Category Archives: Wellness

Things about self-care during the pandemic that you already know but should hear again anyway.

As the pandemic begins to show signs of weakening its grasp on the world, the stress and pressures of the past 15 months continue to wear on educators everywhere. This blog covers some aspects of self-care that may provide helpful reminders to us all for managing the ongoing situation, and a call for us to be honest with ourselves about how we’re doing, to give permission to ourselves to ask for support, and when we need it, to ensure that we get the help that we need.

I don’t actually know how long it feels like it has been since I first learned we went virtual last March. It simultaneously feels like it’s been forever and just a few weeks. I do know that by the time I got to 18 December, the last day of the fall semester, I had nothing left in reserve. I woke up on Saturday morning and I have no idea how long I sat there on the edge of the bed staring at the wall before I realized it. The fatigue and the burnout had been mounting for months and I knew that my self-care had been slipping. It took about 2 weeks of intense rest and recovery before I was able to resume any sort of work and I still find myself fatiguing mentally more quickly than ever before.

I’d outlined this article talking about self-care months ago, and in the spirit of this article, will admit that it was originally due on 18 September. Between asking how I was qualified to talk about this topic as I felt that I was barely holding things together myself, and challenge that there was always one more thing on my to-do list that needed doing, that date came and went on the calendar. So here we are, at the end of another semester, but the topic is as relevant as ever. I’ll focus on 3 key areas here, and share what I can about my successes and challenges in meeting my own self-care needs.

Meet your basic needs

As physiologists, we KNOW that bodies need rest, exercise, and sustenance. But how often do we make sure that we’re getting everything that we need?

The initial work-from-home situation meant that one of my first realizations of the new pandemic reality was that I needed to make myself go outside the house or else I would spend days in a row trudging between the bed, the refrigerator, and my at-home work area. I have added a daily, recurring to-do item on my task manager, “Get outside and move!” Most days this works. I have better success if I do it early in the day, as sometimes I find that I don’t have the energy or motivation after a long day on Zoom. Looking ahead to the fall and returning to campus, my challenge will be to preserve this time for walking, running, and other outdoor activities when my daily commute resumes.

The American College of Sports Medicine (ACSM) recommends that we get at least 30 minutes of moderate intensity exercise 5 times per week, or vigorous activity for at least 20 minutes 3 times per week. Everyone should also engage in muscle-strengthening activities at least 2 times per week.1 That looks like different things to each of us, but the trick is to find something that you enjoy doing. Or at least, that you don’t hate doing.

The average adult needs between 7 and 9 hours of sleep per night. This amount slowly decreases as we age. This hasn’t ever been an area that I’ve struggled with. I actively use the sleep management features on my phone, with wind-down times, do not disturb hours, and reduced brightness and color hue settings. During the pandemic, however, sleep has been an important marker of my stress and fatigue. As the fall semester progressed, I found my nightly sleep creeping up, at one point getting 10-11 hours of sleep per night and still feeling tired. Make sure to get an appropriate amount of sleep to meet your rest needs, and use any changes in your sleep pattern to help identify changes in your stress and overall mental health.

And finally, I know that I am preaching to the choir telling you that a well-balanced diet is key to both maintaining energy levels throughout the day, supporting your immune system, and keeping up with other aspects of your general health. On this note, I would also bring up that occasionally indulging in a favorite meal or treat can often be mentally restorative, but that moderation is key here. I’m now on my second 50-lb bag of flour of the pandemic and while most of my baking has been breads, pastas, and other staple foods, the occasional cake or batch of cookies can be very powerful in keeping me feeling like my normal self.

Tracking priorities

Someone once explained priority management to me as juggling. Some of the balls in your hands are made of glass, some of them are made of plastic. A few of those balls may be the size of softballs or even a bowling ball, most of them are going to be smaller and more manageable. The trick is to know which of your priorities are the glass balls, the ones that have to be managed and kept up in the air until they are completed. The plastic balls can occasionally be set down, or when things get away from us, sometimes even dropped. I felt bad every time I looked at my task manager and postponed working on this piece for the PECOP blog, but I also knew that it wasn’t one of the balls that were mission-critical for me to keep in the air, so it got set down or shuffled around.

To keep track of which of my to-do items are made of glass and which are plastic, I set them to different priorities in my task manager. There are lots of to-do list and task manager apps. My personal favorite is Todoist, but there are some other fantastic ones out there, including Habitica, Things 3, and others. Find one that works for your organizational style and keeps you motivated to get things done. I’ll admit that I was hesitant to move away from using stickie notes for my to-do lists, but I find that I’m far more organized now then I was with my old system, and it allows me to stay on top of my responsibilities much more accurately. Even if I do postpone some of those tasks a few (or more) times when I know that they have flexibility to them.

