Learning to manage the stress and trauma of medicine

Medical professionals must be cool, calm, and careful in emergency situations, managing each incident and then moving on to the next task unfazed. Clinicians in training are expected to learn how to maintain their composure through practice—to cope … well, by coping.

Over three Sunday afternoons last fall, medical, nursing, and physician assistant students learned specific practical tools to help them manage the inevitable workplace stress. During a three-session workshop, the students learned skills as diverse as reflective writing, mindful listening, trauma management, breathing techniques, and how to communicate across health care disciplines. The idea of the program, then called Relational Impact Medicine and since renamed Resiliency Education and Skills Training, (REST), is for students to learn techniques of self care in the same way they learn to perform procedures: by watching, learning, and practicing.

The REST program “offers an experiential and educational program that helps health care professionals learn how to ward off burnout,” said Ava Diamond, who developed REST with her colleague, Jacqueline Cohen, who has an M.A. in drama therapy. Improving clinicians’ coping and teamwork skills doesn’t benefit only the staff. “The outcome is also improved patient care, because when you have resiliency and collaborative teamwork, you have better patient satisfaction.”

Michelle Joy, a third-year medical student who participated in the workshop, said that while learning the science of medicine is essential, it’s also important to learn better ways to connect with patients and colleagues. Busy as she is, she decided it was important to learn how to care for herself in order to care for other people. “It was to signal myself to take time for this,” she said.

Diamond and Cohen were childhood friends who reconnected a few years ago through Facebook. Diamond is a clinical social worker with experience treating trauma and substance abuse in both private practice and hospital settings. Cohen holds a master’s degree in drama therapy from New York University; she has taught in New York City public schools and consulted for a number of nonprofit organizations using drama therapy, narrative techniques, and relational therapy.

The two women have been developing REST for about two years. They worked with Columbia University’s Program in Narrative Medicine to better understand how narrative works in the health professions. Narrative Medicine seeks to develop clinicians’ “narrative competence” through reading and reflective writing in an effort to improve clinicians’ capacity for attention, reflection, representation, and affiliation with patients and colleagues.

In addition to practice in narrative construction, mindfulness meditation, and communication skills, REST offers students specific training in trauma management. Eager to bring the program to an academic setting, Diamond and Cohen contacted Auguste H. Fortin VI, M.D., M.P.H., associate professor of medicine, who has worked with Yale medical students on self -care and burnout prevention. “What appealed to me about this program was the recognition that so much of what happens in medicine can be traumatic,” especially for students, said Fortin. “They are at their most vulnerable as students. Seeing a patient die, seeing a birth go wrong, being blamed for mistakes, being responsible for mistakes. All these can be traumas.”

Based on feedback from the first group of participants, Diamond and Cohen hope to offer the program in future semesters, ideally over a longer time frame than three sessions of two hours each. Whatever the shape of future workshops, what hit home for the participants was the “absolute need for work like this,” Diamond said. The ultimate goal is to help preserve and develop the human side of medical care—to the benefit of professionals and patients alike.