The ABCs of Dealing with the Resident in Distress

1
The ABCs of Dealing with the Resident in
Distress

• When and How to Intervene
• What Resources are Available
• Challenges

2
Three Scenarios

• Resident who self identifies
• Accept there is a problem
• Are accepting of advice
• Have usually considered options
• Resident who is struggling but not yet
  identifiable
• Resident who is identified for substandard
  performance
• Will be focused on the issue that brought them to
  you
• Often expect you to solve their problems-
  dependency issues

3
Five Early Warning Signs of Stress

• Increased physical problems and illnesses
• Increased problems with relationships
• Increased negative thoughts about things
  previously enjoyed
• Increased unhealthy behaviours.
• Inability to continue to push on

4
Burnout-what does it look like?

• Physiologic
• fatigue, frequent illnesses, lack of
  concentration, somatic symptoms
• Psychological
• depression, anxiety, frustration, poor self
  esteem, pessimism, cynicism, irritated, blaming
  others
• Behavioural
• absenteeism, poor motivation, nonproductive,
  indifference, increased risk taking

5
Who Comes to See Me?

• Crisis in Confidence
• Academic difficulties
• Professionalism breaches
• Anxiety/depression
• Career uncertainty
• Significant physical health concerns impacting
  training or requiring learning accommodation
• Cultural adjustment issues

6
Challenges Dealing with Residents

• Negative thinking
• Perceived lack of control
• Perceived inability to change the situation
• Want a quick fix
• Fear of repercussion is extreme
• Fear of disclosure is bigger

7
Poor Wellness Seeking Behaviours

• Few have family doctors, many dont see how it
  might help
• Poor preventative care strategies
• Very limited idea of how to access supports or
  therapies
• Ignoring the basics- nutrition, exercise, sleep,
  connecting
• Delayed gratification to the extreme

8
Essential Elements of a Wellness Advisor

• Availability
• Accessibility
• Confidentiality
• Preferably experienced in dealing with physicians
  and or trainees
• Preferably non-evaluator
• Linked to a range of services and referral
  sources

9
What do the Residents Need?

• Someone to listen
• Normalizing
• Options
• Help to plan strategy for change
• Support
• Resources

10
Strategies for Successful Change

• Goal setting- consider level of distress
• Homework
• Consider leave- vacation, medical, personal
• Careful planning
• Week at a glance
• Follow up even if seeing another provider
• checking in
• Opportunity to stay involved- mentor?, program
  wellness leader

11
Essential Resources

• Family physicians accepting residents
• Therapists
• primarily Cognitive Behavioural Therapists
• Basic career counselling
• Professional assessments
• Psychiatric
• Learning
• Occupational

12
Essential Resources

• Mentors (especially for IMGs, Pool C)
• PAIRO
• Financial consultants
• Educational/remediation consultant
• Professionalism
• Communication

13
DRWs Top 10 Referral List

• Family physician list
• Individual therapists
• Physician Health Program (OMA)
• Linking to therapist
• Psychiatric assessment
• Substance abuse
• ADVICE!
• PAIRO
• Contract issues
• Legal advice

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Top 10 Referrals

• Mentors
• Resident- especially IMG/Pool C, also chief
  residents
• Faculty
• Accessibility Services, UT
• Advice
• Assessments
• Educational consultant (Sue GT, PGME)
• Communication skills
• Professionalism support

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Top 10 Referrals

• Career counselling
• Mark Franklin or faculty mentor/champion
• Support Groups
• Eating disorders
• Community based
• Stress management
• MBSR
• Stress-busting for residents
• Personalized resident plan
• Online tools

16
Be Familiar With

• Intimidation and Harassment Policy (PGME)
• PAIRO-CAHO agreement
• CPSO registration requirements
• Mandatory reporting vs. ethical reporting (CPSO)
• Incompetence or incapacity that compromises care
  of patients

17
Be Familiar With

• University services and policies
• Sexual harassment officer
• Cultural Diversity Officer
• Ombudsperson
• EAP programs