Take a break

I think this one is the hardest, especially during the pandemic. Work-from-home has made it easier than ever to get a few more things done since we didn’t have to commute to the office anymore. Add in the pressure of social media posts telling us how others have had time to learn new musical instruments, pick up hobbies, and engage in elaborate projects, it’s easy to feel like we are underachieving in our own personal lives. For me personally, I’ve spent more time in office hours with students and the email flow has at least doubled compared to pre-pandemic levels when the semester is in session. That feeling of always having something to do and never being done makes it hard for me to disengage at the end of the day. Not only does this lead to prolonging our working hours, but it may have negative health consequences. A new report from the World Health Organization gives new evidence that work weeks longer than 55 hours may lead to increased risk of ischemic heart attacks, strokes, and other adverse events.2

I’ve talked about using a task manager with my list of things I need to be working on; I use that tool in concert with my calendar app to tell me where I need to be and when I need to be there. As much as possible, I will only add things to one or the other, but not both. The two exceptions that I make to this is scheduling my exercise on busy days when I’m likely to put it off or get side tracked into other tasks and blocking out periods of time where my explicit task is to walk away from work and relax for a little bit. Another useful tool is using the in-office hour settings on my calendar app and do-not-disturb features on my mobile devices to help enforce no-work hours when I am done for the day.

The difficult thing about our current situation is that I don’t think I’ve said anything that we don’t already know, that we haven’t been told numerous times by others, and that we probably often repeat to our colleagues when we provide words of comradery and support to one another. As educators, we often find ourselves in the role of care givers, so it’s far easier for us to tell others to take care of their basic needs, manage our priorities, and take breaks then it is for us to follow our own advice. On that note, the one thing that I will add to this article is this:

It’s okay to not be okay. The stress and pressure are real and we are each dealing with the current situation in ways that may or may not be keeping us together. Just because someone has their stuff together on the outside doesn’t show us what they need on the inside. I love that we’re asking each other how we’re doing more often, but I fear that we’re giving the easy answers and not taking full advantage of our wonderful community for the support that it can provide. Give yourself permission to take those breaks, to leave those emails unanswered for an extra day, and to make sure that you’re getting the self-care that you need. And for those times when everything is too much? Reach out and utilize your support networks and health care options to make sure that you are getting what you need. Finally, as a community of educators, we see you, we feel you, and together, we’ll get through this together.

1 ACSM. Physical Activity Guidelines. https://www.acsm.org/read-research/trending-topics-resource-pages/physical-activity-guidelines. Last accessed 15 May 2021.

2 Pega F, et al. (2021). Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environmental International. In press, corrected proof. https://doi.org/10.1016/j.envint.2021.106595

Ryan Downey is an Assistant Professor in the Department of Pharmacology & Physiology at Georgetown University. As part of those duties, he is the Co-Director for the Master of Science in Physiology and a Team Leader for the Special Master’s Program in Physiology. He received his Ph.D. in Integrative Biology from UT Southwestern Medical Center. His research interests are in improving science pedagogy and in the sympathetic control of cardiovascular function during exercise. When he’s not working, he spends time as a certified scuba instructor, baking bread, and playing board games.

Ryan Downey, Ph.D., M.A.
Assistant Professor
Co-Director, Graduate Physiology Program
Team Leader, Special Master’s Program in Physiology

Department Pharmacology and Physiology
Georgetown University Medical Center
Washington, D.C.

 

Why demonstrating and embracing uncertainty should be a learning objective, especially in uncertain times?

