Issue 29 | June 2015 A key role of a doctor is to care for others.  However, what happens when a doctor is not caring for themselves? In October 2013, beyondblue released a report (National Mental Health Survey) which revealed some startling statistics.  Doctors reported substantially higher rates of psychological distress and attempted suicide compared to both the Australian population and other Australian professionals.  In particular, young doctors and female doctors appeared to have higher levels of general and specific mental health problems and self-reported greater work stress.  On a positive note, doctors appear to have a greater degree of resilience of the negative impacts of poor mental health.  Within South Australia, the health care system is undergoing major change over the next four years, with Transforming Health.  In addition the current intern training program is being reviewed at a national level to ensure that the training meets the changing needs of the Australian population. There are also concerns around the possibility of the demand for medical training positions exceeding the availability of positions.  For some, uncertainty and change, increases feelings of stress.  With all this in mind, it is important that the wellbeing for all doctors, especially junior doctors, remains a focus.  From the Chair | Professor Kevin Forsyth Considering the welfare of our junior doctors is an important aspect of our health service and its provision of clinical care. Junior doctors are, by definition, the most inexperienced doctors in our health service, yet they are frequently in the front line of clinical care provision, inducing in them considerable stress and pressure. We need our junior doctors to be well supported, with provisions to enable them to function to their optimal level. Supports around them are an important component of such stress reduction and junior doctor support.   We know that adverse events occurring to junior doctors can have far-reaching consequences for many of them, including altering career pathways. Supporting our junior doctors as best we are able is critical to them and their professional future. I encourage all who read this edition to consider ways that they can better support our junior doctors. Quality Assurance of Training Settings (QATS) A regular checkup to see if junior doctors are being trained well, in healthy workplaces. Recently, SA MET examined our junior doctors' training environments through the Quality Assurance of Training Settings. Healthy training environments in which junior doctors thrive are made up of many factors.  High quality teaching, supervision, and opportunities for clinical skill development operate alongside factors such as orientation, infrastructure and freedom from physical and psychological threats.  It can be difficult for junior doctors to speak up about negative situations in the workplace, to the ultimate detriment of both training and personal wellbeing.   The Quality Assurance of Training Settings (QATS) project has been designed to offer a confidential platform for trainees to rate and comment on aspects of their workplace learning environment, inviting trainees to share their views via anonymous online surveys.  The SA MET Unit gathers and retains these data and findings are aggregated before delivery to Local Health Network (LHN) leadership.  Pilot surveying has demonstrated QATS’ functionality and utility as a screening tool.  Over 200 trainees shared their perspectives, finding evidence for both positive and negative indications. The SA MET Unit was pleased to learn of the high standards of clinical teaching and supervision experienced by most respondents. It was positive to find a high prevalence of health-protective factors, such as trainees feeling part of collaborative teams with their peers.  Many also recognised, however, that more could be done to make counselling available for trainees who were already experiencing difficulty.  Moreover, although maintaining good physical health is fundamental to working and learning, the data indicate that teaching hospitals still have some way to go in terms of providing the necessary infrastructure. The pilot surveys found only one in four trainees had access to high quality catering facilities when on call, and good quality accommodation was available to even fewer. Analyses have begun of data from the recent surveys. Findings from this survey round will be used to inform improvements to postgraduate medical training in SA.   Resilience in times of stress Jane Coward, is an organisational psychologist and also the Manager, Organisational Development Workforce Directorate.  Jane has provided ideas on how to build resilience in times of stress.  She also highlights a web-site survey, determining your character strengths to increase your abilities to move forward in a positive manner. There are times in everyone’s lives when a combination of circumstances, personal and work related, result in us feeling stressed and overwhelmed. It’s at times like this when we want to have resilience - the ability to withstand, recover and grow in the face of stressors and changing demands. Research has shown that when we are resilient we perform better under pressure, are more able to make good decisions and generate ideas in response to the problem.  Resilience is also associated with positive health outcomes such as lower blood pressure, better sleep and healthier immune functioning.   