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Keren Ziv, MD, chair of our department's Anesthesiology Wellness Committee.

Anesthesiology Volunteers Train for Innovative Peer Support

December 4, 2017

Hosting a four-hour volunteer training session the evening before a holiday weekend might seem like a losing proposition. On November 9, however, Keren Ziv, MD, chair of our Anesthesiology Wellness Committee, and Shevaughn Marchese, our department’s program manager, prevailed. They welcomed 24 of our department’s physicians, nurse anesthetists, and staff members to train as peer supporters in a pilot program that offers optional, confidential, and immediate support and information to colleagues suffering in the aftermath of adverse or difficult events.

Brenda Bursch, PhD, led the training in her role as Professor of Psychiatry and Biobehavioral Sciences, and a member of the Semel Institute for Neuroscience and Human Behavior.

“I was very impressed with how engaged everyone was,” said Dr. Bursch, who asked participants why they were drawn to this work. “Each person had a story from their own experience, or of someone they knew. They recognized this was real and important.”

The pilot program is a component of the Employee Mental Wellness and Resilience Initiative, which emphasizes three core elements:


•An online self-assessment tool to help identify risk for depression, anxiety, or trauma.
•Resiliency-skills training sessions.
•Acute localized support, including the training of managers and supervisors to help identify employees in need, peer support, and referrals to professionals for targeted treatment.

Ours is the first department in the UCLA Health System to train members to function as peer supporters. For decades, anesthesiology has been spotlighted as a high-risk profession for suicide, substance abuse, and -- more recently -- burnout. In the last decade, studies on the “second victim” phenomenon have alerted health care systems to the emotional devastation that critical care professionals can suffer after unexpected patient death, the experience of treating disaster victims, or committing errors that lead to tragic consequences.

Creating a “Just Culture”

In their article, The Impaired Anesthesiologist: Not Just About Drugs and Alcohol Anymore, Gregory Rose, MD, and Raeford Brown Jr., MD, wrote, “In anesthesiology, the acuity of our patients and the urgency of care that we provide may translate into errors that can be catastrophic. Errors that lead to adverse outcomes inevitably produce two victims: the patient and the physician. These errors lead to an increasingly depressed state for the practitioner.

"This is compounded by a medical culture that encourages physicians to cover their pain. “The unspoken message of this culture could be summed up as ‘big boys and girls don’t cry’ – a belief that physicians cannot and should not show weakness or vulnerability,” the authors concluded.

Swati Patel, MD, our chief of Pediatric Anesthesiology, reached out to Dr. Bursch after reading about her work with pediatric residents here at Mattel Children’s Hospital UCLA. They agreed with Dr. Ziv that the anesthesiology department would be an ideal match to test the Mental Wellness and Resilience Initiative’s peer support pilot, and the call went out for volunteers.

Dr. Ziv and Ms. Marchese administered a wellness survey to our physicians, who overwhelmingly indicated that “finding a supportive colleague who understands” to talk to after a difficult or adverse event was their #1 desire from the program.

“We’ve had a need for this for a long time,” said Dr. Ziv. “I’m very proud that we’re the first department to do this at UCLA. Programs like this only succeed if leadership is on board, and Dr. Mahajan’s interests are very much aligned with this. He’s been very supportive.”

The training session explored working in a “Just Culture” -- a non-punitive environment where accountability is shared, and mistakes are learning opportunities. Speakers examined the dangers that face “identified individuals” or “second victims” -- the healthcare workers who are suffering after adverse events.

Dr. Bursch and Karen Miotto, MD, the chair of UCLA’s Physician Wellness Program, demonstrated communication techniques through role-playing exercises. The trainees then broke into small groups to practice approaching and supporting distressed colleagues. They found that there is a learning curve, and it’s not always easy to pivot from communicating and asking questions as a clinician to providing empathic and non-judgmental support as a peer.

“As human beings we want to get information, but that’s not helpful,” said Dr. Bursch. “Not to grill for details, or to problem-solve, and to reflect back emotion – that’s hard to do.” Instead, she said, peer support requires you to “track the emotional content of what they’re saying. You want them to feel seen and supported.”

The trainees were encouraged to listen and redirect conversations back to the emotions and needs of the distressed colleague through open-ended questions:


• “How are you feeling?”
• “What do you need?”
• “How can I help you?” 


"The training gave us guidance and confidence,” said Dr. Ziv. “It helped us become better listeners.”

Dr. Bursch plans to provide an additional training session for those who would like more coaching. In addition, peer supporters will have monthly check-ins and debriefings where they can request additional coaching and resources.

“Until now, there hasn’t been someone trained to see how you are and to refer you to other resources if you need additional help,” says Ms. Marchese. “We have other procedures in place for safety and patient care. This is where we look at the physician as a human, an individual.”

To learn more the program, or about becoming a peer supporter, please contact Dr. Ziv, [email protected], or Ms. Marchese, [email protected].

- by Claire Winters

 

Gallery Photo 1
Peer Support 2 ed2
Nirav Kamdar, Susana Vacas and Kenneth Kuchta (foreground) and Gordon Lee, MD, in background.

 

Gallery Photo 2
Peer Support 1 ed
Mary Fortson-Harwell, PhD, Jessica Lloyd, MD, and Rebecca Wilkinson at the training.

 

 

 

 

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