Uncertainty.  We have all heard that word quite frequently lately.  It tends to carry negative connotations and feelings of uneasiness.  It seems the answer to every question these days is, “well, it depends”.  As physiology educators, this is not new to us.  How many times have we answered a student’s broad question with this same phrase?    Regardless of how much active learning is accomplished in the classroom, students at all levels are tasked with preparing for and taking standardized tests.  My children started taking assessments in preschool, multiple choice tests for grading purposes in kindergarten, and state assessment tests in 3rd grade.  Then there will be standardized tests for admissions to college, graduate admissions, and licensing.  It’s no wonder that some students are conditioned to study ‘to the test’ instead of having the goal of truly learning the material, and are hesitant to express when they don’t know something.   I spent the first decade of my career teaching science at the undergraduate level and have spent the last five years teaching in the professional school setting, including medical, dental, and podiatry students.  I have found that these health professions students in particular become especially aware of uncertainty when they start gaining experience with clinical cases and with patients.  I also notice that they are uneasy with uncertainty even from the interactions in the classroom – they are high achieving students and don’t want to be wrong, to be perceived as not knowing an answer or a concept, of maybe feeling like they don’t belong.  In truth, many students have the same questions, and the same feelings, but are hesitant to express them.   It is known that dealing with uncertainty and ambiguity, especially in professions where people are serving patients whose health is at stake, can result in the experience of stress, anxiety, depression, and burnout (1).  Wellness is an important consideration, especially in a climate where things seem to be changing day-to-day and we are provided limited information and answers.  How one deals with uncertainty can lead to life and professional decisions including which career or specialty to pursue.  While this concept is not novel, actually teaching students how to tolerate or even embrace uncertainty is a relatively new concept, one which I think should be made a more purposeful objective in our courses.   What if instead of shying away from admitting we don’t know something, we learn how to accept it, and how to approach the problem to find the most effective answer?  How do we best learn to tolerate uncertainty, and train our students how to cope with and learn from uncertainty?  What are the benefits of embracing uncertainty?   

Bring uncertainty into the classroom Thoughtfully and purposely embedding uncertainty into activities in the classroom does several things.  First, it allows students to learn that not every question has an absolute answer.  Students need help shifting their mindset.  This also encourages students to work with material at higher levels of Bloom’s taxonomy, like evaluation and application.   Additionally, this helps create a culture in the classroom where asking questions and admitting to what we don’t know is a good thing, and brings value to classroom discussions.  This allows students to bring in their own experiences in an attempt to work through a problem and arrive at an answer, enhancing students’ learning.  Students can build their confidence as they find value in embracing the unknown as they learn to navigate the process to find the answers to their questions.   The learning theory constructivism suggests that students build their own learning, that knowledge is built upon knowledge, and that it works best in context (2). This encourages students to bring their own experiences to the learning process, and the result is that each student may bring a different perspective and answer (3).  These principles match well with the intention of teaching how to manage uncertainty.  A goal is for students to be engaged and motivated in an active learning environment, allowing them to share ideas and build their knowledge based on their prior knowledge and experiences.  

Leading to deeper learning To further expand the idea of students building their mental models, activities designed to allow for more open-ended thinking or answers, which build upon each other, can be utilized.  For example, in the cardiovascular physiology component of our medical course, we build on the basic concepts in a series of small group sessions which encourage students to work in their teams to answer questions pertaining to these concepts.  We may start with the principles of hemodynamics but eventually work our way to the integration of cardiac function and vascular function.  These sessions require students to not only recall knowledge, but also apply information in a manner which may lead to uncertainty.  They learn to question the severity of perturbations, the balance of factors which interact, and the cause and effect.  We find students may become frustrated with the “it depends” answer, but they learn how to view the nuance and ask the appropriate questions.  This type of exploration and learning transitions well to more clinical sessions, where students need to know which questions to ask, which tests to order, and which colleagues to consult.    

Demonstrate uncertainty as educators and professionals In addition to our basic science session, I spend a lot of time teaching with clinical colleagues in the pre-clerkship medical classroom.  We have a small cohort of core educators who participate in a special type of small group learning we call Clinical Reasoning Conferences.  The core educators are either basic scientists or clinicians and come from different disciplines, bringing different experiences and expertise to each session. We are always joined by content experts in our sessions with the students as well.  This means that we are likely to be in a session where we are not the content expert, but have immediate access to one. This gives us an opportunity to demonstrate uncertainty in the classroom, to students who feel constant pressure to know everything and to perform at the highest level.  To be honest, it took a while for us to get comfortable with telling the students, “I don’t know”, but that “I don’t know” was, in reality, “I don’t know but let’s get the answer”, which gave us the opportunity to demonstrate how we get the answer.  It could be a reference from the literature, a clinical resource, or a colleague.  Students not only benefit from getting perhaps a more comprehensive answer to their questions, but also knowledge that no one can know everything or even how much is still unknown.  It is imperative in medicine that they learn and practice how to find appropriate information in order to make the most informed decision when it comes to patient care.  These practices have also been shared by other medical educators (1).  Clinical Reasoning Sessions also include students teaching the material to their colleagues, and we make it clear in our expectations that we much rather they describe their process and maybe come up with an incorrect conclusion than have short, although correct, answers which do not demonstrate process and reasoning.  Another goal is to allow the students plenty of chances to practice answering questions of a clinical nature posed by faculty, and allow them to become comfortable asking faculty questions, well before they start their clerkships.    

