H.R. Church is clinical assistant professor, University of Nottingham, Nottingham, United Kingdom. At the time this work was produced, she was a PhD student, University of Sheffield, Sheffield, United Kingdom; ORCID: http://orcid.org/0000-0003-0455-9576 .
D. Murdoch-Eaton is dean of medical education and head, Academic Unit, Medical Education, University of Sheffield, Sheffield, United Kingdom; ORCID: https://orcid.org/0000-0002-2246-8785 .
Acad Med. 2021 May 1;96(5):695-700. doi: 10.1097/ACM.0000000000003809.
Doctors experience a range of negative reactions when managing acutely unwell patients. These may manifest as emotions or behaviors. Without appropriate coping strategies, these 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.
Twelve doctors within 2 years of graduation from medical school recruited from 2 sites in 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, semistructured interviews, and self-efficacy scores.
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.
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.
医生在治疗病情突然恶化的患者时会经历一系列负面反应。这些反应可能表现为情绪或行为。如果没有适当的应对策略，这些情绪和行为可能会妨碍最佳的临床表现，从而直接影响患者的护理。运动员使用表现增强常规（PERs）来最小化其负面情绪和行为对竞技表现的影响。作者研究了 PERs 是否可以类似地改善最近毕业的医生在治疗病情突然恶化的患者时的情绪和行为控制能力，以及医生是否认为对临床表现有任何影响。
从英国谢菲尔德和切斯特菲尔德的 2 个地点招募了 12 名在医学院毕业后 2 年内的医生，他们在 2017 年 4 月至 12 月期间使用 PERFORM（使用元认知优化准备的表现增强常规）模型实施 PERs 4 个月。医生使用自我报告的混合方法数据，包括思考 aloud 评论、半结构化访谈和自我效能评分，评估 PERFORM 对他们管理患者能力的影响。
医生报告说，PERFORM 提高了他们在现场模拟中治疗病情突然恶化的患者时控制负面情绪或行为的能力，自我效能评分显示出统计学上的显著提高（P =.003，效应大小=0.89）。定性数据显示，在临床绩效的某些方面有所提高，例如增强知识回忆和决策能力。这些绩效属性似乎对专业间关系和患者护理产生了积极影响。医生个性化了他们的 PERs，并支持在医疗保健教育中更广泛地实施 PERFORM。
这是第一项在医学背景下使用基于运动心理学的个性化 PERs 的研究。PERFORM 模型可以引入现有的急性患者管理课程中，提供情绪调节指导，同时进行临床技能培训。进一步的研究可能会调查 PERFORM 在其他需要情绪和行为控制的环境中的效果，例如手术。