The good news is that people can learn skills which build resilience and these are reflected in the five building blocks of wellbeing and resilience identified by Dr. Martin Seligman in the field of Positive Psychology: Positive emotion, Engagement, Relationships, Meaning and Accomplishment (PERMA). Programs are now being run across SA Health which teach resilience building skills and there is extensive literature on the subject which is readily available.   A good place to start is to make good use of your character strengths – associated with greater psychological well-being, less stress, lower depression, and increased engagement and job satisfaction. A simple way to identify your strengths is to complete the free Values in Action Survey. This is a well-established and scientifically validated tool, linked to the work of Dr. Seligman. This provides you with a strengths profile, helping to build your resilience by understanding ‘your best you’ and giving you skills to identify strengths in others. In challenging times when you may be feeling overwhelmed you can use your character strengths to pull you out of the emotional stress and gain a clearer perspective on a positive way forward. PERMA We all want to be happy, productive and be in healthy, meaningful relationships, but sometimes this proves to be difficult to achieve.  However, Positive Psychology suggests that happiness is obtainable. Respected positive psychologist, Professor Martin Seligman, developed a theory of happiness and identified the building blocks of wellbeing.  This model is called the PERMA model.  PERMA stands for five essential elements that should be in place for us to experience lasting wellbeing.  These include: Positive emotion - including emotions such as peace, gratitude, satisfaction, pleasure, inspiration, hope, curiosity, and love falls into this category. Engagement - when we are truly engaged in a situation, task or project we lose our sense of self and concentrate intensely on the present.  The more we experience this type of engagement, the more likely we are to experience wellbeing.  Positive Relationships - good relationships are core to our wellbeing. Meaning - meaning comes from serving a cause bigger than ourselves. Accomplishment/achievement - we strive to better ourselves in some way, whether this is to master a skill, achieve a valuable goal or win a competitive event.  Each of these elements is essential to our well-being and satisfaction with life. Together, these elements form the solid foundation upon which we can build a happy and flourishing life. For more information, visit the Mind Tools website. The South Australian Health and Medical Research Institute (SAHMRI) Wellbeing and Resilience Centre, in partnership with Techwerks, held a series of Resilience Training courses recently.  If you’d like to receive information on future resilience training, please email the Wellbeing and Resilience Centre via wellbeing@sahmri.com. You can also visit the Wellbeing and Resilience website and Facebook Page. Want to learn more? Check the SA MET website and future newsletters for dates of upcoming training for PERMA+.   Tips on managing stress and maximising happiness Are you interested in tips to help you manage stress? Look after yourself – take a break and relax, exercise and eat well, keep in touch with friends and family. Set time aside to listen to music, read or enjoy other hobbies. Daily exercise – exercising releases endorphins in the brain and also lifts your mood. Choose a physical activity or exercise that you enjoy, join a sports team or gym! Learn to identify and monitor stressors. Create an organised plan for handling stressful situations. Research stress management and find out what techniques work best for you. Learn breathing exercises and utilise them – using breathing techniques can be done anywhere and as often as you like. Make a list of the important tasks for the day or week. You’ll feel more organised and in control. Learn to say ‘no’ when you are busy and can’t take on extra work. You will feel more assertive and you will be able to complete your own work first. A moment with ... Dr Jill Benson Dr Jill Benson AM, has worked as a GP for over 30 years, in addition to working at the University of Adelaide, in Aboriginal and Refugee health and also working for Doctors Health SA.  She was awarded a Member of the Order (AM) in the 2012 Australia Day honours for service to medicine through contributions in the field of mental health, particularly for refugees and people seeking asylum, and to the Indigenous community in SA. What are some of the changes that you have observed over the last 10 years affecting junior doctors? There seems to be increased competition now for places in specialty training, including general practice, and less certainty about jobs. Junior doctors are studying very hard almost as soon as they’ve left medical school, to get into their chosen specialty. Doctors seem to have lost their ‘private space’ in hospitals where they could debrief with their colleagues. The hours might officially be better than they used to be, but there seems to be an expectation that young doctors will work longer than they are paid for, in order to get the work done and to stay in the ‘good books’ of senior colleagues. Many still seem to be working dangerously long hours. What do you think are some of the issues that junior doctors are dealing with when they balance their work and private life?  