as well as see if there are any *Actions* or *Don’t forget* items that need put on your To Do list. Then shred or burn the papers over the sink, wash up and exhale.

Cultivating compassion for having done your best… as well as showing yourself kindness and generosity for the true complexity of the challenges of our work is also a powerful component of this practice. For further strategies for lessening the grip of emotional eating, check out these downloadable resources:

Four N’s Instead of Food as Friend [PDF]

Meeting Emotional Needs without Food [PDF]

Getting support, such as through coaching, counselling and the excellent courses here at TEND also helps with reducing the burnout, compassion fatigue and vicarious trauma that can leave us overly vulnerable to turning to food as a (lousy) “friend”.

 

7. Build a Nourished Life

Indeed, everyone benefits from support to build nourished lives such that we have less depletion and stress to prompt us to over-eat after work or at night. This can include creating more belonging, boundaries, a less taxing workload, play/fun/hobbies, rest and sleep, regular enjoyable exercise, emotional supports, and especially: alignment between our core values and our actual lives.

Building a nourished life takes time, and guidance/supports, but it’s important that we put some energy into the prevention of being spread thin, not just coping with it.

What’s ONE thing you might do this week to move the needle a tiny bit on behalf of more movement, rest, play, or connection? You could get to bed 20 minutes earlier, you could do a 15 minute yoga video in your living room, you could plan a coffee date with an old friend, you could sign up for art lessons, you could explore options for coaching or counselling.

 

8. Curate a Menu of Alternatives

Ok, back to more directly disrupting the habit of eating at the end-of-day when you are finally off duty… it’s helpful to develop a menu of alternatives to snacking or imbibing.

Perhaps a bath, a good book, magazine, podcast or show on Netflix? Colouring, crafts, games or texting? A warm drink? Some puttering or light tidying up or getting things ready? Or if this last one feels like more work (which may prompt eating as an escape or reward), then leaving those tasks for morning?

Looking over your menu can help you choose what will soothe, restore and calm you tonight.

 

9. Enjoy a Low Calorie Treat

For end of day, you may like to plan for a yummy-to-you low calorie treat (eating at night is not necessarily problematic unless it involves EXTRA calories)… winter seems like a wonderful time for a baked apple (here’s a microwave recipe).  

It’s helpful to keep high temptation treats like chocolate, chips, ice cream, cookies, etc. either out of the house, or at least out of sight and hard to access… as we do tend to eat more in response to availability. Forbidding these foods is not necessary (and often really backfires into all-or-none yo-yo-ing), but often having single serving options, planned treats when eating out, and healthier alternatives such as popcorn instead of Doritos; broth, decaf or herbal tea instead of wine; or Fudgsicles instead of Hagen Daz are very supportive.

 

10. Reconsider the Division of Labour

If part of your evening over-eating is related to feeling beleaguered and exhausted regarding the division of labour in your home, it can be helpful to have a series of conversations about who does what when with your partner/family. Teaching kids to pitch in can be an investment that pays off in the long run.

If you live alone, get creative in how you might outsource some work  such as cleaning or getting more ready-made foods from the grocery store, and/or have chore or cooking parties with other single friends. Finally, most of us can also lessen our weariness (and vulnerability to emotional or “Eff It” eating) by softening our standards, letting go of impeccability and embracing imperfection with more compassion.


For more, check out this webinar with Dr. Deb Thompson and Françoise Mathieu on how to curb emotional eating [from December 4th, 2017]

Learning to Navigate Workplace Conflict

navigate-workplace-conflict-meaghan-welfare-mathieu

 

In today’s world of work, we can be certain of three things: there will be change, there will be stress and these two factors may eventually cause conflict between staff and/or their leaders.

We speak to many professionals who work in a wide range of sectors and the most common source of distress is the ever-increasing pace and volume of work. The expectations of working faster with fewer resources and having to do more with less, are causing serious problems. These problems can cause team members to experience resentment and internal conflict.

Many of these issues stem from budget cutbacks. As a result, companies and organizations face massive changes: layoffs, reorganizations, job abolitions, changes in mandate, elevated conflict and a lot of uncertainty and fear of what is yet to come. 

Perhaps one of the most significant changes we have seen in the last few years – again, directly related to budget cutbacks – is the increase in competitive relationships in the workplace. This can directly contribute to interpersonal conflict, increased stress and sick leave, and a general dissatisfaction with work.

Navigating through these challenging times can be hard – even for the most resilient.

So, what can we do about all this change?

While conflict and stress are never truly preventable, we can learn effective approaches for maximizing positive outcomes. Here are three strategies to help you navigate change and conflict. 

