3 On-Shift Tricks (Adapted From An Olympic Coach) to Perform Your Best in High-Stress Situations
This post was inspired by the book “The Confident Mind” by Nathaniel Zinsser, Ph.D., released in January, 2022.
The author is the director of performance psychology at the West Point Military Academy, and the book provides techniques for priming your state of mind to perform at your best during high-stress situations.
Dr. Zinsser has been a consultant for many professional teams (Philadelphia Flyers, New York Giants, as well as keynote speaker for the MLB and NBA), and mentored a number of Olympic medalists and business leaders. In my opinion, many of the techniques in this book directly apply to our work in Emergency Medicine.
How do we build confidence as a resident?
According to Zinsser, acquiring confidence starts with building our mental bank account. Our mind maintains a bank account of memories for the sport, craft or profession that we want to excel in. In our case, this is a catalog of experiences that we’ve had in the Emergency Department. Our mental bank account grows when we make “ESP deposits” - Memories of quality Effort, Success, and Progress. When our mental bank account is full with these memories, we feel confident. When it feels empty, we experience self doubt.
How do we put this into practice?
As you’re getting to bed after a shift, close your eyes and reflect on the time you spent during your shift. Ask yourself:
Where did I put forth quality effort today?
What success did I have due to my effort?
What progress did I make?
For example, our answers to these questions might look like this:
Effort: I put in quality effort during that last patient of my shift.
Success: That patient had a very difficult airway, but I stayed calm, and secured it.
Progress: I’m making progress with my airway skills. Not every airway is going to be easy, and it’s the difficult ones that will make me better.
At the end of the day, take note of these moments and visualize them. Even better, you could make a quick note in a journal our notes app.
How do I use this before my next shift?
As you’re walking into the hospital before your next shift, take a second to reflect on these moments. You’ll start the day with the sense that your mental bank account is loaded with memories of quality effort, success, and progress, and you’ll be ready to perform at your best.
What about in the moment?
Alright, so let’s say a critical patient is arriving, and you were told they have a difficult airway and might need a cric upon arrival. How do we prime our state of mind in the immediate moment? According to the book, there are three easy steps: Cue your conviction, Breathe your body, and Attach your attention:
Cue your conviction: Find a phrase that helps you convert your nervous energy or performance butterflies into pure excitement.
In the book, a quarterback tells himself: “Do it like you know it.”
And a marathoner tells herself: “Time to cruise.”
A resident might say: “Trust your training.”
Breathe your body:
Take a second to focus on your breath. Focusing on your breathing means you can let your body tap into what it knows, and practice without your brain interrupting.
Attach your attention:
Find a detail to be deeply curious about, like the rhythm of your words as you communicate with your team. Or, how the CMAC feels in your hand as you prepare to intubate. If you become captivated by what is before you and the action you are performing, your senses become absorbed by it and you let your actions flow.
Have peace with your results, and learn:
Lastly, accept all results, and learn from what doesn’t go well. We are all imperfect humans, and spending excessive time dwelling on mistakes only erases the confidence that we’ve built up. I found this topic interesting because confidence has been a major area of growth for me, so of course I wanted to share what I learned from this book.
