Do expert surgeons use mental skills to improve their surgical performance?

Abstract

Purpose: Surgeons often experience stress that may negatively impact performance. Mental skills are psychological techniques designed to prevent skill deterioration under stress and enhance performance. Mental skills curricula have proved effective in other disciplines but are rarely used in surgery. Additionally, research on mental skill use by surgeons has been very limited. The objectives of this study were to (1) explore whether expert surgeons use mental skills to enhance their performance, (2) determine how they implement mental skills, and 3) assess the need for mental skills training in surgical residency. Methods: After IRB approval, 7 expert surgeons (≥ 15 years of experience, prominence in their respective fields) from general surgery, obstetrics/gynecology, and neurosurgery voluntarily participated in semi-structured interviews. Responses were transcribed and analyzed until themes were identified. Results: All interviewed surgeons indicated that they regularly use some combination of mental skills to achieve their ideal performance state for surgery, manage intraoperative stress, and manage distractions before and during surgery. Further, all participating surgeons reported feeling responsible, as the leader of the surgical team, to project a calm demeanor during stressful situations to optimize the team's performance. While none of the participating surgeons had received mental skills training, 71% (5 of 7) advocated for the incorporation of mental skills training into surgery residency. Conclusions: Mental skills are routinely used by expert surgeons to enhance performance and manage stress. While mental skills seem to be acquired over years of practice, experts agree that these skills warrant formal introduction during residency.