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Introduction:
A career in medicine asks a lot of any person; individuals must be well-rounded and academically capable with a clear work-life balance. From day one of medical school, I believe culturing resilience and reflection is vital. The NHS (no date, para. 1) defines resilience as ‘our bounce-back ability in the face of difficulty or challenges. Resilience is the ability to adapt and grow following adversity’. This supports students with the pressures of study, their transition into a doctor, and their career development thereafter. ‘Reflection is thinking about what you’ve done, what you did well, and what you could do better next time’ (GMC, 2016, p.12). An imperative part of this is using the lessons learned from a previous experience to influence how a future action is carried out (Sandars, 2009). An error in either skill can have major implications on the individual or in extreme cases, the patient.
Resilience:
Resilience is often thought of as an intrinsic quality (NHS, no date). Most students will have encountered it through their academic background and personal hardships. It will be further developed as the very nature of the university itself shifts a student’s geographical, social, and academic environment encouraging uncertainty and self-doubt. Eley et al. (2013, para 6) importantly highlighted that ‘resilience is a dynamic process’ evolving as an individual accumulates experience and overcomes failure.
Medical students will be exposed to many pressures as part of their study demanding the necessary resilience to adapt (Kiziela et al, 2019). Medical school alters an individual’s approach to learning and how they understand concepts by applying their existing knowledge to unfamiliar contexts. I have found that resilience contributes to my perseverance with the intense workload and taking responsibility for my learning. Consequently, the effort a student has made towards developing their resilience will be reflected in their exam results.
Thompson et al. (2016) demonstrated that medical students will have greater levels of mental stress, thus promoting the importance of emotional resilience. Distress may stem from a poor work-life balance through prioritization of study over social activities, or vice versa. This can lead to burnout which ‘includes the concepts of overwhelming emotional exhaustion, cynicism due to academic workload, and feelings of inefficacy due to excessive academic demand’ (Yu and Chae, 2020, para. 2). Speaking out and seeking help with psychological health is often seen as a weakness in the healthcare setting with a stigma around it (Thompson et al., 2016). From a student’s perspective, if self-management of a problem fails, the possibility of being a ‘good doctor’ seems impossible. Emotional resilience can be utilized to find an equilibrium, maximize a student’s happiness, and increase their capacity to move forward after a period of difficulty.
For medical students transitioning to doctors, a clinical setting can be overwhelming. Oliver (2017, para. 2) describes that ‘practicing medicine has never been straightforward Doctors carry responsibility, risk, uncertainty, and self-doubt’. A GP on my placement educated me on the importance of resilience, as factors like long hours, excessive workload, poor work-life balance, compassion burnout, and managerial and regulatory changes, are increasing the demand of the job (Oliver, 2017, para. 5).
Doctor-patient interactions require emotional resilience. A patient needs a doctor to make difficult decisions, regardless of the pressures upon them from their personal and work life (Epstein and Krasner, 2013). My cardiology work experience taught me that resilience is required to remain emotionally detached and objective when responding to a patient’s needs. This is key when delivering distressing news or dealing with agitated patients. Moreover, as every patient is unique, they will have different ideas, concerns, and expectations for their care. Resilience can help overcome the challenge of tailoring the information available to each patient and persevering when it’s not effective.
As such, the mismanagement of resilience in doctors can affect their personal performance and ultimately patient care. Similar to medical students, a deficit or absence of resilience can cause burnout (Eley et al, 2013). Doctors often disregard the first indicators of mental distress including tiredness, frustration, and feeling out of their depth. Many hold on to the idea that the situation will self-resolve and their resilience will carry them through (Quill and Williamson, 1990, cited in Epstein and Krasner, 2013). Unfortunately, this often isn’t the case as the most extreme cases of burnout, decrease resilience and cause emotional deterioration (Yu and Chae, 2020). During my placement, it was clear that sharing experiences with others helps unburden an individual and ensures the continual development of a resilient mindset.
