Saturday, April 19, 2014

The Promise of Beginning Again ...

Hi Everyone,

A Happy Easter weekend to you all! I was thinking about Easter and Spring and the promise of new beginnings as I lay in bed this morning listening to a happy and vocal little chickadee calling for his mate.

Many of you have attended the Caring On Empty Compassion Fatigue Resiliency workshop, or have done some reading about compassion fatigue recovery and resilience, and have made plans for the small but important lifestyle changes needed to build your personal wellness. For at least a while, you were excited and enthusiastic about your plans, happy to be following ideas like "put the oxygen mask on yourself first" and "never give from the depths of your well, only from the overflow".

And then life happened. Your loved one had another health crisis. Your thesis was overdue. Your teenager got caught cheating on an exam. Your elderly mother-in-law moved in downstairs. An edict came down about working more overtime. You got sick yourself. Or you just got bored with the routine. Despite the best of intentions, your self care lapsed, quickly followed by a lapse in your self compassion. Self critical thoughts filled your head and, filled with shame at your "failure" to follow your plan, you distracted yourself by becoming busier still. Many of us can become lost in that fog of busyness and shame, forgetting that we always have the possibility of beginning again.

Beginning again has been a theme of poets and spiritual writers over the centuries. Poet, Rainer Maria Wilke, writes, Resolve to be always beginning - to be a beginner.  Jennifer Ritchey Payette says, It's humbling to start fresh. It takes lots of courage. But it can be reinvigorating. You just have to put your ego on the shelf and tell it to be quiet.  Buddhists speak of practicing "beginners mind" and the Benedictines follow what St Benedict called "a little rule for beginners". Those of you who practice yoga may be aware of tapas, meaning fire or heat, the discipline of showing up to practice again and again. 

Beginning again involves humility. Remembering that we will never be perfect at anything and forgiving ourselves for not being so. All we will ever need to be is human (by definition, imperfect) and all we will ever need do is to practice beginning again - and again and again and again ...

So, when it seems that life conspires against you and your plan, forgive yourself for giving up, re-assess, and begin again. We can begin again every day. In fact, every "failure" is a starting point. The only real failure occurs when we don't take the opportunity to start over.

John O'Donohue, one of my favourite poets, captures beautifully the feltsense of beginning again each morning in these few selected verses from his poem, Matins:

Somewhere, out at the edges, the night
Is turning and the waves of darkness
Begin to brighten the shore of dawn.

The heavy dark falls back to earth
And the freed air goes wild with light,
The heart fills with fresh, bright breath
And thoughts stir to give birth to colour...

May I live this day

Compassionate of heart,
Clear in word,
Gracious in awareness,
Courageous in thought,
Generous in love.

And may these words and images bless your beginning again - today, this Spring and all through the year.

With love,


Sunday, April 6, 2014

A Kinder, Gentler Medical Curriculum ...

Hi everyone!

At the end of the month, one of my dear friends will retire from his position as an anesthesiologist and medical educator at Queens University School of Medicine. A warm, compassionate and highly skilled clinician, he has made important contributions to his field by promoting and modelling teaching excellence, developing a resident logbook, and designing and implementing professionalism training for medical students.

Over the years, Ted and I have had many conversations about how to reduce pressure and create a safe learning environment in medical schools, believing that we cannot foster civil, humane, compassionate practitioners in education systems that overwhelm, disrespect, and shame their students. While many educators are beginning to understand the importance of systems that promote student mental health and compassion fatigue resilience, there are still many places where lip service is paid to such notions while educators continue to transmit less-than-helpful values through the "hidden curriculum" of unkind teacher-student interactions and inhuman expectations.

This week, as Ted prepared for retirement, we had another chat about medical education, this time spurred by a new study by Dr Stuart Slavin, MD, MEd, associate dean for medical curriculum at St Louis University, a Jesuit institution in the US.

The paper, published in the April edition of Academic Medicine, looks at the well-being of first and second year medical students before and after changes to SLU's medical school curriculum, changes designed to prevent depression, stress and anxiety. (There is strong evidence that the seeds of these mental health problems are planted in medical school.) Student mental health was measured in 5 classes of 175-178 students - two before the changes and three after - at the medical school orientation, the end of year one and the end of year two.

Slavin says that the study showed a dramatic improvement in the mental health of the students. Depression rates in first year students went from 27% to 11% and anxiety dropped from 55% to 31%. At the same time, test scores increased, showing improved student performance. Slavin said, "Our students know more, and will be in a better situation, emotionally, to care for our patients."

In planning the study, SLU administrators asked students why they felt anxious and depressed and then designed and implemented curricular changes that would directly address the identified stressors. Without sacrificing critical educational components, SLU changed the curriculum to remove unnecessary stressors, (a far cry to the traditional wisdom of seeing stress as an inevitable part of the path to becoming a doctor), and added a required class that teaches strategies for stress reduction.

Students were taught to better manage energy by taking breaks, sleeping, eating properly and exercising; being mindful or paying close attention to what's happening in the present moment; reframing their perspective to be more realistic; recognizing negativity; controlling their reactions to situations; and cultivating a positive and optimistic outlook that ultimately leads to more happiness and personal satisfaction.

In reporting his findings, Slavin pointed out that it is important to the health care system to address depression and stress among physicians.  "Physician depression and burnout are significant problems and may rightly be viewed as a substantial public health problem, particularly given the evidence of the negative impact that mental health can have on clinical care by reducing physician empathy and increasing rates of medical error."

As we talked about this timely paper, Ted and I agreed that it was sad that such a study needed to be undertaken in the first instance but that it was hopeful and encouraging to see that long-needed changes are finally being made as he comes to the end of his teaching career. We spoke about congruence between course content and the behaviours modelled by educators and how integrity between the two makes for a mentally healthy learning environment. We also shared the hope that this sort of congruence will continue to grow as other programs modify their curriculae.

Before leaving you today, I'd like to take a moment to say congratulations, great job(!) and every good wish for a happy and healthy retirement to my friend, Ted Ashbury. Thank you for all you've done for so many years to try to make medicine a kinder and gentler profession.