Cite this post as:
Mike Lauria. Imperturbability: William Osler, Resilience, and Redefining Mental Toughness by Mike Lauria. EMCrit Blog. Published on February 3, 2016. Accessed on April 19th 2024. Available at [https://emcrit.org/emcrit/imperturbability-william-osler-resilience-and-redefining-mental-toughness/ ].
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Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: February 3, 2016
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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hi Mike I must say I admire your passion for this topic. so kudos there. You asked a salient question about whether mental toughness training/ study may reduce mental health problems in doctors/nurses/paramedics in training and during their careers. Let me flip the question . Could such training increase mental health problems? I think we both know that there is no clear answer here but the possiblity it may is not ruled out beyond question. Therefore we need to really think about what we want to achieve, lest we make things worse not better. Increasingly I have come to the… Read more »
interesting. i think you are both correct… ketaminh is right in suggesting that “life experience” helps to allow us to be “cool” in the face of chaos. but there is more to it than that. we can be older, but not always wiser. and Mike suggests that one can attain certain skills/lessons via formal training to help us learn to be level minded and focused in times of turbulence. as Kipling wrote: “If you can keep your head when all about you Are losing theirs and blaming it on you, If you can trust yourself when all men doubt you,… Read more »
A culture of mental toughness or cognitive resilience or whatever you want to call it..I am not the only one who thinks we need to be careful in terms of mental health of future physicians. Specific training may improve things..but we dont really know. It may worsen things too.
I agree though..medical training culture needs to do better.
http://www.idealmedicalcare.org/blog/
Minh, As always, thank you for your stimulating and thought provoking comments. First, I humbly submit to you and all the other physicians that I sincerely admire in terms of clinical experience as well as experience with many of these troubling mental health issues. I am, I recognize, only in the nascent stages of my career as a physician. So, feel free to object if my opinions seem naive and misconstrued. That said, coming into this training with outside perspective has, I believe, allowed me to provide a somewhat distinct view on the current state of education and training (at… Read more »
thanks Mike. I think we can agree to disagree which is fine. The current medical culture is one molded from decades of medical tradition stretching back to Osler who advocated a virtual monastic style of medical training, whereby junior doctors lived onsite and tended to patients. Residency as it still is was forged from this ideal. Mental toughness as Osler advocated was forged by an almost religious devotion to medicine. with daily rituals of ward rounds, study and hospital tasks. So the culture forged then and now is the same one that leads to the mental health problems that plague… Read more »
Thanks Mike for another interesting post! Have enjoyed reading the pro/con comments as well 🙂 I think that resilience training and mental toughness training/knowledge is a must for people in high stress and high risk environments like EM, critical care, resus, hems etc. My own opinion is that a sound knowledge of the concepts before you get a taste of the real heat will both benefit your own mental health and well being, as well as your patients. Sure you will probably get wiser and “tougher” as the years go by, but having these tools will make the journy smoother… Read more »
Hey Fredrik,
Thanks for reading and commenting. I really appreciate the addition and emphasis on the ENTIRE team. Good call.
-Mike
Thanks for an interesting post. I think however that the notion of mental toughness is dangerous in the way it makes an individual’s performance and emotional well being a entirely personal responsibility, when many of the causes of burnout and failure are structural in nature. In that way it bears resemblance with positive psychology that have been criticized for making matters worse for individuals who cannot – for one reason or another – live up to the tyranny of staying positive. That said I agree completely with the idea that we need to train more purposely and in that way… Read more »
Hey Martin, Thanks so much for reading and your insightful response. I agree with your point that the causes of burnout and failure (at least as they are reported in the literature) are primarily structural in nature. Indeed, as I mentioned in my response to Minh, there are numerous cultural aspects that need to change. Keep in mind, however, that these issues are mainly related to chronic stresses, not the acute stresses to which I am largely referring (although I grant the two are not entirely independent). I think the most beneficial effects have been documented in dealing with stress… Read more »
Hi Mike. Thank you for your extensive answer. I’m glad that you are open to risks of imposing the responsibility of a system failure upon the individual, and I fully agree with you that we all have to look in the mirror and try to improve ourselves before we can expect anyone or anything else to change. By training and improving our performance as teams and individuals and keeping away from “a tyranny of the toughest”, I think we can get the best out of both approaches. Looking forward to your developments of the concepts. Best regards Martin PS: No,… Read more »
As a current MS3 and budding EM doc, I’d love to have something like this in undergraduate medical education. I think too often we delude ourselves into thinking the ability to study hard or stay up late is mental toughness. While yes, it does take stamina and discipline to study for the step exams or get through an overnight call, it says nothing of one’s ability to act as the “calm amidst the storm.” I, for one, applaud your efforts on this topic and would happily engage in any training that makes me better in that regard.
