A message to Doctors in Training. And to their supervisors

To our Interns and Resident Medical Officers

I saw Rebecca's tweet this morning, and I totally get it. She's not alone. Replies from colleagues across the world were hugely supportive, and others repeated her feelings and acknowledged her vulnerability and humanity. 

Her fear - our fear - is rational. The biological role of this fear is to grab your attention. It prevents complacency & makes you consider carefully what to do next. Daniel Kahneman called it the System 1 response - it's fast, unconscious, automatic, and it makes us stand up and be ready. As doctors, we know it originates in the amygdala, but we know too that an uncontrolled stress response isn't helpful. Chronic stress arises from every headline in our feed, re-activating our fear response. 

COVID-19 has got our attention, so now what? We need to engage our pre-frontal cortex and rise to the challenge ahead of us. System 2 is our thoughtful, conscious and considered response. Its strength is complex decision-making, and yours is ready for this. 

A lot of planning and action has brought Australia to where we are right now. Yesterday, Dr Paul Kelly, the Deputy Chief Medical Officer, told us 'We are not Italy, Iran or Spain'. We are not the US either. His talk is worth reading, because not only are we a few weeks ahead of countries that have been devastated by COVID-19, we are structurally strong and unique in our health care preparedness and geographical spread.

 As you prepare, please make time to prioritise your self-care activities. These need to established habits as we move into the coming months. It's tempting to drop self-care as work gets busy, but it is one of the most important things we can all do to be resilient and successful in the long run. This battle is not going to won quickly. Hold out your hand in front of you, and think of 5 self-care activities - one must include engaging with others - and work out how to prioritise them into your working week.

 When I went through a stressful time a few years ago, I discovered the benefits of mindfulness meditation and as one of my inspiring social media gurus said about traumatic experiences, 'Meditate the fuck out of it'. It worked for me, and it works for a lot of people going through tough times.

Smiling Mind is an Australian app that's free to use: https://www.smilingmind.com.au/

You're ready for this. These are scary times, and the threat is real. Let your fear move you. Let it change what you do, but not who you are.

Feel free to use this space in any way you like. Ask questions, debrief with each other, share resources that help you get through. We are here for you.

A message to Supervisors of Doctors in Training

I wrote today to our doctors about Rebecca's tweet. She is a consultant psychiatrist and what she says has resonated with a lot of doctors. I want to share with you some thoughts about the support they will need in the coming weeks and months. I know that most of you know and do these things already, but part of our role in Medical Education is to support both experienced and new supervisors, which is why I've included registrars and PHOs into my message.

As you know, our doctors will find the coming months very challenging. We will need to lean on each other more than usual and be on the lookout for signs that a colleague needs help.

Managing concerns and anxieties

There will be much anxiety among our teams about whether they will catch SARS-CoV-2 at work. There's already a lot of information about COVID-19 in the media, and not all of it is constructive. Supervisors can help people stay focused on normal routines as much as possible and encouraging doctors who show signs of stress or anxiety to access help via employee assistance programs or through their GP. Many GPs and psychologists now provide support via telehealth.

Doctors exposed to COVID-19 patients or who become unwell may need advice from line managers or HR. Please maintain confidentiality and consider the issue of inadvertent discrimination.

Team resilience-building

Doctors are more likely to be resilient and to practice resilience in a work culture that supports it. Personal connections among team members encourage support-seeking behaviours. Learning from the challenges we face will promote a growth mindset and learning culture. Other ways we can support team resilience include:

1. Involve junior doctors in problem-solving. You'll not only get better solutions, but you'll also be demonstrating to the team that their ideas and input are valued. When you step back together and reflect after learning, noting how you reached the solution, this will foster positivity and proactive behaviours in the face of future challenges. 
2. Acknowledge and show value to responsibilities your team have outside of the workplace. It can be as simple as asking about significant others, children or supporting flexibility where possible to help them deal with challenges in other parts of their lives. Autonomy is important to people and much seems out of our control right now.
3. Strengthen social support and connections within the team. We know that people with social connections live longer, suffer less depression, are healthier and more resilient. Physical restrictions in place currently limit large team gatherings, but making time for fun, camaraderie and celebrations is essential.
4. Provide opportunities for growth. Most of our services have changed, and formal teaching is likely to be de-prioritised or shifted to specifics related to COVID-19 preparations. But every day, there are learning opportunities - each contact with a doctor in training can encompass a brief teaching scenario - we explain the principles of the One Minute Preceptor in our supervisor development training. We are going to share a video about it with you soon.
5. Promote health and energy. Although gyms and team sports are out right now, our doctors need to look after their physical and mental health. Apart from modelling resilient behaviours and attitudes yourself, encourage healthy habits, taking a lunch break and getting away on time as much as possible. As supervisors, it's our responsibility to have a handle on the daily workload and stresses of our RMOs and interns. They will put off coming to you about it as long as possible, so they don't appear weak or inefficient. 

Try not to reward them for being 'always on' and be on the look-out for opportunities to thank or praise for good work done. Knowing that they're on track can be difficult sometimes and they will value your feedback.

Thank you for your work with the doctors early in their training - I know they appreciate your guidance and support. The effort we put into team resilience will keep them healthy, happy and productive, and it's the small actions that make a big difference over time.

Regards,

Danny

Director of Clinical Training