MCW Student and Resident Behavioral Health Resources

A 20-Minute Daily Exercise Plan for People Too Busy to Work Out
Life Hacker

Five Speedy And Ultra-Effective Workouts For People Who Are Really Busy
Self.com

Six Fitness Tips for Busy People
The Good Men Project

Personal Trainer's Guide to Time-Efficient Workouts for Busy Clients
Virtuagym

EatRight.org
Academy of Nutrition and Dietetics

FamilyDoctor.org
Food and nutrition: Find out how to incorporate healthy food, proper nutrition, vitamins and supplements into your diet.

FoodShare: A Recipe for Good Health | Wisconsin Department of Health Sciences
FoodShare is Wisconsin's food stamp program and serves residents with limited incomes.

FoodWIse
FoodWIse is federally funded by the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) and the Expanded Food and Nutrition Education Program (EFNEP) and serves Wisconsin residents with limited incomes.

Taste of Home Recipes
Fifty tasty budget-friendly healthy meals.

USDA MyPlate
The USDA Center for Nutrition Policy and Promotion (CNPP) was established in 1994 to improve the nutrition and well-being of Americans.

Are you a sleep deprived medical resident? 4 symptoms to watch for.
American Medical Association

Residency and the 80 Hour Work Week (Video)
Healthcare Triage

Sleep Hygiene (Video)
Johns Hopkins Medicine

Sleep Loss and What To Do About It (PPTX)
Learning objectives: Increase awareness of signs of fatigue; understand the impact of fatigue on performance; list fatigue mitigation strategies

Work-hours and depression in first-year resident physicians (Video)
University of Michigan

MCW Resources

• MCW Wellness Events Calendar (intranet site; requires MCW credentials to access)

Architecture Tours (Free)

• Milwaukee City Hall Tour (Completed in 1895 and designed by famous Milwaukee architect Henry C. Koch)
• Milwaukee Public Central Library Tour (Completed in 1898 and designed by renowned architects Ferry and Clas)
• St. Josephat Basilica Tour (Completed in 1896, it is one of only three basilicas in the U.S.)

Art Museums

• Gallery Night MKE
• Marquette University’s Hagerty Museum of Art (Free for students)
• Milwaukee Art Museum Winter Series (January – March; free admission)
• Milwaukee School of Engineering Grohmann Museum of Art ($3 admission with student ID)

Beer Gardens

• Milwaukee's Beer Gardens (Summer and fall locations)

Entertainment

• Marcus Theatres Value Tuesdays and Student Thursdays

Farmers Markets

• Milwaukee Farmers Markets
• Milwaukee Winter Farmers Market

Museums, Zoo, Public Parks

• Milwaukee Public Museum Kohl's Thank You Thursdays (Free admission every first Thursday of the month)
• Milwaukee County Zoo Family Free Days & Events
• Mitchell Park Domes ($6 admission with student ID)

Music

• Chill on the Hill (Tuesdays, 6:30-8:30 p.m. from June through August)
• Jazz in the Park (Thursdays, 5-9 p.m. from the end of May through the end of August)
• Milwaukee Symphony Orchestra Student Discount

Sports

• Milwaukee Brewers Student Specials
• Milwaukee Milkmen Minor League Baseball Team (Tickets start at $9)
• Milwaukee Bucks Student Discounts
• Milwaukee Admirals Hockey Student Discounts

American Medical Association
Learn more about self-care and avoiding burnout.

Association of American Medical Colleges (AAMC)
Student service providers, faculty, staff, and current medical students share personal stories of resilience, resources for maintaining well-being, and programs, practices, and strategies they have found to be effective in building student well-being.

“The purpose of meditation is not to create a blank mind. It is to change your relationship to your thoughts and feelings…from a sense of urgency …to a sense of calm, observing nonjudgment.” Todd Davison, MD

“Paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” Kabat-Zinn (1994) Wherever you go there you are: mindfulness meditation in everyday life. New York: Hyperion.

Mindfulness practice has been shown to increase left prefrontal activation. And, people with more left prefrontal activation report more positive affect and have reduced levels of cortisol (Hall, 2008).

