When a patient arrives in Dr. Adam Szulewski’s (Artsci’06, Med’10) trauma room at Kingston Health Sciences Centre, the ability to focus on what’s important while tuning out distractions can be a matter of life and death.
Strategies such as breathing techniques, planning, and leaning on experience and teamwork work together to limit cognitive overload and help Dr. Szulewski cope with the huge amount of emotion, stress, anxiety, and uncertainty he often faces in the emergency department.
“When I’m in a resuscitation room, all my energy is focused on trying to help this one person,” he says.
“In a system where things can be chaotic, you need to have approaches to identify when you feel stressed and overwhelmed, so you can use them to be as effective as possible. For example, when I’m resuscitating a patient, announcements on the hospital’s overhead speaker system about a chemical spill or missing patient on another ward are pure noise. This used to bother me, but I’ve developed an ability to tune these types of irrelevant distractions out completely.”
Now an associate professor in Queen’s emergency medicine and psychology departments and Fellowship Director, Resuscitation and Reanimation, Dr. Szulewski can trace the origins of his research on these strategies back to his days as a resident physician. He’d watch his emergency-room mentors almost instinctively pause and gather their thoughts by doing a “recap” where they summarized the treatment and discussed next steps with everyone in the room.
“It provided a bit of a silence for a second and then people would come up with ideas and we’d go from there – it was almost like taking a collective breath in a way,” says Dr. Szulewski. “It offered the leader a way to deal with the cognitive load of managing the case as well as helping all the individuals in the room. It’s something that developed organically in resuscitation medicine, but we’re seeing big parallels in sports and in other domains: for example, when a basketball player pauses and takes deep breaths at the free-throw line.”
In a system where things can be chaotic, you need to have approaches to identify when you feel stressed and overwhelmed, so you can use them to be as effective as possible.
Understanding the ways to avoid cognitive overload starts by delving into the three main types of human memory: sensory, long-term, and working. Sensory memory refers to all the transitory stimuli your brain receives and quickly discards, such as tastes, smells, and noises, while long-term memory holds all of a person’s stored information. In between the two lies the working memory that interests Dr. Szulewski, where all the complex thinking happens.
His work also builds on the research of Nobel Prize winner and Princeton University professor emeritus Daniel Kahneman, who developed a theory of System 1 and System 2 processing. The first relates to recognizing patterns in about 90 per cent of situations, which allows automatic processing of information, while the second occurs when people face unfamiliar or unexpected situations when they need to think to respond.
Dr. Szulewski’s research centres on the ways learning and experience help reorganize the mind’s information systems, so that basic skills become so ingrained and automatic that they allow more brainpower to be applied where it’s really needed.
Although his research focuses on achieving a better understanding of physicians’ decision-making under pressure, the lessons learned apply to almost any complex professional field, or even when something completely unexpected comes up in everyday life.
Dr. Szulewski likens this to people turning down the radio in their car to increase their ability to concentrate on driving in a worsening snowstorm or when someone simply asks for quiet because they need to think.
“Certainly, if I have time to breathe and to relax, that’s going to help. I think there is something to be said for having a general approach to uncertainty, which is something that we get very comfortable with in resuscitation and emergency medicine,” he says.
“As we develop and mature as human beings, we acquire different experiences that help us listen to our ‘spidey sense’ to know when we need to slow down and think things through. At the end of the day, we’re all humans, we all have the same type of brain, and we all need the same kinds of pauses and resets.”
