37. Stress Inoculation | HALO procedures, racing the clock, low fi sim, and the power of an audience

We break down three techniques to inoculate yourself against the stress of time critical tasks.

Guest Bio: Jason Hine, MD is a community emergency medicine physician at Southern Maine Healthcare where he is the Medical Director of Education. He is a graduate of Tufts University School of Medicine and the Temple EM Residency program where he served as chief. He serves as an Associate Editor and Author on the DownEast EM blog and podcast and has an interest in procedural skill set decay as well as the role of academics in improving the recruitment, retention, and satisfaction of community physicians.

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We discuss:

The importance of stress inoculation training when you need to perform a HALO procedure [05:15];

There are numerous high-acuity, low-opportunity (HALO) procedures in emergency medicine: cricothyroidotomy, perimortem c-section, transvenous pacemaker placement, lateral canthotomy…
Most emergency physicians will only do a handful of these in their career. And when they do them, chances are they’re going to feel stressed.
Stress inoculation training can help reduce the physiologic activation that occurs.

How inoculating for stress helps you 1) perform well when confronted with the situation in real life and 2) serves as a memory aid [07:05];

When you learn under stress, that memory sinks in better, sinks in deeper, and holds more firmly.

3 techniques for stress inoculation [08:00];

Time yourself. Working through a procedure while seeing a clock run creates stress. What you’re looking to do is not just do that task quickly, but to execute it flawlessly within a specific time frame.
Add an external cue to induce stress. Use something that triggers an adrenaline rush. Examples: the sound or a crying baby or the beeping of a telemetry monitor. Use these audio cues to inoculate stress when doing a task.
Perform in front of an audience. Ask your peers, learners, or family to watch you either in real time or in simulation.

Why you should not only ask people to observe you, but also request that they provide feedback on your imperfections [16:40];

It’s powerful to admit that you’re imperfect. It demonstrates that you truly are a lifelong learner.

The advantages of low-fidelity stress inoculation strategies as compared with simulation labs [18:00];

Simulation labs can be too artificial, never truly mirroring a real patient.
By using a stopwatch, external cues or an audience, you can induce stress in situ in your practice environment.

Additional tools for reducing stress [19:20];