THRIVING AMIDST CHAOS: The V.A.A.R. Mantra Solution Presented by: Carol Shelby and Dr. Vineeth John University of Texas Medical School Houston, Texas

A Typical Monday Morning Delinquent ACLS cards and the site rotation threatening immediate suspension Resident forget to notify the RT ofc about absence Delinquent patient logs Delinquent evaluations (residents/faculty) Residents not meeting mandatory survey deadlines Faculty wanting to fire the resident mid rotation Residents taking off early and site supervisor livid Lectures cancelled last minute, poor attendance Residents not paying much attention to critical important s

The Life of a Residency Coordinator Busy Chaotic Cyclical Constant evaluations Being evaluated Multiple interface systems Multiple stakeholders Balancing service, education, and budget

Who are we though really?

How Do We Survive? Personal qualities Motivation Time management skills Organizational support

CHAOS AFTERMATH Balancing Tasks Toxic Work Place CHAOS Misinterpretations Mistaken Intentions Daily Hassles Multiple Interfaces Constant Interruptions Frequent Rejections

CHAOS AFTERMATH We lose our values? We forget who we are? We stop being generous? We give up too soon? Need blueprint to help guide us

V.A.A.R. Mantra We lose our values? Virtuousness We forget who we are? Authenticity We stop being generous? Altruism We give up too soon? Resilience

Whitehall study

Imbalance in effort and reward Low levels of control in one’s job Whitehall study

V irtuousness A uthenticity A ltruism R esilience

Aspiring to be at one’s best Doing the right thing; all the time Meaningful purpose Source: Lipman-Blumen & Leavitt, Becker, Eisenberg

Better Decision making Increased Creativity Enhancing social capital

Virtuous Action 1 Virtuous Action 2 AMPLIFY Organizational Virtuousness Negative Outcomes Traumatic Events BUFFER - Kim Cameron

Knowing others is wisdom Knowing oneself is enlightenment - Lao Tzu

Know your story Manifest your values Find your own voice

Shame Guilt Perfectionism

“We cultivate love when we allow our most vulnerable and powerful selves to be deeply seen and known, and when we honor the spiritual connection that grows from that offering with trust, respect, kindness and affection.” “ Shame, blame, disrespect and betrayal and the withholding of affection damage the roots from which love grows. Love can only survive these injuries if they are acknowledged, healed and rare. -Brene Brown, PhD

Practice courage and reach out: Talk to self with self-compassion: Own the story:

Photo - Gregory Heisler

Selflessness Practice or principle which keeps other’s wellbeing a priority Increases the fitness of others while decreasing the fitness of others (Evolutionary approach)

Givers – Injected Energy Created opportunities Respected others Takers- Sucked energy “Black holes” Energy Vampires

- Craft your job so that you can give more - Practice five minute favors - Seek help more often Adam Grant

Strength in the midst of change and stressful life events.

Resilience Physical Spiritual Psychological Social

We shape our network Our network shapes us Our friends affect us Our friends’ friends affect us Network has a life of his own

HAPPINESS AND SOCIAL NETWORKS appin in the Framingham social network. Fowler J H, Christakis N A BMJ 2008;337:bmj.a2338 ©2008 by British Medical Journal Publishing Group

Erikson Ki et al. Hippocampus. 2009;19: Scatterplots showing increase in fitness (VO 2 peak) is related to increase in hippocampal volume cm 3 Correlations significant for both left and right (even after including age, sex, years of education as covariates)

Boecker H et al. Cereb Cortex. 2008;18(11): Reduction in opioid receptor availability after exercise (red is P<0.05)

Resilience Physical Spiritual Psychological Social

Jeff Widener/ Associated Press

“ The common experience …..of being carried away by an outside force, of moving effortlessly with a current of energy at moments of highest enjoyment” - Mihaly Csikzentmihalyi

CHALLENGESCHALLENGES SKILLS HIGH LOW HIGH ANXIETY BOREDOM FLOW

Goals are clear Feedback is immediate A balance between opportunity and capacity Concentration deepens The present is what matters most Control is no problem The sense of time is altered The loss of ego -Mihaly Csikzentmihalyi

“ Flow is a state of self forgetfulness, the opposite of rumination and worry… In this sense moments of flow are egoless. Paradoxically, people in flow exhibit a masterly control of what they are doing.. And although people perform at their peak while in flow, they are unconcerned with how they are doing, with thoughts of failure or success- the sheer pleasure of the act itself is what motivates them” -Daniel Goleman