Thanks Justin, I appreciate the words of support. Yeah, I agree. I think it may be really great to institute something into pre-clinical training program to help students in their clinical years deal with acute stress and the challenges they face. Thanks again for reading!
-Mike
I think some very interesting points were made by Mihn and Mike in regards to the need for compassion in medicine (both towards patients and one another) as well the need for mental toughness. We must do a better job of caring for our residents who have an 80% burnout rate in IM and 90% in surgery (American Psychiatric Association 2015 Annual Meeting). We also need to teach techniques to persevere through very stressful moments such as self talk and tactical breathing. We should also teach leaders that providers need to recover after extremely high stakes cases and traumatic experiences.… Read more »
Hey Abe,
Thanks so much for the feedback. We sincerely appreciate it. I look forward to hearing what you think about future posts!
-Mike
Another reading tip on enhancing performance under stress is: http://www.rand.org/pubs/research_reports/RR750.html
Hey Fredrik,
Thanks so much. I’ll have to check it out. Thanks for your continued support and feedback. Much appreciated.
-Mike
Mike, In my professional career as a medic, I have focused myself on learning to perform better under duress as the hundreds of hours of training, years of education and the confidence instilled by the above is for nothing if one cannot control emotions and cognative distortions under duress. It is encouraging that professionals in your position see this and are putting energy into passing the knowledge to others. I myself being a field medic for some years now, have in training my medics for the Army, worked on passing on this knowledge. I am currently a civilian paramedic and… Read more »
Hey Anthony,
Thanks for reading and commenting.
That’s really cool that other organization are teaching and developing similar concepts. Love the idea of the multi-dimensional approach with body, mind, and spirit. I’m hoping to continue to develop and adapt these topics.
Thanks again.
-Mike
Mike, The specific working vocabulary used by Sir W. Osler is important to understanding mental toughness. I would point you to what Wyatt Earp said in much the same period. “When I say that I learned to take my time in a gunfight, I do not wish to be misunderstood, for the time to be taken was only that split fraction of a second that means the difference between deadly accuracy with a sixgun and a miss. It is hard to make this clear to a man who has never been in a gunfight. Perhaps I can best describe such… Read more »
I should add that successful implementation of SET caused a significant increase in successful outcomes during critical incidents. In ALL cases so far, during debrief everyone that was a part of phased SET felt that it aided in the outcome of the incident, and all thus far felt they were better able to handle the changing environment as a result. Follow up interviews indicate that SET lowered psychological trauma to the responder in 3/6/12 month reviews, with none expressing symptoms 12 months later. We should operate inside our skill/capability envelope. Training, repetition, and SET allow us to expand that envelope… Read more »
Mike, Great article. There’s no question in my mind that this kind of training, if executed carefully and thoughtfully, would improve the effectiveness of resuscitation by critical care providers. I sense however, and as you have already alluded to in a couple of your articles, a certain resistance by the greater medical field. Perhaps you’re aware of a recent NYTimes article contemplating why doctors commit suicide (http://www.nytimes.com/2014/09/05/opinion/why-do-doctors-commit-suicide.html?_r=2). In this article, the idea of Osler’s “Imperturbability” is directly attacked as being in a way partly responsible for physician suicide, contributing to this hostile culture of medical education. I disagree, I think… Read more »
Thanks Jay. I clearly agree with you. I think there is a difference between the people that say “Hey, you need to toughen up and deal with it?” vs. “We need to develop resilience in our trainees and colleagues.” Ostensibly, they are similar. I would argue that is not so. Also keep in mind that I’m talking about resilience in ACUTELY stressful clinical situations, not dealing with unruly, rude, or disrespectful colleagues. Although developing resilience may help with the chronic stresses of the medical profession, I don’t necessarily have the evidence to support that quite yet. Also, as I have… Read more »
Also: How Bad Do You Want It by Matt Fitzgerald is a great book on Mental Toughness. Matt is a former athlete/Ironman and endurance athletics writer.
Thanks for the recommendation, Tim. I’m adding it to my list!