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Medical Education Jan 2010Findings from the contemporary psychological and movement science literature that appear to have implications for medical training are reviewed. Specifically, the review... (Review)
Review
OBJECTIVES
Findings from the contemporary psychological and movement science literature that appear to have implications for medical training are reviewed. Specifically, the review focuses on four factors that have been shown to enhance the learning of motor skills: observational practice; the learner's focus of attention; feedback, and self-controlled practice.
OBSERVATIONAL PRACTICE
Observation of others, particularly when it is combined with physical practice, can make important contributions to learning. This includes dyad practice (i.e. practice in pairs), which is not only cost-effective, but can also enhance learning.
FOCUS OF ATTENTION
Studies examining the role of the performer's focus of attention have consistently demonstrated that instructions inducing an external focus (directed at the movement effect) are more effective than those promoting an internal focus (directed at the performer's body movements). An external focus facilitates automaticity in motor control and promotes movement efficiency.
FEEDBACK
Feedback not only has an informational function, but also has motivational properties that have an important influence on learning. For example, feedback after successful trials and social-comparative (normative) feedback indicating better than average performance have been shown to have a beneficial effect on learning. SELF-CONTROLLED PRACTICE: Self-controlled practice, including feedback and model demonstrations controlled by the learner, has been found to be more effective than externally controlled practice conditions.
CONCLUSIONS
All factors reviewed in this article appear to have both informational and motivational influences on learning. The findings seem to reflect general learning principles and are assumed to have relatively broad applicability. Therefore, the consideration of these factors in designing procedures for medical training has the potential to enhance the effectiveness and efficiency of training.
Topics: Attention; Education, Medical; Feedback, Psychological; Humans; Motor Skills; Observation; Practice, Psychological; Psychomotor Performance
PubMed: 20078758
DOI: 10.1111/j.1365-2923.2009.03421.x -
Surgery Apr 2018Surgery is a performing art-each surgical procedure is a live performance that has immediate and irreversible consequences for both the performer and the audience.... (Review)
Review
BACKGROUND
Surgery is a performing art-each surgical procedure is a live performance that has immediate and irreversible consequences for both the performer and the audience. Surgeons operate with surgical instruments, whereas musicians perform with musical instruments. Both perform in high-stress, high-risk work environments, where small errors in motor performance or judgment can have immediate negative consequences. While there is abundant literature on musical performance and their impact on outcome, little similar research has been published in the field of surgery. We aimed at identifying expert musicians' practice and performance strategies that may aid surgeons to enhance their surgical performance.
METHODS
In the study, 82 relevant English-language articles from 1974 to 2017 matched applicable search terms. Nominal Group Technique was applied to identify 5 key domains that comprise important parallels between surgical and expert musical performance.
RESULTS
The 5 key domains identified were: (1) extensive training and deliberate practice, (2) dexterity and ambidexterity, (3) performance evaluation and competition, (4) performance-related injuries, and (5) performance anxiety. We found focused and mindful training in motor performance, not performing immediately after a hiatus from practice, training to improve the precision and responsiveness of the nondominant hand, continuous and critical self-evaluation, training in injury recognition and prevention, and pharmacologic factors to be of utmost importance.
CONCLUSION
Critical parallels exist between surgical and expert musical performance that may improve surgical outcomes by adopting musicians' strategies for combating physiological and psychologic performance-related issues. Raising surgeons' awareness for this subject content may improve surgical performance and patient outcomes, as well as help prevent occupational injuries.
Topics: Clinical Competence; Competitive Behavior; Humans; Music; Performance Anxiety; Practice, Psychological; Surgeons; Surgical Procedures, Operative; Work Performance
PubMed: 29336812
DOI: 10.1016/j.surg.2017.09.011 -
Frontiers in Physiology 2023There is a growing interest in the scientific community about the progression and congruity in the performance of talented participants who complete representing...
There is a growing interest in the scientific community about the progression and congruity in the performance of talented participants who complete representing different nations in the most important international events. The prediction of incoming performances is nowadays in demand with the objective of returning in talent investment. Talent identification programs have tried to select and develop sports talent over years. However, to our knowledge, there is a lack of research about success in swimming World Championships (WCs) performance considering continents-country and how successful outcomes are influenced by these variables. Therefore, the primary goal is to analyze the effect of early specialization comparing the performance progression model of the countries gathered by continents. Participant's data from all Junior and Senior WCs between 2006 and 2017 from International Swimming Federation (FINA). One-way ANOVA, ANCOVA and regression model were used to explain whether the variable category, age, best z-score, experience, and continent influences the performance obtained in Absolute WC. Significant differences ( < 0.01) were found between the average performance obtained by the two different categories (junior: swimmers participating in junior WCs before senior WCs; senior: swimmers participating in senior WCs without previous participation in junior WCs), where swimmers from category junior showed significant better performance's times than seniors, except in America. ANCOVA results showed that generally, the greatest differences where in the earliest ages, with best performance registered in category junior in all the continents. Also, the experience was a significant variable in the general model. Swimmers who had participated in junior category prior absolute obtained better performance's times than those swimmers who participated directly in absolute, in the first participation in senior WC. Thus, early specialization is a key factor to obtain better results in senior WCs for all the continents, except in America.