Reflection:
Similarly to resilience, I have found that reflection is heavily emphasized at medical school. Despite the purpose of reflection differing between individuals, the general concept, as written by Sanders (2009, para.60), indicates that ‘the aim of reflection is to inform future actions so that they can be more purposive and deliberate’. A key aspect to consider is the consequences of an individual’s behavior. This could be towards peers in medical school or other healthcare professionals in the clinical setting (GMC, 2016).
In an academic environment, purposefully reflecting organizes a medical student’s previous learning, and once engaged, it’s simple to apply it to different scenarios and assimilate the new knowledge with the old (Harris et al., 2012 Schmidt et al., 1989, cited in Ribeiro et al., 2019). During my own studies, I have found that critically analyzing feedback, positive or negative, is imperative as it allowed for the identification of my strengths and weaknesses and re-evaluation of my learning techniques. By establishing reflection as a habit, Ribeiro et al. (2019, para. 4) explained that it ‘fostered medical students’ engagement in learning and increased learning outcomes’. Reflection can thus enhance performance and enjoyment in the course.
However, reflection might be a difficult task for medical students as discussing failure can cause painful emotions. Boud et al. (1985, cited in Sanders, 2009, para. 81) acknowledge that to overcome this, one must ‘recognize and release these emotions since they can block further reflection’. Without accepting the fundamental issue, an individual can withdraw from the process directly inhibiting their future progress. The absence of engagement in reflection could be an indicator that the student isn’t compatible with the healthcare sector.
Unsurprisingly, the power of reflection for doctors is huge and again can be triggered by challenging patient interactions. Watching a senior colleague diffuse a tense situation or a time a doctor themselves had to console an anxious family-member, can act as sources for reflection. A doctor should mirror the positive approaches and pinpoint why other interactions were unsuccessful. However, my work experience has taught me that reflection isn’t an excuse for dishonesty; transparency is vital. Making time to apologize and explain the consequences of an error to the patient is crucial whilst following the correct protocols to maintain the patient’s trust in the profession (GMC, no date).
Reflective techniques are seen throughout the health service, for example, evaluating the services provided by the healthcare facility and whether it meets the needs of the patients (GMC, no date). Reflection also plays a part in reviewing a doctor’s performance. The GMC states that the skill ‘plays an important part of the process of revalidation, which all registered doctors go through every five years to ensure that they can maintain their registration’ (GMC, no date). It’s been brought to my attention during my aforementioned placement that this process is paramount to avoid the degradation of standards impacting patients. Furthermore, group reflection is essential for multidisciplinary teams to review patient care. By discussing a patient’s history and current treatment, including what didn’t suit a patient, a future care plan can be created.
A lack of reflection in a doctor could potentially harm a patient. Repetition of reflective techniques needs to occur frequently, otherwise, individuals may find the task more challenging than necessary (Sandars, 2009). Mistakes are inevitable due to human error, nonetheless, through reflection the effects of them should be minimized. Patients require doctors who use the reflective process to identify possible mistakes, doctors who don’t rush into decisions, and those who have the confidence to ask for help (Epstein and Krasner, 2013). The quality of reflection thus impacts the level of care a patient receives.
Conclusion:
Overall, it’s clear that without resilience and reflection, huge limitations would be placed upon an individual’s academic and professional development. These skills require constant adaptation to different scenarios so it’s unlikely they will ever be perfect. Habitual engagement is essential for progression, drawing on previous experiences before, during, and after an event, as even ‘the anticipation of challenging situations also stimulates reflection’ (Mann, Gordon, and Macleod, 2009, para. 88). To avoid the absence or shortfall of these skills, I understand that a student and doctor needs to protect their mental health. Maintenance of a robust work-life balance is key, especially as ‘higher levels of resilience were associated with lower levels of psychological distress’ (Bacchi and Licinio, 2017, para. 4). Most importantly, reflection and resilience are both imperative to keep the patient at the forefront of a student’s and doctor’s mind.
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