Whether or not you’re a health care provider, chances are you’ve spent the year thinking, talking, and reading about health care. We’ve had national conversations about everything from the global pandemic to rising health care costs to rationing resources to the politicization of medicine. Much less discussed—but very much affected by all of this—is the unintended consequences the pandemic has had on our medical students and residents. In March, most medical schools pulled all learners from clinical rotations, though a few graduated them early to help with COVID patients. Residents from all specialties were repurposed in hospital COVID units. Memes circulated about orthopedic surgeons trying to run ventilators. While these jokes provided some much-needed levity, there was a sharp underlying edge. Residents were being called on to take care of conditions they hadn’t seen since studying them briefly in medical school. Many were deeply distressed, afraid they would fail to help or, worse, that they would hurt a patient. Clinical medical students lived in limbo. Concerns about PPE shortages and their safety as our next generation of doctors led the Association of Medical Colleges to bar them from answering the call for help. They remain in limbo as they struggle to take vitally important board exams, adapt to the virtual curriculum, interview for residency virtually, and spend extended periods of time unable to see loved ones. We do a great job educating our students on how to figure out what fluid to give a patient, how to pick and order the correct medications, and the steps of an operation. But we don’t do a great job teaching them resilience or dealing with failure—a significant oversight given that as physicians, we will harm or kill a patient despite our best efforts. Resilience, or the ability to adapt to and recover from challenging situations, can help moderate the burnout that we feel as physicians. Doctors who don’t learn this skill in medical school can develop resilience through coaching, a practice that provides a framework for examining our thoughts. We spend so much time learning how “doctor” without learning how to “doctor” ourselves. Coaching can do this. It helps us learn to control the way we feel about our lives. Even though health care providers think of themselves as extremely rational people, the fact of the matter is that we are human. And that means that most of what we do is all based on emotion. Here’s a simple example. I live in Chicago, where driving in traffic is a fact of life. Some days I don’t care that I’m stuck in traffic. Other days I’m a raging lunatic. What is going on? On the days I don’t mind traffic, I appreciate the time it is giving me time to call people, decompress, or listen to a podcast. On days when I’m angry, I am focused on how traffic is keeping me from something else I want to—or need to—be doing. Not surprisingly, on the days when I’m cool with traffic, I show up at home in a much better mood than when I’m angry about traffic, which of course impacts how I interact with my family and how the rest of my evening goes. Traffic itself is totally neutral. Yet what I think about traffic totally changes how I show up when I get home. This is a small example of how coaching has helped me. Before coaching, I didn’t realize why I was acting a certain way. Thanks to coaching, I can now come up with a framework to recognize moments like these and choose how to respond to events outside my control. Coaching in medicine has been shown to reduce emotional exhaustion and improve resilience, and it can improve the quality of life for our medical students and residents. Yet even though many coaching resources exist in medicine, including through many of our major medical societies, there is no national consensus on calling for coaching for our trainees. It should be an essential component of our training. The AMA has published a handbook on coaching in undergraduate and graduate medical education that offers valuable resources on introducing coaching and the mindset to work in medical training. This handbook helps define the differences between coaching, advising, and mentoring and gives a concrete framework on how to bring coaching to your institution. One of the bright spots that can come from the pandemic is the increased awareness of our trainees’ mental health and well-being. Let’s start this process of resilience training and coaching from medical school on, and teach our students and residents to be well before they are ever sick. Ami N. Shah is a plastic surgeon. Source