Understand the Transition Phase

 

We all know that change can be difficult, however, even more stressful is the time between the end of the old and the beginning of the new – the transition phase.

The ability to navigate through the transition phase is all about the practice of resiliency. By recognizing our strengths and working on our areas of growth, we will be better equipped to deal with the uncertainty of this phase.

It is also important to explore what about the unknown is causing us the most stress. Is it that we are afraid of losing our job? Losing a good manager? Losing control over certain roles and responsibilities?

A good strategy is to focus on the areas of our lives where we have control. In The 7 Habits of Highly Effective People, Stephen Covey presents the circles of concern and influence. He encourages us to focus on those things in our lives that we have influence over and avoid squandering our energy on those that are outside of our control.

However, there will be times when we truly have no control over the future. During these times, we can fall into what psychologists refer to as “fortune-telling.” This is when we obsess over all the possible scenarios that may or may not take place. Fortune-telling can be a normal response to uncertainty, but if it dominates our days and nights, we may need to seek outside support from a counsellor, coach or a mentor.

 

Reflect on Your Reactions to Stress

 

Change can be hard for many of us, and it can elicit a whole host of reactions among different people. Understanding your unique response to stress can help you be proactive about taking positive steps to care for yourself.

A good strategy is to reflect on the question: “What does change and uncertainty mean for me?” Consider this question in general terms, not just as it relates to work.

Here are a few more questions to consider:

  • Am I someone who thrives on change? Or, does change make me anxious and irritable? 
  • What are my stress responses? How do I act when I am stressed? 
  • Are my reactions to stress similar or vastly different from those of my colleagues? How can I use this information? 
  • Are my negative reactions to change short-term or longer lasting?

Some of us dislike change and uncertainty but can, with time, adjust extremely well to the new situation. Sharing this process with your close colleague and even a trusted supervisor can help prevent some misunderstandings and ruffled feelings.

 

Embrace Conflict

 

As we navigate through our work days, we are confronted with conflict on different scales – perhaps someone drank the last cup of coffee and didn’t make more; maybe someone jammed the photocopier and walked away; or maybe you are experiencing bullying and harassment.

The fact of the matter is that conflict has a ubiquitous influence on our working relationships.

A 2008 study conducted by CPP Global found that employees spend an average of 2.8 to 3.3 hours a week dealing with conflict. Human resource workers spend upwards of 51% of their week addressing conflicts. 

Unmanaged conflict is costly. It affects the mental health of employees, which results in absenteeism, employee retention issues and a negative institutional reputation. 

Good employees and strong leaders are those who are not only aware of their conflict and communication styles, but are those who are able to direct those styles and skills towards win-win outcomes and positive working relationships.

Let’s face it – the work can be fulfilling, but if the relationships are bad, the ship will sink quickly. Anchor yourself at work with the knowledge and skills you need to participate in meaningful conflict.

There are two elements to understanding conflict:

Know yourself 

If you know your default response to conflict, you will be better prepared to deal with conflicts when they arise. There are many benefits to knowing your style, including; the ability to move seamlessly between styles based on the situation; the ability to adapt your style based on the style of those you are in conflict with; and increased confidence with your ability to deal with conflict.

Know your organizational conflict culture

All companies, organizations and workplaces have unique cultures of conflict. Do you work in an environment where conflict is embraced and seen as a force multiplier, or is conflict avoided at all costs?  If you know the culture, you will be better equipped when conflict arises to be a positive contributor to the culture.

Conflict can be fun! People often laugh at this statement, but it is true. Conflict is inevitable, and the best strategy is to develop a good understanding of your own responses to conflict. Learn to welcome conflict as a productive and enhancing workplace force.

 

Parting Advice

 

Not all workplaces can afford to send their staff to outside training, so employees may need to take matters into their own hands.

Invest in your future by attending workshops and trainings that will enhance your interpersonal skills. Many not-for profit organizations offer inexpensive workshops on conflict management and communication skills.

Here are some great resources to get started:

 

Books: 

Resolving Conflicts at Work by Kenneth Cloke

Conflict Resolution for the Helping Professions by Allan Barsky

Is Work Killing You? A Doctor’s prescription for treating workplace stress by David Posen

Rebounders: How Winners Pivot from Setback to Success by Rick Newman

Building Resilient Teams by Dr. Patricia Fisher

The Advantage: Why Organizational Health trumps everything else in business by Patrick Lencioni


Author: By the TEND team with files from Meaghan Welfare.

 

The Future of Compassion Fatigue Education: Working Partnerships with Mental Health Professionals

*Reprinted with Permission

The concept of compassion fatigue (CF) has received increased attention in the animal care and welfare professions in recent years. This is a positive trend. Today, thanks to courses such as IAABC’s Animal Behavior Consulting: Principles & Practice, which contains a full module on compassion fatigue, people who work with animals are better able to access resources informing them that they are not alone in feeling depleted or altered by their work as caregivers for people and pets who are stressed, traumatized, sick, and in need of compassionate services.

