Wellbeing talk for intern orientation week. ISLHD (Illawarra Shoalhaven Local Health District) presented by Dr Bishan Rajapakse (Emergency Physician, FACEM, PhD) and Dr Skye Macleod (Emergency Fellow /UOW lecturer) - an informal and exploratory talk about strategies for maintaining and promoting wellbeing in the challenging healthcare area of modern medicine

1. Intern O-
Week
Wellbeing – in a challenging
healthcare environment
ISLHD Intern Orientation Program
Dr Bishan Rajapakse (FACEM/Phd)
Dr Skye Macleod (EM Fellow/UOW Senior
lecturer)
Wed 25th Jan 2023

2. Getting to
know our
team

3. Bio-psycho-social Exercise/experiment -
an invitation to participate (2 min)

4. Aspirations
of this
session
• Start the conversation about wellbeing
• Know who your crisis team will be ahead of
time
• Get yourself a failure buddy
• “Know thyself” and “know thy team”
• Know what drains you and what sustains you,
and find ways to “fill your cup”
• and fill it often; at least daily

5. Why wellbeing – for me?
Topic close to my heart..
• Personal experience of Burnout
• Suicide of Friends
• Student/Doctor representative
• Detrimental to entire Healthcare
community
• More wellbeing à better patient care
Vision - A kinder more compassionate
health care system

6. Wellbeing – points you & your colleagues
raised ? (survey results)
• How do you develop a wellness
routine when roster changes every
10 weeks?
• Who do you turn to professionally
if you are facing tough times?
• Boundary setting around
expectations for overtime?
• What about making mistakes?
• What sort of Mental Health
services are available in ISLHD?
• Long hours and work stress of
internship
• Not being able to balance work and life
• Lack support structures – new to
Wollongong
• Not enough time for mental health
• Unsupportive colleagues & workplace
bullying
• Being too insular in the medical world
(forgetting about the world outside
medicine)
• Having to be a medical Adult
What would you like to ask the wellbeing panel ?
What are the biggest concerns for your
wellbeing in the internship year?

7. Prioritizing “Self-Care”
Bio
Social
Psycho
Spiritual
Emotional
Prioritizing “Self-Care”
Prioritizing “Self-Care”
Bio
Social
Psycho
Spiritual
Emotional
Prioritizing “Self-Care”

8. My key wellbeing
practices
• Meditation
• Hobbies; surfing, music, dance, travel
• Relationship time: “Inner circle”
• Reading, writing, debriefing
• Mentorship / Coaching
• Community groups
& Healthy “ED Work-life Integration”
Training/Education/Regular Debrief

9. What sustains you & what drains you? (your
survey results)…
• Exercise /swimming
• Sunshine/ nature
• Socializing
• Friends and family
• Art
• Music (listening and playing

10. Words from Skye

11. My Journey to Fellowship
30
15
30
40
50
80
60
100
90
100
10
70
10
15 15
20
40
50
60
70
90
100
20
10
40
85
60
20
10
50
40
10
5
2
70
50
0
10
20
30
40
50
60
70
80
90
100
Start
Internship
PGY1
RMO PGY 2 Choosing a
Specialty / Job
App.
SRMO PGY 3 -
New Hospital
Start ED
Registrar PGY
4
Primary Exams
PGY4
ICU Reg PGY 5 ED Nights in
Charge PGY 5
FEx Exam -
Written PGY 8
FEx - OSCE
PGY 8
Finishing
Training (US
Term) PGY 8
Start ED
Consultant
PGY 9
Stress Fatigue Confidence

12. So maybe I should just resign now….?
• There are things you can do to help!
• Day-to-Day
• Take your (uninterrupted / unpaid!) breaks / Team coffee
• Few tasks need to be done immediately
• Sleep, Rest, Exercise and your life outside of medicine
• Claim your unrostered OT
• Social - Relationships, Friends, Family, Pets
• Over a Career
• Mentors
• Debriefing
• Prioritise your health - so you can look after your patients too
• Your Plan B / Plan C job in medicine (a fellowship NOT mandatory!)
• You CAN take leave, drop your FTE, parental leave etc
• Recognise burnout (ideally before it happens)
• Remain humble

13. Getting help?
Who can you turn to when times are
tough?

14. GETTING
HELP
• DPET / JMO office
• EAP
• Pyschologists
• Cousellors
• GPs
• Mentors (formal / informal)
• Heads of Department –
trusted senior colleagues
(registrars consultants)
• Wellbeing Champions
• Inner circle
• Family and friends
• Community groups

15. Social Media resources

16. Who is your Crisis support crew & plan? Think
about it before you need it (today even)

17. MY CRISIS PLAN- what is yours?
• Department
• Consultant mentors
• Directors of Training/ Department
• potential leave/ time out
• Hospital, Health service & NGOs
• Employee Assistance Program (EAP)
• Psychologist
• Doctors health Advisory service (DHAS)
• DRS4DRS (https://www.drs4drs.com.au)
• External
• Good GP
• Family/Friends
• Community
• Coach
ED mentors
General
Practitioner

