Using Insights From Sports Psychology to Improve Recently-Qualified Doctors' Self-Efficacy While Managing Acutely Unwell Patients

Abstract
Problem
Doctors experience a range of negative reactions when managing acutely unwell patients. These may manifest as emotions, such as low confidence or behaviors, such as tremors or fidgeting. Without appropriate coping strategies, such emotions and behaviors can impede optimal clinical performance, which directly affects patient care. Athletes use performance enhancing routines (PERs) to minimize the effect of their negative emotions and behaviors on competitive performance. The authors investigated whether PERs could similarly improve recently qualified doctors’ emotional and behavioral control while managing acutely unwell patients and whether the doctors perceived any effect on clinical performance.

Approach
Twelve doctors within 2 years of graduation from medical school recruited from 2 sites Sheffield and Chesterfield, United Kingdom implemented PERs using the PERFORM (Performance Enhancing Routines For Optimization of Readiness Using Metacognition) model over a 4-month period between April and December 2017. The doctors’ perceptions of PERFORM’s effect on their ability to manage patients was evaluated using self-reported mixed-methods data, including think aloud commentaries, semi-structured interviews, and self-efficacy scores.

Outcomes
Doctors reported that PERFORM improved their ability to control negative emotions or behaviors during an acutely unwell patient in situ simulation, showing a statistically significant improvement in self-efficacy scores (P = .003, effect size = 0.89). Qualitative data revealed perceived improvement in aspects of clinical performance such as enhanced knowledge recall and decision making. These performance attributes appeared to positively impact interprofessional relationships and patient care. Doctors individualized their PERs and supported the wider implementation of PERFORM in health care education, particularly during the transition from student to qualified physician.

Next Steps
This is the first study to employ individualized PERs based on sports psychology in a medical context. The PERFORM model could be introduced into existing acute patient management courses to provide emotional regulation coaching alongside clinical skills training. Further research might investigate PERFORM’s effect in other environments where emotional and behavioral control is paramount, such as surgery.