Preparing for the unknown: mental readiness lessons from the military

May 21, 2020

In this Joule COVID-19 Learning Series webinar, host Dr. Jillian Horton talks to Dr. Stephanie Smith, a resident doctor in Calgary, about her experiences in crisis care. Before medical school, Dr. Smith spent more than a decade as a critical care nursing officer in the Canadian Armed Forces, serving two deployments in Afghanistan and one in the Philippines following Typhoon Haiyan. 

Dr. Smith explains how the STRIVE mental readiness model she learned in the military, and adapted for medical students, can help medical professionals deal with stresses of practicing during a pandemic.

tweetable: “I think the military has done a great job of teaching me how to manage my own personal stress response. I don’t think there’s one perfect solution, but I do think we all need to develop a toolkit of skills to manage our stress.”  ‒ Dr. Stephanie Smith

KEY TAKEAWAYS

You’ve just started your residency – I can’t imagine a more challenging time to be entering the profession. What are you hearing from fellow residents about coping during the pandemic?

Dr. Smith says a lot of the stress residents are experiencing is related to the unknown:

  • When will they write the Royal College exams?
  • Will they get the clinical placements needed to prepare them for medical practice?
  • Can they afford the unexpected costs related to COVID-19, like childcare?

tweetable: “As residents, we know we’re all in this (COVID) journey together, but it certainly has been an adventure so far, to say the least.”

How did your previous training and deployments in the Canadian Forces prepare you for what physicians are seeing during the pandemic?

They helped Dr. Smith become comfortable with uncomfortable situations, for example, when there are:

  • Limited resources.
  • Limited clinicians to provide care.
  • Unpredictable injuries and patient volumes.

tweetable: “Everyone is going through the same struggle, but you have the opportunity to pull together as a team and make the best of a really challenging situation.”

In medical school, you took a military model called STRIVE and adapted it for medical students. Why did you think it would be valuable?

  • When Dr. Smith started medical school, she quickly realized students were exposed to very distressing events, very early in their education. Her peers would often approach her for advice on how to process the death of a patient, for example, or the witnessing of a traumatic injury.
  • Dr. Smith saw an opportunity to share the resiliency training she received from the Canadian Forces and adapt it to medical education.
  • Through STRIVE, medical students would be able to work through simulated events to experience a range of emotions, learn how to deal with them, talk about their feelings and develop a plan of action to manage similar situations in the future.

tweetable: “I saw STRIVE as an opportunity to give back some of the skills I learned along my journey in the military.”

The STRIVE model consists of a set of evidence-based, behavioural therapy techniques – referred to as the Big Four+.  Here is how Dr. Smith explains them – and their benefits:

1. Box breathing:

  • Visualizing each number as you count, breathe in slowly for a count of four;
  • Pause and hold your breath for a count of four;
  • Exhale slowly for a count of four;
  • Repeat three to five times.

How it helps:

  • Calms your sympathetic nervous system.
  • Brings down the heart rate.
  • Feel less anxious and overwhelmed.
  • Often easier to fall asleep at night.

 

2. Goal setting:

You can use these two acronyms to help define your goals:

  • SMART: create Specific, Measurable, Achievable, Realistic and Timely goals. These are often long-term goals: for example, what is your plan for getting through the pandemic? What do you plan to do when it’s over?
  • WINWhat’s Important Now. These are often short-term goals: for example, what is your plan for caring for a patient who presents with symptoms of COVID-19?

Narrow down what is most important and get rid of all external distractions.

 

3. Visualization:

  • Create an experience in your mind before performance.
  • Condition the mind to anticipate what is going to happen and prepare for the task to come.
  • Know detailed steps of task, rehearse different outcomes.
  • See yourself succeeding.

 

4. Self-talk:

  • Become aware of self-talk.
  • Replace negative messages with positive ones.
  • Develop a positive mantra such as: “I can do this,” or “I am trained and ready.”

tweetable: “A positive mantra for me is ‘you are so enough,’ something my father taught me. Saying that can get me back on cue and remind me that I can accomplish what I need to.”       

Learning about these models is one thing, using them is another. How can we ensure physicians deploy these techniques when they need them?

  • Dr. Smith says it could be as simple as putting cue notes on the back of your name tag, like a smiley face or a positive mantra.
  • Practicing the STRIVE techniques regularly will make it easier to draw on them in a crisis situation.
  • A supportive team culture is the best way to ensure physicians use the mental readiness model. If the entire health care team says, “everyone take a deep breath, we are going to do the best we can,” it will make it much easier to achieve specific goals.

tweetable: “It helps people sleep at night knowing they are doing the best they can and that the organizations we work in are there to support us and prepare us for the jobs we have to do.”

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This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about this topic? Please connect with us at jouleinquiries@cma.ca.

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