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A message to learners,

From Dr. Jonathan DellaVedova, Wellness Lead Clinician, NOSM Postgraduate Medical Education:

Each December I am grateful for the twinkling lights, comforting foods and Christmas party invites. A festival of lights and togetherness seems fitting during this darkest time of year. December can be difficult, especially when the connections aren’t there and the sheen of the holidays fails to live up to its promise. We residents and doctors also sacrifice our own restoration time so others can be merry. Last December we faced our most difficult period as a school when we sadly lost one of our own.

A counsellor here in Sault Ste. Marie offered me a helpful analogy about suicide that I will never forget. She said suicide is like a puzzle. You might get a piece, and I might get a piece, but unfortunately no one ever gets all of them. If any reasonable person did, we would drop everything, swoop in to the rescue, and suicide would not exist. But that is not how it works. Even a person’s closest loved ones might only get a handful of clues, and all of the people left behind are surprised by all of the information they did not have, leaving feelings of sadness, devastation, regret, and guilt.

This past week we lost another medical learner to suicide. In this case I have absolutely none of the pieces, and you might argue that I have no business writing about it. But I say “we” because though the suicide happened at another school, our medical education family is small. We all share a common experience; one that outsiders cannot understand, nor would we necessarily want them to.

It may be that the pressures of medical training had nothing to do with this particular tragedy. But one need only glance at the stats to know that our profession and its trainees are particularly vulnerable. It is impossible not to speculate about the role of the high-stakes training environment, social pressures, financial pressures, repeated exposures to trauma, and what happens when we are not progressing as planned.

Our profession situates itself at the forefront of the advancement of health. We are singularly motivated by evidence and data. And yet we are stuck when it comes to suicide. We are humanitarians who fail to recognize our humanness.

When, according to the CMA, 8% of physicians have considered suicide in the past year, it’s clear that the entire system needs an overhaul. In the meantime what can one program or one school do within the larger context of the healthcare system and the education system? I look around at my colleagues, some of the most caring and influential leaders I have ever encountered. Can’t we, as a new school, unshackled by tradition and graced with innovators, take a few of these puzzle pieces off the table?

It’s Christmas time and John Lennon’s “Imagine” is on high rotation. Imagine a world where learners with academic challenges get the individualized planning and coaching they need in a timely way. Imagine that we have more than enough trained faculty to provide the extra attention our learners deserve. Imagine a world where learners struggling with mental health issues get time off or a reduced workload without stigma. Imagine a world where learners’ basic collective agreement protections are respected at a bare minimum, and without reproach. Imagine that all learners have timely access to primary care, psychiatric care and psychotherapy when needed, including debriefing traumatic events. Imagine a world where our learners enjoy the many benefits of distant rotations without having to worry about suitable housing or social isolation. Imagine a world where learners receive emotional, practical and financial support if they come to learn that clinical medicine is not for them. Imagine that we all learn in a climate of cooperation, collegiality, respect and kindness.  All of this is within reach if we have the will.

I cannot help but observe the spike in learners requesting help before the holidays. For our first year residents, the veneer of residency is wearing off. For our senior residents a period of intense exam studying is beginning. And our mid-residency trainees are slogging through heavy clinical years. We are all affected by the scarcity of sunlight this time of year. All of our residents will be working some part of the holiday and I cannot remember a January 2nd during residency where I felt like I actually got a break. The togetherness and restfulness that the season is supposed to bring can easily get lost in the shuffle.

With all of that being said, if you are on solid footing this year, please take a few minutes to reach out to a colleague with an invitation, a card, a note, or a kind word. It goes a very long way. Meanwhile NOSM’s deans and other senior leaders have redoubled their commitment to changes that will achieve a healthier, more humane, more flexible and open learning environment. And so we have reason not just to imagine, but to hope.

Resources for students, residents and faculty at NOSM:

-PARO 24 Hour Helpline: 1-866-435-7362
-Physician Health Program: 1-800-663-6729
-Resident Wellness: residentwellness@nosm.ca
-Learner Affairs: learneraffairs@nosm.ca

 

Mental health tips for NOSM medical students

If you’re feeling overwhelmed, please reach out. NOSM is here to help. Nick Alderton is a Senior Learner Affairs Officer at NOSM who also holds a Masters in Applied Sports Psychology from the University of Ottawa. His forte is counseling high calibre athletes, and he draws parallels between them and the high achieving medical students he sees at his day job. Both thrive on competition and pressure to perform and sometimes it can be overwhelming.

Here are a few of his tips for helping manage mental health:

1.    Be self-aware and recognize the signs of high anxiety and stress.

“There’s a variety of different reasons why people might feel more pressure at different times, but often with high achieving students and athletes it’s easy to catastrophize—to think about the worst possible outcome of what might happen if you don’t do well at something or to exaggerate the negative outcomes of what might happen,” says Alderton. He suggests that you need to be aware of when you’re feeling this happen as it often manifests through negative self-talk.

