This is a special bonus EM Cases main episode podcast: Shift Preparation – Pre-gaming with Dr. Rob Orman

We spend a lot of our time in the ED dealing with things that are not directly related to patient care – EMR requirements, phone calls, admin issues etc – hence the daily “grind” that we’re all so familiar with. And while we can advocate for change, the system is unlikely to drastically change to make the “grind” suddenly disappear for our next ED shift. However, changing our mental framework or mindset is relatively easy.

Changing your mindset may help shift your attention to the positive aspects of ED work and ultimately may improve your job satisfaction – to get joy out of work. But this does not just happen. It requires preparation before every shift. Elite athletes and performers do this all the time. It is surprising that we do not all routinely use mental preparation before every shift just like professional basketball players or actors do before showtime. In order to do your job at your peak level, whatever that is, you need to mentally prepare.

The question is: how do we best mentally and physically prepare for an ED shift? Dr. Rob Orman, master educator and fellow podcaster joins Anton to discuss a few options in this special edition podcast…

Podcast production, sound design & editing by Anton Helman

Written Summary and blog post by Anton Helman December, 2019

Cite this podcast as: Helman, A. Orman, R. Shift Preparation – Pre-gaming with Rob Orman. Emergency Medicine Cases. December, 2019. [date]

Shift Preparation – Pregaming Options

Do what works for you. If you want to try a “prescription” pre-game preparation strategy, think about it in 4 parts:

1. Before your commute sleep (“power nap” of 10-15 minutes, consider casino shifts to preserve circadian rhythm – see below and practice good sleep hygiene – see below), eat (protein-rich food), exercise (5-10 mins of high intensity exercise), try a cold shower to “wake up”.

2. During your commute walking, biking or running is ideal for the exercise and for “clearing the mind”; if driving or using public transportation listen to a medical podcast to get you thinking in a medical framework, followed by an inspirational song.

3. Just before your shift starts – have a ritual (whether that is deep breathing or “box breathing”  or getting your favourite drink or going to your shift early and chatting with colleagues) and remind yourself of 3 things: the purpose of being an EM doc, the privilege of being a doctor and what you are grateful for at work.

4. As your shift starts employ positive self talk (tell yourself “I got this”) and get your team “pumped up” with a positive statement.

Casino shifts – preserves the anchor period (2am-6am when it is the most important for your circadian rhythm to get some sleep in order to adjust properly) and is associated with more total sleep, reduced sleep debt, shorter recovery time, reduced cognitive impairment, improved work performance and improved career longevity (listen to Episode 11 for details)

Sleep hygiene: Strategies to minimize the negative effects of Shift Work and Sleep Deprivation

Sleep deprivation impairs short term recall, performance on intensive tasks, increases distractibility, error of omission and commission, and risk tolerance – all things important to EMShift work causes sleep debt, associated with mental and physical health issues.

Sleep Hygiene – employ a pre-sleep routine, no caffeine or alcohol before sleep and after night shifts retire in a room that is quiet (consider ear plugs or white noise machine), dark (consider eye mask) and free from interruptions.

Napping – mid-afternoon either 10mins or 90 mins (not 30mins) allowing 1hr to ‘wake-up’, and try to nap during the anchor period of your night shift (off-duty sleep supplemented with naps while on duty is effective for sustaining vigilance, learning, and memory when working at night).

Light therapy – sleeping in pitch dark and waking in bright light help to signal our circadian rhythms.

No screens for 1-2 hours before sleep – the blue light from smartphones, tablets and laptops signals your brain to stay awake.

Guided mindfulness sleep exercises can help you wind down after a shift – MIT sleep resources

Drs. Helman and Orman have no conflicts of interest to declare