The fact that surgeons work in high-stakes environments is not surprising — often, lives depend on how well they perform in the operating room. But traditionally, new surgeons going through basic training wouldn’t have heard much about the emotional labour that goes into the job.

Historically, surgeons were expected to stay stoic, and have not had much of a platform to discuss dealing with the emotional challenges they may face. As The New York Times reported, medical schools and residency programs have avoided discussion of emotional responses among medical professionals.

But that view has been changing. “I think, more and more, we’re really looking at the surgeon as this holistic person, and what really needs to go into that to be that expert-level performer,” said Sydney McQueen, an MD and PhD candidate at U of T studying surgical performance, in an interview with The Varsity.

“Rather than just putting people through five years of surgical training and hoping that they come out at the end with all the skills they need, [we’re] really starting to identify what are all those skills… things we haven’t traditionally always thought about as explicitly.”

Labs like McQueen’s have been helping to introduce discussions about mental health and well-being into surgical training. She recently co-authored a study that identified which skills might help surgeons control their emotions in high-stress situations.

How mental skills from other fields could apply to surgery

Another co-author of this study was Dr. Siobhan Deshauer. Deshauser, who has personal experience as a professional musician, decided to take a cue from the fields of music, athletics, and military service, all of which have already begun to incorporate emotional intelligence into their training.

The lab interviewed 17 surgeons who had significant previous experience in one of these fields, asking them about mental health skills they had learned in their previous careers that might have transferred into surgery. Most of the responses ended up falling into a few different categories.

First, many respondents had routines for moments of acute stress, such as breathing exercises or mental scripts, which they would use to calm down and re-assess the situation. Some had developed habits which they practice at the beginning of a surgery to prepare themselves for stressful situations.

The co-authors noted that when the participants were feeling overwhelmed, they often paused, regrouped, broke their goals into manageable steps, and strategized to find the best path forward. The participants often explicitly learned these techniques from training in their previous fields.

Many also used techniques in their downtime to improve their mental and physical well-being, which generally helped them feel more calm and in control. Some discussed reflecting on surgeries and re-evaluating their responses to better prepare themselves for similar situations.

Potential impact of the conclusions on clinical practice

Surgery training still has a long way to go. However, studies like this one, which identify mental wellness skills that could help surgeons perform, are invaluable to its progress. Identifying these skills is only half the battle, and training surgeons to adopt them presents its own unique set of challenges.

Positive mental responses take years of practice to become automatic, and the more consciously surgeons have to think about maintaining a level of calm, the less attention they can dedicate to their work.

Any question about emotional skills also has to account for the variation between individuals, and not all students will benefit from learning the same techniques, as McQueen noted. But, in light of the surgical community’s attempts to solve such problems, seasoned surgeons are beginning to open up invaluable discussions about how they experience the operating room.

“There’s definitely been surgeons I’ve talked to that really try to make an effort with their trainees to have those conversations outside of the [operating room], and let them know… ‘This is what I was feeling in that moment, and I took a pause, I put my finger on the bleeder, and I took some deep breaths until I was personally ready to continue,’” said McQueen.

Knowing that they aren’t the only ones experiencing emotional challenges can be invaluable for current trainees’ self-confidence — and can help the newest generation of surgeons get a head start on building skills to overcome them.