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Practice Pearls: Stress Management

As a student, you may be concerned about dealing with stressful situations as a qualified healthcare professional, as this can be an area in which you don’t get much exposure as a student. Particularly during your first on calls, seeing your first acutely unwell patients, and potentially even your first time on a crash team, it can seem daunting to manage these stressful moments and still perform at your best as a clinician.

To bring you real advice from senior clinicians, we have collected some practice pearls from our team of experienced clinicians, and have married them to some practical techniques that can be used to not only manage stressful situations but thrive in them – from proactive preparation, through the stressful moment and into your debrief and feedback after the situation is resolved.

Before the moment: Self-care

“You are never too busy to take a break.” – Dr Emma Cox | Emergency Medicine and Quality Improvement Fellow at Royal Free Trust

“Try to take your breaks (ideally with colleagues), and carry a water bottle. Being refreshed and refuelled will help you care for others.” – Dr Melody Redman | National Institute of Health Research Academic Clinical Fellow in Paediatrics

You may have heard a lot about ‘self-care’ and resilience in the medical press of late. The two buzzwords have become major sources of contention for many professionals who feel that systemic issues of understaffing prevent them from taking adequate breaks and staying fed and hydrated.

Whilst there may be times when scheduling issues mean taking breaks is challenging, as Dr Emma Cox says, you are never too busy to make time for a break. It is simply a case of making it a serious priority. Feel no pressure from your peers to miss breaks. You have nothing to prove. Breaks are more than just an opportunity to grab some food, and take the weight off your feet. Your freshness of mind is a patient safety issue. You might think you’re just as sharp as normal, but human beings are surprisingly bad at gauging their own performance in the moment. Instead, learn to notice little cues that you may need to recharge.

Some people find the HALT mnemonic helpful in remembering when they may need to defer making a decision or starting a procedure. It states that you should try to hold off on making important decisions if you are:

  1. Hungry/Thirsty

  2. Angry

  3. Lonely (whether by yourself or with others)

  4. Tired

If the needs of patients truly make it inevitable to miss some breaks or work later than scheduled, remember to exception report all of it to get that time back later.

In the moment: Square Breathing

Square breathing – sometimes also known as box breathing – is a technique that can be used to manage stress in the moment. It is used by the military in combat situations to improve focus and concentration. Research has shown that box breathing can improve participants’ reported levels of stress and anxiety, and some studies have even shown decreased levels of stress hormones such as cortisol following a period of square breathing.

Square breathing involves actively equalising the length of your inhales and exhales. It is an accessible technique for healthcare professionals, as it involves just four easy steps, that can be practiced anywhere:

  1. Inhale for a count of four

  2. Hold the air in your lungs for a count of 4

  3. Exhale for a count of four

  4. Hold your exhale for a count of four


After the moment: Debriefing & Feedback

“Ask colleagues to debrief after any challenging events – ideally with a cuppa.” – Dr Melody Redman | National Institute of Health Research Academic Clinical Fellow in Paediatrics

It is important to have a debrief after challenging situations, be that formally or, as Dr Melody Redman suggests, in a more informal setting with colleagues. Debriefing helps healthcare professionals to analyse and learn from their own performance and the performance of the team, and there is some evidence that good quality debriefs can help protect the mental health of staff, particularly after adverse incidents. The PEARLS Healthcare Debriefing tool is often used as a framework for debrief discussions, and you can use it to guide your own informal or personal debriefs. It suggests a five-step process for facilitating an effective debrief:

1. Setting the Scene

In this stage, the group should outline the reason for the debrief and set the tone of non-judgmental analysis to improve patient care

2. Reactions

This step invites initial emotional reactions to the challenging situation and allows members of the group to express their feelings in a non-confrontational setting

3. Description

A description is then given of the case or incident. This is to clarify the facts surrounding the case and ensure there is a shared understanding of events and decisions.

4. Analysis

An analysis of the performance of the team is performed, utilising discussion of the performance domains of:

  1. Decision making

  2. Technical skills

  3. Communication

  4. Resource utilisation

  5. Leadership

  6. Situational awareness

  7. Teamwork

5. Application/Summary

The group can then share their take home messages for how they are going to change their practice in the future.

Your hospital may hold more formal debrief groups regularly, such as Schwartz Rounds or Balint groups.

“All feedback is good feedback – de-personalize and take the bits from it that will benefit your practice moving forward.” – Dr Soloman Kamal-Uddin | Paediatric Emergency Medicine Consultant & Head of Medical Strategy for Europe, Paediatrics and Rare Disease, IQVIA

During a debrief you should receive feedback from your peers and seniors on your own skills and performance. It is crucial to remember, as Dr Solomon Kamal-Uddin advises, that this feedback is intended to help you strengthen your clinical practice and develop as a practitioner. Try to ensure you reflect on any feedback and utilise it to help you learn – after all, that is what medical training is all about!

Medics.Academy’s ‘Leadership in the Crash Team’ video course contains further discussion of some of the techniques we’ve written about here. It’s part of Medics.Academy’s new F|Docs platform, which provides video courses on clinical scenarios you may encounter as a foundation doctor, as well as the ‘hidden curriculum,’ with videos on understanding your contract, preparing for life as an FY doctor and more.

Have you ever used any of these techniques in day to day life? Tell us about your experiences by emailing our blog team at anna.harvey@medics.academy

Want to talk to other students who are about to start the foundation programme in August? Join our Facebook community of final year medics and junior doctors here.

About the Author

Anna Harvey is a final year medical student and

Medics Academy Fellow. She is interested

in women’s health, education and journalism.

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