MANAGING TRANSITIONS - University of Toronto...MANAGING TRANSITIONS SAMPLE PRESENTATION Christopher Hurst M.Ed, Office of Resident Wellness Transitions Whether a change in one’s

MANAGING

TRANSITIONS SAMPLE PRESENTATION

Christopher Hurst M.Ed,

Office of Resident Wellness

Transitions

Whether a change in one’s daily routine is an

intentional change, a sudden surprise that gets

thrust upon one, or a growing awareness that one

is moving into a life stage characterized by

increasing or decreasing stability, it will trigger a

cycle of reactions and feelings that is predictable.

(Adams et al. 1976)

Overview of Session

• Identify transitional processes in the workplace that

challenge personal and professional well-being

• Become familiar with a psychological model of transition

• Explore available options for successfully adapting to

transitional challenges

Mindfulness & Noticing

• Curiosity

• Attentive observation

• Open mindedness

• Presence

Mindfulness in Medicine; Rochester School of Medicine

What Transitions are you Going Through

in Your Workday/Personal Life?

What are the Pressures and Stresses

Related to Transitions?

Office of Resident Wellness Top Ten Presenting Issues 2006 - 2011

0% 2% 4% 6% 8% 10% 12% 14% 16%

Uncertainty with career choice

Desire to transfer to another Program

Underperforming

Workplace relationships

Stress

Mood disorders

Marital/partner/relationship

Depression

On remediation

Anxiety

What is Being Left Behind?

Transition Cycle

Eos Life-Work Resource Center

http://www.eoslifework.co.uk/transprac.htm#T1

Increased Anxiety “I feel anxiety is going to

consume me”

“I can’t sleep from worrying”

Low Mood “I’m exhausted”

“I can’t get motivated”

Loss of Control “I feel completely

overwhelmed”

Uncertainty “I don’t know what’s expected of

me”

“Everything is new and

unfamiliar”

Decreased Confidence “I feel like I don’t know anything”

“I don’t know if this is right for me

anymore?”

Adaptive Steps

Well

Being

Feel

Good

Okay

Distress/

Despair

Difficulties breaking into the system. Guilt for “neglecting my family”

Faculty

Well

Being

Feel

Good

Okay

Distress/

Despair

Resident

Well

Being

Feel

Good

Okay

Distress/

Despair Felt my education

goals in specific

rotation were not

met.

What Does Your Transitional

Curve Look Like?

Feel Good

OK

Distress/

Despair

Well

Being

Time

Transition Graph

What Do You Notice When You

Look at Your Graph?

How Do You Manage to Perform Well Despite

the Stress of Transitions?

What feelings, thoughts and actions help you

cope?

What Relationships Helped?

Mark them down on your graph.

Don’t let circumstances dictate who you get to be…

- Vik Maraj

Narrative Exercise

• Think of a transition time when you handled a

stressful situation in a way that reflected how you

want to be as a physician.

• How did you manage to perform well despite the

stress?

• Who else was involved, and how did they contribute?

• What lessons from this story are useful to you?

Take 10 Minutes

For the storyteller:

• What happened?

• How did you manage to perform well despite the stress?

• Who else was involved, and how did they contribute?

• What aspects of the context made a difference?

• What lessons from this story are useful to you?

For the listener:

• Be attentive, don’t interrupt.

• Ask questions to help your partner clarify and provide details.

• Don’t talk about your own ideas or experiences.

• Use reflective questions and empathy when appropriate.

Debrief

Transition Factors

Lockyer J, Wycliffe-Jones, Raman M, Sandhu A, Fidler H. Moving into medical practice

In a new community. The transition experience. JCEHP 2011; 31(3).

Skillful Transitions

• Is there an area ( internal, external, professional,

location) where you need to develop additional

strategies?

• Is there a new strategy that you want to try out as

a controlled experiment in the selected area?

Attention and Arousal

Arousal not only affects the absolute amount of cognitive

resource available, it also affects the effectiveness with which it

is allocated. For example, in more stressful contexts, attention

becomes highly focused on tasks we identify as being of

dominant importance. Peripheral (or, more accurately, less

dominant) stimuli are not attended to — referred to in the stress

literature as tunnel vision. In addition, our ability to differentiate

between relevant cues and irrelevant cues is impaired, often

resulting in a perseveration of attention on a narrow, sometimes

inappropriate set of stimuli. Therefore, in states of high arousal,

our ability to allocate our attention effectively can deteriorate.

Coming Back to Resilience

Knowing When to Slow Down

When your stress levels are high, when you’re feeling rushed, when the problem is complicated or there are unexpected complications, when team conflicts arise:

• Step back for a moment

• Take a few breaths, bringing your awareness to each inhalation and exhalation.

• Expand your awareness to your physical sensations, expand your awareness to the situation at hand --- look closely at the details of the situation without judging

• Focus on priorities - what do you need to do next?

• Focus on the next most important task

Adapted from: Mindfulness in Medicine: What is it? Ted Bober & Ann Davidson, Physician Health Program, OMA 2011

RESIDENT WELLNESS

RESOURCE BOOKLET

RESIDENT WELLNESS RESOURCE BOOKLET

E-couch • A self-help, interactive program with modules for depression, generalized anxiety and worry, social anxiety,

relationship breakdown, and loss and grief. It provides evidence- based information and teaches strategies

drawn from cognitive, behavioral, and interpersonal therapies, as well as relaxation and physical activity

techniques.

• URL: http://www.ecouch.anu.edu.au/welcome

MoodGym • An innovative, interactive web program designed to prevent depression. It consists of five modules, an

interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook, and

feedback assessment.

Overcoming Perfectionism • This information package is designed to help you understand what is helpful and unhelpful about being a

perfectionist. The goal is not for you to give up your high standards altogether, but to learn to pursue healthy

high standards rather than unrelenting high standards that negatively impact your life. This Infopax is

organized into modules that are designed to be worked through in sequence. We recommend that you

complete one module before going on to the next. Each module includes information, worksheets, and

suggested exercises or activities.

CALM • Computer Assisted Learning for the Mind contains podcasts and audio files that can be easily uploaded to

mobile devices. The tunes included within this website are geared towards mental resilience, managing

stressors, healthy relationships, and meaning in life

Where To Go For Help: Office of Resident Wellness

Dr. Susan Edwards

Director (Tues, Thurs) 946-4015

Susan.edwards@utoronto.ca

Christopher Hurst, M.Ed.

Wellness Consultant

416-978-6861 christopher.hurst@utoronto.ca

Diana Nuss, Office Coordinator

Assistant To Dr. Susan Edwards and Christopher Hurst 416-946-3074 pgwellness@utoronto.ca

What Can the PGME Office Do For Me?

• Appointment with the Director of Resident Wellness

• Advice

• Advocacy

• Referrals to appropriate providers for stress and other issues

• Speak to resident groups

Where To Go For Help:

University of Toronto

• www.utoronto.ca

• Sexual Harassment Officer

• Anti-racism and Cultural Diversity Officer

Family Care Office

• www.familycare.utoronto.ca

• 416-978-0951

Where to Go For Help: Physician Health Program, OMA

• Confidential assessment and triage for all physicians

experiencing difficulty with stress, mental health or

substance use issues.

• www.phpoma.org or 1 800 851-6606

Where To Go For Help: PAIRO (Professional Internes and Residents Association)

• www.pairo.org or 979-1182

• Local PAIRO rep

• 24 hour crisis line 1-866-HELPDOC

• Information for internationally funded residents

• Resident Well Being Committee

• Advice on rights of residents

Comments? Questions?

Thanks