Resilience, learning from the astronauts and soldier training

6a00d8341bf7f753ef01a3fccb1203970b-piIn the UK we have been following a British astronaut , who is working at the International Space Station for 6 months. He is the first British astronaut to be there. Last weekend he did a spacewalk with a colleague. The walk had to be shortened as the other astronaut developed a leak of water into his helmet.
This particular problem has happened more seriously before – in 2013 an astronaut Luca Parmitano had water fill his helmet, a life threatening situation. Did he panic? No. He had spent several years training and many simulated hours to prepare himself for this moment. “My background of being a test pilot teaches me to react quickly and come up with a plan as fast as I can.”
He survived. So how did he cope?
“Of course at one level there is fear- but fear can be a tool to help us think quicker. You can’t let it turn into panic. And it’s all to do with training- which is the light that sheds away fear … We learn new things all the time. Especially when unexpected things happen.”
Training an astronaut involves psychological awareness of self, an understanding of why you react in a certain way under stress both with other people and to a stressful situation.  It mixes this self awareness with extreme repetitive training of complicated procedures such that when the unexpected happens and lives are threatened, the astronaut reacts automatically, and the training kicks in. The resilient person also stands firm in adversity.
In medicine, we train many hours for collapses and resuscitation procedures, and the training kicks in. But do we understand the human factors? Will we work smoothly with other people under stress? Will we take or give up leadership decision-making roles as needed? Will we know our weak areas, our vulnerable aspects of the self?
Behavioural  teaching methods work well for dealing with serious situations, conditioning us to react predictably and according to guidelines as Pavlov’s dogs did when the bell rang. The response becomes predictable.  So how do we train doctors and nurses for psychological resilience, knowing themselves, and knowing they will be strong?
Harvard Business School is looking at resilience in the Army. It is how people learn from failure that determines their resilience. Do they react with optimism, and learn from the experience, move on and do better, become stronger?
I end with a quote from the referenced Harvard article:
“How human beings react to extreme adversity is normally distributed. On one end are the people who fall apart into PTSD, depression, and even suicide. In the middle are most people, who at first react with symptoms of depression and anxiety but within a month or so are, by physical and psychological measures, back where they were before the trauma. That is resilience. On the other end are people who show post-traumatic growth. They, too, first experience depression and anxiety, often exhibiting full-blown PTSD, but within a year they are better off than they were before the trauma. These are the people of whom Friedrich Nietzsche said, “That which does not kill us makes us stronger.”
This is developed into a resilience training programme for the Army: “master resilience training” is based on PERMA: positive emotion, engagement, relationships, meaning, and accomplishment – the building blocks of resilience and growth.
When we train doctors and nurses who are in the front line we can learn from this approach. It is a serious job and we avoid it at our, and our patient’s, and our health services’, peril.


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