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A Fresh Look at Resiliency in Medicine

resilience resources Dec 09, 2022

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We all know that the term and concept of resilience have been used against physicians (and other healthcare workers) over recent years. The implication was that a lack of fortitude on behalf of physicians was the cause of burnout and moral injury. We all know that burnout is an occupational issue, not a mental health condition.


Resilience is the ability to withstand or bounce back after challenging events. Only the resilient make it through pre-med, MCAT, interviews, medical school, more interviews, and the pressure cooker of residency. Studies demonstrate that physicians are some of the most resilient people. 



That’s why I was so relieved when I listened to Michael Cavanagh, Ph.D., at Harvard’s Institute of Coaching in Leadership and Healthcare Conference in 2021. He’s a coach and clinical psychologist out of the University of Sydney. He gave a framework for understanding resilience as an organizational and systemic matter, not an individual one.


The burden doesn’t fall solely on the physician. He explained, “Building resilience is about building resource-full environments. And the internal capacities that help us access the external resources needed to face the whole set of challenges to be found in the context. “ He emphasized that our internal resources allow us to access the external resources to flex and acclimatize. If the system doesn't provide the necessary external resources, we cannot fully adapt. Used with permission by Dr. Michael Cavanagh


I’m bringing this up because we, as physicians, need to embrace resiliency and enhance it to the best of our ability. We work in some incredibly stressful environments. Once we recognize injustice, we appropriately respond. Unfortunately, we often villainize words and concepts, lumping the whole set of circumstances together and labeling them as bad - and that is what has happened to the concept of resiliency. Understandably, some physicians still have a visceral reaction to the word. But we don’t want to throw the baby out with the bathwater. We need to understand the systematic piece of resilience and look for where we have control. It's still a very important characteristic that we can enhance.


Let's define resiliency more fully. Being in a resource-rich environment that allows you to bounce back and manage yourself after stressors while remaining in integrity with your values and priorities and remaining useful to those you care for. It's the whole system - what your organizational and personal resources are, your capacity/bandwidth to access those resources, and then your intentionality as a steward of those resources.


Dr. Kemia Serraf of Lodestar Trauma-Informed Coaching gives a beautiful analogy of a dam to this systemic process of resilience. Over the next couple of weeks, I plan to break it down into bite-sized pieces to walk you through a self-evaluation. 


If we look at resilience being represented by a large reservoir that is situated, created even, by a dam such as the Hoover Dam, we recognize it's a dynamic process. The capacity and the water level correlate to your bandwidth, the ability to contribute, serve, and function best. Rivers flow into the reservoir to fill the water level. These are the resources you draw from – your organization's resources, your support system, and your physical, mental, social, emotional, spiritual, and financial resources. Each of us has individualized tributaries that affect the various rivers' flow. What fills your social cup may be different from mine. There are also spillways that intentionally divert water out of our reservoir. This represents the energy you put into various tasks. And as with any flawed human product, there are cracks in the dam. Fissures that our capacity escapes through unexpectedly. Other vital components in the analogy are the towers where spotters are on the lookout. They can see upstream issues,  the water level, and downstream issues. These represent those people around us who know us best. They serve as an early warning system. 


I look forward to walking through some reflective exercises using Dr. Serraf’s analogy over the next few weeks. 


Until then,

Have a joy-filled week!  Tonya

Are you interested in your residency program partnering with me to use coaching for residents and faculty members can flourish in their chosen careers? If so, set up a strategy call with me to discuss an individualized approach. Meet me, ask your questions, and see if it's a good fit.  

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