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Slide Notes

This resource will provide you with a variety of tools, tips and self care strategies to help you 'be well' during this important transition in your training.





Prepared by Kate Jurd
Medical Education Unit
Toowoomba Hospital
Australia
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Thriving as a junior doctor

Published on Jan 01, 2018

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PRESENTATION OUTLINE

Thriving as an ED trainee

This resource will provide you with a variety of tools, tips and self care strategies to help you 'be well' during this important transition in your training.





Prepared by Kate Jurd
Medical Education Unit
Toowoomba Hospital
Australia

The more well you are...

What does being well even have to do with being able to do your job?

The more well you are… the better your state of mind, body and spirit and the more effective you are as a doctor

….. the better you communicate with patients and colleagues,

..... the better you work in a team

..... the better you perform in a busy and sometimes hectic work environment.

Photo by Cayusa

When you are unwell you are unpleasant to be around

If you aren't taking care of yourself, – ie not eating properly, not sleeping well, not exercising body or brain, you may come to work

- impatient with those around you
- abrupt/angry
- unreasonable
- quick to react
- with low energy
- inability to concentrate
- inability to make decisions

Being unwell makes you unpleasant to be around and difficult to work with.
Photo by Found Animals

Self care strategies

So lets look at some of the self care strategies that will enable you to perform better in the workplace.





Eating well

Eating well can be a challenge in a busy hospital environment. It also may be difficult to find nutritious wholesome foods at the hospital cafeterias and eateries.

Think about your current go to meal before a shift.. in fact do you even have something to eat before a shift?

Grabbing a donut or chocolate bar just prior to starting work won't provide you with the sustenance to function well during your shift.

Having something easy to preheat when you get home from a shift eliminates the need to grab take away.

Eating well therefore requires PLANNING and food PREP


Planning and preparation

Plan the grocery shop, write down the meals for the coming week - for your shifts and meals at home.

Categorise:
Before shift
During shift
After shift
Snacks

Batch cooking (aka meal prepping or cooking in bulk) eliminates the need to cook every day, and ensures that you do have a nutritious meal during your shift and when you get home.

Think of meals that are nourishing and will keep you satiated - protein foods, healthy fats and vegetables (for nutrients and fibre)

From the weekly meal plan create your shopping list.









Photo by Sofia Z.

Taking stock of what's in the fridge and pantry

Be sure to consider what you have in the fridge and pantry, so you can use what's there rather than buying more.

Check the labels on the packets, tins and bottles, throw out any product with more than 5 ingredients, or names that you can't pronounce. Be wary of sugar and vegetable oils, these are only added for taste, palatability and to extend shelf life, not for nutritional value.


Use glass jars to keep your pantry items fresh and to avoid moth infestation.
Store: seeds, nuts, rice, coconut flour, almond meal







Shop on the  periphery of the supermarket

At the supermarket - shop on the periphery where the more wholesome foods are located- the aisles are filled with prepackaged processed foods.

Also consider the local markets to find fresh and or organic produce. Buying in season ensures fresh nutrient dense vegetables and fruit.




Photo by Dean Hochman

 prepare meals in advance

Once the grocery shop is done...

Pick a time each week when you know you'll be able to do a bunch of meal preparation. Mark it in your diary and incorporate it into your weekly routine.

Wash your fruit and veges. Chop fruit & vegetables and divide into containers 1. for salads/snacks/smoothies 2. meal prepping

Use a slow cooker or casserole dish
Curries/Stew/Chilli con carni
Chicken/lamb/vegetables & herbs

Baked egg cups or muffins: Mix eggs and veggies together (you can add meat as well), then bake in muffin tins.

Roast a huge batch of vegetables and pair them with hard boiled eggs, salmon, tofu or tempeh
Wild rice salad, vegetables, satay

Brown rice/white basmati rice (cook and freeze in meal size containers)

Salad bowls with added grains or seeds: quinoa, chia, pumpkin seeds






Photo by ghknsg548

Healthy snacks

Healthy snack foods:
Boiled eggs
Baked vegetables
Nuts and seeds
Cucumber, radish, carrot,
Capsicum with Guacamole. ...
Greek Yogurt (full cream/no added sugar) and Mixed Berries. ...
Apple Slices with Almond Butter. ...
Cottage Cheese with Flaxseeds and Cinnamon. ...
Celery Sticks with Cream Cheese. ...
Kale Chips. ...
Dark Chocolate and Almonds.




Photo by andrechinn

Eat colourful | Eat fibre | Eat quality fats | Reduce sugars

TIPS for healthy eating
Eat colourful, Eat fibre, Eat quality fats, reduce sugars

Eat real whole food

Choose healthier fats from foods such as avocados, salmon, sardines, macherel, olives, nuts and seeds as well as oils such as olive, avocado oil, flaxseed or nut oils.

Increase your intake of antioxidant rich foods: berries, tumeric, beetroot, pomegranate, raw cacao and kale.

Avoid unhealthy processed fats: vegetable and seed oils (canola, soy, sunflower etc).


