The need to DEBRIEF
Many of us fail to recognize our need to process traumatic or stressful events that occur during working hours. Ignoring feelings of failure or inadequacy can have long-term impacts on both our mental health and patients’ care. Debriefing can allow us to process our emotions, support our team members and work through any systems or performance issues that may have been brought to light1. Normalizing this process and teaching our residents and medical students how to debrief can help us all build resilience.
The seven step process outlined in the Academic Life in Emergency Medicine article below is adapted from the Mitchell Model of Critical Incident Stress Debriefing. It can serve a guide or starting point for those of us with less experience leading these discussions. We would encourage trying this after ANY significant negative outcome, not just patient death.
- Set ground rules
- Present facts first
- Elicit thoughts
- Open up about reactions
- Discuss symptoms
- Teaching and learning
- Re-entry and closure
- Chung, Arlene. Wellness and Resiliency During Residency: Debriefing Critical Incidents and podcast. Academic Life in Emergency Medicine. January 25th, 2017. wellness-resiliency-debriefing-critical-incidents
The AAP has also developed a Resilience Curriculum with a specific senior resident guide that can also be adapted for use with faculty members. It outlines a workshop curriculum to teach our trainees when they should debrief and how to provide a supportive environment that supports others in the session.
We have just received or will soon receive brand-new bright-eyed junior medical students starting their clerkships. At the same time, we are busy with ERAS questions, LOR requests, and advising the fourth year students as they embark on the journey to the residency match. As we enter one of the busiest times of the year for academic pediatricians who work in medical student education, it is the perfect time to discuss sleep and rest.
Did you know that adults need 7 or more hours of sleep per night for the best health and wellbeing? While we can’t create more hours of the day or always decrease our workload, here are some realistic tips for your sleep environment that may make your sleep more restful.
- Your bedroom should ideally be cool – between 60 and 67 degrees.
- A comfortable and supportive mattress and pillow should be used. The life expectancy for most quality mattresses is 9-10 years so it may be time for a new one.
- Eliminate excessive light (no – tv or electronics, yes – black out curtains) and noise (white noise machine, fan, CPAP for your snoring significant other) from your bedroom.
Watson NF, Badr MS, Belenky G, et al.; Consensus Conference Panel. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. Sleep. 2015;38:1161–1183.
National Sleep Foundation. www.nationalsleepfoundation.org
Rumination – bad for your job and hazardous to your health.
When physicians perseverate on patients, stressful experiences or work-related tasks it can impair wellbeing. Everyday pressures to meet deadlines and keep up with demands can follow you home and keep you up at night. They can impair your ability to keep organized or focus on other tasks. Ruminating on stressful events is a poor coping strategy that has been described as the “enemy of resilience”. Self-reflection is an important learning tool for physicians, but when the focus is only on the negative you miss the big picture and stunt personal growth.
The Center for Creative Leadership recommends the following tactics to help change your habits:
– Interrupt the pattern – move, stretch, do something physical when you find yourself starting to ruminate
– Re-focus on something you can control
– Put things in perspective
– Get above it all
The #1 Reason You Are Stressed and How to Change It. Center for Creative Leadership https://www.ccl.org/articles/leading-effectively-articles/banish-stress-stop-ruminating/