The Rusty Scalpel's Edge- keeping your skills in rare procedures
Contributor: Jason Hine, MD
Are you dangerous when it comes to preforming rare procedures like cric, transvenous pacing, or Blakemore tube placement? Do you have a means to keep the rust away? In this podcast we review an Annal of Emergency Medicine article on mental practice and how we all should be practicing to keep ourselves sharp.
The Study
The Source:
Applying Successful Strategies in Sports to the Practice of Emergency Medicine. Ann Emerg Med. 2024 Aug;84 [pubmed] [google scholar]
Emergency Medicine Docs and Professional Athletes
This article and its authors note the similarities between Emergency Medicine physicians and professional athletes. Both work/operate in high pressure situations, with high stakes, high emotions, and the need to perform at a near perfect level. By reviewing the data on mental practice in the sports and neuroscience literature, these authors outline some best practices for EM providers to keep their skills up in rare procedures.
We founded SimKit to tackle exactly the issues covered in this article:
- HALO (high acuity, low occurrence) procedures don’t happen enough in clinical practice to stay sharp.
- Access, time, cost, and motivation are all barriers to getting practice in. It requires you to:
- Call your local sim center
- Schedule a session
- Pay for the time and space
- Build the training
- Go in and practice
- IF you are super motivated and do the above, you’ve gotten a one-off training session in… and 6 months to a year later you are right back where you started.
So we decided to deliver the training to you, and incorporate all the spaced repetition. Subscribe and see all the barriers to procedural confidence melt away. Check out the video below to see what we are all about.
Mental Imagery Script
These authors recommend mental imagery scripts for mental practice of HALO procedures. These scripts are broken down into three cues: visual (red), kinesthetic (green) and cognitive (yellow).
PETTLEP Model for Mental Practice
If a mental imagery script doesn’t exist for a given procedure, then we have to make one. One way of creating such a script is the PETTLEP Model- Physical, Environmental, Task, Timing, Learning, Emotion, and Perspective- the seven elements that should be addressed when creating a mental imagery script. An example of a PETTLEP model for cricothyrotomy is below.
References
- Schneider JE, Blodgett M, Lang S, Merritt C, Santen SA. Mental Practice: Applying Successful Strategies in Sports to the Practice of Emergency Medicine. Ann Emerg Med. 2024 Aug;84(2):159-166. doi: 10.1016/j.annemergmed.2023.12.011 [pubmed]
- Riggs J, McGowan M, Hicks C. Dream one, do one, teach one: a mental practice script for bougie assisted cricothyrotomy. CJEM. 2024 Feb;26(2):90-93. doi: 10.1007/s43678-023-00630-y. [pubmed]
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