However, as interest in compassion fatigue continues to grow, it’s important to be mindful of the quality of the resources being created to meet the increasing demand for compassion fatigue education. Just like dog training, compassion fatigue education is an unregulated industry. Anyone can advertise themselves as a compassion fatigue educator; there are no regulations or standardized training programs for this field. A variety of organizations do offer certificates programs for individuals who wish to become compassion fatigue educators. However, this process varies widely from one certifying organization to another, with some training programs being far more in-depth than others.

These certificates can be a good starting point for anyone interested in deepening their understanding of compassion fatigue, particularly management and leadership who wish to become better informed in order to support their staff and volunteers. But for those who intend to pursue a part- or full-time career in the compassion fatigue education field, the certification process alone will likely not be in-depth enough training to adequately build competency in safely engaging other people in this highly emotional, complex work.

Like their counterparts in professional dog training, professional compassion fatigue educators should demonstrate a commitment to ongoing education, support from other professionals, and clearly communicated boundaries that recognize the limitations of their skills and role.

Read the full article below:

The Future of Compassion Fatigue Education: Working Partnerships with Mental Health Professionals

New Curricula Build Resilience in Young Medical Professionals

Maclean’s Magazine recently published an article stating that approximately 29% of young doctors experience symptoms of depression or receive a clinical diagnosis. Why? Part of the problem lies in the immense competition young doctors face to obtain jobs. The culture of residency, where young physicians are often required to work excessive hours to stay competitive, is cited as a major source of mental health deterioration. Perhaps most obvious are the stresses associated with making difficult, life-and-death decisions with little to no experience.

Compounded, these issues are causing a mental health crisis among young health-care providers across Canada, and particularly medical students. Lack of sleep, stress and poor self-care contribute to diminishing mental health. Zane Schwartz writes that there is hope: “Young doctors across Canada are trying to change [the] statistics, encouraging struggling peers to seek support and building programs that make it easier for them to take care of themselves…the new curriculum for the University of Toronto, rolling out this fall, which will include several weeks of resiliency training.” Resiliency training is at the forefront of efforts seeking to help future medical professionals cope with the stresses of their work. At UoT, Shayna Kulman-Lipsey, Manager of Counselling has launched a number of initiatives aimed at breaking the stigma attached to seeking help. She argues that the ability to gain resiliency is dependent, in part, on reaching out to peers for support, which can be difficult in an environment that stigmatizes asking for help as a sign of weakness. If medical students develop the skills to maintain resiliency earlier in their careers, they will be better equipped to take on high-stress workplaces and maintain high levels of patient care later.

In the United States, a similar need has been identified by the American Academy of Pediatrics (AAP). This month, the AAP released a special article in Pediatrics, the Official Journal of the AAP titled “The AAP Resilience in the Face of Grief and Loss Curriculum” authored by a group of physicians from across the United States. According to the publication, The AAP Section on Medical Students, Residents and Fellowship Trainees identified a need to address the management of grief and loss that health care professionals experience throughout their careers. The development of this new curriculum was endorsed and sponsored by the  AAP Section on Hospice and Palliative Medicine.

A large portion of the new AAP curriculum focuses on the physician-patient and physician-family relationship, with modules designed to help pediatric health-care professionals learn to communicate effectively with children and their parents. The last section of the curriculum, Part D: Introduction to Personal Well-Being, has been developed specifically to address physician well-being. Like the folks at UoT, the authors here argue that teaching medical students personal strategies to cope with stressful events in the workplace will promote long-term well-being and resiliency as their careers progress. The new curriculum recommends a Wellness Learning Plan, that “might be incorporated at the beginning of medical school and reviewed with the student’s advisor or mentor quarterly.” While the AAP publication is specific to the experiences of grief and loss, the message is more broad: resiliency is critical in maintaining personal well-being in high-stress, trauma-exposed workplaces. Educating students early in their careers with these types of curricula may offer longer-term prevention of burnout, fatigue and secondary traumatic stress.

To read more about programs for medical students at the University of Toronto, please visit:  http://www.md.utoronto.ca/Annual_Report/learner-experience/resilience

To learn more about the new “AAP Resilience in the Face of Grief and Loss Curriculum”, please visit: http://pediatrics.aappublications.org/content/pediatrics/early/2016/10/06/peds.2016-0791.full.pdf

Maclean’s article: http://www.macleans.ca/education/new-curriculum-addresses-mental-health-for-young-doctors/