Developing Resilient Sports Medicine Teams: Implementing a Professional Development Plan
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August 19, 2019
By Jeremy D. Howard, MS, LAT, ATC
With the athletics season and school year about to begin, it’s a good time to implement policies and interventions to get ahead of barriers to teamwork and cohesiveness within your sport medicine team. Non-traditional work weeks of 60 or more hours, frequent travel and lack of control over scheduling have been identified as major stressors that lead to concerns for work-life balance for Athletic Trainers (ATs) according to Mazerolle, Eason and Goodman in “An Examination of Relationships Among Resiliency, Hardiness, Affectivity, and Work-Life Balance in Collegiate Athletic Training” published in Journal of Athletic Training in 2018 and Barrett, Eason, Lazar and Mazerolle in “Personality Traits and Burnout Among Athletic Trainers Employed in the Collegiate Setting” published in 2016. While these professional experiences lend themselves to the major concerns for burnout and professional attrition rates in athletic training, there is simply more to the puzzle. These stressors may have additional negative outcomes in the professional relationships of the sports medicine team that creates barriers rather than reinforcing highly effective performance between team members.
Two research articles “Protecting Relationships From Stress” by Lavner and Bradbury published in Current Opinion Psychology in 2017 and “Palliative Care Professionals’ Inner Life: Exploring The Relationships Among Awareness, Self-Care, and Compassion Satisfaction and Fatigue, Burnout, and Coping With Death” by Sanso, Galiana, Oliver, Pascual, Sinclair and Benito published in Current Opinion Psychology in 2015 describe the undermining nature of stress on interpersonal relationships. These maladaptive behaviors include declining perception of satisfaction, increased anxiety leading to insomnia, decreased work performance and compassion, inability to action problem solving/thinking outside the box and decreased willingness to communicate. A separate but important component mentioned by Lavner and Bradbury is the spillage of work-stress into personal life and relationships. These issues come together to form a proverbial perfect storm affecting a sports medicine team’s professional dynamics and interprofessional relationships.
Understanding the issues that can dismantle the effectiveness of a sports medicine team allows directors of sports medicine, head ATs and other key leaders to prioritize and implement measures to overcome the potential pitfalls and stressors a school year and athletics season can bring. But, where does one start?
Lavner and Bradbury recommends an approach targeting the following resilience initiatives: optimism, self-awareness, self-regulation, mental agility and connection. These are five of the six constructs that form the Army’s Master Resilience Training (MRT) curriculum which has been shown to increase physical, cognitive and mental performance. Enabling a sports medicine team with skills designed to target these specific tenants can better prepare the professionals for the impending stress on team cohesion that comes with a new sport season and school year. Now, let’s unpack these with some skills and drills per construct of resilience.
1. Developing Optimism
Developing optimism within the team is not simply looking at the world through rose-colored glasses, always seeing rainbows or always looking for the silver-lining. In reality, the skills supporting this construct are designed to counteract the negativity bias, or to focus on the bad things in life and not see or overlook the good things.
Positive emotion is fleeting and hard to hang on to. Optimism can enhance outside the box thinking for the purposes of problem-solving and driving creativity. Leaders can empower their sports medicine teams with skills such as teaching them how to ‘Hunt the Good Stuff,’ a skill designed to force people to really seek out the positive emotion and to reflect and savor the why behind it being perceived as positive.
Sometimes optimism even looks at setbacks or problems and allows the person to seek out where they may find a positive component to the issue. This can be implemented through a ‘Hunt the Good Stuff’ journal where the person writes down three good things that happened each day then reflects on why each is good, or through a weekly ‘Hunt the Good Stuff Thursday’ sharing of good stuff between team members and even patients. No matter what, it must be done regularly to have positive affect on perception of stress.
2. Becoming Self-Aware
The notable author of “The Seven Habits of Highly Effective People,” Stephen Covey was once quoted saying, “We think we see the world as it is, when in fact we see the world as we are.” Many professionals can think back about times, under stress, that they have assigned motive to other’s actions, but it is worth asking , “Was I right?”
When someone acts in an unexpected manner, it’s surprising. But there are some important concepts to understand about ourselves before looking out to others. First and foremost, is that not everyone has the same personality or communication preference. There are some very interesting personality typing programs such as Shipley Communication’s 4 Lenses Temperament Discovery assessment or the Personality Plus Profile that organizations can use to group personnel into personality types and educate each group on effective interactions. Having this awareness helps with team dynamics and interprofessional relationships by giving people the skills and awareness on how to better communicate.
Further, another army MRT skill-model known as activating events, thoughts and consequences explains how thoughts drive consequences. In particular, the skill focuses on explaining when an activating event occurs there is a heat-of-the-moment thought that is the person’s interpretation of the event. This thought then results in consequences (emotions and reactions). Activating events, thoughts and consequences focuses on understanding that we can be proactive in addressing events. Preparing ourselves with productive thoughts allow us to shape our emotions and reactions associated to the thought about an event. This is a crucial steppingstone to build upon for sports medicine team members to develop self-awareness.
3. Implementing Self-Regulation
Self-regulation is the ability to express emotions appropriately and to stop and reshape counterproductive thinking. The major point here is that one cannot self-regulate without first being able to identify an issue and identification requires self-awareness. Thus, self-regulation skills build upon what is learned in the self-awareness skills. One of the most effective skills supporting the construct of self-regulation is deliberate or box breathing. This deep diaphragmatic breathing technique harnesses the body’s parasympathetic nervous system to calm down when in times of high stress. Stress drives people into sympathetic responses fight-or-flight, which only enhances the perception of stress both mental and physical and is nothing shy of detrimental to the body.