Photo by Anna Pelzer

Always eat before your shift

Eat before your shift, what ever time your shift have a good meal before you leave home.

Boil eggs in advance, so if you do sleep in, you can eat them on the way to work.

Soak chia seeds overnight - cover with full cream milk, almond milk, or any non dairy milk that you prefer. In the morning just add berries/cherries, sunflower seeds, ground linseeds, almond butter, cinnamon.

Kale protein smoothie. Add following to blender: ice blocks, frozen berries, kale and or baby spinach leaves, dessertspoon cacao, dessertspoon collagen powder (optional) half kiwi fruit, chia seeds, flaxseed meal, sunflower seeds, almond butter, cinnamon, almond milk (or full cream milk)
Blend until smooth

These suggestions are rich in essential omega 3 fats ( brain health), fibre (gut health) and protein to help build and repair body tissue and provide the amino acids your brain needs to function an optimal level to make you feel awake and alert.

This type of breakfast also helps you stay fuller for longer compared to a carbohydrate breakfast of cereal and toast.
Photo by Push Doctor

Air fryer or compression cooker for evening meals

Use an air fryer or compression cooker to cook quick and easy meals.
Chicken thighs, fish, salmon, sweat potato, pumpkin : coat lightly with coconut oil, herbs of choice, almond meal - cook 10 minutes or according to directions.

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The benefits of exercise during your training is really important.
Regular exercise is good for decreasing cardiovascular risk, decreasing stress, improving sleep, improving mood, and a whole host of other benefits. It's a health tool!

Find a form of exercise that feels good. That you actually enjoy and look forward to.

Schedule your exercise routine - add it to your diary
Photo by revcorwin

Exercise snacking =  mix it up, cardio, HIIT, weights

Aim to get at least 30 minutes of exercise a day - but it doesnt have to be continuel - your choice if you want to do the 30 minute workout or break it up into 5-10 minute exercise snacks - the goal is to move more throughout the day.

5 Minute Kitchen Workout - Dr Rangan Chatterjee
1. 5 – 10 bodyweight squats.
2. 5 – 10 calf raises.
3. 5 – 10 press ups - against wall or bench top
4. 5 – 10 tricep dips - using a kitchen chair
5. 5 – 10 bodyweight lunges on each leg

Nitric Oxide 4 minute routine - Dr Mercola

HIIT - High intensity interval training - a 15 minute workout which gives you the same benefits as a 40 minute session. 1 minute high intensity (sprinting) followed by 1 minute walking or slow jog (anarobic), similar workouts can be done on an exercise bike.

Yoga
Weights
Tai Chi
Photo by sanchom

Getting started...

Find an exercise buddy - or organise a group from your department who like the same type of activity - you can motivate each other!

Be inclusive to all members of your department, nurses, admin - put up a notice to advertise
"Walking group every Wednesday & Friday - join us"

"Saturday morning Park Run at 7.00am - join us"

Be consistent - your goal is to exercise everyday

Photo by Luis Quintero

Get outdoors and be in nature

It may not appeal to everyone but morning is the best time to workout or run and it's an energizing way to start the day,

Try trail walking/running around Toowoomba/SE QLD - double goodness - you get the physical benefits and vitality from exercise and the benefits of being out in nature (very therapeutic) ie good for the mind body and soul!

Sleeping well: Make your bedroom a sleep sanctuary

Sleeping – we need at least 7 hours of sleep every night, and if we fall short, we don’t function as well. There is an increasing amount of literature and research on the effects of sleep deprivation on performance, competence and health – so important doing shift work to get sufficient sleep.

The quickest and easiest fix to improve sleep is to improve the environment you sleep in..

Make your bedroom a sleep sanctuary. This means avoiding activities like work or watching TV in the bedroom.

Bedtime rules:
- Beds are for sleeping not working
- Keep you bedroom quiet, cool and dark (use blockout curtains, eye mask)
- No screens, laptops, tablets, mobile phones at least 1 hour before bed
- Don't keep the phone or electronic equipment in your bedroom
- Try a sleep focused breathing or meditation exercise before bed to calm and relax the mind.
- Have a warm bath or shower before bed

Melatonin, magnesium, ashwaganda and teas (such as chamomile)

Photo by mark chaves

Being mindful

Mindfulness misconceptions - what your colleagues might think:

It's for hippies and alternative lifestyles
It's tarot card and candles
It's in some way religious or cultish
It's just not my thing!

Being mindful is about being present, having complete focus on your daily tasks and interactions with patients and work colleagues.

Mindfulness meditation helps you develop skills in concentration, focus and connection. The practice is to see, hear, and feel more clearly what ever is appearing in each moment. It isn't about clearing your mind - it is about noticing what is appearing in your consciousness, whether this is a thought, a body sensation or a sound.

Science now confirms that daily medication practice promotes changes in the brain.

