Posted 20/03/2020 in Category 1

Stress and Performance in Emergency Medical Teams: A Simulation Study

Stress and Performance in Emergency Medical Teams: A Simulation Study


There is no doubt that emergency medical teams work in very demanding situations. Recent events with the Covid-19 virus has, and continues to, illustrated that. The situations faced by emergency medicine teams are uncertain, changeable and require accurate decision-making and co-ordinated action. How teams perform matters for patient outcomes. A recent paper by two MySportsMap members Marc Jones and Martin Turner, with other co-authors including emergency medical consultants, explored how emergency medical teams perform in a simulated medical competition (Carenzo et al., 2020). The focus was  with a focus on understanding the psychological factors that were associated with better performance. The ability to work effectively as a team is something many of the sports medicine professionals listed on our site can relate to. Whether it is a sports physio working with a sports doctor to deal with a severe injury on the pitch, or a sports physio working with a sports psychologist to help the rehabilitation of an athlete from a long term injury.


The main focus of the study was to explore how challenge and threat states link to performance. The authors also explored how psychological variables, specifically cognitive anxiety, somatic anxiety, self-confidence and team identity, and team characteristics, specifically time spent training and years of postgraduate experience, link to challenge and threat. The focus was on challenge and threat states given their links to performance across many domains including sport  and medicine. A challenge state occurs when personal resources meet or exceed situational demands, whereas threat occurs when demands exceed resources. 


Data were collected from 95 participants over three days of competition at SIMCUP Italia 2018 a medical simulation competition. Participants took part in teams of four (one team had three hence the overall number of 96). The teams took part in a series of simulations, involving clinical, psychomotor and relational skills. At the end of Day 1 the ten highest ranking teams moved on to Day 2 and then the six highest ranking teams moved on to the finals (Day 3). At the start of each day, before competing, participants were asked to complete a questionnaire that included brief measures of challenge and threat, cognitive anxiety, somatic anxiety, self-confidence and team identity. On the first day, participants also reported the amount of time they had practiced for the competition as a team (in hours) as well as their post-graduate year. 


The results of the study showed that challenge and threat appraisals were linked to performance. Specifically, a high level of resources is associated with better performance until very high demands. At this stage performance is unrelated to perceived resources, and this is where the authors suggested skilled breakdown occurs. This happens when resources are at a similar level to demands and suggests that, in this medical simulation competition at least, personal resources need to exceed, not just meet demand for performance benefits. The authors also found that higher confidence was associated with a higher challenge but there was no relationship between anxiety levels or team identity and perceptions of challenge or threat. Not surprisingly, greater levels of training were associated with greater perceptions of challenge. Being prepared means teams can face demanding situations ins a more positive state. The findings with anxiety were interesting. This shows that teams who did well were just as 'anxious' as teams that underperformed but their perception of the task as a challenge was linked to better performance. This illustrates the complex relationship anxiety has with performance. It is not necessarily bad and can have many positive benefits (e.g., is a powerful motivator). 


The authors suggested that psychological interventions aimed at improving medical teams performance could be focused on modifying team-members perception of demands and resources. For example a sports physio and medic dealing with a difficult sports injury would focus on what they could control and what they trying to achieve, factors linked with higher challenge states. The authors do note that this was an exploratory study but it does show that how teams work together can have an effect on performance in medical care. Of course simulation studies are not real life and so we must be careful in drawing comparisons. That said the the interesting aspect of the study was that it provided a model that described how demands and resources interacted to influence performance, in a simulated stressful environment and provides the basis for interventions that can help sports medicine teams work effectively together.


We hope you found this interesting and can see the link to sports medicine teams. On our site we have a wide range of experts who work in sport medicine teams, for example, sports physiotherapists, sports therapists, chiropractors, osteopaths and medics who offer support across injury rehabilitation and prevention; fitness training and strength and conditioning


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