Complexity, Mental Rehearsal and Responding in Emergencies

The tragic air crash in the French Alps this week makes us reflect not only on our own mortality but also on how we clinicians manage time dependent emergencies in our complex environment. We have drawn heavily from aviation experts in our attempts to address safety and better manage human factors. In accepting the fact that most of these tragic events were not accidents (unpreventable events) we have sought preventative measures to reduce risk. We now formally learn about errors and use tools such as checklists with the hope we can reduce the occurrence of preventable adverse events. Learning in medicine however remains knowledge and skill focused (appropriately so) however we need to understand the non-clinical context of thinking including how we respond during critical events. While most clinicians have been deemed/assessed as competent providers many are still unable to perform in times of crisis. In these situations tasks may become more complex and difficult to execute. Mental imagery/rehearsal is used by athletes during their pre-event preparation. This strategy may improve a clinician’s ability to recognize key events and trigger rehearsed 'fixed action responses' ultimately helping them execute time dependent complex tasks. 
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