18. EAP / Converge – overcoming barriers to
engagement and stigma
To make an appointment,
call Converge International on:
convergeinternational.com.au
Your Mobile Solution for on the go
EAP Support by Converge International
EAP Connect
Install today to find out more
To download search ‘EAP Connect’ in your app store
Manager Assist
Coaching and advice to assist
with a variety of people
management issues and
develop your leadership
competencies.
Employee
Assistance
Program
Lifestyle Assist
Manage addictive
behaviours, promote
nutrition and fitness,
to increase mental and
physical wellbeing.
Career Assist
Career
development and
planning, resume
and job seeking
assistance,
interview skills,
vocational
counselling.
Conflict Assist
Strategies, tools and
coaching to deal with
difficult workplace and personal
situations.
Employee Assist
Support and
counselling for a
broad range of
personal and work
related issues.
Money Assist
Financial
counselling to
help you work
through financial
wellbeing
concerns.
Your wellbeing
is important
Available for up to 3
sessions per issue
per year
Employee Assist is available to immediate family members
Confidential
Free
1300 use eap
(1300 873 327)

20. Peer support – continuing the wellbeing conversation?
• Hand n Hand
• https://www.handnhand.org.au/
• Clinical Supervision?
“ a reflective model used by other
health professions such as psychologists
and nurses, and typically would involve
meeting for an hour fortnightly (face to
face or online) in a group of peer with a
‘supervisor’ to reflect on issues arising
in working as a junior doctor, as a way
to prevent burnout and gain support”
• Co-peers, maybe other senior
peers (perhaps a mix)
• Maybe getting coffee outside of
hospital
• In person/face-face better than
virtual (but virtual better than
no peer support)
Survey Results

21. Mentorship, Coaching .. and the power of
debrief
• Mentor
• Senior Mentor? Formal /.Informal
• Co-Mentor
• “Failure Friend”
• Coaching & coaching course
• Life
• Online
crossing the shaky line from “Surviving” to “Thriving”!
• Debrief
• Verbal, written
• Formal
• Community based

22. Coping with Error…find yourselves a
failure friend
https://bishansworld.wordpress.com/2012/06/20/making-mistakes-stress-
management-and-leading/
“Medical Error: It never gets
easier”
“We just get more skilled in
understanding and coping with
error”

23. Coping with Medical Error
Reflective practice
Writing (eg Journal)
Talking
• Friend
• Mentor
M&M meeting
The “Re-Frame”
changing one’s perspective
• Focus on what you Did do
well
• Consider Systems/Teams
• Learn and Improve & teach
BE KIND!!!

24. • Here’s a title you suggested ->
“Emotional Female. It made me
more mindful/aware of
pressures on some doctors”
Inspiration for Perspiration….
Think, learn and read/listen “outside the box”

25. Prioritizing “Self-Care”
Bio
Social
Psycho
Spiritual
Emotiona
Prioritizing “Self-Care”
Know what fill’s your cup and practice often
(why not daily?)

26. Can we translate
Meditation into real
Medical practice?
?
Disaster Training
Exercise/Sim
Explore
feasibility in
practice?

27. Looking after Relationships (incl relationship
with self, loved ones & friends /community)
Whatever your
situation - it’s a
challenge
So - check in with
yourself & close
relationships
often
Be kind to
yourself. Re-
charge as often as
you need
They say “work” is like a rubber ball and “family,
friends, health, and spirit” are glass balls.
If you drop the rubber ball of work, it will
bounce back (albeit with some consequence)
If the other four balls fall, they’ll likely be
damaged or shatter

28. Take home points
Know
Know thyself
• What drains you
• What rejuvenates or
inspires you (and plan
time doing this)
Start
Start the
conversation,
about wellbeing
• Experiment with a
“Check-in
Buddy”/Failure Friend
• Have a crisis Plan ;
Proactively engage
with resources, before
you need it
Share
Know that you are
not alone
Have
Have fun in your
Internship!

29. Taking it further /
Questions from the
Audience?
… we will be available to
chat with you in the
morning break
Or email us at
Bishan : Bishan.Rajapakse@health.nsw.gov.au
Skye: smacleod@uow.edu.au
Please scan here to fill out the
feedback survey and share your
comments / reflections on this
session

30. Extra resources
& links for
those who are
interested

31. Mind full
Medic Podcast
https://podcasts.apple.com/a
u/podcast/season-2-wrap-up-
and-wellbeing-2-0-with-dr-
cheryl-
martin/id1513559414?i=1000
546754027
Emergency Physician,
Yoga Instructor and
ACEM Wellbeing
Champion
https://podcasts.apple.com/
au/podcast/operating-with-
respect-and-leading-system-
and/id1513559414?i=10005
90009697
Highly recommended listening!!

32. Dr Andy Tagg – Paediatric Emergency Physcian & Medical Educator –
short video on struggles, vulnerability and Wellbeing
https://youtu.be/NY9-n9aok1o

33. https://emet-
islhd.blog/podcasts/episode-11-
what-is-this-wellbeing-thing/
https://youtu.be/hjsgLpzMvHI
Wellbeing interview for ISLHD JMO
Orientation on Wellbeing
Bishan Rajapakse – Em Physician; - youtube
interviews/podcasts
https://fairfoodforager.buzzsprout.com/
791252/10905450-64-dr-bishan-
rajapakse-nature-community-caring-for-
our-mental-physical-state-living-well

34. https://bishansworld.wordpress.com/2017/04
/21/the-rising-tide-of-burnout-a-major-threat-
to-our-healthcare-system/
https://litfl.com/a-scenic-route-to-
emergency-medicine/