Rethinking Residency

Not all mentors are truly advocating for you. In medical training, negative advocates can subtly or overtly hinder your progress—whether through discouraging words, biased evaluations, or withholding key opportunities. It’s time to recognize and call out negative advocacy in medical education. True mentors uplift, empower, and create opportunities—not roadblocks. #medicaleducation #residencytraining #workplaceadvocate

One of the biggest challenges with setting boundaries may be an unacknowledged internal drive to avoid those boundaries. No amount of accomplishment can resolve empty feelings. You could pour a literal ocean into a cup with a hole in it and the cup wouldn’t fill up. But we still sometimes find ourselves in the trap of pursuing fulfillment in that way, moving through our work lives with infinitely porous boundaries that allow others to make outrageous demands on our time. Saying yes to every project, committee assignment, and other ancillary duty may be a way of making yourself indispensable. A hungry attempt to ensure that you’re needed. Feeling overstretched may feel bad, but it may also be shielding you from even more difficult emotions.

Research indicates that healthcare professionals often have higher rates of past trauma compared to the general population. A study found that 68% of healthcare workers reported experiencing violence, abuse, or neglect, with 33% encountering such adversities before the age of 13. Those with childhood adversity reported more recent life events and greater psychological distress than their counterparts without such backgrounds. The demanding nature of healthcare work can exacerbate these issues, leading to higher rates of post-traumatic stress disorder (PTSD) among healthcare workers. In critical care settings, the prevalence of PTSD can reach 30%, significantly higher than the 3.5% observed in the general population. Given these findings, it's essential to integrate trauma-informed care (TIC) principles into healthcare training and support systems. TIC involves understanding, recognizing, and responding to the effects of all types of trauma. Key principles include safety, trustworthiness, peer support, collaboration, empowerment, and cultural sensitivity. AND FURTHER, knowing this, to enhance the well-being and effectiveness of healthcare workers with trauma histories, consider the following strategies: - Comprehensive Training: Implement TIC training programs that educate healthcare professionals about the impact of trauma and equip them with skills to manage their own experiences and support colleagues. - Supportive Work Environment: Foster a workplace culture that promotes psychological safety, open communication, and peer support networks to help staff manage stress and prevent burnout. - Access to Mental Health Resources: Provide readily available mental health services, including counseling and stress management programs, to support healthcare workers dealing with trauma-related issues. - Regular Screening and Monitoring: Conduct routine assessments to identify signs of psychological distress among staff early and offer timely interventions. - Policy Development: Establish organizational policies that prioritize staff well-being, including zero-tolerance stances on workplace violence and harassment, and procedures for reporting and addressing such incidents. By adopting these strategies, healthcare organizations can better support their staff, leading to improved job satisfaction, reduced turnover, and enhanced patient care. https://lnkd.in/e9wsZ94v

While it's important to challenge learners, the intent should always be to build knowledge and resilience—not to diminish self-worth. Unfortunately, pimping has often been normalized in medicine as a rite of passage, despite evidence showing that learners thrive better in supportive and respectful environments.

Sports medicine and family medicine physician-writer Dominick DeFelice, MD shares his perspective and experience in physician advocacy in our newest article, "Healthcare Advocacy in an Age of Turmoil." "In terms of cost, Medicare and Medicaid carried a $1.9 trillion price tag in 2023 for its roughly 120 million enrolled members. A quick back-of-the-napkin calculation shows that the average person on either of these plans costs about $16,000 to take care of per year. There is no universe in which that number should even approach $16,000. It sizzles the brain to envision how this is possible. By comparison, the entire country of France averages a little over $5,000 USD per person per year. But it does not need to be so, my fellow healthcare workers. If you are like me, discouraged by our healthcare system, discouraged but not broken, then this motivates you to do better and be better. To incorporate into your duties as a healthcare worker, as a person with more knowledge in your given field than anyone, the additional though crucial job of making our country’s health needs known to lawmakers. Lawmakers who could, rather swiftly if so motivated, change the entire landscape of our healthcare and our very lives. I urge you to consider walking with me and the scant few others who have entered into the tornado that is healthcare advocacy. It’s scary, off-putting, and disheartening more often than not, yet it is how we will move forward." Read the full article here: https://lnkd.in/eKefURjZ

?? Shout-Out to Kathryn Lawson, PhD! ?? This year, we’ve been incredibly fortunate to feature a thought-provoking series by Kathryn Lawson, PhD, on Rethinking Residency. Her contributions have brought invaluable insights to our readers, focusing on stress management for physicians—a topic so crucial in today’s high-pressure healthcare environment. From exploring practical techniques to build resilience to addressing systemic challenges in the medical profession, Kathryn’s articles provide actionable strategies and a compassionate perspective for physicians navigating the demands of their careers. Thank you, Kathryn, for sharing your expertise and helping us rethink what it means to thrive in residency and beyond! You can read Kathryn’s powerful series here: Stress Management for Physicians. https://lnkd.in/e8rff3wn

If you are experiencing bullying and incivility, it is critically important to emphasize that you are not to blame. Talking about tools and strategies to address these behaviors is intended to give you power, but it does not give you responsibility. It is also critically important to acknowledge the roles of racism, intolerance, and anti-LGBT bias in workplace incivility and workplace abuse. These intolerant behaviors are often accompanied by gaslighting efforts that may leave those affected questioning their perceptions. Institutional support is crucial but may be lacking. You do not have to face these alone. Rethinking Residency Hostile Workplace Recovery, LLC Healthy Workforce Institute Restoring Health to Healthcare, LLC

I recently interviewed a fourth year medical student about her experience on a surgery rotation as an M3 for Rethinking Residency. I felt an immediate kinship with Sierra Norman. Her mission - exposing abuse of power within medical training- is aligned with Rethinking Residency’s work. By sharing her story *in real time* she aims to help others who may be going through similar experiences. Many physicians don’t share these stories for ten years after training, if ever, so I truly admire her advocacy. Read the full interview here: https://lnkd.in/eXhiAwkx

How do we resolve conflicts adaptively? If your immediate response is “compromise,” that’s sometimes right. But often if we approach conflict resolution with intentionality, we can do better than what Merriam-Webster defines as “settlement of differences by arbitration or by consent reached by mutual concessions." Win-win solutions feel better than “mutual concessions,” but are only possible when we understand both what we want and what the other person wants.

De-escalation is frequently discussed as almost a cure for violence, a guaranteed way to reduce tensions and avert conflict. These discussions ignore the wide variability around definitions of de-escalation, both in real-world and in research settings. Once we agree on a definition of de-escalation, there is still the question of effectiveness. A recent study identified 64 de-escalation training programs conducted over a 40-year period and found that there was no evidence of effectiveness (Engel, et al. 2020). Nobody is taking that finding and concluding that we should stop using de-escalation. But it does beg the question of how to make the use of de-escalation techniques actually work.