1 in 5 physicians experiences emotional, psychological and physical damage related to burnout. The corollary to this is that many don’t experience burnout and manage to prevent it – why might consider these individuals to be resilient. Resilience should be taught in medical school and doctors need to recognise burnout in their peers and other staff.

Resilience can be defined as the “capacity to respond to stress in a healthy way such that goals are achieved at minimal psychological and physical cost”, i.e. in other words resilient individuals have the capacity to bounce back after stressors and set backs and potentially be stronger.

The current issue of Academic Medicine 2013 (88) has a nice article by Zwack and Schweitzer and an accompanying editorial by Epstein and Krasner that respectively identify and discuss the characteristics of the resilient physician:
– mindfulness
– self-monitoring
– limit setting
– & attitudes that promote constructive and healthy engagement with difficult challenges at work (rather than withdrawal or avoidance)

Some of these characteristics are teachable or coachable and should be considered as manatory in medical school.

Zwack and Schietzer article on resilience

Epstein & Krasner editorial on resilience

Well this is a half truth. Teamwork is emphasized at medical school. But is it really taught the way it works in the real world. It is more theoretical than real In medical school you do team based exercises but these are largely with peers. In hospitals and other healthcare settings there is a mix – doctors, nurses, allied health and all of differing levels of seniority. And particularly in the hospital system there is pretty constant turnover of junior staff.

We examine the competency of individuals but not of teams or competency within a team.

Teams can become dysfunctional if there is one bad player or sometimes they continue to excel despite a poor team player – nobody really knows why.

For me the key issues are clear roles, inter-team member support (the buddy system) and a common purpose.

Some of my blog posts are titled “Things they didn’t teach in medical school”.

Well I’m tempted to start another series entitled “Things my IT department won’t do for me”.

Years ago a colleague, A/Prof Matthew Links @cancersolutions tried to introduce the Moodle LMS for our oncology unit. It was blocked. No internal hosting and then no access to the external site through a firewall. Ironically – Moodle became the LMS of choice for our organisational learning unit and it is now accessible remotely.

Now we have two new problems – you can’t access any web-service (e.g. an online reference manager)that links to social networking. You can’t Facebook or tweet on hospital time……unless of course you own a mobile phone. Hmmm, I think the number of smartphones per person in our hospital is 1.2 so chances that there isn’t use of social media that is more disruptive than doing it from your hospital desktop are zilch.

The other problem is we can’t use Skype or similar services to support or clinical and educational activities. We have a registrar seconded to a satellite hospital which is 20 mins away by car. We can’t simply video-link them for a journal club. Skype or similar would be the simple solution. The alternatives – full Telstra-based video link or Webex and teleconferencing seem too hard and too expensive. And nobody want to help. Yet, if I were sitting in Tampa I could fly-by-wireless my drone into a bombing strike somewhere in Afghanistan.

It’s time the technology departments of the Australian public hospital system worked out what was happening in the outside world and caught up very quickly…..maybe in a Moore’s Law propotionality.

This will be a brief one: they didn’t teach public speaking in medical school.

I did toastmasters in high school and then after doing the college exams and losing all humility I thought I was OK at public speaking. The a couple of years ago I gave a talk at a conference I was all nerves – it was the International Liver Cancer Association Meeting and I think it was the first and only presentation from an Australian. The room was one of those in which you were blinded by lighting and couldn’t see the audience well. All of the ‘gods’ were either on the stage panel or got up to ask questions afterwards. For the first time in ages I got ‘nerves’.

Speaking in public is something I actually have to do all the time but it is not always straight forward.

Here are some tips – both practical an perhaps tongue-in-cheek:

Tips on Public Speaking

Perhaps the commonest complaint of my trainees when they are in the first year of their specialty (medical oncology) training is that they just don’t know where to start. In one respect this is understandable – the party-line is you need to know everything.

These are my tips:

(1) study stuff that will make your job easier. If you don’t know how to prescribe anti-emetics to prevent chemotherapy-induced nausea then read up on this.

(2) study stuff you see in clinic or on the wards that you didn’t know anything about. This entails keeping a list – get a notebook, send yourself an SMS or email, use Evernote or a similar app to remind yourself what you need to look up.

(3) do sweat on the small stuff. In this case the small stuff is the basic science behind treatments. By knowing this you will be able to do the higher level activities better.

(4) have a plan. Set yourself a goal about knowing about a particular topic by a certain time.

(5) have a template of questions. Really – it is not possible to go and learn about ‘colon cancer’ without a targeted plan. Think of questions that that apply across disciplines e.g. is systemic chemotherapy useful for metastatic colon cancer, in monotherapy better than polychemotherapy, what is the optimal duration of therapy, etc, etc???

(6) study stuff that interests you – the other stuff will fall into place naturally

(7) volunteer to present at meeting or to teach – then you will be forced to study

(8) pick something you think you already know and revise it – get up-to-date

(9) close your eyes and drop your finger on a contents page