CATALOGUE AND DISCUSS STRESSORS

 Residency is replete with stressors mild and extreme. There is no

way to obviate them all, so many are part of the business (patient death,

complications,  emergencies, tragedies, breaking bad news, loss of sleep, etc). Others

seem quite arbitrary and even spiteful (trivial calls, nursing complaints, negative

intra-professional interactions, etc). No matter the nature, they all add up.

   One method of diffusing the power of this daily barrage of stressors is to survey and catalogue them; to recognize, acknowledge, and enumerate them. They then should be discussed in a group with others who are going through a similar experience, or who have done so in the past. Here, it is important to bear in mind that emotions and attitudes are contagious in groups; therefore, this sort of cataloguing needs to be qualitatively different from simply complaining. Distressing emotions dissipate (rather than amplify) if they are accurately identified and appropriately expressed in a supportive interpersonal environment. This is a mechanism of change that serves at the conceptual bedrock of counseling, psychotherapy, and cognitive/behavioral therapy: When people self-monitor or self-evaluate, maladaptive patterns are disrupted and adaptive coping is promoted. Put another way, simply asking a question about something directs the listener’s mental map to attend thoughtfully to that something (this is called the principal of simultaneity: change occurs simultaneously with questioning about that area). By simply enumerating residency stressors, therefore, their impact can be diminished. By sharing negative experiences – and getting supportive responses from trusted others; or by deploying reframing strategies that move them to broader frames of reference regarding that which is distressing them - residents can also diminish a sense of loneliness and uniqueness in facing the stressors, and learn different ways to face inevitable coping challenges in the process.

Not all stressors are externally imposed. Intrinsic characteristics and self-demands can create stressors as powerful as those that are imposed externally.

In surveying our residents we found that the majority had significant perfectionist tendencies. While a degree of perfectionism is certainly required in medicine, strong perfectionist tendencies can lead to a constant sense of defeat and frustration, particularly in a field of challenging outcomes such as neurosurgery.

Building Resilience

Consider the following measures of addressing resident challenges and stressors:

-Have residents periodically catalogue major daily stressors.

We  periodically survey our residents on challenging occurrences and ask them to catalogue specific types of stressors. For example, when asked to count the number of unpleasant interpersonal interactions they encountered in their work over a two week period, several residents reported values in the 50’s to 80’s.

-Review stressors monthly in an academic session.

At our program, particularly poignant and productive sessions have followed the death of a child, a significant error in ICU management, a particularly bad operative complication, sub-optimal interactions between some of the residents, a perceived vindictive action taken by a nurse, and more.

-Discuss strategies for addressing the stressors.

-Discuss internal as well as external stressors (what pressures and conflicts come from within). As noted above, personality surveys may be of assistance here.

-Look for “silver linings” of various stressors/occurrences (learning opportunities, growth opportunities, opportunities to give solace, etc.).

-Periodically take residents “off reservation” where they may feel more comfortable to discuss various workplace challenges.

At our program we hold a monthly “Program Director’s Dinner” held at a local restaurant or the P.D.’s home. Here, all aspects of the residency are “fair game,” particularly the “rough spots.” Discussions are very open (perhaps facilitated by wine) and have led to many corrections of Program mechanics.