Improved self-regulation comes from increased acceptance and self-awareness. In other words, approaching and accepting stressors or negative emotions leads to less avoidance behavior, rumination and impulsive reactions to these inner experiences. Perry-Parrish, et al. (2016). Mindfulness-based approaches for children and youth. Current Problems in Pediatric and Adolescent Health Care.

Outcome Data for Mindfulness

• 2015 meta-analysis found moderate evidence of improved anxiety, depression and pain. Effect sizes ranged from 0.30 – 0.38. Goyal, et al. (2014). JAMA Internal Medicine, 174(3):357-368.
• 2010 meta-analysis found mindfulness-based psychotherapy to be moderately effective for improving anxiety and mood symptoms. Effect sizes ranged from 0.59 – 0.97. Hofmann, et al. (2010). Journal of Consulting and Clinical Psychology, 78(2):169-183.
• 2004 meta-analysis found that mindfulness training among medical patients (mixed cancer diagnoses, coronary artery diseases, chronic pain, obesity, etc.) produced medium strength effect sizes on measures of mental health (mood, anxiety, sleep) and on physical health (pain, physical impairment, report of physical symptoms). Effect size of approximately 0.5. Grossman et al. (2004). Journal of Psychosomatic Research, 57: 35-43.

Resources to Begin Your Practice

• Free Mindfulness-Based Stress Reduction Class
• Stanford WellMD

Books

• 10% Happier by Dan Harris
• Radical Acceptance by Tara Brach
• Wherever You Go There You Are by Jon Kabat-Zinn
• Mindfulness for Beginners by Jon Kabat-Zinn

Apps

• Calm
• Headspace
• Healthy Minds Program
• The Mindfulness App

Optimistic Explanatory Style (PPTX)
David J. Cipriano, PhD

The Power of Believing That You Can Improve (Video)
TED Talk by Carol Dweck

Flip the Switch to Positive Mood: 10 Quick Ways to Buffer Stress (PPTX)
David J. Cipriano, PhD

Positive Emotions Open Our Mind (Video)
TED Talk by Barbara Fredrickson

Self reflection helps to set right the relentless technical and impersonal aspects of healthcare. By reflecting on our experiences, we reconnect to what gives meaning to work and life. Pausing to reflect gives us the chance to consider the ethical aspects of healthcare, to tolerate uncertainty, maintain curiosity and to promote empathy. There is good evidence for the health and emotional benefits of reflective writing (Pennebaker, 2000), and these are potentiated when you choose to share with a trusted friend or colleague. For some pointers on how to get started, try the University of Texas at Austin's Dr. Pennebaker’s suggestions.

Visit the Medical Humanities website and inquire about joining Moving Pens – a writing group for students, residents and faculty which meets on campus two times per month.

The Social Muscle
Harvard Business Review

John Cacioppo, PhD

• Unplug – put away screens and devices
• Do small favors – do something helpful or nice for others. Their gratitude will make you feel more connected.
• Work together – take a task that you usually divide up and do it with someone else.
• Engage people around your differences – we usually join around our commonalities. Share ideas or opinions that may help you and the other person grow in knowledge.
• Just say hello – Oprah Winfrey (John Cacioppo, PhD)

Dr. Shelly Gable at UC Santa Barbara

• Active Constructive Responding
  
  • Will you be there for someone when things go right?
    
    • Active Constructive (Joy Multiplier): Authentic, enthusiastic support. Ask questions that flesh out the achievement or success. Highlight or get your partner to talk about his/her role in bringing about this outcome.
    • Passive Constructive (Conversation Killer): “That’s nice.”
    • Passive Destructive (Conversation Hijacker): “That reminds me of the time…” or “Well, did I tell you what happened to me today?”
    • Active Destructive (Joy Thief): “Well too bad there’s no raise to go along with it.” or “You’re in for a big headache.” or “Be careful what you wish for.”

Obviously, the Active Constructive response builds and deepens relationships. Give it a try. Practice it.

Friendships: Enrich your life and improve your health
Mayo Clinic

Feeling Lonely? These 3 Ideas Can Help
Psychology Today

Hayward TEDx Talk by Emma Seppala
The Center for Compassion and Altruism Research and Education, Stanford Medicine

PERMA – R is for Positive Relationships
The Positive Psychology People

Eight Powerful Self-Compassion Exercises & Worksheets
PositivePsychology.com

10-Minute Lovingkindness Meditation with Sharon Salzberg (Video)
Join Sharon Salzberg for this 10-minute guided lovingkindness meditation to practice cultivating more compassion for yourself and others.

