Self-care in the curriculum

Despite the title this is not a how-to on self-care. I used this title because I thought it would appeal more than anything verging on the political. As educators many of us decide to leave politics (and policy) alone, no doubt to the relief of our funders, employers and government (who try to stifle debate in various ways).

I have been attending the Edinburgh Fringe and, as my daughter is a comedian, tend to go solely to comedy shows but this more serious one caught my eye l and I went to watch it a few days ago.  . It is a performance piece but it drew my attention because it came out of research at Bristol university which involved interviews with struggling GPs. The topic appealed but it also seemed like an attempt to disperse research findings in a different way. The interesting thing is that art tends to give more space for audience interpretation and I think I took away a slightly different message to that described as the focus of the researchers (which I read about later).


At the same time, there has been a twitter debate going on, surprisingly ignited by Stephen Hawking and Jeremy Hunt (health secretary). This is about Hunt’s use / misuse of evidence regarding the issue of weekend cover in the NHS. Then, today, I saw this piece in the BMJ.  It resonated with the issues in the Festival show and one of the common themes was morale.

How is this relevant to education? Well, in the performance piece the GP detailed her familiar history of school and extra curricular achievements (school captain and Duke of Edinburgh award all demonstrating her resilience and leadership skills) and her academic progress. She went on to describe her training and then the increasing requirements of GPs in the NHS – forty patients a day, consultations less than ten mins, more bureaucracy – the inevitability of mistakes and the lack of support. It’s a story of the well-meaning and high-achieving individual burning out.

The research apparently had a focus on the barriers to help-seeking for those suffering with symptoms of mental illness but the performance piece very much highlighted the role of system issues in aggravating the problems. As the Festival blurb said, the GP in the performance is “a fallible human being who, like the system, can only take so much before she really breaks.”

This was all Interspersed and illustrated with dance and music. She interestingly portrayed the solutions of the compulsory well-being coffee break (stress-inducing) and exercise (temporary respite only). Much of the text was apparently verbatim quotes from the interviews. Basically she describes burnout induced by the system and the implication is that advice on “self-care” is insufficient. There needs to be more care in the system.

Why does this matter to those in education? Well, “self care” and such are part of the curriculum and we perhaps should ensure this goes deeper than just ticking a curriculum box, more even than just trying different ways to teach it. The piece reinforced (through different media) the issues and discussions I have heard in other fora but it stimulated me to think at the end, as we departed the theatre, “so, what next?” Does anyone do anything other than agree about the problems?

I then moved on to the AMEE conference in Helsinki. There were around a dozen presentations about mindfulness and stress reduction (unsurprisingly) but one I attended was a brief talk by Menno de Bree (a philosopher) entitled “The cruelty of mindfulness” . He noted that “if we address burnout only on the individual level we give them the implicit message that they have to adjust themselves to a demanding environment (and not vice versa)”

The Edinburgh play quoted the analogy of the boiling frog. Do we stay silent as we watch the trainees enter a system that might harm them or as their education is squeezed? Do we give the message that a few self-care principles will help them survive whatever the system dishes up to them (if they are resilient enough) or do we question the system itself? The training environment has more potential to be able to model the values and attitudes that could improve things and perhaps trainees would then be more likely to take this culture into the broader health system. Other health systems may not be so close to meltdown as the NHS but perhaps educators are a group who need to practice speaking out, to ensure things are still heading in the right direction, take on the professional role of advocacy and exercise those muscles, before they gradually lose the ability to do so.


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