Emotional sufferance

Resident : How can we tell that a trainee suffers from emotional distress ?

Staff : First and foremost, you should look for early signs of difficulty : lateness, absenteeism or excessive amounts of sick leave, not getting through workload compared with peers, aggressive and disrespectful behavior with patients and colleagues, inability to compromise, difficulty prioritizing, inappropriate complaints, avoiding to seek opinion or help, uncertainty about career choice, rejecting constructive criticism, and being disillusioned and defensive.

Resident : I don’t quite get it. I mean, I have never been through all this when I was a trainee.

Staff : Most of the training healthcare professionals will rise to the challenge of the transition from student to responsible professional, but a small proportion is at risk of failure. So if we detect early signs of emotional sufferance, minor difficulties can be prevented from escalating into major problems.

Resident : What do you mean ?

Staff : In general, those major problems include a risk of harm to patients and to the trainees themselves. A supportive approach, that is supervision and support, usually leads to a satisfying result, as the patient’s safety and the trainee’s should always be the primary consideration.

Resident : Therefore, prevention, early recognition and early intervention are always preferred over a punitive approach in dealing with identified issues.

Staff : Exactly. The first steps are to speak with the trainees, to listen and assess their distress and to seek advice from, or refer to, an expert practitioner.

Resident : I can now tell that one of my trainees presented alcohol problems, was always tired, physically ill, anxious and maybe even depressed, self-neglecting, failing to perform tasks as desired and often departing from protocols and procedure guidelines, and committing ongoing medication errors.

Staff : These are exactly some of the signs of a psychological or emotional collapse. In this case, trainees often fail to seek advice appropriately and are irritable and almost often counter-challenging.

Resident : What can we do to help them ?

Staff : First of all, speak with the trainees, at an early stage, in an appropriate place and time, and give them the opportunity to respond and resolve the issue before it progresses any further.

Resident : This helps gather the information you need to make an assessment of their distress, right ?

Staff : Of course. And once you identify the problem, potential solutions are usually easy to find.

Resident : What if the trainees refuse to cooperate ?

Staff : You should put them at ease and explain the purpose of your meeting them by providing details of the concerns raised. Encourage them to talk and listen to them actively. You should acknowledge the trainee’s thoughts and feelings, and be willing to give praise where it is due. You can also set short-term and achievable goals, be positive and maintain confidentiality.