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Dr. Jamie Riggs, a fourth year University of Toronto Emergency Medicine Resident at St. Michael’s Hospital, says that his background as an athlete helped him to develop protocols for mentally and physically preparing for medical procedures.

“In sports, psychology is a common and accepted part of achieving high performance,” says Riggs, who group up playing multiple sports, including road cycling. “When I started in medicine, I noticed we spend a lot more time doing and a lot less time training.”

In a paper recently published in the Canadian Journal of Emergency Medicine, Riggs lays out guidelines for “mental practice” – a cognitive rehearsal of a skill without physical movement – for bougie-assisted cricothyrotomies, colloquially known as crics. These emergency interventions, which are necessary for patients with blocked airways who can’t be intubated as normal, are difficult to prepare for because they occur so infrequently.

Out of a group of 100 or so residents, only a handful will actually perform or be involved in a cric during their training. Despite this, any of them could find themselves in the situation of having to perform one during their career.

At St. Michael’s Hospital, residents like Riggs train in a state-of-the-art simulation centre where they are able to practice skills and rare procedures using manikins and carefully prepared mock emergency scenarios. Because of the breadth of injuries and illnesses emergency physicians can see on any given day and how busy residents are, it’s not always possible to run through simulations of every possibility.

“Emergency medicine is about being ready for anything at any time. The challenge is that the scary things may only happen a few times, if ever, over the course of a career,” says Riggs.

“In my mind, any tool that will give us the chance to improve our performance during those few, scary and extremely consequential moments is a tool worth exploring.”

Riggs and his co-authors Melissa McGowan, FIRST 60: Prehospital, Trauma and Resuscitation Sciences Program Manager at St. Michael’s Hospital, and Dr. Christopher Hicks, Emergency Physician and trauma team lead at St. Michael’s Hospital, interviewed emergency physicians about their own experiences performing crics. They then pared down the information they collected and developed a concise, straightforward script for guiding trainees and physicians through the procedure.

Residents practice a bougie-assisted crichothyrotomy during an emergency medicine skills training day in the Unity Health simulation centre.

While this particular paper focuses on just one medical procedure, Riggs says mental practice can be – and is – used broadly in health care.

Riggs says mental practice can look different depending on the situation. While he’s on shift, he might take a few moments before a patient arrives in the emergency department to take some deep breaths and run through the script of what’s about to unfold in his head. If he’s at home, he’ll close his eyes and envision scenarios while running through the steps silently.

“I use mental practice all the time,” says Riggs. “I find it calming and reassuring.”

By Olivia Lavery

Photos by Eduardo Lima

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