“R*silience” is a dirty word.

The world breaks everyone, and afterward, some are strong at the broken places. (Ernest Hemingway).

Now no sane person ever said that training in EM is easy.  No one ever said that you won’t see people at the extremes of suffering, and heights of pain.  These moments will affect you, and they will change you, now that’s part of life, and seeing it at it’s most extreme limits is one of the privileges and burdens of being an EM doc.

We have no control over what comes through our door (or flow out of our departments).  Sometimes there will be no end in sight, you’ll be tired, you’ll have 2 or 3 or 5 things on the go and worried you aren’t doing any of them particularly well.  You will feel like you cannot cope.

That is okay.  That happens to everyone.  It is normal.  It shows a degree of insight, and situational awareness which is good, and should be encouraged.

There will be shifts where you cry.  That is also okay.  It happens to everyone.  It shows that despite the NHS’s best efforts you are still, in fact, a human being.

Resilience in the context of your training is a word that someone who doesn’t know you uses when he or she means to say “I know it’s shit but you just need to cope”.  So when some people talk about resilience training I worry they want to teach you to suck it up.  It’s an excuse for poor workplace design and management.  It suggests that your management team have given up on making the lives of their employees easier.  In which case they need to go on the frickin’ course, not you.

Examine your own working day:-  You arrive, see patients, have lunch, see some more patients and go home.  There is no scheduled time for you to do audit, CPD, attend courses, or even usually do your bloody mandatory trust induction.  Annual leave is a fight.  Study leave is a rare privilege.

Even the most single minded surgeon is not operating for 10 hours straight day in and day out .  Their day is broken up with up with clinics, admin, ward rounds, and MDTs.  Remember you are in a training job.  Clearly the majority of your time should be on the shop floor, but it is insane to think that it should be 100%.

When people talk about resilience training,   I see a secondary agenda in which the trainee is being somehow chastised for not coping with an inhumane working environment.   It is essentially rationalising institutional bullying.  I’m not using hyperbole here,  someone is effectively telling you it’s your fault, where you are likely under-appreciated, unsupported, and over-worked, they are saying  you weren’t strong enough.  The truly resilient response to such a stimulus is to give them the finger.

Now, there are some very good bits and pieces out there on resilience, I think training in resilience is probably useful if you are going to a battlefield, or work for Médecins Sans Frontières, but for christ’s sake if you need to use techniques picked up from people working during a humanitarian crisis to manage a normal working day or night in a British hospital THERE IS SOMETHING FUNDAMENTALLY WRONG WITH YOUR WORKPLACE.

A few months ago I had two consecutive resus patients die.  I then needed to tell their families that their loved one had died back to back. I felt like the angel of death, and it was emotionally exhausting.   It affected my confidence, I certainly didn’t want another resus case, and it took me a little time to process what happened (after a period of alcohol fueled reflection with some colleagues).  That is okay.   That shows that this ED Registrar still has his some vestige of soul left .  I think there are probably different ways of being resilient, but that most of the ways we describe it are in terms of a masochistic ability to block out human suffering.  I dont think that that is healthy for us, or good for our patients.

Emergency medicine especially needs a variety of different types of people working in it to work.  We need the methodical, as well as the gutsy, we need the blunt as well as the touchy-feely, so to assume that they’ll all be able to cope with the same pressures in the same way is madness.

I also worry that people can be too resilient .  If you keep on being told that there is nothing you can do to change your environment and all of the changes have to be internalised to adapt to the environment you find yourself in then maybe you’ll tolerate poor conditions for too long, or fail to do things like report failures in safety or quality that really should be reported.  You might also fail to see or act to help people who don’t have the same hardened carapace that you do.  Not to mention the obvious effect on your ability to develop rapport with your team and your patients.

So if someone suggests you go on resilience training as part of your ED training;

Think hard.  Be resilient.  Tell them to get bent.

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