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This breath control pattern is super simple and has the effect of calming you down and slowing your heart rate. This breathing technique uses a long, slow exhalation that triggers the parasympathetic, rest, and digest systems into action. It counteracts your fight-or-flight system and will calm you down after just a few cycles.

The process is simply to exhale twice as long as you inhale. For instance, as you inhale through the nose using the full belly breath to a count of 3, you exhale out to a count of 6.
Photo by Jason Michael

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Punctuating your day with breathe work:

5 deep breaths before you start a new task, speak to a patient and speak to your supervisor.

Photo by Brett Jordan

                                      Take a brain break...

Now that your gas is cooking… Take a Blood Gas Brain Break

1. Take a deep breath in through you nose (count of 3)

2. Exhale through your nose (count of 6)

3. Now just notice your feet on the floor, notice any sensations in the body, moving up from feet, calves, thighs, stomach, chest, back, neck, arms, hands. head.

4. Notice the sounds, near...and far

5. Stand as still as you can for another two deep breaths

Source: Dr Shahina Braganza




Self awareness

In times of transition it is beneficial to self reflect or look inwards to determine what is working in your life, what areas need improvement and how you can move forward with purpose and meaning in what you do and how you live.

"Self Awareness is having a clear perception of your personality, including strengths, weaknesses, thoughts, beliefs, motivation and emotions.

Self Awareness allows you to understand other people, how they perceive you, your attitude and your responses to them in the moment.

So: know yourself. Make an effort to observe your own behaviours through other people’s response to you.

Recognise if you’re grating on them, or bringing out the worst in them. And work out what helps you come across in the way that you intend – in a way that is effective, both for getting the job done and also for building a positive regard of yourself. " Dr Shahina Braganza

Purpose and meaning in work

What gives you meaning and purpose in your job?

Ikigai is a Japanese concept that means 'reason for being'

Starting with self awareness and being able to articulate your purpose.

"Purpose is a recognition that we belong to and serve something bigger than ourselves. How lucky are we that this is inherent to the job we are paid to do! We have a purpose every time we show up to work.

Work on creating the big picture for yourself – and working out your place in that picture."

Dr Shahina Braganza


Photo by brf

Journaling 

Journaling goals, both learning and personal on a daily basis is worthwhile reflective practice.

Acknowledging gratitude and positive accomplishments is a powerful tool for self growth.

Start your day with gratitude and optimism - the idea of a daily gratitude practice is to engage your body and mind in a positive manner. It reframes your mood and can add positivity to the most stressful days. It also helps us keep perspective on what really matters.


What am I grateful for today? What am I excited about today? What are my goals for today? Who can I reach out to and serve/help..

Think about the extra things you can do for your patients, taking time to listen and focus on what they are saying and their concerns.

Plus how you can help your team or a colleague who might be feeling under pressure at work.

Positive self talk and growth mindset

Replace the 'I dont think i can do this' into " I can do this, I need to focus and take one step at a time. You can change the way your brain looks at things by using affirmations, developing a mantra or directive phrase.

The idea is to reframe the negative thoughts and develop new scripts. eg 'slow down, Ive been here before' or 'stop, focus' breathe. I can do this.

Move from a fixed mindset to a growth mindset.

Building your relationships at work

Building your relationships at work

"...that is with everyone on your team, medical, nursing, allied health, administrative staff, the wardies and the cleaners.

Establish respect and regard for those you work with. They all play their part in the patients encounter in the hospital, whether just in ED or as an inpatient.

Because when you are surrounded by people who firmly believe that you have integrity – basically, people who will have your back – you have a massive safety net.

These are the people who will help turn your potential errors into safe practice, and if a matter is ever in doubt, will believe in your intention." Dr Shahina Braganza

Look out for one another - if you see a colleague who is out of sorts, down, unusually quite - just ask.."Are you ok?"
Photo by Mimi Thian

Have a failure friend

Nourishing and investing in relationships – family and friends. This is your safety net of people you can turn to when things get you down. Make these relationships mutually beneficial.

"Some people talk about having a “failure friend” – that friend they can call upon from the depths of their shame and humiliation. To debrief about the disastrous event that befell you. That friend whom you trust to listen carefully; who allows you to wallow for a bit, but who then honestly sets you back upon the right path, whether it’s helping you to gain some perspective on the issue, or to reflect on what you might learn (and do better) from the experience."

Dr Shahina Braganza


Photo by DocChewbacca

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WRaPEM
Wellness website created by ED clinicians and medical educators in Queensland.

Their aim is to provide a thought provoking forum for idea sharing and creativity, focused on the development and wellbeing of healthcare professionals.

WRaP EM is creating an expanding Free Open Access Medical Education (FOAMEd) curriculum and blog to help achieve these goals. They want to facilitate tangible cultural growth in hospital work spaces through connection with other like-minded clinicians.





Acknowledgement

1. Dr Shahina Braganza, Staff Specialist, Gold Coast Health https://shahinabraganza.com

2. Wellnessrounds: https://wellnessrounds.org/ - Dr Mary L. Brandt

3. WRaPEM: https://wrapem.org