Yes, we can improve performance in 60 minutes! Sport Psychology principles and its application to performance in the OCSE Dr. Kirsty Forrest Ian Maynard, Ph.D Joanne Butt, Ph.D Dr. Brian Nicholson Slide 1: Cover Page

Overview of the Research Project Project initiation Getting started …. Aims of the project Funding For medical students KF

Objectives of the Session Sport psychology Performing under pressure Elite sport and preparing for OSCE Overview of the 6-week intervention Cognitive and somatic anxiety intervention Activity 1 Develop awareness of our own responses to stress Activity 2 (a) Cognitive restructuring (b) Cue controlled relaxation JB

Performing Under Pressure Mentally and physically prepared Manage emotions Do not let uncontrollable factors affect their performance Able to focus and refocus Have high levels of self belief JB

Psychological Skills Training for OSCE Intervention Overview Completing the CSAI-2 Cognitive and somatic anxiety, and self confidence Develop awareness Responses to stress IM

Psychological Skills Training for OSCE Cognitive anxiety & self confidence Controlling the controllable factors Cognitive restructuring Building confidence Planning and focusing Somatic anxiety 6-stage process of applied relaxation Systematic desensitisation Coping responses IM

IM Session Progressive Relaxation 2 15 – 20 mins 3 Release-Only Relaxation 5 – 7 mins Cue-Controlled Relaxation 2 – 3 mins Differential Relaxation 60 – 90 secs Rapid Relaxation 20 – 30 secs APPLICATION TRAINING 2 3 4 5 7 8 9 10 Figure 1. The different components of applied relaxation with approximate time to get relaxed at various stages IM

Intervention Examples Activity 1: Developing awareness of our own responses to stress Activity 2: (a) Cognitive restructuring (b) Cue controlled relaxation IM

What characteristics do elite sport and OSCE/your world share? Developing Awareness What characteristics do elite sport and OSCE/your world share? JB

The mirror of sport and preparing for the OSCE What characteristics do elite sport and OSCE/your world share? High pressure situations Demand for results Performance is critically evaluated Continuous need for improvement Performance edges are critical Personal accountability for performance Good communication JB

Recognising when you are under stress Common Early Warning Signs Mental (e.g., inability to concentrate, difficulty in making rational judgements) Emotional (e.g., state of anxiety, increased moodiness, angry outbursts) Physical (e.g., tense muscles, erratic breathing, cough/colds) Behavioural (e.g., increased or decreased sleep, social withdrawal) Activity 1: see Booklet p. 7 JB

Activity 2a: Cognitive Restructuring Countering Identifying negative thoughts Thought stopping cue Reframing Activity 2: see Booklet p. 10-13 IM

Identifying Negative Thoughts and Expectations Examples: OSCE Negative Self-Talk I don't know what to expect Its so difficult getting through so many stations I hope I say the correct things I shouldn't have asked that question IM

Thought Stopping Involves briefly focusing on the undesired thought and then using a cue or trigger to stop the thought and clear it from your mind. Cues or triggers can be mental or physical (e.g., saying the word 'stop' to yourself, clenching your fist) IM

COUNTERING – OSCE Specific Reframing Negative Self-Talk to Positive Self-Talk I don't know what to expect I'm well prepared, I've been through this before. I have the skills to perform at each station. Its so difficult getting through so many stations Just take one station at a time, and stick to my routine I hope I say the correct things I'll perform well because I have the knowledge I shouldn't have asked that question Its Ok, its just one question, I will accrue points from asking questions at each station IM

Activity 2b: Progressive Relaxation Stage 3: Cue Controlled Relaxation Focus on breathing Use of 'cue' words e.g., 'relax', 'loose' etc IM

Changes in CSAI-2 Scores: Pre and Post Intervention Pre-OSCE CSAI-2 (M) Post-OSCE CSAI-2 (M) T-Test Results Cognitive Intensity (decreased) 25.39 20.83 t=3.57;df=17; p<.01 Cognitive Direction (less debilitating) -10.06 -2.89 t=-3.66;df=17; p<.01 Somatic Intensity (decreased) 22.78 17.94 t=3.09;df=17; p<.01 Somatic Direction (facilitative) -10.11 1.44 t=-4.49;df=17; p<.001 Self-confidence Intensity (increased) 14.22 21.50 t=-5.19;df=17;p<.001 Self-confidence Direction (facilitative) -5.06 9.59 t=-5.18;df=16; p<.001 Intensity Range : 9-36 Direction Range: -27 to +27 - Understanding your own scores JB

Summary Psychological skills intervention: Successful transition from sport to medicine [OSCE] Multi-modal Stress Management Training Programme (6 weeks) Focus on managing cognitive and somatic anxiety, and improving self confidence Provided examples of cognitive restructuring and cue-controlled relaxation JB

Thank You for Listening Final Comments Summary of the project Benefits for the medical students Future work Thank You for Listening KF