Leading Through Complexity: Managing Cognitive-Emotional Load and Building Resilience

The Challenge

As graduate medical education (GME) leaders with diverse backgrounds, we’ve witnessed the complexities of successfully managing cognitive-emotional load—the mental effort required to process and manage emotional information and experiences—while building leadership practices that support personal resilience. How do GME leaders successfully respond to the daily cognitive-emotional overload that often includes an urgent call about a resident or faculty member in crisis?

What Is Known

Effective GME leadership requires a nuanced understanding of human dynamics, organizational power systems, and personal resilience (ie, the ability to adapt well, exhibit resourcefulness, learn, and grow in response to and from challenges). Yet many GME leaders have limited formal leadership training, which may make us vulnerable to several myths.¹ These myths (Table) create unnecessary pressure that feed into cognitive-emotional load and can hinder personal resilience.

Table Limiting Assumptions About Leadership

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How You Can Start TODAY

As leaders, we must effectively manage cognitive-emotional load and build resilience. The GROW model streamlines the thinking process, which makes cognitive and emotional demands more manageable, and builds our capacity for purpose-driven work.³ It focuses on planning, addressing obstacles, and identifying supports, reinforcing lessons learned.

1. Goal—Desired Outcome: What are you trying to achieve? When leaders create a vision of success and engage others in that outcome (eg, seeking their input) they can more effectively navigate challenges. Clarifying desired intentions can alleviate anxiety, building resilience by helping us focus. Example: You receive several complaints from residents about their ID badges and potential role confusion. Walking to the resident meeting, you ask yourself, “What outcome do I want from this meeting with residents? What does a success look like?”

2. Reality: Where are you now? Assess current state: evaluate actions taken so far and clarify what is working and not working. Engage in reflection and assessment: Identify obstacles, biases, and emotional triggers blocking progress. “What is (not) working.” Ask yourself, “What resources (processes, human financial, physical, intellectual) do I have?” Example: After listening, you ask the residents, “What have we done so far to address these issues? What has worked/not worked? How many are experiencing this issue?”

3. Options: What are your ideas, alternatives, and barriers? Brainstorm: What are your team’s and peers’ ideas? Apply creative problem-solving techniques to manage overload for all by allocating separate time for brainstorming and evaluative activities. Exploring options boosts creative problem-solving and reduces decision-making fear. Example: Give residents 15 to 20 minutes to generate solution ideas to solve the issues. Then give 15 to 20 minutes to prioritize their listed ideas based on the group’s goals.

4. Will: What are you going to do next? When? What support do you need? Create a plan for moving forward with resolving the issue. How will you keep yourself accountable? Example: Map out a timeline with deliverables (eg, vote in 2 weeks, vet with other interest holders in 4 weeks, implement changes in 8 weeks).

What You Can Do LONG TERM

1. Manage your schedule (instead of the other way around). Sustaining resilience begins with recognizing our limits and needs as leaders. Start by managing how you spend your time. Limit the number of meetings in a day. Schedule “Do Not Disturb” (aka DND) time on your calendar for thinking, catching up, planning, or taking a brief walk. Calendar impromptu appointments to remember what you did that day. Write 1 to 2 meaningful goals to accomplish to start the day.

2. Regularly seek insights on your leadership from multiple sources. Schedule a 360-degree assessment every 2 to 3 years. Get a confidant—a coach, mentor, or someone whose opinion you trust—to give you greater insight into your leadership effectiveness and impact(s) through observation and feedback on your behaviors during moments of cognitive-emotional workload. The future of medical education depends on our ability to manage complexity while fostering innovation and inclusion.

3. Cultivate and deepen leadership skills through intentional professional development and relationship building. Effective leadership in GME requires developing a network of colleagues inside and outside our health systems. Identify national conferences and programs that will bring you in contact with colleagues (eg, exchange stories, experiences) to learn new strategies. Having colleagues to call on for support or ideas can be helpful when dealing with various challenges (eg, GME office restructuring, growth plans, accreditation requirements).

4. Manage overload with techniques to manage your own thinking. Thinking about how we think helps overwhelmed leaders shift from rumination to reflection. Use the STOP mnemonic to expediate this thinking shift: Stop; Take a breath; Observe; and Proceed. If your mind is racing, actually stop what you are doing. Take a breath and pause, then observe your current thoughts and feelings. Ask yourself: “What information/resources do I have/not have?” “What mood am I/others in?” “What are my possible blind spots in this situation?” “What/who is affected by my decision?” Only then proceed with what comes next.