Practitioner Corner: Performance Psychology and Medicine

Aman Hussain, MSc, University of Winnipeg, Canada
Jason Brooks, PhD, Phenomenaldocs.com, Canada
Cal Botterill, PhD, University of Winnipeg, Canada

As the applied sports psychology field continues to mature and grow, applied consultants are branching into other high performance venues such as medicine and emergency professions. Performers in these venues are finding use for the same psychological skills that elite athletes use. In the process, performance psychology practitioners are being informed about high stress-high performance environments in which lives are literally in jeopardy. The following is our account of a high-performance physician program that developed in response to a research project exploring ways to improve physician performance and reduce medical error. After 10 years of successful courses, interest in these ideas as part of medical education is growing.

In the Spring of 2006, Cheryl Kristanson of the Faculty of Medicine, University of Manitoba, approached us about designing and delivering a "High Performance Physician" course as part of a research project. The intervention involved administering the Test of Attentional and Interpersonal Style (TAIS; Nideffer, 1981) for self-assessment and performance enhancement, 14 hours of small group classes, pre and post "high and low tech" simulations, with evaluations by senior physicians. Core content for the course came from a "Psychological Skills in Sport and Life Course" that Cal taught at the University of Winnipeg. 

We realized we had credibility in performance psychology, but much less in medicine. Small interactive classes helped to build rapport and we made it our goal to learn as much or more about the medical professionals and their world, as they learned from us during every class and interaction. To further familiarize ourselves with medical issues and demands, we reviewed the medical literature and we signed up for participant/observer shifts in hospital Emergency Medicine Departments. This was a huge sensitizer to the demands and expectations of their field (e.g., cardiac arrests, aneurisms, accident victims, preventable health problems, overload, and stress)!

Qualitatively, the study produced impressive results and testimony. A follow-up study by Eunice Friesen (2009) a year later found lasting evidence of performance payoffs, as well as improved coping skills, perspective, and quality of life. Inter-rater reliability complications with physicians jeopardized initial quantitative results.

Working with this special group of people, we observed:

• The stakes are high with life or death consequences that dwarf those found in sport.
• Expectations are incredibly high. The medical history is full of "saviour" expectations for doctors.
• Fear of failure is a challenge. The perspective to "approach success" beats "avoiding failure" but consequences make it difficult.
• Over-analysis can hurt perceptiveness. "Cognitive training" and stress can interfere with field perception.
• Emotional preparation/processing is key. Emotional inoculation can improve stress responses.
• Work schedules are often debilitating (one resident reported a 136-hour week). Recovery and self-care are necessary but difficult for doctors to follow. 
• There are different kinds of top performers (self-awareness is important, but TAIS profiles suggest diversity is fine).
• Preparation, teamwork, and conditions are often controllable and can be improved, whereas uncontrollable factors (i.e., workload & changing teams) are challenges.
• Citizen health efforts need to improve. There is resentment towards medical resources that are expended on people who don't help themselves.
• These are incredibly bright, dedicated, and talented people. Medical residents are great resources: quick learners/great to work with.

Over a 10-year period, we have now delivered at least two "High Performance Physician" courses per year, and graduated over 400 medical residents and attending physicians. Feedback continues to be highly favorable with referrals leading to scheduled new courses. Our course has been certified by the Royal College of Medicine, and the Department of Emergency Medicine at the University of Manitoba. Doctors Manitoba (the professional membership of physicians) and CEO, Bobby Cram, have been supportive in promoting courses, and providing funding for our related book "Sustainable High Performance". This book, which is available from McNallyRobinson.com describes the key lessons covered in our courses, along with testimony from graduating physicians.

Medicine is a profession steeped in history and tradition, so change sometimes takes time. But the following testimony provides evidence that efficiencies can be developed in the medical professionals’ environments, perspectives, and strategies. We have found it immensely rewarding when graduates discover personal and professional strategies that enhance their health, happiness, and performance. They have chosen rigorous demanding "public service" careers. They deserve the best that we can offer!

Some testimony from our graduates includes:

• "This program teaches physicians to make self-care a priority, create a positive workplace by supporting each other, and prepare emotionally for highly stressful tasks"
• "The program helped me identify that I tend to think about others at the expense of myself. It taught me that in order to bring my best to the game at work I need to look after 'me' outside of work"
• "Mental preparation has become absolutely essential for me prior to the start of all my shifts. It reminds me to always bring 'my best player to the game' in order to be ready for challenges and chaos that I may face during a shift"
• "I came to realize that opening up to my friends and colleagues about emotional and personal struggles was NOT a character weakness, but actually a necessity, and that their advice and support would be an enormous source of strength"
• "Thank you for providing a safe environment (sanctuary) for me to sort out self-defeating thoughts"
• "Thank you for helping me regain my perspective and my health"

An earlier version of this piece was published in the Canadian Sport Psychology Association 2016 summer newsletter. We hope that many AASP members will find inspiration in our story and might try to find opportunities to expand their praxis, embracing clients from medical and emergency professions as well.

References

Botterill, C., Brooks, J., & Hussain, A. (2014). Sustainable high performance. Winnipeg, MB: Lifeskills Inc. 

Friesen, E. K. (2009). An educational intervention in performance enhancement: What works and why? Unpublished Master's Thesis. Educational Administration, Foundations, and Psychology. University of Manitoba.

Nideffer, R. M. (1981). The ethics and practice of applied sport psychology. Ann Arbour, Michigan: Mouvement Publications.