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A Fresh Look at Resiliency in Medicine, Self-Evaluation Part 2

We are in the middle of a series of fresh perspectives on resiliency in medicine in which the entire system is considered - not just an individuals. Last week, I started you on a resiliency self-evaluation using Dr. Kemia Serraf’s model of a dam system. This week, we are continuing to audit your ability to snap back after daily challenges, including unexpected ones. Do you have your pen and paper or digital writing device?


Let's define resiliency more fully once again: 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.


Ideally, our reservoir of resilience would stay at a steady state with a self-sustaining equal inflow and outflow. We know this isn’t realistic. We live dynamically. There will be crises that naturally lead us to throw open all the intakes and outflows to rise to the occasion.  (This is why the pandemic was incredibly difficult- many of you were needed to maintain the open flow for three years in crisis mode which is just not sustainable.) Normally, there will be times of calm and stagnation. But most often, we live in between with constant changes of the water levels. If your depth of resilience is below a desirable level, you can tend to the upstream tributaries and rivers to increase water flow, and adjust gates/valves and spillways downstream to decrease the outflow or a combination. This does take effort and so putting in the time now to think through this will be helpful. 


Let’s start with the rivers, which represent your available resources. They include what your organization provides for you plus your physical, mental, social, emotional, spiritual, and financial supplies. Each river has individualized tributaries that make them up. We also know that each river will not be the same size. But it’s essential that combined, they add up to the needed water flowing into the reservoir that holds your reserves.


Now, understandably, it takes effort to tend to these tributaries, clear the fallen branches, beaver dams, and the like. But as you can see – leaving them untended leads to you being dangerously drained. So it’s worth the effort, and it's great to get some routines in place before you're critically low.


During the audit, you may uncover the most important tributary that needs priority attention. Please remember to do this audit from a place of self-compassion, not self-judgment. You’re just gathering data to leverage later. You are, like the rest of us, human.



Organizational River. This is the organization you work for, within, or beside. How’s this river flowing right now? What resources does your organization already provide you? Give space to truly see what is there. What could they provide to help fill your basin, your ability to do this challenging work in an effective way that also allows for rest and recovery? What do you need to ask for? How do you want to go about it? Who are the key stakeholders and decision-makers who need to be involved? Who can help advocate? Is the river polluted? Is it a toxic culture that's damaging your water quality? Do you want to have a voice and attempt to influence change or do you need to protect yourself or both? What does that look like? How will you know if and when it's time to change which organization river you draw from?


Physical River. What’s the state of your physical river? (Again, be objective without self-criticizing). We know the basic foundations are sleep, movement, and good nutrition/hydration. How can you increase the health of these tributaries? Brainstorm, and don’t shut your idea flow short. What else works best to optimize your physical health? What are one or two small steps you can take now? This is not a time for all or nothing thinking. 


Mental River. How’s this river flowing? We know the basic foundations of mental fitness are competence, connectedness, and autonomy. What skills would you like to gain? What might you want to learn more about to grow your competence? What ideas do you have about increasing connection at work and outside of work? Where do you have more agency than you give yourself credit? How could you improve your autonomy? Where else may you uncover agency? What else is mentally stimulating for you – at work or outside of work?


Social River. What do you notice about this river? I’m dubbing this the social aspects of your life outside work – family, friends, and community. We are social beings. What is one simple thing you can do to enhance your social life?


Emotional River. What’s your assessment of your emotional state? What does emotional regulation look like for you? What would support your psychological health? What are your support systems and positive coping skills? What is missing, if anything? How do you want to access it?


Spiritual River. How do you define your spiritual river? What are the tributaries that flow into it? How do you define your purpose? When do you carve out time to reflect on things bigger than yourself and the momentary adversity? What practices reconnect you to meaning in life? What helps you be mindful and present with the people and tasks placed around you? What have you been neglecting? What small tweaks can you make to move toward a fuller spiritual life?


Financial River. Objectively what’s going well with this river? What minor changes could you make to sure up the flow?


Okay. Now that you have your audit complete of the state of your resources, which one is the low-hanging fruit – the easy to adjust? Which one will have the most significant return on investment for you? Make a plan to tend to one or both.


Next week, we will turn our attention to the spillways, the places where our energy and resources are utilized.

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.

 Original post 12/2022, updated 1/2024


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