Promoting Resident Wellness
Through Better Stress
Management
Margaret Rea, Ph.D.
GME Counselor
UC Davis School of Medicine
Why are We Concerned if Residents are
Not Managing Stress Well?
The Evolution of the Resident
July
September
November
January
We Want to Avoid:
 Physical
Changes
 Emotional changes
 Maladaptive responses
 Poor Patient Care
Bad Equation
High demands of work
+
Perfectionism
+
Feelings of lack of control
+
Few Rewards
= STRESS
We Want to Avoid Burnout:

Emotional exhaustion

Depersonalization

Feeling inefficient on the job

Emotional Exhaustion=

Feeling emotionally overextended
and exhausted by work

Depersonalization=

Unfeeling and impersonal response
to one’s efforts

Feeling Inefficient=

Incompetent
We Want to Protect Against:

Depression

Anxiety

Substance Abuse
We Want You To:
Maintain meaning and satisfaction with
your job
 Maintain and or get back some of the
energy and enthusiasm that brought you to
medicine
 Maintain a personal life and achieve some
balance between work and home

What Can We Do To Assist
You?

We can’t make the stress of residency
disappear, but we can try to assist you in
achieving some balance so you can
maintain your physical and psychological
health
How do we do that? Can we do
that?
We Do Not Want To Cause More
Stress with Stress Management
What Techniques Do you Currently
Use to Promote Wellness?
Unhelpful Stress Management
Techniques
Escape through drugs and alcohol
 Short cuts at work: lying, dumping: “Its
pending”
 Overeating/under eating
 Taking out on others: colleagues, students
 Acting out at home

Can Residents Really Use Typical
Stress Management Techniques?
Can Residents Modify Their
Style and Consider Wellness
Obsessive traits
 High to unrealistic expectations of self
 “Addiction” work
 Competition to do better than others
 Stress is a motivator

Life Curriculum for Residents
Duke University: ERASE
 Exercise
Relaxation
 Activities
 Supportive Relationships
 Emotional Expression

Exercise: Can Residents Really
do This?
Exercise Options for Residents
Hospital
Walk
Stairs
around hospital
Hospital
Gym: Rooms
7148 and 7156- Code 541
Equipment
24
at home
Hour Gym
Ramp
Relaxation
Deep breathing
 Muscle relaxation
 Meditation
 Imagery/Visualization
 Mindfulness

Meditation

Focus on:
Sound
 Image
 Phrase
 Breathing

Time Outs
I pod/CD- (only for time out)
 Power nap
 Social Interlude: call a friend,call home,
grab coffee with fellow resident
 Walk the perimeter or ramp
 Library

Enjoyable Activities: Can You
Remember Any?

Try to remember what used to be
enjoyable

Try and find a concrete hobby that can
balance chaos of the hospital
Support Systems !!!!!!!!!!
Reach out to family and friends
 Keep personal relationships intact
 A short phone call can help
 Form alliances with other residents
 Consider counseling, even one session

Emotional Expression
Expressing emotions in safe and appropriate
way leads to better coping with family,
friends, counselor
 Keep a journal
 Touch base with seniors and supervisors
ISOLATION=POOR OUTCOME

Why Consider Counseling
Venting to someone helps
 Practice stress management skills
 Problem solve
 One session or continuing
 Regular or intermittent

Mental Traps Keeping You From
Counseling
Fear of exposure to fellow residents,
colleagues, patients
 Fear it is not confidential
 “I can heal myself”
 Fear failure

Avoid Trap
 “If
I admit I am struggling
THEY will figure out I really
don’t belong, I can do it”
What Else Can Help?
Reframing World View: You
Have a Choice
We often can’t change the reality, but we
can change how we think about it
 We can take control of how we respond to
events
 We can adopt more helpful
interpretations


Realism not perfectionism

Embrace the challenge and opportunities

Avoid victim interpretation
“They are out to get me, they are dumping
on me, they are slamming me”
vs.
“It is a bad night, how can I make things
work”
Avoid the Trap of “Service
PTSD”
You begin re-living a bad service or ward
experience
 You then predict it will happen again
 You become pre-occupied, expecting
worse
 You walk in with heightened arousal and
stress

Avoid the Victim Role at Home

If you arrive home feeling abused, your
family will often respond negatively

They want your presence so be present
Take Charge of Your Wellness:
Be Mindful!!!!!
Eat
 Laugh
 Take a Time Out
 Communicate
 Get Support, Reach Out
 Take Care of Each Other