The hours of course and part of this are that medicine is ‘addictive’ and there is always more to do. The work is never finished, you never actually know everything you need to know, the senior staff are never entirely happy with you, so you keep on working. Sometimes when you aren’t working, what has happened (or not been completed) in the day is still nagging at you and it’s hard to be relaxed with your family and friends. Hobbies, sport, healthy eating, sleep – the essential things for a balanced life, are likely to slip. Is there a piece of advice that you would give to junior doctors that may assist them to successfully manage their work life and their private life? Don’t let medicine take over your life. Don’t let being a doctor become your whole sense of yourself. Nurture your relationships, listen to your loved ones and make sure you’re laughing enough every day. Keep up with your sport, music, hobbies and your religious activities.  Are there any programs, groups or projects focusing on wellbeing and managing work life balance that you see would be beneficial for junior doctors to become involved in? There are mentoring programmes in some hospitals and the South Australian Medical Women’s Society. These can help junior doctors come into contact with other doctors who have worked through some of the difficulties young doctors might be facing. Jill, what are some of the things that you do to ensure you maintain a healthy balance between your work and your private life while managing your own stress levels? I make sure I look after the basic things – sleep, exercise, good food, health. I laugh all the time, read a lot and do volunteer work. I prioritise time with friends and family several times a week – most of whom aren’t doctors. I’m a spiritual person and I remind myself regularly of the true meaning of my life and why I’m in the helping profession. I have fun hobbies like knitting that give me a sense of achievement that is mine, whereas in medicine, no matter what I do, I can only do my bit and the rest is up to the patient or to other people. Any success or failure does not belong to me.  I’m a dedicated travel addict and go overseas at least twice a year and interstate regularly.   Dr Maura Kenny Dr Maura Kenny is Coordinator of the Mindfulness-based Cognitive Therapy (MBCT) Programs at the Centre for the Treatment of Anxiety & Depression, South Australian Health. She is also the Convenor of the Discipline of Psychiatry’s Mindfulness Research Group at the University of Adelaide.  Maura specialises in Cognitive Behaviour Therapy and Mindfulness-based Cognitive Therapy in the areas of Stress, Affective and Anxiety disorders, and has used these approaches in clinical, organisational and workplace settings. Maura is also the Co-Director of the Mindfulness Training Institute Australasia, offering a training and supervision pathway in mindfulness-based interventions. She has recently been made an Associate Teacher/Trainer of the Oxford Mindfulness Centre, University of Oxford, UK. Maura, you did your medical intern year in Scotland.  How was your experience as a junior doctor? At the time, it was an exhausting, wonderful, often rather terrifying and sometimes exhilarating rollercoaster.  I was confronted with decisions, dilemmas and elements of human suffering that in retrospect, I was probably ill-equipped to deal with being all of 22 years old. All I could bring to it then was the energy and compassion of the naïve, which is not such a bad thing. The only piece of pastoral care advice I was given at med school (Illegitimi non carborundum) did not help at all! You now use mindfulness in your practice and assist other doctors to learn the practice of mindfulness.  How do you find mindfulness helps your practice?  I cannot state strongly enough the difference between life as a doctor before and after I began a mindfulness practice. By the time I was introduced to this approach, I was a junior consultant with two young children and was permanently feeling on edge, overwhelmed and tired with all the external and internal demands (we set such high standards for ourselves). As I began to practice mindfulness meditation daily, something shifted physically and I just felt so much more calm and at ease. My mind felt quieter, more spacious and less worried, and I became more productive at work. I also felt a significant shift in how I managed things at home. Does mindfulness help you manage the pressures and demands on you as a doctor? As above, a whole lot of things seemed much easier to deal with. It really demonstrates the idea that we add so much more to the stresses of the job with our reactions to them – worrying and over thinking things, anticipating problems before they have even arisen, being reactive and irritable when they do arise, and so on. Mindfulness gave me a sense of being more regulated and steady, more able to cope and a capacity to respond a bit more thoughtfully rather than reacting in an unhelpful way. I still fall into old patterns, of course, but I am more aware of them, can bring some kindness to them and then can choose to do it differently in the next moment, in the next breath. Sometimes when people are feeling overwhelmed and stressed they don’t feel like they can find the time to practice any type of self-care.   