Report on Tomorrow’s Doctors

Professor David Peters, Director, Westminster Centre for Resilience, University of Westminster

Published in JHH13.3 – Nutrition and Lifestyle

Professional resilience used to be seen primarily as a characteristic of people who are relatively stress-proof and so less susceptible to burnout. It was formerly assumed too that these qualities were predetermined. More recently, it has been recognised that people can learn to be more resilient, that positive adaptation to professional challenges is possible, and that certain skills and attitudes enable doctors to flourish in their work.

For the last three years the Westminster Centre for Resilience team has been developing resilience workshops for NHS staff. Our encounters with GPs and foundation doctors has left us in no doubt of the need to be resilient in both ways: throughout long and often stressful careers doctors are expected to function well and with grace and make life or death decisions under pressure; and in medical practice they encounter extraordinary levels of emotion and suffering which, whether or not they realise it, they will inevitably be affected by.

If we define resilience as the ability to make appropriate decisions while retaining emotional awareness and empathy, and to achieve this without too high a personal cost, resilience would seem to be a very desirable quality in a doctor; perhaps even a necessary one.

The evidence that empathic patient-centred doctors are also more resilient supports the potential for positive cycles of satisfied patients and fulfilled doctors. In order for this to come about however, medical education may need to evolve as, crucially, the way healthcare is conceived and organised undergoes radical change in the face of the 21st century’s demands.

The big problem

The GMC, aware that students and qualified doctors are experiencing increasing levels of workplace stress and burnout, has urged medical schools to include personal resilience in their professional development programmes. With these issues in mind we convened a symposium of medical school colleagues involved with teaching about resilience, professional development or self-care, to begin asking where, how well and with what outcomes the GMC’s instruction is being carried out.

As far as we can establish this was the first meeting of UK medical educators to specifically address the topic of student resilience and self[1]care. Teachers from 28 of the UK’s 34 medical schools came to the meeting at the University of Westminster in Central London in June 2016. Sixty participants took part in a format that included presentations, panels, and large group facilitated conversations. World Café and Open Space processes encouraged collaborative dialogue – knowledge-sharing so that creative possibilities could arise.

We came together around the assumption that in the increasingly overstretched territory of modern, industrial-scale healthcare, more attention to personal resilience (starting at medical school) will be a vital basis for safe and sustainable professional practice. Medical training is both intellectually and emotionally demanding, and the ways students adapt may well determine career[1]long professional habits and styles of practice. Perhaps dropout, burnout, career dissatisfaction, and consequent staff wastage would be reduced if the burdens of medical student, foundation and post-foundation stressors were better understood and addressed. Our implicit proposal was that an enhanced ‘resilience-curriculum’ could be an essential first step in this direction. Associated questions included whether a deeper understanding of resilience would help doctors become more authentically patient-centred.

The challenges for medical education

A panel of four students and one foundation year doctor opened the symposium. Their common concerns and solutions included the current selection focus on A level grades, and medical schools’ failure to prepare students for the emotional rigours of professional practice. The panel members recognised medical education’s ‘invisible curriculum’, how it shames mistakes and ‘weakness’, discourages emotional honesty, fosters isolation and competiveness, persuades teachers to be anonymous rather than authentic, and generally fails to champion reflective practice.

The panel wanted more mentoring for students and for distressed or ill students to be identified and helped early, compassionately and without being stigmatised.

Moving from the illusion of certainty as a student to the reality of uncertainty as a foundation doctor is a giant step. The transition should be better supported. They saw the potential for a ‘hard science’ perspective on emotion, mindfulness, stress-resilience, self-care and wellbeing (using the emerging fields of contemplative and emotional neuroscience) as having important implications.

Some solutions and conclusions

We selected six medical educators to present their projects as examples of effective models aimed at addressing some of these issues: mindfulness training (Monash Medical School, Melbourne), Schwartz Rounds (introduced at University College London), SafeMed (University of Cork) and two models for professional development (Plymouth University and Barts & the London). The recently established online Tea and Sympathy Network emerged as an example of an extra-curricular resource that could be extended to undergraduates.

Medical students need support for resilience both educationally, and through social networks and online resources. With this in view, the symposium proposed creating a ‘parallel resilience curriculum’ to extend and enhance schools’ own efforts. Concerned medical educators will form a special interest network to develop these resources and pursue research into the effectiveness of educational interventions. The centre will seek funding to help build this network and for developing online resources, sharing information and supporting further collaboration. A second one-day meeting will be held in summer 2017.

The full report is available online and as a printed version at the centre’s website.