PubMed: 37288433
DOI: 10.3389/fphys.2023.1075167 -
Journal of the American College of... Nov 2023Performance anxiety is fear, anxiety, or avoidance of performative tasks, due to possible evaluation or criticism by others. Performance anxiety is well described in...
Performance anxiety is fear, anxiety, or avoidance of performative tasks, due to possible evaluation or criticism by others. Performance anxiety is well described in public speakers, musicians, and even surgeons. Its impact on radiologists and especially radiology trainees has not been explored. This article details performance anxiety, framing radiologists as performers, and highlights its potential impact on trainees and practicing radiologists. We offer strategies to manage and enhance the effects of performance anxiety that can be implemented in a training environment.
Topics: Humans; Radiology; Radiologists; Internship and Residency; Performance Anxiety; Anxiety
PubMed: 37634799
DOI: 10.1016/j.jacr.2023.06.038 -
Medical Problems of Performing Artists Sep 2018Elite performance encompasses a complex balancing act involving a series of professionals attempting to help an individual perform to the limit of their abilities,...
Elite performance encompasses a complex balancing act involving a series of professionals attempting to help an individual perform to the limit of their abilities, whilst simultaneously striving to further their capacity. Teachers and performance scientists are under pressure to try to push performers harder to be able to achieve success in competitions, performances and their career. Clinicians must strive to keep the physical and mental health of performers in as good shape as possible while they are balancing these often extreme physical and psychological training demands--'the show must go on.' Efforts to better understand mechanisms that may impact both performance capacity and risk to health are therefore highly important, and feature in research presented in the current issue.
Topics: Art; Humans; Mental Health
PubMed: 30508821
DOI: 10.21091/mppa.2018.3031 -
International Journal of Environmental... Jul 2021Human performance optimization of tactical personnel requires accurate, meticulous, and effective monitoring of biological adaptations and systemic recovery. Due to an... (Review)
Review
Human performance optimization of tactical personnel requires accurate, meticulous, and effective monitoring of biological adaptations and systemic recovery. Due to an increased understanding of its importance and the commercial availability of assessment tools, the use of heart rate variability (HRV) to address this need is becoming more common in the tactical community. Measuring HRV is a non-invasive, practical method for objectively assessing a performer's readiness, workload, and recovery status; when combined with additional data sources and practitioner input, it provides an affordable and scalable solution for gaining actionable information to support the facilitation and maintenance of operational performance. This narrative review discusses the non-clinical use of HRV for assessing, monitoring, and interpreting autonomic nervous system resource availability, modulation, effectiveness, and efficiency in tactical populations. Broadly, HRV metrics represent a complex series of interactions resulting from internal and external stimuli; therefore, a general overview of HRV applications in tactical personnel is discussed, including the influence of occupational specific demands, interactions between cognitive and physical domains, and recommendations on implementing HRV for training and recovery insights into critical health and performance outcomes.
Topics: Autonomic Nervous System; Heart Rate; Humans; Monitoring, Physiologic; Workload
PubMed: 34360435
DOI: 10.3390/ijerph18158143 -
Journal of Dance Medicine & Science :... Dec 2022Performance anxiety (PA) is debilitating and impacts the sufferer's ability to perform. Forgetfulness, concentration loss, and physical symptoms develop, leading to some...
Performance anxiety (PA) is debilitating and impacts the sufferer's ability to perform. Forgetfulness, concentration loss, and physical symptoms develop, leading to some giving up performing.
Methods: An online questionnaire was used to gather data, including demographic questions and the Kenny Music Performance Anxiety Inventory (K-MPAI). The questionnaire was distributed via social media and the British Association for Performing Arts Medicine (BAPAM) database. Data was collected over a 2-month period and was analyzed using simple proportions with a score of ≥ 104 on the K-MPAI indicating the presence of PA and ≥ 130 indicating notable levels of PA.
Results: Thirty-three participants completed the questionnaire (57.6% female). When looking at the ages of participants (18 to 80), the most common age range was 31 to 35 (33%). Two-thirds of participants were deemed to suffer from PA after completing the K-MPAI. A large proportion of participants with PA (63.6%) scored above the threshold score of 130 indicating "significant performance anxiety." Females or currently unemployed performers showed higher levels of PA than other subgroups. However, a chi-squared test showed no significance between sexes (p = 0.32) or employment status (p = 0.31) and the incidence of PA.
