LOYOLA’S

THRIVE INITIATIVE

Don’t just survive residency, THRIVE.

RECAP FROM THRIVE INTRO SESSION

• The purpose of the THRIVE program is to provide our residents (YOU) with the resources needed to: overcome challenges, adapt to changes, and maintain balance in your life so that you can succeed both professionally and personally.

• How to THRIVE?

• Borrow from world of performance psychology

• Performance psychology focuses on identifying and applying psychological principles that facilitate peak sport performance and optimal human performance.

PEAK PERFORMANCE

• Authors: Brad Stulberg and Steve Magness • A few common principles drive performance across all fields

• Certain practices or habits lead to continued success

• We will be discussing their book in the next 2 sessions

PEAK PERFORMANCE:

GENERAL DISCUSSION QUESTIONS

• Initial reaction to the title of the book?

• What does peak performance mean to you?

• What is the purpose of this book?

• If intended to teach us something, did it succeed (thus far)?

• Was there a specific passage that left an impression on you (good or bad)? Can you share that passage and its effect?

• The purpose of this book was to bring light to certain issues (burnout, psychological/physical/mental wellbeing), did your opinions about these issues change after completing this first section of the book?

FOREWORD

• Is healthy, sustainable peak performance possible?

• Is it possible in medicine?

• Write down your own version of peak performance- what would this look like?

INTRODUCTION: GREAT EXPECTATIONS

• Unprecedented Pressure

• Competing against machines

• Competing against each other

• Going to great length

• Bigger, Faster, Stronger- But at what cost?

• Stress

• A better way

PEAK PERFORMANCE: THE GROWTH EQUATION

CHAPTER ONE The secret to sustainable success

PERIODIZATION STRESS+ REST = GROWTH

• Stress and rest cycles are important for athletes

• Stress > Rest = burnout or injury

• Rest > Stress = complacency or plateau

• Achieving a balance between the 2 phases is the challenge • Can you describe situations where you have found the right

routine?

• How did you accomplish this?

SUSTAINABLE PERFORMANCE STRESS+ REST = GROWTH

• Deena Kastor example

• It’s what she wasn’t doing that made her successful

• Not exactly practical for a resident

• Point is that she found what she needed to do to be successful and adjusted her schedule to fit her needs

• Write out a typical service day schedule

• Note your hours of ”free” time

• How many hours are there?

• What do you do with this time now? What could you do with this time?

• What is a day off like for you?

ALL THE BEST FOLLOW STRESS AND REST STRESS+ REST = GROWTH

• Train hard, train easy

• Examples:

• Norway cross country skiers

• Kenyan runners

• How would train hard/train easy work for for residents?

THE MIND AS A MUSCLE STRESS+ REST = GROWTH

• Roy Baumeister’s work on intellectual power and will power

• How and why we ’run out of gas’

• Example – the cookie and the radish

• The energy we expend is not unlimited

• What is your own radish example?

• Resisting cookies is a dangerous game

• Hungry for love study

THE RHYTHM OF STRESS AND REST STRESS+ REST = GROWTH Our next chapter will focus on first half of the equation: STRESS

CHAPTER TWO Rethinking Stress

THE DOSE MAKES THE POISON

• Selye and the innate stress response (poor mice)

• Over time adaptation to stress

• Some stress can produce desirable effects

• Example: body-building

• If stress too large or lasts too long= failure to adapt

**Above highlights the paradox of stress..effect depends entirely on the dose

SKILLS COME FROM STRUGGLE

• Growth comes at the point of resistance

• Ex- the downside of a predefined teaching curriculum

• Ex- Why do only some events cause learning during human tutoring?

• Ex- Nic Lamb, professional big wave surfer, do what scares you

• Takeaway points:

• Open ended exploration is key to learning

• Stepping out of comfort zone is the path to development and growth

• See failure as a growth opportunity

• How could above concepts be applied to you?

SYSTEM 2 LEARNING

• System 1 is automatic

• Auto-pilot thinking

• System 2 is true learning

• Working hard and struggling

• Examine information critically

• Idea is that strengthening neuronal connections takes time.

• Give up and opt out default back to system 1 (known)

• Stick with it eventually difficult system 2 task becomes simple system 1 activity

What are examples of tasks during residency that have become system 1…or that may still be system 2?

JUST MANAGEABLE CHALLENGES

• Another way to view stressors?

• “Just manageable challenges”

• If a task is too easy it will not be a stimulus for growth

• Too hard, youll be too distracted by fear, anxiety, etc to focus

• Something just outside of comfort zone is best type of challenge • Opportunity for growth

• Discuss examples in medicine • What internal/external factors can make a challenge more or less difficult?

CHAPTER THREE Stress Yourself

PRACTICE DOESN’T MAKE PERFECT…

SINGLE-TASKING

• Dr. Bob!

• Multitasking and medicine

• Describe a typical work day, how many activities may you be doing at once?

• Does our work lend itself to single-tasking?

• Are there parts of your day (both at work and at home where you could single-task?)

THE HARD PART ABOUT SINGLE-TASKING…

• Technology is:

• Good

• Bad

• Omnipresent

• Addicted to our smartphones

• Pesky dopamine and the science of gambling

• Out of sight out of mind?

• Phantom vibration syndrome

• Are you checking your phone right now?

BLOCKS OF STRESS

• Importance of the work: rest ratio

• Exact ratio depends on the line of work

• This model runs counter to the idea of the ‘work grind’

• What is your take on this model? • Mandated breaks?!