In order to use this technique, start by conducting a high-low assessment on your breathing technique. Place one hand on your chest and one on your stomach, take a breath in and note which hand moves. The goal of this skill is to only have the hand on your stomach move during respiration. Once the correct hand is the only one moving, add a time component to the respiration cycle. Start with four seconds inhaling, hold at the top for four seconds, exhale for four seconds and hold at the bottom for four seconds. This can be expanded to longer time frames later, and without using the high-low assessment with development of skill familiarity. This skill is very useful in overcoming the jitters and agitation that comes with stress. It also helps to facilitate sleep.
4. Harnessing Mental Agility
Mental agility helps one to think flexibly, accurately and thoroughly (FAT). It takes the perspective of others into account in order to understand problems better. These concepts are very important as when people get stressed, they start to pigeonhole or have tunnel vision on the issue. With the stress blinders on, the person cannot see potential solutions for issues that are outside the box.
One of the most effective skills for this construct addresses common thinking traps such as jumping to conclusions, mind reading, me-me-me, them-them-them, always-always-always, and everything-everything-everything. In each of these thinking traps it is seen how one can start to assign or assume blame or causality of an issue to either themselves or another.
Leaders can teach their team members to overcome FAT thinking by using cues and questions to drive mental agility, such as:
- Jumping to Conclusions - Slow down. What did I miss?
- Mind Reading - Speak up. Did I express myself/expectation?
- Me-Me-Me - Look outward. How did others contribute to this issue?
- Them-Them-Them - Look inward. What role did I play in the outcome?
- Always-Always-Always - Grab control. What’s changeable/What is in my control?
- Everything-Everything-Everything - Look at the behavior. What specific behaviors explain the situation?
While these cues and questions may come off silly upon initial review, using them breaks your focus on assigning blame and allows you to remove the negativity and bias-driven blinders to see the full picture. With knowledge of the full picture, team dynamics can be reinforced instead of eroded.
5. Reinforcing Connection
Connection, like communication, is truly key! Connection between professionals drives winning streaks by strengthening relationships, enabling effective communication and empowering altruistic team support through empathy. Leaders can use skills similar in nature to the Army’s MRT skill of active constructive responding to enable connection between sports medicine team members. This skill teaches professionals to respond in a manner that is authentic and constructive thereby validating the other person. Now, this skill takes a great deal of work to truly apply effectively. In this skill, people are taught about the four styles of responding, they are:
- Active Constructive ‘Joy Multiplier’- Elaborating on the experience and asking authentic questions to show interest, ex: “I bet you were really excited to learn about the Level 1 SFMA, how do you plan to implement that here and what patients do you think would benefit most?”
- Passive Constructive ‘Conversation Killer’ - Distracted and/or understated responses, you are not tuned into the conversation, ex: “Yup, Uh-huh, Oh really, that’s cool.”
- Passive Destructive ‘Conversation Hijacker’- Ignoring the event, changing the topic, being the ‘One-Upper’, ex: “No way, you know I just attended the Level 2 SFMA and it is way better.”
- Active Destructive ‘Joy Thief’ - Squashing the event/accomplishment and/or negative focused responses, ex: “There is no way you are going to be able to conduct an SFMA on any patient with the patient load we have, you wasted your money.”
Understanding and implementing these key communication concepts can truly strengthen the connection felt between professionals. This enhanced perception of connection in the team holds the potential to increase employment lifespan and decrease professional attrition. It helps to develop a professional family.
Sports medicine team leadership implementing these constructs into their professional development plan for their employees can enhance the operational capacity of their team by giving their employees coping skills to manage the stressors. Implementing a plan across the sports/academic year can decrease perception of stress and burnout in the setting. It is never easy, but it is a worthy venture to implement if the development of a resilient sports medicine team with professional longevity is coveted.
Mazerolle, S.M., Eason, C.M., & Goodman, A. (2018). An examination of relationships among resiliency, hardiness, affectivity, and work-life balance in collegiate athletic training. Journal of Athletic Training, 53(8), 788-795. doi: 10.4085/1062-6050-311-17.
Barret, J., Eason, C.M., Lazar, R., & Mazerolle, S.M. (2016). Personality traits and burnout among athletic trainers employed in the collegiate setting. Journal of Athletic Training, 51(6), 454-459. doi: 10.4085/1062-6050-51.7.08.
Lavner, J.A. & Bradbury, T.N. (2017). Protecting relationships from stress. Current Opinion in Psychology, 13, 11-14. doi: 10.1016/j.copsyc.2016.03.003.
Sanso, N., Galiana, L., Oliver, A., Pascual, A., Sinclair, S., & Benito, E. (2015). Palliative care professionals’ inner life: Exploring the relationships among awareness, self-care, and compassion satisfaction and fatigue, burnout, and coping with death. Journal of Pain and symptom Management, 50(2), 200-207. doi: 10.1016/j.jpainsymman.2015.02.013.
About the Author
Jeremy Howard is the State Health Promotion Officer for Florida Army National Guard under the Resilience, Risk Reduction, and Suicide Prevention Program. Howard graduated with a Bachelor of Science in Athletic Training from Florida Gulf Coast University (#DunkCity) and from the University of Saint Augustine for Health Sciences’ Master of Health Science in Athletic Training programs. He is currently pursuing an Educational Doctorate in Health Sciences at the same institution. In 2002, Howard enlisted in the Florida Army National Guard and is still currently serving; he is also a veteran of Operation Enduring Freedom-Afghanistan. His professional interests include Concussion/TBI, Injury Prevention Programs and Manual Therapy.