Is MORE resilience really the answer?

In medicine, we are talking about wellness and resilience more than ever before. Yet reported levels of burnout in physicians remain high. Is it possible to foster resilience? What works for you?

I am currently in the midst of an online course for emerging leaders in academic medicine, and this week's unit was all about fostering resilience in residency. The above quote was this week's discussion prompt, and below are my thoughts and reflections surrounding it. I had so much to say (shocker) that I decided to turn it into a blog post -- I hope you enjoy.

Firstly, I want to acknowledge the fact that having made it through medical school and into residency --while also managing lives outside of medicine-- means we are already quite resilient. To that end, I think the question is not 'How can I become resilient?' but 'How can I optimize my resilience for this current phase of my life?'. I read a number of different definitions for the term 'resilience' in this week's readings, and I wanted to take a moment to highlight a few.

"Resiliency is portrayed as the ability to preserve and remain positive despite adversity."

I personally find this one quite problematic... it gives me big 'toxic positivity' energy. If we aren't able to remain positive 100% of the time when things go south, does that really make us less resilient? The idea of 'remaining positive despite adversity' has a perfectionistic flavour that I think in the long-term is destined to be self-detrimental. In order to survive in this profession, not only do we need to be able to give ourself grace and accept that we can't be perfect all of the time, we also need to be able to acknowledge the reality that sometimes things are just really shitty, and there's not always something we can do about it.

"Resilience is the ability of an individual to respond to stress in a healthy, adaptive way, such that personal goals are achieved at minimal psychological and physical cost."

I like this one a lot. It doesn't say to 'be positive' at all costs; rather, it says to be healthy and adaptive. In my mind, this gives the individual the flexibility to decide what might be most appropriate to foster well-being in any given situation. I also really like the concept of minimizing psychological and physical cost as a component of resilience -- we aren't hyperbolizing to say we will 'always' be happy or 'never' be stressed; instead, we are saying that we will do our best to minimize harm to ourselves.

"The dimensions of resilience (which include self-efficacy, self-control, ability to engage support and help, learning from difficulties, and persistence despite blocks to progress) are all recognized as qualities that are important in clinical leaders."

In particular, I like the way this breaks resilience down into multiple facets. It makes the concept of what resilience entails much more specific, and as a result (in my mind at least), far more actionable. Two things in particular really resonated with me:

1) Something I hadn't explicitly thought about much before is the role of self-control in fostering resilience... but it makes a whole lot of sense now that I do. When we feel we have an internal locus of control, we essentially feel that we have the ability to make meaningful change in our lives (as needed) for the sake of our own wellbeing. This has the knock-on effect of ensuring we are able to live our lives in a way that is in accordance with our values. In residency, however, when so much of your life and your schedule is dictated by others (and as such, is quite literally out of your control), there is an element of learned helplessness that creeps in. Within individual programs, there are also undoubtedly systemic factors that further enhance these feelings that there is nothing we can do to improve our situation. I imagine this over-arching feeling of a lack of self-control over oneself and one's life is one of the biggest drivers of burnout in resident physicians.

2) I think learning from past difficulties is an absolutely HUGE part of fostering resilience -- in life in general, but especially in medicine. Unfortunately, I think the historical culture of medicine continues to promote this pedestal of perfectionism -- that we are always supposed to know everything and to get it right every single time. If this is the idea we have internalized about ourselves, then there is a HUGE threat to our identity when we make a mistake. As a result, we tend to enter these huge shame spirals, which are only made worse and more debilitating when we keep these (oftentimes irrational) feelings of inadequacy to ourselves. When we lack the courage to share our stories, we shut ourselves off from the support that comes with being vulnerable; people can't support you if they don't know what you're going through. Learning to accept that we are all imperfect and leaning into viewing our mistakes as opportunities for growth is absolutely essential to our longevity. And we need to find a way to work this into the culture of medicine moving forward.

If you are interested in reading more of my thoughts around this, check out a post I published in CMAJ last year titled The Fallacy of Perfection.

Interestingly, none of these definitions of resilience touch on what I have found to be the #1 contributor to preserving and enhancing my own resilience these past few years: SELF-COMPASSION. Briefly, the three main elements are:

1) Self-kindness vs self-judgement: Can I be gentle with myself when I get it wrong?

2) Common humanity vs isolation: Can I take a step back and appreciate that this happens to others too? Can I find the courage to talk to someone about this?

3) Mindfulness vs over-identification: Can I be introspective enough to notice how I am feeling? Can I allow myself the time and space to feel it, accept it, and move through it?

Dr. Kristin Neff has put a TON of work into this topic (her whole life's work in fact), and I would encourage you to take a gander through her website and/or books if you are curious to learn more. I myself just finished reading her latest book -- 'Fierce Self-Compassion' -- this morning.

I will leave you with this quote from an article I read recently, which I think nicely ties together my thoughts around this topic:

“Those who find meaning in their work, strive to maintain a work-life balance, and identify and focus on their values and priorities are at lower risk for burnout”.

...so, if you want to optimize your resilience:

a) Find something that you are genuinely passionate about.

b) Protect your time outside of work (remember that "no" is a complete sentence) .

and

c) Get clear on what things in life are important to you and how you want to show up in the world every day.