G.R.A.C.E

Dr. Wael Garas shares his recent experience with training in resilience.

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Two weeks ago I had the privilege of spending three days with 60 other clinicians in Santa Fe, learning a unique approach to cultivate compassion and resiliency in our work as health care providers, called the G.R.A.C.E model.  This retreat at the Upaya Zen Center was led by Roshi Joan Halifax, a leader in bringing contemplative approaches to healthcare especially in the care of the dying.  For two decades Roshi Joan has led a yearly intensive called Being with Dying that has trained thousands of clinicians in contemplative end of life care.  Personally, the Being with Dying program was deeply enriching for my medical practice and personal life.  I found the most compelling part of the intensive was being with so many like minded clinicians who also knew in their hearts that something fundamental was missing from medical education and practice – namely learning to skillfully engage with the suffering of others in compassionate yet resilient ways.  I believe the cultivation of these skills is crucial to stem the tide of burnout and what some call “compassion fatigue” among heath care workers.

Halifax’s G.R.A.C.E model is based on a premise that compassion itself cannot be taught but emerges from qualities and skills that can be cultivated.  Essentially our ability to sustain attention, regulate emotional arousal, and nurture our deeper intentions all contribute to more meaningful and personally sustaining clinical interactions.   And so the G.R.A.C.E. model has five elements as Roshi Joan writes:

 

1. Gathering attention: focus, grounding, balance

2. Recalling intention: the resource of motivation

3. Attuning to self/other: affective resonance

4. Considering: what will serve

5. Engaging: ethical enactment, then ending

 

A more detailed explanation of each of these elements can be found here 

I think of the first 2 elements as providing the foundation for the subsequent ones, which seem to emerge more spontaneously if my grounding and intention are strong.  I realized during the retreat that although my yoga and meditation practice made gathering attention and grounding myself easier, recalling my intention for generally being in healthcare and specifically what I wanted to offer the individual patient in front of me was something I never really did before but is quite powerful.  When I remember to do this, I find the clinical encounter to be smoother, more meaningful, and I feel more confident in my clinical decisions.  I am still learning to use this approach more consistently but what I have experienced so far convinces me it can be a valuable tool in developing resiliency and preventing burnout in health care.

 

A more detailed presentation of the G.R.A.C.E. model can be found here 

 

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