How to Practice Self-Compassion: 8 Techniques and Tips
PositivePsychology.com

Kristin Neff, PhD: The Three Components of Self-Compassion (Video)
The world's leading researcher of self-compassion and founder of the Mindful Self-Compassion program explains the core features of self-compassion.

Self-Compassion Benefits Healthcare Workers
PubMed

Stress and Depression Questionnaire
The Stress and Depression Questionnaire is a valuable tool to help you connect with resources if you are struggling with depression or anxiety. It is completely anonymous, but at the same time interactive because a member of our clinic will respond if need be. The instructions at the site will explain further.

University of Pennsylvania Positive Psychology Center
Visit the site to access numerous self-administered surveys on optimism, happiness, resilience, grit and more.

What do you value? What gives your life purpose? A pleasant life consists of a string of positive experiences and acquisitions, which tends to produce short-lived happiness. A meaningful life has to do with self-expression, serving others and staying connected to your community. This type of life tends to result in longer lasting happiness and greater resilience.

Take the Values in Action survey to help you clarify.

Then, challenge yourself to live out one of your top values this week or to boost one of your lower values – see examples below:

• If one of your values is Compassion, what is one way you can foster compassion in your co-workers?
• If one of your values is Justice, how can you make sure that an underprivileged patient gets everything she needs today?
• If you value developing relationships with your patients, add, “What do you like to do for fun?” to your History and Physical/Intake interview.
• If you value Equity, how can you be an ally and speak up when you hear microaggressions in your vicinity?
• If you value Listening, practice one reflective statement per patient (e.g., “Sounds like you are feeling scared right now.”)

Two components of anxiety

It seems like life as a student is one constant round of testing and assessment. Whether it is Step, course exams or shelf exams, the stress of being evaluated can sometimes make it a challenge to do your best.

First of all, most failures of memory on tests are failures of retrieval - not of encoding or storage. That means that it's in there, you just need to find the right key words or search words to find it. This is difficult to do when your anxiety is high. The anxiety has two components: physiological and cognitive. Both of these components take a lot of practice and that practice should take place in conditions similar to the actual test. Take practice tests under such conditions (sitting at a desk, timed, lights on, appropriately dressed, etc.). Then you can practice slowing down the physiological arousal as well as the negative thoughts.

The first step is to slow down the physiological activation.
This is happening in the autonomic nervous system, particularly the sympathetic branch. Activating the parasympathetic branch (for all intents and purposes, the vagal nerve) is the classic antidote to sympathetic arousal. Deep breaths stimulate the vagal nerve (at least the branch of it that runs down our chest) - not to mention the benefits of increased oxygen intake. Rocking stimulates the vagal nerve, and some say that placing your tongue on the roof of your mouth, right above the front teeth does too. Of course, any mindfulness meditation can counter autonomic arousal as well.

The second component is the cognitive one.
These are the negative thoughts that often go like this: "If I fail this test, I'll fail this course. And if I fail this course, I'll fail medical/graduate/pharmacy school…” Or, some sort of horriblizing like that. This is what interferes with retrieval and you will have to learn to challenge these thoughts. Examples of healthy self-talk to counter the negative are: "I'm smart enough to have gotten this far...Residencies are placing less emphasis on test scores and are thinking more holistically....I know of people who did not achieve their goal Step 1 score and who are still perfectly happy with their path and career in medicine….One test does not capture the creativity, planning and organization that it takes to be a good researcher."

