Pressure

Your reaction to the Situation Can Create Pressure

You are in the corridor waiting for the bell, so that you can then go and read the clinical scenario on the door. You’ll have two minutes then another bell will ring to let you know that you can enter the room for your first oral viva in the Fellowship exams.  There are several other candidates in the corridor, all standing outside doors, waiting for the bell.  You’ve done lots of practice, you’ve been interrogated by some of the toughest examiners at various hospitals. You know your work, you’ve dealt with many difficult cases, you have the knowledge.  This time it’s the real thing, the Fellowship Exams, so why do you feel so much more nervous over something that you have been doing for years? Chances are it’s the way you are thinking about this event. What if I don’t do well? What will people say about my performance? I have worked and studied so hard for this one event, what if I stuff it up? I am ready for this exam, and there is an expectation from colleagues and family that I will pass.

It doesn’t matter what the situation is – medical exams, higher school certificate exams, major sporting events -in fact, any situation to which we attach a great deal of importance. The way we think about a situation greatly impacts how we feel, which is then likely to impact how we perform. Essentially we become so fixated on the outcome that we forget about the process that we need to go through to complete that 10 minute essay, or describe a medical procedure, or answer a consultant’s question on clinical rounds, or provide a handover to the next shift. This outcome- orientated thinking isn’t limited to examinations or other events; it also happens in everyday work shifts as doctors struggle to impress consultants who observe and evaluate their training on a regular basis.

So what can you do to reduce this outcome-orientated thinking and shift your thinking to the ‘here and now’ so that your sole focus is on what you need to be doing right now to perform successfully in your event.

1. Engage in imagery. Each day you should spend some time performing imagery whereby you see yourself successfully performing, whatever it is that you have to do. Your focus should be on seeing yourself successfully perform each technical component of the situation. For example, if you have to give a presentation and you’re nervous about the impact of the first sentence, you can practice in advance, in front of a mirror, and record yourself on your smart phone. Adjust your voice and body language appropriately until you are satisfied. What do you need to be doing technically when examining a patient in front of a consultant? Imagine yourself doing this competently as though it was a normal workday situation. What you will find is that your attention is then on the process, rather than on being evaluated by others.

2. Control your thoughts. During times of heightened anxiety or nervousness we often engage in “what if” thinking. What if this happens or that happens. This is not performance-orientated thinking. This is you focusing on the outcome and not on the process. Control your thoughts by visualizing a stop sign that is right in front of your face or scream ‘STOP’ internally to yourself. This is to get your mind off the circular loop of “what if “ thinking. Then ask yourself, what do I need to be doing right now to execute this performance? For example, you have just been asked a fairly simple question by the examiner during a practice viva. It’s such a simple question that you think there’s a trick to it, so you decide to show how much you know, and your response takes too long. You become annoyed at yourself for making this mistake at a crucial time. “I can’t believe I just did that. I just wasted precious time. What if I fail?”  This could be circling around in your head. This is where the stop sign or yelling ‘stop’ comes in.

Then ask yourself, what do I need to be doing right now? For example, I need to be focusing on a succinct response to the question, rather than focusing on whether the examiner is trying to trick me. This has taken you out of the “what if” thinking and it has brought you into the “here and now”.

Remember, it is not the situation that creates pressure, it’s your reaction to it. It’s likely that you are thinking about outcomes and not the process of what you need to be doing right now. To better manage the situation, use the above techniques to stay in the “here and now”.

Be mindful, it’s worth it!

Dr. Patsy Tremayne

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