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

Negative emotions and behaviours experienced during stressful situations may influence junior doctors’ capacity to manage clinical emergencies through compounding difficulties in synthesising information and decision-making. This may explain why newly qualified doctors frequently report under-preparedness to manage acute unwell patients. Until now, very little has been offered in the way of a solution to this problem. Elite athletes are coached in the application of Performance Enhancing Routines (PERs) to minimise the impact of negative emotions and behaviours during high stakes competition. Similar ideas trialled in healthcare, such as mental imagery, were found to enhance performance and decrease stress. However, the “one-size fits all” approach used in both these domains overlooks the importance of when and how individuals optimally apply PERs. To our knowledge this project is the first to design and evaluate an individualised, self-regulatory PER model to improve junior doctors’ emotional and behavioural control during acutely unwell patient management. The study contained Exploratory, Pilot and Full Intervention Phases. The latter was a dual-site multiple case study which used mixed-methods. The model was initially coached in simulation and successfully transferred to real clinical scenarios. Application of the model during an acutely unwell patient in situ behaviours (p=0.003). Doctors agreed that the original model reflected its application in clinical practice and were able to individualise it through adaptation or creating new PERs. Feedback supported the wider use of PERFORM and recommended improvements. This study supports previous findings that doctors do experience negative emotions and behaviours during the management of acutely unwell patients, which can affect clinical performance and that they currently lack strategies with which to manage them. Potential future work includes wider rollout of the programme to newly qualified doctors; inter-disciplinary adaptation for other healthcare professionals and/or feedback into other professions, including sport.