Soon after Jessica Lloyd, MD, began her career as a pediatric critical care physician, she realized she wasn't prepared for one aspect of the job: the emotional trauma. In particular, she was struck when a 7-year-old cancer patient she was caring for unexpectedly took a turn for the worse. As he died, she watched his father hold his hand as he repeated, "I love you so much. I love you so much."
"After the boy died, I kept hearing those words in my head," says Lloyd, holding back tears five years after the incident. "We didn't think he was going to die, and I felt so sad. It was a surreal moment because it was such a painful loss, yet I had to go on to the next patient."
Lloyd decided to take a break from the emotional intensity and transitioned to new roles as a general hospitalist and the associate program director of the University of California, Los Angeles, pediatric residency program. But her previous experiences also made her eager to teach residents how to cope with the emotionally charged situations they faced on the units.
Searching for answers, Lloyd approached psychologist Brenda Bursch, PhD, a professor of psychiatry and biobehavioral sciences at UCLA, who had successfully used an intervention for families dealing with the trauma and stress of military deployment. Bursch was optimistic that the intervention—known as FOCUS (Families Overcoming Under Stress)—could be adapted for pediatric residents.
Working together, Bursch and Lloyd developed Mattel Children's Hospital's Pediatric Residency Resilience Training Program. In 2015, more than 80 residents at UCLA participated in the six hour-long modules, which cover such topics as emotion regulation, communication with angry patients and parents, reflective narrative writing, inspirational goal setting and problem-solving.
The program taught residents how to be more aware of their reactions and how to alter their responses using basic cognitive-behavioral therapy techniques. Participants also watched videos of attending physicians sharing their own experiences with stress, depression, moral distress and death. Residents told Lloyd it was particularly helpful to see that their superiors have struggled with similar issues, she says.
The training helped UCLA pediatric resident Robert Guglielmo, MD, when he was treating a 5-year-old girl whose cancer had spread throughout her body. He had known the patient for two years, and was with her the night before she died.
"I reframed my role as a physician when it became clear that she was going to die," he says. "Rather than being a healer, my job was to keep the patient comfortable and help her parents through potentially the worst days of their lives."
Guglielmo also found the sessions about communicating with parents to be particularly valuable.
"We explained that anger is protective and often there is fear behind the anger," Bursch says. "We taught the residents how to calm themselves, give effective apologies and engage in active listening."
Over the past year, Bursch has been receiving phone calls from hospitals in other cities and states that are interested in starting similar programs. Now, she is developing resilience training and peer-support programs for employees throughout the UCLA health-care system, including nurses, physicians, housekeepers, pharmacists and other staff members. She is also piloting an online mental wellness tool for nurses and doctors that assesses levels of anxiety, depression and resilience, and then provides immediate evidence-based self-help tips based on their answers.
"This is an example of how we can apply our psychology skills to a medical setting in important ways," Bursch says. "I've met so many people from around the country and within my own institution as a result of doing this program. It's amazing how many people are interested in improving hospital staff mental health."