• Is it possible in our line of work?

• If you could redesign one of our service rotations today, how would the day look?

GET YOUR MIND RIGHT

• Mindset matters

• Get your mind right

CHALLENGE RESPONSE/HOW BEST VIEW STRESS

• The word stress elicits negative reaction

• McGonigal’s work on stress

• How we view stress determines on how stress influences us

• Idea of viewing stress as a challenge

• Can we have this challenge response at work? At home?

• How best view stress

• As a challenge

• Reappraising pre-performance anxiety as excitement

RECAP

• STRESS + REST = GROWTH

• First few chapters focused on stress

• Now turn our attention to the concept of rest: • The work of not working

CHAPTER FOUR The Paradox of Rest

SEARCH INSIDE YOURSELF

• Google understands stress + rest = growth

“TURNING IT OFF”: FROM STRESS INTO REST

• Mindfulness: highly specific training for being more present at all time

• Mindfulness lets us choose how to respond to stress

• Amygdala hijack

• ‘Calm conversations’

• In the middle of challenge lets you remain calm and collected

• Devote energy to completing the task, not to worrying about it

• After a challenge mindfulness lets you choose to turn off stress

• Mindfulness is a gateway to rest

BREAKTHROUGH

• Bannister takes a break

• Matt Dixon and supporting sessions

• Time to reframe rest?

CHAPTER FIVE Rest Like the Best

QUICK RECAP

• Chapter 1: Growth Equation

• Chapter 2: Rethinking stress

• Chapter 3: Interval training for any line of work

• Chapter 4: Mindfulness and the value of taking breaks

• This chapter will look further into the concept of taking a break and the unique benefits of different break styles

• ”Menu of rest options”

MENU OPTION 1: WALKING BREAKS

• Association with walking breaks and creative thinking

• “Give your ideas some legs”

• Something better than nothing

• Why is walking effective (and essential)?

• Also obvious physical health benefits

MENU OPTION 2: ALL NATURAL

• Being in nature, looking at nature during breaks can be beneficial

• Link between nature and creativity, lets us get to restful state, lets task mind turn off and creative mind turn on

• Emotion journal article

• “Put yourself in the way of beauty”

MENU OPTION 3: MEDITATION 2.0

• Previous chapter touched on mindfulness and planned daily meditation

• Unplanned “on the spot” meditation can also be useful

• If you leave an activity and carry stress with you, lose the benefits of the break time:

• Try 10 deep breaths, comfortable position, in and out of nose

• Acknowledge pain, tightness, and negative thoughts and then let them go to

• Refocus on breathing

• After 10 breaths stay with breathing or shift to open monitoring (body scan of all sensations)

MENU OPTION 4: SOCIAL RECOVERY

• Social interaction is important

• Firm outings (although book suggests going out solely to discuss work isn’t very helpful)

• CA- friend outings

• Importance of talking, joking, and debriefing with colleagues

• Can be hard, after long or hard day…

• Natural inclination is to go home and retreat inwardly

• Benefits of being social however are enormous especially after stressful situation.

MENU “OPTION” 5: SLEEP

• 195+ million Americans don’t get enough of it

• Residents know this too well

• Why aren’t we getting enough sleep?

• Blue light = badness • Throw off circadian rhythm

• Shift internal clock multiple time zones?!

• Harvard study- reading before bed

• What is your routine like after hours? How many time zones are you shifting?

SLEEP AND OUR GROWING MIND

• Sleep important for :

• Consolidating and storing information (Harvard sleep study)

• Processing emotional experiences

• Self control and decision making

• Most important supporting session we have

• Maria Konnikova on sleep

MENU OPTION 6: NAPPING

• Naps restore energy and concentration during midday lulls.

• Ideally:

• Less than 30 minutes

• Even closing eyes for 10 min effective.

• Greater than 30 minutes can be counterproductive because of sleep inertia

• Google and apple have nap rooms- what do you think about this in terms of practicality for our jobs?

MENU OPTION 7: EXTENDED BREAKS AND VACATION

• Had a tough month..tough year?

• What did you do for recovery?

• Vacation is IMPORTANT

• No haphazard days off or vacations, place them strategically

• Days off are IMPORTANT

• Observe the Sabbath

• “Show this to your boss”

*Keep in mind if stressors are still around the symptoms of stress will inevitably return. Womp womp.

PUTTING IT TOGETHER: THE COURAGE TO REST

• Issues:

• Most Americans work on nights and weekends +

• Society glorifies the grind and nonstop work+

• Worry we’ll be surpassed by competition if we take breaks+

• We know there are benefits to rest but we still don’t get enough of it+

• Resting hard is hard

**Remember topics discussed during this session are meant to show you how to work and rest smarter

**Remember that hard work becomes smart and sustainable when supported by rest

PUTTING IT TOGETHER: PERFORMANCE PRACTICES

• See handout

• All section 1 performance practices listed

• Summarizes concepts from chapters 1-5

• Assignment:

• Look through list of practice and pick 2 or 3 that seem feasible for you

• Actively work on applying these to your life

• At next session will discuss what worked (or didn’t)

NEXT TIME…

SESSION 3

• Today

• Discussed the overarching key to sustainable performance

• Analyzed each component of stress+rest= growth in greater detail

• Next time

• Section 2 (priming) will look at specific routines and rituals to usher in great performance

• Section 3 about finding your purpose (more on this next time)

• Discussion of performance practices (what worked/what didn’t)