Clare Gerada: Dissecting resilience
BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4974 (Published 28 November 2018) Cite this as: BMJ 2018;363:k4974
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Clare Gerada is correct that the lack of opportunity to make friendships with colleagues damages a doctor’s ability to develop resilience. The loss of hospital accommodation has been a big loss. It allowed junior doctors of various grades to live alongside other healthcare professionals and meet up and support each other after work. The accommodation was also cheaper and meant that doctors were based near the hospital, reducing travel time which adds to the stress of work.
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Clare Gerada's piece goes to the heart of the sad loss of the team spirit we once enjoyed from "traditional" training. I am very concerned to discover that the GMC is unable to tell me how many non-Consultant doctors have committed suicide in the last 5 and the last 10 years. They are supposed to look after us. Such stats are so very basic.
The strain on Juniors today is severe, and no longer supported by the "Firm" system, is it surprising that so many Juniors are voting with their feet? I personally knew two Juniors who killed themselves, unsupported in their time of need. Neither were mentally ill.
Competing interests: No competing interests
Dr. Gerada is absolutely correct that friendship is the special dimension of social capital that nurtures our resilience. I used to teach Anatomy and can confirm that the longterm cooperative learning some student groups had then, led to bonds that have lasted over 30 years. Not all medical students can be acculturated to their profession (some from overseas found UK higher education especially challenging). However, I observed a number of traditional extra-curricular Medical School groups (rowing crews, local charity volunteers, choral singers) did promote social resilience. The ability to laugh at oneself safely is a lifelong asset. Of all the medical traditions, the hospital Christmas pantomime seemed to have the most lasting impact. As a 'participant observer' of acculturation, I was especially touched when invited to be a last-minute replacement for the Rear End of an Elephant in the Jungle Book, one Christmas.
Competing interests: No competing interests
Re: Clare Gerada: Dissecting resilience
Dr. Gerada highlights the reality of building resilience amongst doctors [1].
As a medical student the idea of entering this emotionally tough profession is daunting. At our medical school, cadaveric dissection is still promoted and taught. This offers a unique way to discover the fascinating anatomical structures within our bodies and to collaborate with peers. We catch each other's faints at the first sight of a human body, navigate our way through the abdominal structures but most of all gain a vital support system during our first steps on our medical journey.
Although the traditional structures within medical schools are rapidly changing, we feel that some newer structures do prepare us psychologically for a career in medicine. Cardiff University has a relatively new curriculum, C21, which consists of case-based learning sessions. In these sessions, we discuss pertinent medical cases in groups of 10, meeting twice a week. This facilitates discussion of personal experiences of various conditions, our thoughts on evidence-based medicine and good clinical practice. It is a safe place to debrief after seeing potentially upsetting situations on placement. These spaces allow us to build resilience and learn from one another. We share our knowledge to promote camaraderie, offer incentives such as cake to make the pain of learning cell-signalling a little easier and importantly celebrate our achievements. We are a team and with that we value the skills each member brings to the table.
However, despite this sense of togetherness in medical school, there are a few factors which cause an underlying competitive streak and promote a rift between our classmates. First is the hot topic of rankings. This creates dispute and results in individuals gaining an inherent power to intimidate others. Nevertheless, it should be recalled that each ‘number’ is a person with a special skills sub-set and this cannot be undermined on the basis of an exam. It is a common joke that number 300th in the year still graduates as a doctor – and this holds true. Therefore, our focus should be to empower our peers to develop their skills to be the best they can wherever in the rankings they may fall. Horrifyingly, it has been noted that revising with friends is a questionable idea as it may be detrimental towards your own rank [2]!
The nature of the FPAS (Foundation Programme Application System) process further fuels rivalry. It seems that individuals are obsessed with gaining points, especially for publications. We feel that research, expressing opinions and the process of peer review should be enjoyable exchanges amongst peers. However, these are often periods when individuals become secretive about their work and seclude themselves. We feel this is not a sustainable approach. By definition, research is about disseminating knowledge, critically appraising each other’s work and promoting collaboration. The basis of a multidisciplinary team (MDT) is reliant upon this, surely it should be encouraged at an earlier stage.
Soon after FPAS application has gone through and we are thrust into the world of ‘real’ Medicine - with overwhelming shift patterns, there is barely enough time to eat let alone discuss our fears, and insecurities of day to day life. Often it feels as if our friends are scattered across the globe, there is no cake and no safe environment to have such discussions. Virtual environments, in the form of Facebook groups, such as Tea and Empathy have received a lot of public attention. They have connected individuals and enabled them to discuss topics from day-to-day life, mental health struggles and career planning. Luckily in Wales, hospital accommodation is free. This is useful as it offers a sense of community amongst junior doctors and reminds us that perhaps we are all in the same boat.
We recommend improved strategies to build openness and discussion amongst colleagues. An example of this could be increased awareness of the benefits of attending Grand rounds and Schwartz rounds. These may enable junior doctors to develop their confidence in presenting cases and voicing concerns.
References:
1. Gerada Clare. Clare Gerada: Dissecting resilience. BMJ 2018; 363 :k4974
2. Nowbar and Francis. A friend in need. Student BMJ 2014;23:g7345
Competing interests: No competing interests