RESILIENCE A DOUBLE-EDGED SWORD DEVIN GREENE | CL

working during a pandemic
human rights
gun violence
white nationalism/supremacy
xenophobia
racism and lack of accountability why TALK ABOUT THIS?<br>

INFLUENCES ON RESILIENCE DEMOGRAPHICS PERSONALITY FACTORS ENVIRONMENTAL FACTORS SOCIAL SUPPORT(S) LEISURE ACTIVITIES PREVIOUS ADVERSITY INDIVIDUAL MASTERY COMMUNITY MASTERY<br>

A HOT TAKE in medicine, resilience can often be weaponized and can have adverse impacts marginalized groups<br>

’THE GROSS NECESSITY OF WEAPONIZED RESILIENCE’ “as a people we take on this cape of resilience to avoid having deeper critical conversations about what is creating a need for said resilience. we ignore the fact that something is happening to create a need for resilience, and as a response to the hopelessness of the situation, wear this cape in order to feel something, anything at all other than the numbness that comes from wearing it.” 
– MARGOT MACY (OP-ED FROM THE MEDIUM.COM)<br>

being a physician (in the US) is difficult
wellness is becoming more of a ”hot topic” in medical education
data is limited as it relates to best approaches to promote wellness LET’S focus on wellness for a spell…<br>

BURNOUT 44 PERCENT ~400 FACTOIDS of US physicians experience symptoms of burnout (at least weekly) physicians commit suicide each year, with numbers estimated to rise no standardized definition, not self-limited, and has an uncertain prognosis<br>

FACTORS that CONTRIBUTE TO BURNOUT INDIVIDUAL FACTORS ORGANIZATIONAL FACTORS<br>

definition is not standardized; data is heterogenous
most examined interventions
mindfulness
stress management
peer-to-peer discussions
positive psychology
3 ‘Ps’ of resilience
positive emotions associated with creation of ego resources CONCEPTS RELATED TO RESILIENCE<br>

cross-sectional national survey study of 5445 US physicians & a sample of 5198 US working individuals over ~5 months
physician resilience > general population WEST ET. AL (2020) CONNOR & DAVIDSON (2003) resilience inversely related to burnout
burnout rates were substantial even among the most resilient physicians burnout is not a deficit in resilience
addressing systems issues are needed to reduce rates of burnout HOW DOES RESILIENCE RELATE TO BURNOUT?<br>

“healthcare heroes” and the “invincibility myth” “invincibility myth” that physicians are these infallible beings and should be in tip-top shape at all times.
can be patronizing and feel empty BLAME THE INDIVIDUAL gaslighting and increasing cynicism through the message that physician’s must “toughen up” or cope with toxic work environments PUT ONUS ON INDIVIDUAL ask us to use various resources but no time outside of care responsibilities.
“I had to go through this, so you do too” THE HARSH REALITY<br>

WHAT ARE (VIABLE) APPROACHES? ORIENT Towards shared values PROMOTE AUTONOMY PROVIDE ADEQUATE ReSOURCeS PROMOTE WORK-HOME INTEGRATION<br>

TAKEAWAYS resiliency is an increasingly important topic of discussion in healthcare focus on the system, rather than individual is important marginalized groups are differentially impacted by various stressors even the most resilient people get burned out medicine is a human endeavor and not an assembly line<br>

REFERENCES Abbasi, J. (2022). Pushed to Their Limits, 1 in 5 Physicians Intends to Leave Practice. In JAMA (Vol. 327, Issue 15, p. 1435). American Medical Association (AMA). https://doi.org/10.1001/jama.2022.5074
Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). In Depression and Anxiety (Vol. 18, Issue 2, pp. 76–82). Wiley. https://doi.org/10.1002/da.10113

Edmondson, E. K., Kumar, A. A., & Smith, S. M. (2018). Creating a Culture of Wellness in Residency. Academic Medicine, 93(7), 966–968. https://doi.org/10.1097/acm.0000000000002250

Epstein, R. M., & Privitera, M. R. (2016). Doing something about physician burnout. The Lancet, 388(10057), 2216–2217. https://doi.org/10.1016/s0140-6736(16)31332-0

Epstein, R. M., & Krasner, M. S. (2013). Physician Resilience. Academic Medicine, 88(3), 301–303. https://doi.org/10.1097/acm.0b013e318280cff0

LaDonna, K. A., Cowley, L., Touchie, C., LeBlanc, V. R., & Spilg, E. G. (2022). Wrestling With the Invincibility Myth: Exploring Physicians’ Resistance to Wellness and Resilience-Building Interventions. In Academic Medicine (Vol. 97, Issue 3, pp. 436–443). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/acm.0000000000004354

Liu, J. J. W., Ein, N., Gervasio, J., Battaion, M., Reed, M., & Vickers, K. (2020). Comprehensive meta-analysis of resilience interventions. In Clinical Psychology Review (Vol. 82, p. 101919). Elsevier BV. https://doi.org/10.1016/j.cpr.2020.101919

Macy, M. (2021, May 22). The Gross Necessity of Weaponized Resilience. Medium. https://margotmacy.medium.com/the-gross-necessity-of-weaponized-resilience-b4eef882bb2d

Meyer, I. H. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. In Psychology of Sexual Orientation and Gender Diversity (Vol. 2, Issue 3, pp. 209–213). American Psychological Association (APA). https://doi.org/10.1037/sgd0000132


Seligman, M. (1990). Learned optimism. Pocket Books.

Shanafelt  TD, West  CP, Sinsky  C,  et al.  Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017.   Mayo Clin Proc. 2019;94(9):1681-1694. doi:10.1016/j.mayocp.2018.10.023

Southwick, S. M., & Charney, D. S. (2012). Resilience. Cambridge University Press. https://doi.org/10.1017/cbo9781139013857

Southwick, S. M., & Charney, D. S. (2012). The Science of Resilience: Implications for the Prevention and Treatment of Depression. In Science (Vol. 338, Issue 6103, pp. 79–82). American Association for the Advancement of Science (AAAS). https://doi.org/10.1126/science.1222942


‌West, C. (2021, March 3). Physician burnout: It’s not a resiliency deficit. YouTube; https://www.youtube.com/watch?v=p-IZFEzYqq0&t=1807s

West, C. P., Dyrbye, L. N., Sinsky, C., Trockel, M., Tutty, M., Nedelec, L., Carlasare, L. E., & Shanafelt, T. D. (2020). Resilience and Burnout Among Physicians and the General US Working Population. In JAMA Network Open (Vol. 3, Issue 7, p. e209385). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2020.9385

West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2016). Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet, 388(10057), 2272–2281. https://doi.org/10.1016/s0140-6736(16)31279-x<br>