Yes, we can improve performance in 60 minutes!

Sport Psychology principles and its application to performance in

the OCSEDr. Kirsty ForrestDr. Kirsty Forrest

Ian Maynard, Ph.DIan Maynard, Ph.D

Joanne Butt, Ph.DJoanne Butt, Ph.D

Dr. Brian NicholsonDr. Brian Nicholson

Overview of the Research Project

Project initiation Getting started ….

Aims of the project Funding For medical students

KF

Objectives of the Session

Sport psychology Performing under pressure Elite sport and preparing for OSCE

Overview of the 6-week intervention Cognitive and somatic anxiety

intervention

Activity 1 Develop awareness of our own responses

to stress

Activity 2 (a) Cognitive restructuring (b) Cue controlled relaxation JB

Performing Under Pressure

Mentally and physically prepared Manage emotions Do not let uncontrollable factors affect

their performance Able to focus and refocus Have high levels of self belief

JB

Psychological Skills Training for OSCE Intervention Overview

Completing the CSAI-2 Cognitive and somatic anxiety, and self confidence

Develop awareness Responses to stress

IM

Psychological Skills Training for OSCE

Cognitive anxiety & self confidence

Controlling the controllable factors

Cognitive restructuring Building confidence Planning and focusing

Somatic anxiety

6-stage process of applied relaxation

Systematic desensitisation

Coping responses

IM

Session

Progressive Relaxation

15 – 20 mins

Release-Only Relaxation5 – 7 mins

Cue-Controlled Relaxation2 – 3 mins

Differential Relaxation60 – 90 secs

Rapid Relaxation20 – 30 secs

APPLICATION TRAINING

23

4

5

7

8

910

Figure 1. The different components of applied relaxation with approximate time to get relaxed at various stages IM

Intervention Examples

Activity 1: Developing awareness of our own responses to stress

Activity 2: (a) Cognitive restructuring (b) Cue controlled relaxation

IM

Developing Awareness

What characteristics do elite sport and OSCE/your world share?

JB

The mirror of sport and preparing for the OSCE

High pressure situations Demand for results Performance is critically

evaluated Continuous need for

improvement Performance edges are

critical Personal accountability for

performance Good communication

What characteristics do elite sport and OSCE/your world share?

JB

Recognising when you are under stress

Common Early Warning SignsMental (e.g., inability to concentrate, difficulty in

making rational judgements)Emotional (e.g., state of anxiety, increased

moodiness, angry outbursts)Physical (e.g., tense muscles, erratic breathing,

cough/colds)Behavioural (e.g., increased or decreased

sleep, social withdrawal)

Activity 1: see Booklet p. 7 JB

Activity 2a: Cognitive Restructuring

CounteringIdentifying negative thoughtsThought stopping cueReframing

Activity 2: see Booklet p. 10-13IM

Identifying Negative Thoughts and ExpectationsExamples: OSCE Negative

Self-Talk

I don't know what to expect

Its so difficult getting through so many stations

I hope I say the correct things

I shouldn't have asked that question

IM

Thought Stopping Involves briefly focusing on

the undesired thought and then using a cue or trigger to stop the thought and clear it from your mind.

Cues or triggers can be mental or physical (e.g., saying the word 'stop' to yourself, clenching your fist)

IM

Negative Self-Talk Positive Self-Talk

I don't know what to expect I'm well prepared, I've been through this before.I have the skills to perform at each station.

Its so difficult getting through so many stations

Just take one station at a time, and stick to my routine

I hope I say the correct things I'll perform well because I have the knowledge

I shouldn't have asked that question

Its Ok, its just one question, I will accrue points from asking questions at each station

COUNTERING – OSCE SpecificReframing Negative Self-Talk to Positive Self-Talk

IM

Activity 2b: Progressive Relaxation

Stage 3: Cue Controlled RelaxationFocus on breathingUse of 'cue' words e.g., 'relax', 'loose' etc

IM

Changes in CSAI-2 Scores: Pre and Post Intervention

Pre-OSCE CSAI-2 (M)

Post-OSCE CSAI-2 (M)

T-Test Results

Cognitive Intensity (decreased)

25.39 20.83 t=3.57;df=17; p<.01

Cognitive Direction (less debilitating)

-10.06 -2.89 t=-3.66;df=17; p<.01

Somatic Intensity (decreased)

22.78 17.94 t=3.09;df=17; p<.01

Somatic Direction (facilitative)

-10.11 1.44 t=-4.49;df=17; p<.001

Self-confidence Intensity (increased)

14.22 21.50 t=-5.19;df=17;p<.001

Self-confidence Direction (facilitative)

-5.06 9.59 t=-5.18;df=16; p<.001

Intensity Range : 9-36Direction Range: -27 to +27

- Understanding your own scores JB

Summary Psychological skills intervention:

Successful transition from sport to medicine [OSCE]

Multi-modal Stress Management Training Programme (6 weeks)Focus on managing cognitive and somatic

anxiety, and improving self confidence Provided examples of cognitive

restructuring and cue-controlled relaxationJB

Final Comments

Summary of the project Benefits for the medical students Future work

Thank You for Listening

KF