For someone who would like to practice mindfulness, how much time would you need to commit to gain benefits? Well, we are all different and while there has been a huge expansion of clinical, theoretical and neuroscientific research into mindfulness, it is still early days and there are many unanswered questions. My suggestion would be to find a mindfulness course to get started with the assistance of an experienced teacher and then play with the timing and frequency until each individual finds what they need. It is better to do a small amount most days than one big long practice once a week – just like going to the gym really. I aim for about 15-20 minutes daily and there is some evidence that this length of practice can have measurable benefits on mood, attention and coping. Do you have a tip for junior doctors to assist them in managing equanimity in work and life balance? Remember, that you are not alone in feeling stressed. The culture of medicine is competitive, altruistic, perfectionistic and conscientious – a wonderful but potentially dangerous combination as was seen in the beyondblue survey of the mental health of doctors. Doctors can be very poor at looking after their own mental health and wellbeing for fear of stigma and judgement which adds to the pressure. Junior doctors are working long hours at the time they are most inexperienced, adding to the stress and there is no cure for that except getting the basics right: Asking for help when needed whilst slowly accumulating more clinical experience, and Ensuring plenty of fresh air, healthy food, exercise, contact with nature, enough sleep, and not too much alcohol! Mindfulness is a way to be aware of what is going on in our minds and bodies so we can enact this wise self-care. A regular mindfulness meditation can be a good way to support this, as well as the undoubted benefit of recalibrating and calming our stress neurophysiology. The attitudinal component of this approach teaches compassion towards ourselves that then is extended to the patients under our care. We have to find good ways to look after ourselves as we look after others, so that rather than feel defeated and exhausted over time, we can thrive and find meaning and satisfaction in this wonderful challenging career.   Resources available to junior doctors Want to find more resources, further assistance and tips? Keeping Your Grass Greener – AMSA “Mental health difficulty is perhaps the single most pervasive health issue that affects medical students and doctors everywhere” In 2011, the Australian Medical Students Association (AMSA) with New Zealand Medical Students Association (NZMSA) created the guide Keeping Your Grass Greener. The guide has been created to assist medical students in maintaining their health and wellbeing. In 2014, the guide was updated and now includes articles provided by leading experts in health and wellbeing, and medicine. Employee Assistance Program (EAP) The Employee Assistance Program (EAP) is a counselling service for all SA Health employees. The EAP has been designed to assist all SA Health employees to discuss work related or personal issues, which may affect their: Personal wellbeing Work performance Health or safety The free, confidential and professional counselling services are offered to all employees, their families and volunteers through the EAP. Every year you can access four free, confidential professional counselling sessions for you or your family. For more information, visit the SA MET website. JMO Health The JMO Health website promotes the health and wellbeing of junior doctors. This website has resources including self-assessment tools, breathing exercises, reducing stress and useful contacts. Doctors Health SA Doctors Health SA (DHSA) is an independent and profession controlled organisation. DHSA’s mission is to improve the health of the medical profession. Initially, DHSA identified 2,500 doctors without their own doctor in SA (45% of the profession). They found there was a pressing need for a doctors’ health program offering check-ups, web-based health information, access to after-hours services and a larger network of ‘doctor-friendly’ clinics for on-going GP care of doctors and students.  DHSA offers clinical services including comprehensive after hours check-ups. The website includes many useful resources for medical students, JMOs, GPs, Surgeons and Anaesthetists. There is also information on wellbeing, articles and links, latest news and conferences. Upcoming workshops Managing Workplace Stress Lyell McEwin Hospital (LMH) – 14 July 2015 Modbury Hospital – 17 September 2015 Managing Workplace Conflict Lyell McEwin Hospital (LMH) – 19 August 2015 Professional Development Program for Registrars (PDPR) 24-25 September 2015 19-20 November 2015 Visit the SA MET website for further information. PERMA+ Workshop will be available early next year, details will be available on the SA MET website soon. 20th Medical Education and Training Forum Integrate, Innovate, Inspire Abstract and Poster Submissions have been extended until 26 June 2015. For further information visit the Prevocational Forum 2015 website.   Confederation of Postgraduate Medical Education Councils (CPMEC)   Expression of Interest The Confederation of Postgraduate Medical Education Councils (CPMEC) is accepting Expressions of Interest (EOI) for Elected Directors of the CPMEC Board. Applications for EOI will close on 31 July 2015. All information regarding EOI, application forms and selection criteria is available on the CPMEC website. Copyright © 2015 SA MET, All rights reserved.