Stephen G. Flynn, Raymond S. Park, Pete G. Kovatsis and Anupam B. Jena, The Hack Doctors Should Take From Pop Stars and Quarterbacks, NYTimes, Jan. 6, 2025.
Imagine a pro quarterback stepping onto the field without his coach running pregame drills or a pop star taking the stage without vocal warm-ups. In sports and music, such last-minute preparation is generally nonnegotiable. Coaches review and refine performance, address weaknesses and ensure readiness.
Yet in medicine, where the stakes are often life or death, the idea of warming up with a coach before performing a high-stakes medical procedure is virtually nonexistent.
Pre-operative coaching:
Our findings were striking. Coaching inexperienced clinicians within an hour of intubating an infant significantly improved success rates. The coached group placed the breathing tube in the infant’s windpipe on the first attempt over 91 percent of the time, compared to nearly 82 percent in the control group.
Intubating a baby on the first attempt is a crucial patient safety metric. Infants are particularly vulnerable during intubation because the oxygen levels in their blood can rapidly fall, which creates time pressure and increases the clinician’s mental effort. Studies consistently show a higher probability of low oxygen with more than one intubation attempt, and respiratory events are a leading cause of brain damage and death, an important source of malpractice claims for young children.
Clinicians who received coaching within an hour of performing intubation could not only intubate infants on the first attempt more often, but the intubations proceeded more quickly and more safely. For example, coached clinicians reported improved ability to see the larynx, which predicts greater ease in placing the breathing tube in the right place. The coached group also reported significantly lower mental effort while intubating, which is vital because high cognitive strain while performing a procedure can increase errors.
The importance of ritual:
Warm-ups with expert coaches are standard in music, sports and even military operations. Research suggests they sharpen focus, reduce errors and build confidence. Admittedly, integrating this approach into the fast-paced and cost-conscious world of medicine isn’t without difficulties. Critics may worry about the time required or the potential disruption to work flow. However, warm-up and coaching in our study took just minutes.
And it helps in the transition from an everyday walk-around mindset to the more focused mindset needed for performing a medical procedure.
There's more at the link.
The only written evidence of a key component of movement I was trained in, I found in a copy of ' How to be a Nurse Or Midwife Leader.'
ReplyDeleteOnly written trace its left.
The idea of undergoing surgery where the surgeon has just walked in cold, is not an appealing thought, as warm up its key to reducing stress, enhancing observation etc. Like turning the lights on.
Its vital.
Who wants to work in the dark?
Yes, I agree. Any time you switch from one mode to another you need some transition device. The greater the change, the more you need to do to make the transition effective.
DeleteThe old mantra about procedures has been, "See one; do one; teach one". Fitting, perhaps, to a time when medical care was more slowly paced, with fewer mechanical variations, and concentrated areas of more homogenous treatment population. The more the mixes in each and any of these areas, the more challenging, I think, to the senses, mind, and hands of the person performing the task. Just as a beginning musician can play with a familiar group with more flexibility and fluid skill than with different people grouped together.
ReplyDelete'See one: do one'. A student complaint in a medical exam. Using Actors, with a false prosthetic penis, requiring the insertion of catheter.
ReplyDeleteStudent thinks its not fair as they can't do it for real. I have no idea what the actor thought in response to that observation.
Issue of safety and just sheer practicality when you have fifteen students lined up to do the thing.
The utter obliteration of common sense and descent into nonsense under stress when you have to perform under the watchful eye of a skilled practitioner.
Its a thing.