“Time to Recover” Explained
I was asked a simple question that required a not so simple answer.
Q: How do you remain so calm and focused in a trauma care situation?
Time to recover: This is the time when you realize you will be in a stressful situation and you must address it. Your fight or flight response will kick in and flight is not an option. Therefore, you must compose yourself and address the situation in a calm and appropriate manner.
In 1982, Patricia Benner discussed the Novice to Expert theory. She is a nursing theorist and described 5 stages of development. Novice, Advanced Beginner, Competent, Proficient then Expert. I have read many theories and developed a few myself, but this one captures an accurate description upon which I would like to expand.
I will describe how I would approach your profession (Doctor, Nurse, PA, Medic, EMT, whatever field of medicine you choose) if I could turn back time and repeat my medical professional career. Although I spend my career as a military medical provider, this approach holds true regardless of your affiliation. The phases below are my words, and I have ended each phase where I believe it falls in the Benner theory.
- Healthcare basic knowledge and skills: In this phase, you must learn the language, understand the didactic material presented, begin to read the literature and validate what you are learning and determine what is the current evidence-based body of knowledge. Once taught a specific skill, you must create practical training aides to build and hone your muscle memory for each specific skill taught. Benner – Novice
- Clinical application with a safety net: In this phase, you will take the knowledge learned and begin practical application. Real patients are now under your care, and it is your responsibility to ensure that you have studied, practiced and committed to the trust these patients have placed in your hands. During this phase, find a strong mentor. One that will test you and help you grow in your practice. Evenings should be spent researching new concepts and skills that have been presented in the clinical environment. You will make mistakes, but own them and be honest with yourself, your mentor and your patient. It is critical that you sponge as much knowledge as you can from every provider. Take notes on how they do things, learn their decision-making processes, watch their techniques, and find a way that you can emulate these skills. This is a very uncomfortable phase, but if you put in the time; the transition to phase three will be very rewarding. Benner – Advanced Beginner
- Staff (graduated and starting own practice): This phase requires you to have put in time and energy to master phases 1&2. You must continue to learn and ask questions (this process will never change, no matter what phase you are in; I am still learning and asking questions). You must approach this phase head-on and build your confidence. You will not be proficient in your practice, but will have a great deal of competence on individual tasks. You will have to develop a multi-tasking mind set and begin to find ways to streamline your decisions, your skills, your time and your life. Know that many people get stuck in this phase. It is important that you maintain a strong mentor to help you progress and fully develop yourself as a strong medical professional. Benner – Competent
- Expansion of roles: You now have to understand the system as a whole. Equipment, supplies, logistics, ordering, par levels, hospital leadership, scheduling and all of the functions that you never thought you would have to be responsible for when you were sitting in the classroom during the first phase. These roles will help you understand the processes and answer the questions that frustrated you during your clinical practice. At this point, you have assumed that it is you against the system, but now realize that you are the system, and to be proficient, you have to fully understand the system that you have entered. Once you have done this, you will become a very proficient medical provider. Benner – Proficiency.
- Teacher: You have entered this phase when you have mastered all others. You are now able to stand back and observe what is happening around you and are quickly able to form a decision, redirect others and maintain composure during a crisis situation. You are able to orchestrate the care and allow others to learn under your watchful eye. You will know when to intervene and know when to allow others to make mistakes. You will now dedicate your life to not only caring, but to teaching those that are wanting to become as good as they perceive you to be. Benner – Expert
If you have gotten this far in my story, you are probably asking yourself: Geez, Matt, this sounds great, but I am deploying a few months after I graduate, and you have laid out a plan that will take me years to accomplish. You are correct, the 5 steps that I laid out are based on an optimal situation where time is not of the essence. So, what do I do now?
It is absolutely imperative that you are exposed to stress inoculation and austere medicine very early in your learning phases. This will allow you to develop emotional readiness and adaptability in your clinical practice. Exposing yourself to elements and situations where it seems that the task is impossible to complete will prepare you to make very critical decisions and have a high probability that those decisions will be correct. If you have chosen military medicine, rural medicine, austere medicine or any non-conventional medical practice- you absolutely cannot assume that traditional schooling will adequately prepare you upon graduation. Therefore, it is up to you to ensure that you are exposed to these opportunities. The stakes are extremely high, but not insurmountable. The key to success is controlling your heart rate and developing a systematic approach to your clinical care. Everything that you learn needs to be followed with the question: Now how would I do this if I was in the back of a truck, helicopter, on the ground etc.? Visually walk your mind through these steps and then go outside and practice the skills. There is not a magic pill that will prepare you for these situations. Only you can take the time and put in the effort to be the best provider.
Time to recover: This recovery phase, in my opinion, is the most critical step to being successful in the austere environment. In order to rapidly recover, you must have already practiced and developed rapid response muscle memory and algorithms for the critical decision points. “You have to train your brain.”