A strategy to enhance pre-performance clinical education and wellbeing.

Citation

Aiello, S., Osborne, M. S., Cochrane, T., Sevigny^, C., Marriott, P., & Allen, J. (2023, 20 August). A strategy to enhance pre-performance clinical education and wellbeing. Paper presented at the International Symposium on Performance Science 2023, 17-20 August. Medical University of Warsaw, Warsaw, Poland. https://doi.org/10.26188/24129051

Background: Clinicians deal with various emergencies, including natural disasters and road traffic accidents. The education goal for those who intend to work within an emergency setting is to prepare students for practice, help integrate critical thinking, effective communication, and develop therapeutic skills within a safe environment. Time, money, opportunity and resources are often obstacles when providing real-world practice and experience. With this, manikin-based simulation is a widely adopted and proven technique for clinical training and critical care education. However, with manikin-based simulation, clinical students frequently report anxiety and a lack of authenticity. Therefore, a gap exists between classroom knowledge and the simulated clinical experience, which can result in heightened anxiety and feelings of powerlessness within a contextually uncertain clinical environment.

Aim: Detrimental effects of stress, negative emotions, and sympathetic dominance of the autonomic nervous system can be counteracted by different forms of meditation, relaxation, and breathing techniques. The inter-relationship between respiration and emotions and the influence of respiration on autonomic changes and homeostasis can potentially reverse or reduce anxiety. This presentation explores the factors and hindrances of the 'anticipatory' period of clinical simulation and will describe a clinical simulation education model that hopes to reduce anxiety and support performance. We propose that virtual reality environments and a 'centering’ pre-performance technique related to mindfulness could be used as a first-line method to alleviate performance anxiety and offer an enhanced clinical context within the pre-simulation anticipatory stage.

Main Contribution: The effectiveness of virtual reality environments and the centering technique as an adjunct to manikin-based clinical simulation and more specifically on pre-simulation anxiety remains unknown. In a virtual environment, learners immerse themselves in multisensory environments that simulate reality and allow learners to interact, practice skills and collaborate within a clinical setting. Virtual reality may offer students a unique opportunity to experience and explore a broad range of authentic environments, objects and phenomena that are effective within cognitive and psychomotor domains. Whilst anxiety is a common and expected emotion that may increase concentration (challenge) or impede performance (threat), it is important to support students in their physical, emotional, and behavioural responses. If successful, this will help with the demands presented within their real-world clinical practice. Expanding clinical simulation to include both virtual reality and a centering technique may offer the student an enhanced clinical experience which may reduce anxiety and build confidence by providing an authentic immersive experience within a simulated clinical emergency context.

Implications: This presentation will describe a clinical simulation education design that promotes safe, authentic environments for students preparing for real-world practice. It hopes to explore the factors hindering well-being within an emergency clinical simulation setting and discuss strategies to achieve a productive and authentic education experience. With the implementation of self-regulated centering techniques, this presentation offers insight into managing pre-simulation anxiety and the utility of virtual environments as an immersive learning tool, which may improve performance and preparation for real-world practice. Finally, this strategy has practical implications for emergency care and other specialities such as nurses, fire service and police.