Between 2005 and 2013, 24 doctors who were under investigation by the GMC committed suicide and a further four doctors died in circumstances where suicide was suspected. The GMC’s recent report makes troubling reading and suggests that resilience training for undergraduates may be part of the solution.
But if emotional resilience training is introduced as part of the medical student curriculum, what about those doctors who have already qualified?
A GP who has recently been under a GMC investigation believes resilience training could be of great benefit. ‘I had previously been aware of good "taking care of yourself" techniques, which are resilience techniques without that label, and in fact I consciously used these while under investigation,’ he explains. ‘I had to feel I was taking control and I put myself on a war footing.’
What is emotional resilience training?
Emotional resilience is the ability to move forward effectively in the face of difficulty. Emotional resilience training helps individuals to recognise their own style of thinking about, reacting to and handling adversity. The training is intended to help individuals work on the positives and bounce back from criticism and setbacks.
Doctors are not the only professionals who have identified that resilience training may be of benefit. Lawyers, Whitehall high-fliers and airline pilots all include this topic in training programmes.
Publicity following publication of the GMC’s report suggested that army-style resilience training, formerly known in the USA as ‘battlemind training’, might be the way forward.
Is emotional resilience training the whole answer?
However, Sir Simon Wessely, current president of the Royal College of Psychiatrists and director of King’s College London’s Centre for Military Health Research is sceptical that this is the best solution.
‘There is no evidence that resilience training works for the US army and anyway, doctors aren’t soldiers,’ he says. ‘Requiring people to have personal psychological training suggests it’s their own fault and a problem if they get upset about how they are tested or examined. Fundamentally, it is the responsibility of leaders and management to improve morale and professionalism and provide proper training and support. Doctors need better support for the job they do.’
Carlo Caponecchia at the University of New South Wales School of Aviation takes a similar view. He explains: ‘The implication with resilience is that (the organisation) know this bad stuff is going to happen to you as a consequence of our system, so we make you responsible for the extent to which it affects you.’
What does this mean for GPs today?
Not only do GPs need to cope with their own professional pressures as doctors, but as employers and leaders they need to provide adequate feedback, support, involvement and consultation for individual team members.
A practice, like any organisation, reacts to internal and external threats and these reactions to threat may impact on individuals in negative ways. While recognising that GPs have responsibility for the practice as an organisation and its impact on individuals, might there still be something to gain from exploring personal resilience in more detail?
Let’s look at some of the approaches used in resilience training.
Resilience training is based on the principle that the following behaviours are helpful ways of managing pressure:
- Strong self-belief and self-confidence
- The ability to adapt to change
- Having a strong support network
- Achieving and maintaining a good balance between home and work
- A feeling of having a purpose in life
- An ability to manage emotions and bounce back from negative experiences
This is very good in theory, of course, but hard to hold onto under extreme pressure. What might resilience training add to what we already know?
Steps to take
Research shows that individuals do increase levels of hope and optimism following resilience coaching and feel that they can handle change more effectively.
The following are typical examples of topics included in resilience training and coaching.
- Seek out and concentrate on the positives
- Avoiding making assumptions and jumping to conclusions
- Avoiding the belief that it’s all your fault
- Avoiding blaming everyone but yourself
- Avoiding over-generalising ("She’s always so moody!")
- Develop self-knowledge, reflect, and make changes
- In what circumstances are you least resilient – what really pushes your buttons?
- Understanding and managing negative thought processes
- Remaining calm and focussed
- Work on achieving life-work balance
- Nurture positive professional relationships and professional support networks
How this might work in practice?
Reflecting on his experience, the GP who had been under investigation by the GMC says he had deliberately sought support from colleagues. This had helped him keep the situation in perspective and often helped relieve stress with some black humour.
‘I also valued professional support during the investigation. Having an explanation of what would happen and a timeline of probable events helped me to handle them,’ he says.
‘I also took steps to keep healthy by exercising and cutting down on alcohol. I think I already had a good level of understanding of how to cope, but if I had received actual training, that would have meant my coping mechanisms would have kicked in sooner.’
It seems clear that GPs in particular and practices in general could benefit from improving individual and organisational resilience. Although it can be said that resilience training may appear unfairly to blame individuals for not being ‘tough enough’, it does seem clear that an understanding of individual and organisational resilience can help lead the practice through the present troubled times.
|More in this series
- Alex Davda. A Pilot Study into Measuring Resilience. March 2011: Ashridge Business School
- Karen Reivich PhD, Andrew Shatte PhD . The Resilience Factor (Seven Keys to Finding your inner strength and overcoming life’s hurdles). October 2003: Three Rivers Press, New York
- Resilience Training: Is Your Boss Copping Out on Burnout, NSWU Business School.
- Jackson, D., Firtko, A. & Edenborough, M. Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: A literature review. Journal of Advanced Nursing, 2007: 60, 1-9
- Sherlock-Storey, M., Moss, Mark, Timson Sue. Brief coaching for resilience during oganisational change - an exploratory study. The Coaching Psychologist. 2013: Vol 9, No.1.