Individual Strategies to Promote Resilience
WSRS/WSMAOctober 14,2017Claudia Finkelstein, MDCMDirector Faculty Wellness ProgramsUniversity of Washington School Of Medicine
Disclosures and Biases
> Financial-none
> Individual strategies are not enough
> Not either /or we need structural change AND
increased resilience
> Leaders matter
Agenda/Objectives
➢ Participants will define burnout syndrome and the
(increasing) incidence
➢ Participants will become familiar with some tools
used to assess and identify burnout and resilience
➢ Participants will learn strategies that promote
individual, team and institutional resilience
and prevent burnout
Define Burnout
➢Emotional Exhaustion
Being emotionally overextended and exhausted by
one's work
➢Depersonalization
Unfeeling and impersonal response toward recipients
of one's service
➢ Decreased Sense of Personal Accomplishment
Lack of feelings of competence and successful
achievement in one's work
Incidence and Trends
➢ Incidence
Changes in Burnout and Satisfaction With Work-Life Balance in
Physicians and the General US Working Population Between
2011 and 2014
FOR GENERAL USE
Tait D. Shanafelt MD, Omar Hasan MBBS, MPH, Lotte N. Dyrbye MD, MHPE, Christine Sinsky MD, Daniel Satele MS, Jeff Sloan PhD and Colin P. West MD, PhDMayo Clinic Proceedings, 2015-12-01, Volume 90, Issue 12, Pages 1600-1613,
From: Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US
PopulationArch Intern Med. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199
Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014
MBI vs Single Item Measure: Ask Yourself How Often?
➢ I feel emotionally burned out or emotionally depleted from my work
➢ I have become more callous toward people since I took this job —
treating patients and colleagues as objects instead of humans.
West CP, Dyrbye LN, Sloan JA, Shanafelt TD.J Gen Intern Med. 2009 Dec;24(12):1318-21 Single
item measures of emotional exhaustion and depersonalization are useful for assessing burnout
in medical professionals
Consider Measuring-Individual & System
➢ Physician well being index- 7 Items
➢ Mini Z Burnout Survey
➢ Professional fulfillment
➢ Sleep related impairment
➢ Meaning, Appreciation
➢ Mindfulness
➢ Pajama work/ clicks per day
➢ http://www.ihi.org/education/Conferences/Forum2017/P
ages/Joy-in-Work-Track.aspx
The capacity to respond to stress in a healthy way such
that goals are achieved at minimal psychological and
physical cost; resilient individuals "bounce back" after
challenges while also growing stronger. Resilience is a
key to enhancing quality of care, quality of caring, and
sustainability of the health care workforce. Yet, ways
of identifying and promoting resilience have been
elusive. Resilience depends on individual, community,
and institutional factors.
Epstein and Krasner Academic Med 2013 March 88(3) 301
Resilience Scales With Best Psychometrics
➢ Conner-Davidson Resilience Scale
➢ Resilience Scale for Adults
➢ Brief Resilience Scale
➢ ?UW Scale
CD-RISC
1. Acceptance of Change and Secure Relationships
2. Personal Competence
3. Trust/Tolerance/Strengthening Effects of Stress
4. Control
5. Spiritual Influences
Based on Connor and Davidson’s operational definition of resilience, which is the ability to “Thrive in the face of adversity”.
RSA – Resilience Scare for Adults
➢ Personal Competence
➢ Social Competence
➢ Social Support
➢ Family Coherence
➢ Personal Structure
For Example 0-4 on 25 items
> 1 I am able to adapt to change
> 2 I have close and secure relationships
> 3 I believe that sometimes fate or God can help
> 4 I can deal with whatever comes
> 5 I remember past success and this gives me
confidence for new challenges
Individual Factors
> Self care
Eat, Drink, Sleep, Pray, Love, n-1
> Connection – Compassion – Empathy – Gratitude
> Meaning
> Learn from the past
Error as feedback
> Emotional Regulation
> Mindful (Tech, Self Compassion)
Individual Resilience Strategies: Support
➢ Family
➢ Friends
➢ Peers
➢ Groups
➢ PHP
➢ Coach/ Therapist /Psychiatrist
More on Reflection: Fearless Honesty
➢ Identify your core values (Exercises Online)
➢ Institution values and overlap?
➢ What do you really value?
➢ How do you spend your time and money?
➢ Legacy?
Action Plan: Pick One
> Digital Sabbath – or Variation
> Time Alone: Between Work and Home
> Journal Daily x 20 minutes
> Try Meditating (Insight Timer)
> Gratitude Journal/Letter
> Track your Sleep, Fluids, or Foods
> Take a 10 minute walk 5 x per week
> Self Compassion Practice