11 May 2014
Why high performance sport and medicine have much to learn from one another - a unique insight by London's Air Ambulance doctor and rowing coach Dr Tom Evens. How to perform in the advanced systems where physical condition or skill set are considered a baseline, and the emphasis shifts to the ability to deliver on the "day of the match”. "You have the power to stay calm, just don't try it for the first time on the day of the race,” says Tom.
Inspired by his own experience from a university rowing team, Tom started looking into how professional sport and coaching techniques can be applied to medical training during his career as an air ambulance registrar in Sydney, Australia. Over the last two years, the lightweight rower Charlotte Taylor has, under Tom’s coaching, become a national leader in her category. In May, Charlotte was selected to represent the UK at the 2014 European Rowing Championships in Belgrade - in the lighweight women's single scull category. The race that has leveraged Charlotte into the international league is taking place on Friday 30th May with finals on 1st July.
From delivering the best outcome for seriously injured using the marginal gains theory that underpins the Team GB’s cycling performance to shared mental models that enable the medics who never met to work efficiently on the scene of the incident, Tom has used his experience as a sport coach in the resuscitation room and in the streets with London’s Air Ambulance.
"The key thing both in professional sport and medicine is to clearly understand the goal and the standard needed to achieve that goal. When you understand the level of commitment that is required, it is easy to make decisions. Do I stay in bed or do I train today?”
“London’s Air Ambulance is very clear about its goal and standard — we aim to deliver the highest standard of care at the roadside. This clarity means we rigorously train to take the advanced surgical procedures from the hospital to the patient’s side, but as doctors we also don't mind going back to the basics and checking every piece of equipment at the beginning and end of each shift. We understand that it is part of the standard we are trying to achieve."
Lessons from the athletic track: overcoming anxiety
Pre-hospital care is by its nature eclectic, drawing on diverse range of disciplines ranging from aviation to forensic science. Tom Evens makes a convincing point about how medicine can benefit from looking to the athletic track for strategies regarding training, building resilience and improving performance.
“Training and preparation are crucial. Top athletes devote a lot of time to understanding themselves and developing mindfulness. Anyone who wants to increase their performance should think about the task at hand and ask: What would be the best state of mind for someone else to complete it? Often the best state of mind to achieve your goals is focused confidence. You may feel anxious because you care about the outcome of the challenge, but rather than fearing anxiety it is better to learn to use and manage it. My goal is for my athletes to have a sense of freedom on the day of the race, to trust their processes and to be peaceful about the outcome”
“Clinicians accepted to London’s Air Ambulance have already developed their strategies as professional seniority is an entry level requirement, but they still need to adapt what they have learned in the hospital to the pre-hospital environment. The pressure London’s Air Ambulance teams are under is often greater than what they know from the Emergency Department. There are more expectations, lots going on at the scene and everyone is looking."
How to stay calm when someone’s life is in your hands?
It is difficult to imagine a more high pressure situation, an "outcome" anyone could care more about than the life and recovery of a critically injured person that London’s Air Ambulance medical teams are responsible for at the scene of injury. The pressure of having to perform advanced medical interventions at the scene of the incident, and making on the spot diagnosis and triage decision is magnified by the fact that the responsibility lies with one doctor and one paramedic, without the back up of a team of ten or so that would normally be dealing with trauma patient in the hospital.
"You know that the best thing for the patient is to be calm. That is where training via medical simulations truly makes a difference. The goal of moulages is to create and understand the moment of stress so that everyone can develop their individual strategies to combat it.”
When asked what the qualities that indicate a high achiever are, whether on the athletic track or on board a medical emergency helicopter, Tom lists self-compassion as closely following the more obvious qualities determination and focus.
"The key characteristics I would look for are determination to do the right thing and to focus on processes. Self-compassion is the sense of being kind to yourself for the sake of long term perspectives. Body awareness is crucial, applying as much to a doctor as to an athlete. A medical professional needs to monitor physical aspects of the scene and his actions, constantly asking: Is my position good? Am I holding the instrument the right way?”
You have the power to be calm. Just don't try it for the first time on the day of the race
Tom describes how self-knowledge extends beyond the ability to chose our behaviour. It enables us to escape the personality traits and modify our emotional response to optimise the performance.
“You are not a prisoner of your personality. We all have innate character traits but you are not stuck just because your personality leads you towards a certain behaviour. You can choose to be calm, you have the power to be calm. Just don't try it for the first time on the day of the race.”
Self-recognition and sustainable performance is what in professional sport differentiates training from coaching. What concerns a trainer is whether you can do the task. The question in coaching is can you do the task on match day?
The big advantage athletes HAVE over us at London’s Air Ambulance
“...is that the athletes know when they will be expected to perform. All Olympians know four years ahead the day they need to deliver. At London’s Air Ambulance, the next day might be the most challenging in your life or it could be quite peaceful. As doctors, we have an obligation to be prepared every day.”
At London’s Air Ambulance, medical staff constantly rotate, with the cap on the secondment period currently standing at six months for doctors and nine months for paramedics.
"The rotation of staff at London’s Air Ambulance increases the number of clinicians that receive the coaching, the experience and the opportunity to develop mental strategies for high performance. In my experience, you can often identify a clinician that has been through a secondment with London’s Air Ambulance when you encounter them in the ED or elsewhere. They carry those skills for the rest of their careers.”
If you are interested in finding out more about high performance strategies, Tom recommends the books 'Will It Make the Boat Go Faster?' by performance consultant Ben Hunt-Davis and 'The Chimp Paradox — The Mind Management Programme' by Dr Steve Peters, the psychologist of the British cycling team.