Mental rehearsal helps ER clinicians best prepare for trauma patients

For starters, you map out the course in your mind: what will it look like? What will I feel like? What obstacles should I anticipate? How can I manage these challenges?

In the same way athletes mentally visualize races long before lacing up, doctors and other members of trauma resuscitation teams should map out mental blueprints, and then communicate their strategy to all team members involved in caring for patients, a new study suggests.

Trauma is a fast-paced, demanding environment, and communication is key to ensuring everyone understands their roles and responsibilities. This is exactly why everyone needs to be on the same page, long before patients even enter hospitals, said Dr. Chris Hicks, an emergency physician and trauma team leader at St. Michael's Hospital.

"Mental practice appears to help establish common team goals, set priorities and maintain situation awareness in advance so teams can be prepared for even the most complex and challenging trauma resuscitation," said Dr. Hicks, lead researcher of the study, which was published online today in the Canadian Journal of Emergency Medicine. "We're borrowing principles from performance athletes, musicians and even the military, to help guide clinicians during high-stress, challenging situations."

Mental practice also helps minimize stress during challenging situations, and helps to ensure trauma teams -- which can include up to 12 people -- work cohesively.

Dr. Hicks said he believes this is the first study to demonstrate the positive effect of mental mapping on trauma teams.

Seventy-eight residents participated in the study. Teams of two participants (one from anesthesiology, and the other from either emergency or general surgery medicine) were then split into two larger groups. One became the control group, and received technical trauma training. The other group participated in 20 minutes of quiet mental rehearsal. Group members were instructed to visualize a trauma scenario and how they would behave and function in a team while reviewing a provided script that contained guiding questions. Participants were free to discuss the script with team members.

Both groups then participated in a simulation that mimicked a real-life adult trauma situation. Results suggest 20 minutes of mental practice translated to enhanced team behavior, including improved communication.

"We know that the most consequential mistakes in medicine are not technical or procedural, but non-technical in nature -- errors in communication, leadership, role clarity, resource utilization," explained Dr. Hicks. "Mental practice improves team-based skills and performance, and can improve patient safety and reduce important medical errors."