• The best way to ensure retrieval of information from long term memory is to associate it with enough ‘search words’ from the new information. In other words, take time to think about connections between new information and things you already know.
• Stress interferes with retrieval from long-term memory. Practice stress-busting strategies like deep breathing during practice tests.
• Reflect on your past experiences with exams. What can you learn from your MCAT experience to gain confidence or adjust your thinking/approach?
• Do some futuring: Focus on the satisfaction of having finished this exam and getting to move on to clerkships.
• Increase positive self-talk ("I’m strong, I've got this"). Visualize being in your zone on test day and being successful.
• If you get agitated or panicky, go online and look up a guided relaxation, breathing exercise, or brief yoga practice. These really do work to calm the body. The more calm your body is, the more focused and in control of your thoughts and feelings you will be.
• Be intentional about your wellness plan. Try to maintain regular sleep, exercise, social connection, and study-free zones. Know your limits. When your brain is done, take time to restore, without guilt.
• Self-care can come in smaller doses. You don’t always have to go for an hour run – you can do a 15-minute walk when you hit a wall.
• Watch your alcohol and substance use.
• Ask for help! Counseling or academic support can be extremely useful, especially if you are noticing any avoidance or procrastination. To reach Student Behavioral Health call (414) 955-8933 or our partner, ComPsych at 1 (833) 927-1860. Or, reach out to Kerri Corcoran, LPC, our mental health resource navigator at kcorcoran@mcw.edu. For academic support, schedule an appointment at mcw.mywconline.com.
• Explain to your loved ones what is going on. Have these conversations before stress level is high. Let them know, "I may need to call you every night to complain. You don’t need to fix it, just let me vent." Or: "Please don't take it personally, but I may need some space and may only call once a week."
• Check out the section on test anxiety on my website: www.mcw.edu/thrive (on the landing page)
• And finally: have compassion for yourself. You are an amazing, talented human being who could never be reduced to a test score. You will get through this, as you have gotten through everything else in life.

As you enter your dedicated study time for Step 1, I thought a quick primer in cognitive-behavioral therapy (CBT) is in order.  Simply put, you’ve got to challenge the negative thinking!

For example:

Fear: "I need to learn all this material and it is too much."
Challenge: "I have the ability to focus my mind in a helpful direction right now. I have a study plan and I can focus intentionally on just the bit of information I need to take in today. I already know a lot of this information.”

Fear: "My whole future depends on this score."
Challenge: "I can only give my best possible performance without sacrificing my sanity. There are many potential options for me in medicine and any of them will offer me the professional fulfillment and challenge that I seek."

Fear: "I can’t stop worrying about what score I will get."
Challenge: "Worrying about the future outcome will not change that outcome, but in fact distracts me from focusing. I know how to study, I’ve been doing it my whole life. Anything else is a ‘later worry’ and just interference with the task at hand."

Fear: "My Step score is the only thing that matters."
Challenge: "If the Step score meant everything, it would be the only thing that would be required. Residencies are using a more wholistic approach to admissions these days. I have many other opportunities to shine."

Anxiety

MindShift CBT – Anxiety Canada
MindShift CBT uses scientifically proven strategies based on cognitive behavioral therapy (CBT) to help you reduce worry, stress, and panic.

Stop Panic & Anxiety Self-Help
Learn about the methods used to manage panic and get relief from anxiety: relaxation, mindfulness, teaching audios, mood log and analysis, cognitive diary, healthy goals and more.

Mindfulness

Calm
Calm is designed to help manage stress, sleep better, and live a happier, healthier life.

Headspace
Through evidence-based meditation and mindfulness tools, mental health coaching, therapy, psychiatry, Headspace helps you create life-changing habits to support your mental health and find a healthier, happier you.

Healthy Minds Program
With a combination of podcast-style lessons and both seated and active meditations, you’ll learn what the science says about the brain while developing skills to tap into these learnings for a healthier, happier you.

Mood

Happily (has a free version)
Build resilience, reduce stress and improve mood.

Moodfit (has a free version)
Tools and insights to help your mood.

Sanvello (has a free version)
Strategies for improving your mood.

Sleep

CBT-i Coach
CBT-i Coach is for people who are engaged in Cognitive Behavioral Therapy for Insomnia with a health provider, or who have experienced symptoms of insomnia and would like to improve their sleep habits.

Sleep Cycle
Gentle wake-ups at the perfect time, relaxing sleep sounds, snore tracking, and tailored sleep programs.

Sleep Deprivation

Brain Boy Neurology
Episode 6: Sleep Deprivation During Residency

Burnt Out to Lit Up
Episode 148: Sleep Deprivation, Burnout, and Occupational Injustice with Laura Vater, MD, MPH

On Call with Dr. Larson
Episode 7: Sleep Deprivation

Jason Stephenson
Guided meditations and soothing music.