Preparing for high performance under pressure and for exams

Sarah Dalton speaks to Tony Sloman and Jules Willcocks about techniques and strategies for high performance under pressure and for exams. Doctors are bound to face stressful and anxiety-inducing situations, whether it’s preparing for exams, going for job interviews or situations on the wards. In this podcast, you’ll learn more about a long-term approach to practice techniques for high performance under pressure so that they will eventually become hard-wired and automatic.

Summary Writer:  Peter Hoppett

Script Writers: Sarah Dalton, Tony Sloman and Jules Willcocks

Editor:  Jules Willcocks

Interviewer:  Sarah Dalton

Interviewees:  Tony Sloman and Jules Willcocks

About Tony Sloman

Tony Sloman is the director of Passion and Purpose. Passion & Purpose (P&P) and Associates is a transformational learning organisation that has developed unique programs for over 15 years. Tony is a Lead Facilitator and Coach who designs and delivers most of the P&P programs. P&P techniques are underpinned by the P&P EMPOWER model and evidence-based practical application. P&P serve government, large to medium corporations, NFP and the medical sector. Through a successful collaboration with Dr Jules Willcocks, an emergency physician, they created and deliver a highly successful program across Australia that empowers medical practitioners to ‘show up’ when the pressure is on.

Tony studied at the prestigious Guildhall School of Music & Drama in London and is passionate about developing leaders and professionals that inspire change. Tony’s qualifications; Bachelor of Science (IT, psychology, philosophy), Diploma of Professional Acting, 2 graduate certificates in executive coaching, training & assessment. Tony enjoys ocean swimming throughout the year and time with family.

About Dr Jules Willcocks

Jules Willcocks is an ED consultant and the Director of Prevocational Education and Training at Gosford Hospital.

His interest is in bringing out the best in people principally through mentoring and coaching. He firmly believes that wellbeing is a crucial part of this and that you cannot look after someone to the best of your abilities if you yourself are not well.

He trained as an executive coach and has a particular interest in financial wellness for doctors.

He is married with 2 boys, which is why he’s not living a degenerate life in Las Vegas and loves playing poker and fine single malt Islay whisky.

About Dr Sarah Dalton

Sarah Dalton is a Consultant in Paediatric Emergency Medicine at The Children’s Hospital at Westmead as well as Director of Clinical Engagement for eHealth NSW and Medical Advisor for Capstan Partners. Sarah holds a Masters in Applied Management in Health. She has a long-standing interest in trainee development, and is a strong advocate for improving Quality and Safety in Healthcare. She has a particular interest in clinicians leading change and has completed a Fulbright Scholarship to evaluate Clinical Leadership Development Programs in the United States.

Preparing for high performance under pressure and for exams

With Dr Jules Willcocks, Emergency Physician and Director of Prevocational Training at Gosford Hospital

and 

Tony Sloman, the Director of Passion and Purpose, New South Wales, Australia 

Introduction

Doctors will encounter stressful situations, whether it be resuscitation on the wards or interviews and exams. The nature of clinical exams requires ongoing logical thought combined with physical steps all whilst being observed by examiners. Anxiety can hamper performance which can falter career progression or job offers. Preparing for interviews requires a long-term approach to practice techniques under stress such that they become automatic.

  • Job Interviews
    • This is especially the case when vying for a competitive position.
  • Exams
    • Particularly vivas and OSCEs which occur infrequently during the year, are expensive and can limit career progression.
  • Clinical Scenarios
    • Team leading in resuscitation situations, or dealing with difficult personalities.
  • All these are complicated by COVID this year which has required job interviews via Zoom, cancelled or rescheduled exams and extra precautions required with patients in resuscitation.
  • Anxiety is triggered by the perception of something at stake or the risk of loss which prevents relaxation and triggers an emotional response that is compounded by people watching.
  • People tend to feel more vulnerable which activates the fight or flight response that can culminate in the individual ‘freezing’.
  • fMRI studies show increased activation of the amygdala under stress (1) which restricts activation of the pre-frontal cortex, impairing logical thought process.
  • These problems worsen with time, multiple attempts at exams without proper preparation can reinforce this negative behavioural response.
  • There needs to be comfort with uncertainty as we cannot prepare for exams or interviews with 100% reliability.
  • Recognition that performance is a skill that requires practice, that it should be revised in the same manner as the material examined.
  • Underlying lifestyle habits include:
    • regular sleep
    • healthy diet
    • exercise, and
    • mindful meditation
  • Coaching well in advance if there is extra help that is required.
  • Mindfulness is required to be aware of when stress is coming on.
  • Before entering the room of an OSCE after reading the stem, use serial 7s to focus thoughts.
  • Deep breathing and long pauses activate the vagal nerve response to decrease the heart rate and relax to allow for proper mentation.
  • Anxiety makes people drift into the future and think about the things at stake or relive negative experiences in the past.
    • Own your own space – using a small object in a pocket that can be squeezed to use the sensory stimulus to bring you back to the present.
  • Commit and plan your approach months before the exam or interview, know that stress will be encountered and strategies should be in place to mitigate the stress.
  • Using work as an opportunity to practice techniques during stressful situations such that they become hard-wired and automatic.
  • It is okay to fail, however, each attempt at an exam or interview should be prepared for as thoroughly as possible with a plan in place each time.
  1. Etkin A, Wager T. Functional Neuroimaging of Anxiety: A Meta-Analysis of Emotional Processing in PTSD, Social Anxiety Disorder, and Specific Phobia. American Journal of Psychiatry. 2007 Oct; 164 (10):1476-1488 doi:10.1176/appi.ajp.2007.07030504

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Tags: #anxiety,#behavioural response,#clinical exams,#exams,#fight or flight,#job interview preparation,#job interviews,#mental health,#mindfulness,#OSCE,#Passion and Purpose,#performance,#performance techniques,#preparing for high performance under stress,#pressure,#resuscitation,#serial 7s,#STEM,#stress,#stressful situations,#vivas,#wellbeing

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