1. | Relaxation is vital to your health. The state of relaxation is not a passive action and requires focused effort to be achieved. Synonymous with a high-performance engine that needs a modified exhaustion release system, fellows need efficient ways of releasing stress. From an institutional perspective, many programs incorporate social events to foster relaxed time, noting that many trainees relocate away from friends and family to complete fellowships. Depending on the individual, relaxation can be achieved by partaking in sedentary activities, such as meditation and video games, whereas others prefer physical activities, such as swimming and dancing. Although either method is acceptable, some level of physical activity is generally recommended, as obesity is becoming more prevalent in developed countries, not absent among physicians, and also frequently contributes to a depressed mood. Although anxiolytics and sleep mediations are widely prescribed medications in the United States, many of their effects can be achieved from physical activity. Physical activity forces the body to release endorphins and other chemicals that ensure relaxation and tranquility, in turn bringing the body to a place of contentment, in preparation for reflection. |
2. | Reflection is a necessary and important checkpoint. Many programs have built-in checkpoints (usually every 6 months) for fellows to meet with the chief fellow or program director to reflect on past work and develop strategies to respond to challenges. However, transparency is often unachievable for the trainee due to fear of judgment. Moreover, these checkpoints of scheduled meetings are usually too seldom to use as the sole opportunity for reflection. Reflection is a process that allows an individual to sequentially dissect the events of the past, consider what went wrong, and determine how the concerns can be prevented or changed. Most importantly, it is a time to identify causative factors. It may be unpleasant to reflect on less than ideal events, and hence, it is done less frequently than required. The method for reflection is often unproductive. Strategies such as the STAR (considering the complete Situation, identifying Tasks that were required to be completed, the Actions taken by the individual, and the Results achieved) method can help to organize thoughts in a productive manner. It enhances the opportunity to retrace and analyze the past to improve on the skills necessary to regroup. |
3. | Regrouping to form new strategies. To ensure that the process is progressive, the trainee must regroup. During the process of regrouping, one is actively engaged in acquiring the skills necessary to prevent recurrence of the previous negative outcome or to improve good outcomes. As a first-year fellow, I joined a gym and was excited to lose weight and gain agility. I started a strenuous exercise program and solicited the guidance of a personal trainer. On the third day, the trainer advised me to rest 1 to 2 days before continuing. I responded with a puzzled look; the trainer readily stated, “When you work out that hard you really have to take time to rest, giving your muscles time to repair and rebuild.” In essence, the trainer was saying that my muscles needed to pass through the 3 Rs. They needed time to relax from the strenuous exercise, reflect on the previous week’s activities, and rebuild (regroup) more muscles for improved performance. Regrouping can happen in many different ways. For some, it may entail reading journal papers, getting extra equipment for the clinic, researching faster ways to complete morning rounds, or keeping track of patients. Regrouping also gives us the chance to accept the things we cannot change and to use them to create learning opportunities (7). |
The benefit of the 3 Rs was proven to me during medical school. After encountering a group that played recreational soccer, it became apparent to me that what I termed “free time” was essential to my preservation. After a game, I would leave the field with a feeling of exoneration that was likened to the feeling of returning from a vacation. I achieved a more peaceful resting period, and the endorphin rush was nothing short of that received from psychogenic medications. This was my method of relaxation. Walking home and showering would be a period of reflection that allowed me to retrace my activities in a constructive manner. I was completing the 3 Rs on a regular basis by joining a pick-up game of soccer.
Due to the simplicity of this method, why is it not more prevalent? The answer is that when it is done correctly, it is done infrequently. As we develop our medical armamentarium, we frequently fail in improving our repertoire with appropriate stress reduction skills. Cycling through the 3 Rs can range from spending 15 min away from the crowd to an extended beach vacation. The intensity and duration should be commensurate with work demands. Although time constraints can be limiting, the key is to find something that allows you an opportunity to frequently and effectively relax, reflect, and regroup.