Being aware that you may be “catastrophizing” is a signal to seek advice or reach out for support. Recognize that catastrophizing is “a way of thinking called a ‘cognitive distortion.’ A person who catastrophizes usually sees an unfavorable outcome to an event and then decides that if this outcome does happen, the results will be a disaster.”[1]

This can sometimes be triggered during particular times of increased perceived stress or pressure during a student’s academic year, for example, thoughts might include: “If I fail this exam, I’m a failure in life” or “if I don’t find a CaRMS match, my career is over and I’m going to have to quit.”

2.    Focus on the present moment and the very small steps forward.

“When a student is catastrophizing, it’s helpful to bring them back to the present moment. They can also think about some of the much smaller steps that they can take right now to move forward,” says Alderton.

A good technique is to have a clear idea of what you’re trying to accomplish each day and break it down. “If you focus on the small, small steps, that helps you manage that catastrophic thinking and instead, and regain focus on the desired outcome,” he says.

Mandatory check-ins with first-year students to find out how they’re managing and dealing with the new learning environment, is one strategy Alderton says Learner Affairs uses to support students.

3.    Remember that you only have control over certain actions and outcomes.

“Sometimes it’s recognizing what you have control over versus what you don’t have control over. Reminding yourself that you’re doing the best you possibly can in each of your classes, in each of your rotations, and in your clinical experiences. Ultimately, you don’t have control over where you end up matching. You can only present yourself in your best possible way and that’s all you can really control,” he adds.

4.    Don’t get fixated on being the best.

In high achieving athletes, Alderton says people become used to having a high self-esteem and often times naturally evaluate themselves in comparison to others. The same can be said of medical students who thrive and are used to being in the top of the class.  They come to medical school and are joining a group of other students who are also used to excelling. It’s something I’ve seen a lot in sports and it’s a transition for everyone when you no longer have that standing.  Everyone is top of the class so it can be hard to adjust.”

He says he reminds medical students of what they’ve already accomplished. They have made it into medical school for a reason. “The main thing is realizing that you belong here, and that you don’t have to be the best. You don’t have to always feel like you’re smarter than everyone else or that you have to prove anything. You know, just being here is really an accomplishment in itself. And the competition is over at this point, it’s about you finding the best fit for you and not trying to be the best,” Says Alderton.

5.    Consider participating in unique mental health training that may come in handy both on and off the job.

Alderton encourages students to seek resources that help teach them about their own mental health. For example, a student-led committee is offering Applied Suicide Intervention Skills Training called ASIST to increase awareness. If you are interested in ASIST training or mental health first aid or community courses, please contact Learner Affairs.

6.    Try reflective journaling to gain deeper insight.

Another strategy that Learner Affairs encourages is reflective journaling. Students are taught the value of private journaling throughout their degree to process their experiences. Alderton says journaling helps gain deeper insight into what has happened. “It’s also really good way to identify what sort of doctor you would like to become and what you might want to pursue.”

“It can also help you develop your identity as a physician and think about what kinds of environments are best for you, and help you process difficult experiences, so it’s a good tool for learning and for mental health,” he adds.

7.    Stay connected to your support system of family and friends outside of medical school.

Alderton encourages medical students to stay in touch and connected to their hobbies, interests and friends.

“I think it’s important to maintain a life outside of school and keep the friends you have outside of medicine as well. If all your friends are in medical school and dealing with the same challenges, it can emphasize your own challenges.”

He says keeping up hobbies and getting mental breaks, as well as reminders of the other things in life that bring you joy, renewal or a sense of wellbeing will help you maintain perspective. A change of environment can be healthy.

“In sports, we talk about the analogy of the plant that isn’t thriving; sometimes you need to change the soil and its environment. The same goes for people,” says Alderton.

8.    Book an appointment with Learner Affairs to check-in.

If you need student counselling advice or help with day-to-day student life, contact the NOSM Learner Affairs office to book an appointment. NOSM medical students and learners also have access to Morneau Shepell Assistance Program and to mental health counsellors at Lakehead University and Laurentian University.

 

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[1] How to stop catastrophizing, Medical News Today

 

Top Ten Survival Tips: NOSM’s recipe for self-care

I am starting my sixth month on the job and with my extensive travel and meeting schedule, I realise that now is the time to take stock and role model better self-care.

Time is our most precious commodity. I recommend consciously making time to practice self-care. As a novice at this, I have asked others to help provide some tips for you as we enter the festive season.

Read more in the latest edition of Northern Routes.

NOSM University