Manage expectations In my experience, students appreciate the ability to give feedback and share their expectations of their courses and programs.  They also align these with their own expectations of themselves.  Faculty and course directors work to resolve the students’ expectations with their own, and to assist students in forming and revising their expectations of and their role and responsibilities within the course.  Educating during a pandemic has shined a light on and challenged the way we manage these expectations. A word I have heard my colleagues use lately is grace; we should extend grace to our students, to ourselves, and ask for grace from others.  This is another way we can demonstrate how we deal with uncertainty, which can hopefully serve as a soft teaching point for our students.    

Outside of the science classroom Developing skills to help us manage uncertainty extends to outside of our classroom.  We hope that students will take the lessons and continue to use them in other classes, or outside of school altogether.  Medical schools often offer electives, some of which are tied to wellness or extracurricular subjects.  For example, some of our electives include Artful Thinking, in which students hone their skills of observation, application, and context, and Fundamentals of Improv, so that students can work on skills of listening, support, creativity, and quick thinking and response.  Other schools and programs offer similar experiences for students (4,5).  The narrative medicine program emphasizes skills of reflective writing to focus on the human side of medicine, reminding why we’re here in the first place (6).  

Challenging ourselves and encouraging our creativity One of the most important lessons I learned in the transition to remote and hybrid education over the past six months was to face the uncertainty with planning, reflection, and flexibility.  I am the type to have a backup plan to my backup plan, which I realized gave me the flexibility to be more creative in my course design and preparation.  I feel that my courses benefitted from my ability to challenge myself, because of uncertainty, and I intend to continue to reflect and employ what I consider my ‘best practices’ even when we move back into the in-person classroom in the future.   We are exposed to uncertainty every day.  How we choose to frame our mindset, to help our students and ourselves tolerate or even embrace uncertainty can bring benefits both in and outside of the classroom.  

References and further reading Twelve tips for thriving in the face of clinical uncertainty, accessed 8/28/20  https://www.tandfonline.com/doi/pdf/10.1080/0142159X.2019.1579308 What is Constructivism?, accessed 8/28/20 https://www.wgu.edu/blog/what-constructivism2005.html Inviting Uncertainty into the Classroom, accessed 8/28/20 http://www.ascd.org/publications/educational-leadership/oct17/vol75/num02/Inviting-Uncertainty-into-the-Classroom.aspx Teaching Medical Students the Art of Uncertainty, accessed 8/28/20 https://www.cuimc.columbia.edu/news/teaching-medical-students-art-uncertainty The Alda Method, Alda Center for Communicating Science, accessed 9/4/20 https://www.aldacenter.org/alda-method Narrative Medicine Program, Accessed 9/4/20 https://medicine.temple.edu/education/narrative-medicine-program The Diagnosis, Prognosis, and Treatment of Medical Uncertainty https://www.jgme.org/doi/pdf/10.4300/JGME-D-14-00638.1 The Ethics of Ambiguity: Rethinking the Role and Importance of Uncertainty in Medical Education and Practice https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5497921&blobtype=pdf Helping Students Deal with Uncertainty in the classroom https://www.edutopia.org/blog/dealing-with-uncertainty-classroom-students-ben-johnson Learning: Theory and Research http://gsi.berkeley.edu/media/Learning.pdf          


Rebecca Petre Sullivan, Ph.D.
Associate Professor of Physiology
Lewis Katz School of Medicine at Temple University
Dr. Rebecca Petre Sullivan earned her Ph.D. in Physiology from the Lewis Katz School of Medicine at Temple University and completed a Post-Doctoral Fellowship in the Interdisciplinary Training Program in Muscle Biology at the University of Maryland School of Medicine.  She taught undergraduate biology courses at Ursinus College and Neumann University.  As an Associate Professor of Physiology and a Core Basic Science Educator, she is currently course director in the Pre-Clerkship curriculum at LKSOM and at the Kornberg School of Dentistry; in addition to teaching medical and dental students, she also teaches physiology in Temple’s podiatry school and in the physician assistant program.  She is a member of Temple University’s Provost’s Teaching Academy.  She was the recipient of the Mary DeLeo Prize for Excellence in Basic Science Teaching in 2020 and a Golden Apple Award in 2017 from LKSOM, and the Excellence in Undergraduate Teaching Award from Neumann University in 2012.