Conclusion: The research showed that PA is a significant issue in musical theater, as it is with other musicians who have been studied extensively. We conclude that more research is needed to look at appropriate treatments specifically for musical theater performers.Topics: Humans; Female; Male; Music; Pilot Projects; Dancing; Performance Anxiety; Surveys and Questionnaires
PubMed: 36096646
DOI: 10.12678/1089-313X.121522c -
Journal of Homosexuality Mar 2023This paper explored how UK trans* youth experienced Physical Education (PE) during secondary school, and its impact on remaining physically active. Seven self-identified...
This paper explored how UK trans* youth experienced Physical Education (PE) during secondary school, and its impact on remaining physically active. Seven self-identified trans* people aged 14-25 took part in semi-structured interviews. Findings show participants' performances of gender were restricted by practices privileging the "natural" gender binary. Following school, medical procedures or other physical changes were desired in order to "pass" as their chosen gender before physical activity could occur. Recommendations are presented for improvements to PE policy for trans* youth.
Topics: Adolescent; Humans; Sexual and Gender Minorities; Transsexualism; Sports; Gender Identity; Exercise
PubMed: 34723775
DOI: 10.1080/00918369.2021.1996099 -
Medical Care Nov 2023To determine the extent to which counting observation stays changes hospital performance on 30-day readmission measures.
OBJECTIVE
To determine the extent to which counting observation stays changes hospital performance on 30-day readmission measures.
METHODS
This was a retrospective study of inpatient admissions and observation stays among fee-for-service Medicare enrollees in 2017. We generated 3 specifications of 30-day risk-standardized readmissions measures: the hospital-wide readmission (HWR) measure utilized by the Centers for Medicare and Medicaid Services, which captures inpatient readmissions within 30 days of inpatient discharge; an expanded HWR measure, which captures any unplanned hospitalization (inpatient admission or observation stay) within 30 days of inpatient discharge; an all-hospitalization readmission (AHR) measure, which captures any unplanned hospitalization following any hospital discharge (observation stays are included in both the numerator and denominator of the measure). Estimated excess readmissions for hospitals were compared across the 3 measures. High performers were defined as those with a lower-than-expected number of readmissions whereas low performers had higher-than-expected or excess readmissions. Multivariable logistic regression identified hospital characteristics associated with worse performance under the measures that included observation stays.
RESULTS
Our sample had 2586 hospitals with 5,749,779 hospitalizations. Observation stays ranged from 0% to 41.7% of total hospitalizations. Mean (SD) readmission rates were 16.6% (5.4) for the HWR, 18.5% (5.7) for the expanded HWR, and 17.9% (5.7) in the all-hospitalization readmission measure. Approximately 1 in 7 hospitals (14.9%) would switch from being classified as a high performer to a low performer or vice-versa if observation stays were fully included in the calculation of readmission rates. Safety-net hospitals and those with a higher propensity to use observation would perform significantly worse.
CONCLUSIONS
Fully incorporating observation stays in readmission measures would substantially change performance in value-based programs for safety-net hospitals and hospitals with high rates of observation stays.
PubMed: 37712715
DOI: 10.1097/MLR.0000000000001920 -
Journal of Surgical Education 2020To determine if longitudinal, excellent clinical performance reflected in subjective evaluations during a surgery clerkship would be associated with a greater likelihood...
OBJECTIVE
To determine if longitudinal, excellent clinical performance reflected in subjective evaluations during a surgery clerkship would be associated with a greater likelihood of National Board of Medical Examiners Surgery Shelf Exam ("shelf exam") success.
DESIGN
We retrospectively reviewed medical students' surgical clerkship performance from 2014 to 2019. Clinical evaluations for each rotation were abstracted and students were stratified by performance: excellent performers and non-excellent performers. The rotation performance grades were then combined to classify overall clerkship performance: sustained excellent performers, improved performers, worsened performers, and sustained non-excellent performers. We compared the shelf exam scores between performer class for each clinical rotation and the overall clerkship. Using logistic regression, we also sought to determine if clinical performance predicted passing the shelf exam.
SETTING
Emory University School of Medicine in Atlanta, Georgia.
PARTICIPANTS
Third-year medical students (N = 674) who completed a surgery clerkship.
RESULTS
Excellent performers scored higher than non-excellent performers on the shelf exam during both clinical rotations (all p < 0.01). Sustained excellent performers had the highest exam scores out of all the clerkship performance groups (p < 0.0001). Excellent performers for both rotations were associated with increased odds of passing the shelf exam. Sustained excellent performers had the greatest odds (OR 3, 95% confidence interval 1.5-6.3, p = 0.003) of passing the exam.
CONCLUSIONS
Clinical performance during the surgical clerkship and individual rotations correlates with shelf exam scores. Students should be encouraged to excel on the wards to maximize the educational experience and improve their odds of passing the exam.
Topics: Clinical Clerkship; Clinical Competence; Educational Measurement; Georgia; Humans; Retrospective Studies; Students, Medical
PubMed: 32651118
DOI: 10.1016/j.jsurg.2020.06.033