PERFORM: Performance Enhancing Routines for Optimising Readiness using Metacognition For the Management of Acutely Unwell Patients

SANDARS, JOHN; CHURCH, HELEN; MURDOCH-EATON, DEBORAH

Abstract

Introduction: The stress experienced by healthcare professionals during complex, time-critical clinical encounters can impair clinical performance and produces suboptimal patient care. This is particularly true for junior doctors when managing acutely unwell patients. In sport, athletes minimize the impact of similar performance-related stress using Pre-Performance Routines (PPR), such as visualization (Cotterill, 2010). The use of a single PPR limits their contextual flexibility and impact, but sport psychologists suggest that coaching athletes to use metacognition would allow them to dynamically alter their individually preferred Performance Enhancing Routine (PER) to personalize their approach throughout the changing demands of complex situations (MacIntyre et al 2014). We developed the PERFORM (Performance Enhancing Routines for Optimising Readiness using Metacognition) model as an individualized coaching approach to apply MacIntyre’ et al’s (2014) theory to the medical context. This research aimed to explore the potential usability and efficacy of the application of the PERFORM model for the management of acutely unwell patients by junior doctors.
Methods: The three-phase study used a mixed-methods action research method. The Exploratory phase included an international scoping literature review of educational interventions in acute patient management. The Pilot phase explored the feasibility of coaching the individualized PERFORM model to junior doctors. The Full Intervention phase incorporated a multiple-case study of 12 doctors across two hospital sites to explore the application of the PERFORM model in both simulation and real patient encounters through the use of reflective logs, semi-structured interviews, Think-Aloud commentary and self-efficacy scores. Within- and between-case analyses were performed to investigate the variables of work-place (central teaching or district hospital) and stage of training (first or second year post-graduate).
Results: The scoping review yielded no previous studies utilising personalized PER and the coaching approach of the PERFORM model was considered useful and applicable to junior doctors. The application of the PERFORM model during an acutely unwell patient in situ simulation significantly improved self-efficacy to control stress (p=0.003). The PERFORM model was applied by 11 junior doctors during clinical practice, including non-acute and non-clinical scenarios, and many developed their own personalised PERs. Qualitative data demonstrated the positive aspects of using the PERFORM model in three domains; the doctor themselves, their supportive relationships with colleagues, and on patient care. The doctors most valued their increased awareness of stress associated emotions and behaviours in the workplace.
Discussion and Conclusions: Discussion The application of the PERFORM model created a sense of ‘control’ over the clinically complex environment for junior doctors when experiencing stress in the management of the acutely unwell patient. The study also demonstrated the practicality and usefulness of an individualizable educational intervention which can be adapted to different scenarios through both reflection in-action and reflection on-action. Conclusion Our study of the innovative PERFORM model is the first to demonstrate that the application of individualized PERs by junior doctors can minimize the impact of stress during acutely unwell patient management. The findings suggest that coaching of the PERFORM model could improve clinical performance during complex and time-critical clinical encounters and further research with larger numbers of junior doctors and other healthcare professionals is recommended to explore this potential impact.
References
Cotterill, S. (2010) Pre- performance routines in sport: current understanding and future directions. International Review of Sport and Exercise Psychology. 3(2): 132-153. MacIntyre TE, Igou ER, Campbell MJ, Moran AP, Matthews J.(2014) Metacognition and action: a new pathway y to understanding social and cognitive aspects of expertise in sport .Frontiers in psychology. 5: 1155

Citation

SANDARS, J., CHURCH, H., & MURDOCH-EATON, D. (2020). PERFORM: Performance Enhancing Routines for Optimising Readiness using Metacognition For the Management of Acutely Unwell Patients. In AMEE 2020 abstract book (527)

• Presentation Conference Type: Conference Paper (Published)
• Conference Name: AMEE 2020
• Start Date: Sep 7, 2020
• End Date: Sep 9, 2020
• Acceptance Date: Jan 16, 2020
• Online Publication Date: Sep 9, 2020
• Publication Date: Sep 9, 2020
• Deposit Date: May 4, 2021
• Publicly Available Date: May 5, 2021
• Pages: 527
• Series Title: AMEE Conference
• Book Title: AMEE 2020 abstract book
• Public URL: https://nottingham-repository.worktribe.com/output/5507988
• Publisher URL: https://amee.org/getattachment/Conferences/AMEE-Past-Conferences/AMEE-2020/AMEE-2020-Virtual-Abstract-Book-FINAL-resize.pdf
• Related Public URLs: https://amee.org/Conferences/AMEE-Past-Conferences/AMEE-2020
• Additional Information: #RP5 - Reasearch Papers: Patient Safety; #RP5.1 (3712); PERFORM: Performance Enhancing Routines for Optimising Readiness using Metacognition For the Management of Acutely Unwell Patients