From the trenches: More about grit

The following was compiled from two comments on my recent post about grit written by a doctor who calls himself "Geronimo." It is reproduced with permission.

Grit cannot be assessed by a survey. I wholly agree. As a military physician, my firmly founded opinion is that grit is essential to the practice of medicine. Grit is the elusive characteristic that carries the clinician through the challenges that exceed ordinary capabilities. You cite a paper that argues for surgical training to borrow aspects of SEAL training. I applaud any measure that would allow senior faculty and program directors to unilaterally shape their residents’ training, whether or not it bears any resemblance to the rigors of BUD/S [Basic Underwater Demolition/SEAL training].

The 2011 loss of 30-hour call for medical students and interns was a fatal blow to residency training, in my estimation. I count myself fortunate for having a 30 hour call internship before embarking on my operational career. While downrange, it is not at all uncommon to be woken at inconvenient hours of the night to tend to the wounds of war. If you don’t know how you function cognitively, physically, psychologically, and emotionally while sleep deprived, exhausted, hungry, cold, and pissed off, you’re behind the curve. While it isn’t any fun to work in such a state, or to work with people so challenged, it is decidedly less fun to be a patient expiring for want of any medical provider, let alone a tired one. American medicine used to be in such a place in the not so recent past, to hear the story told by my forbearers.

In harm’s way Part II: Kidnapped MD’s rescue results in death of Navy SEAL

Almost two years ago, I blogged [here] that Americans who put themselves in harm’s way jeopardize the lives of others. I recounted the stories of mountain climbers who were rescued from a ledge, hikers who were captured in Iran and four people who went sailing in the western Indian Ocean and were captured by pirates.

Today we learn that a Navy SEAL was killed during a raid on a Taliban base which freed an American doctor who had been kidnapped last week. At least six other people died during the battle. Their backgrounds have not been detailed. [Story here.]

The doctor had been working for an organization called Morning Star Development, which runs clinics in rural Afghanistan. According to its website, Morning Star Development is a 501(c)3 charity. It addition to its clinics, it is also “training a new generation of Afghan leaders in the best practices of leadership from around the world.”

Americans can work in rural Afghanistan if they want to. I realize the people there need help.

The question is should Americans working in rural Afghanistan, who are aware of the risks they take, expect to be rescued if they are kidnapped?

You see, the problem is that someone’s son was killed saving this doctor.

I know that men who sign up for the Navy SEALs are aware that they risk death. However, it is one thing to risk death in wartime or when trying to kill the likes of Osama bin Laden.

It is something quite different to be killed rescuing a person who should not have been there in the first place.

The death of a brave Navy SEAL was unnecessary. I am angry at Morning Star Development and the doctor who caused this death. I grieve for the Navy SEAL’s family who will live with the fact that their son died while rescuing a doctor, who I’m sure had good intentions, but should not have been in rural Afghanistan.

If I were in charge, I would tell Morning Star Development and similar groups that they are free to send their people to places like Afghanistan. But if harm comes to them, they should not expect to be bailed out by my son, your son or anyone’s son.

Harvard Says: Train Residents and Medical Students Like Navy SEALS

Harvard Medical School recently held a symposium on learning. The topic of the meeting was “Resiliency and Learning: Implications for Teaching Medical Students and Residents.”

Chronic stress, as experienced by physicians, affects the endocrine and other systems causing immune suppression and metabolic disorders leading to depression, cognitive dysfunction and a lot of other bad things. Similar stress follows in the wake of natural disasters, war and severe abuse (again, pertinent to the practice of medicine).

The researchers found that these problems can be avoided or reversed by training as that undergone by so-called “stress-hardy groups” like the Navy SEALS. The qualities that help make Navy SEALS resilient are “a social support network, [o]ptimism (including faith in a higher cause or power), perseverance (work ethic), responsibility and integrity…”

Medical students and physicians can be taught to be resilient resulting in decreased rates of depression and burnout.

Makes sense to me. Let’s train doctors in the manner of Navy SEALS.

But wait. Not mentioned in the Harvard Medical School Focus article is an important feature of the Navy SEAL culture—Navy SEALS do not work 16 hours per day or 80 hours per week. A major part of their training is centered on performing at a high level even when sleep-deprived.

Navy SEAL Hell Week is described as follows: “In this grueling five-and-a-half day stretch, each candidate sleeps only four total hours but runs more than 200 miles and does physical training for more than 20 hours per day. Hell Week finds those candidates who have the commitment and dedication required of a SEAL. Hell Week is the ultimate test of a man's will and the class's teamwork.” It sounds a lot like a surgical residency training program circa 1972.

Although often skeptical when it comes to research from Harvard, I am all for this. We need to institute Navy SEAL style training for all residents and medical students. Let’s start by making them more resilient. No  going home the day after call. No limits on work hours. Let’s do some cases! “OOHRAH!”

[Thanks to Bill Cadigan of the blog “Doctor Parking Only” for tweeting a link to the story.]