Simulated Training for Resilience in Various Environments (STRIVE)

Strive to thrive with resiliency training that prepares you for the unexpected

Course material was developed by Dr. Stephanie Smith and Dr. Joan Horton from the Cumming School of Medicine and was supported by the Canadian Medical Association, Resident Doctors of Canada, the Canadian Federation of Medical Students and the Cumming School of Medicine Undergraduate Medical Education Program and Student Affairs and Wellness Office.

The high rate of burnout in the medical profession raises serious concerns about medical culture and the potential impacts of physician burnout on patient care. It is estimated that half of all medical students are affected by burnout during their education, which can then lead to high levels of stress, psychiatric disorders and suicidal ideation. Stressful clinical events can have a negative impact on the resilience of medical learners and physicians and increase the risk of burnout. 

Simulated Training for Resilience in Various Environments (STRIVE) is a course that teaches mindfulness-based stress management tactics to medical professionals, helping them effectively deal with acute stress and cope after traumatic events. 

Although the STRIVE course was originally designed for medical students, its format is easily adapted for residents, physicians, nurses, first responders, social workers and others who want to develop and strengthen their resiliency skills.

The STRIVE philosophy

STRIVE is based on the Canadian Armed Forces Road to Mental Readiness (R2MR) Program and reinforced with experiential learning through practical simulation training.

The original version of the STRIVE course prepared medical students to thrive in challenging and stressful clinical environments. It taught them the core competencies of resilience through some of the following 10 scenarios:

1. Experiencing a non-accidental pediatric trauma
2. Activating a code alone
3. Managing the death of a patient
4. Debriefing after a suicide attempt
5. De-escalating an aggressive patient
6. Managing a challenging obstetrical delivery
7. Experiencing a team conflict
8. Engaging in a difficult procedural skill 
9. Navigating an ethical dilemma
10. Discussing a personal medical error

The Canadian Federation of Medical Students (CFMS) recommends that all medical students should practise resiliency skills through practical simulation in medical school. STRIVE’s scenarios represent real-life situations that residents are likely to encounter. By being exposed to these stressful events while in training, they can learn how to handle them in a controlled environment to develop confidence, reinforce their resiliency skills and improve their future performance. 

The STRIVE approach

In collaboration with the Canadian Medical Association, Resident Doctors of Canada (RDoC), the CFMS and the Cumming School of Medicine, the student-focused STRIVE course has been adapted to ensure all medical professionals can benefit from the training and build their resiliency skills.

There are four main components to the STRIVE approach:

1.  Resiliency training

This training includes proactive and reactive approaches to stress management, health and wellness. Practical “reset” tools for balance and stability provide a holistic approach that addresses the mental, physical, spiritual and social domains. The training emphasizes the following: 

• the mental health continuum
• the Big 4+ strategies: 
  • arousal control (box breathing)
  • attention control
  • goal setting
  • progressive muscular relaxation 
  • self-talk
  • visualization

2.  Practical simulations 

The resiliency training is reinforced through challenging and stressful simulations that offer a variety of modalities that include role-playing scenarios, actor-led scenarios, skill-based training and high-fidelity medical simulation.

3.  Effective debriefing

Participants are debriefed after each simulation using an experiential learning framework. Debriefs are conducted in an emotionally safe environment to promote open reflection. Facilitators encourage participants to discuss their experiences, evaluate their application of resiliency skills and reinforce strategies to improve future performance.

4.  Reflective practice

To maintain health and wellness while managing both day-to-day and acute stress, participants are advised to practise and reinforce their resiliency skills regularly. They are encouraged to conduct frequent self-checks and assess supportive resources in an attempt to enhance mental health outcomes and optimize performance.

Videos to help develop and reinforce resilience

Through the support of the Cumming School of Medicine, Dr. Stephanie Smith, family medicine resident at the University of Calgary, has created a series of videos to show how STRIVE can help you develop the resiliency skills that physicians need:

• Introduction to STRIVE
• Breathing
• Goal-setting 
• Progressive muscular relaxation
• Self-talk
• Visualization 
• Attention control
• Effective debriefing

Resilience and the COVID-19 pandemic

The COVID-19 pandemic has put an even further strain on Canada’s physicians. With this STRIVE COVID-19 scenario, physicians and medical learners can develop resiliency skills through a simulated training exercise — and gain the confidence they needed to navigate a clinical situation that is changing every day.  

Demonstrating impact

Preliminary findings have shown that STRIVE: 

• increases students’ confidence in their abilities to deal with stressful situations, including supporting peers and patients
• increases resilience as measured by the Connor Davidson-Resilience Scale (CD-RISC)
• teaches relevant skills through simulation, providing students with the opportunity to practise the Big 4+, manage stressful situations and develop confidence.

(STRIVE Research and Implementation Team members at the University of Calgary: Dr. Stephanie Smith, Dr. Joan Horton, Dr. Lauren Griggs, Dr. Franco Rizzuti, Dr. Alex Kennedy, Dr. Aliya Kassam, Dr. Allison Brown)

The STRIVE course could have not been a success without the many medical students, residents, physicians and faculty who volunteered their time to conduct courses over the last few years.

Topics

Resilience Burnout Stress Suicide