What is “peak performance” in orthopedic surgery? A team from Hospital for Special Surgery (HSS) in Manhattan decided to define and answer that question by way of a review of the literature regarding training principles which may (or may not) help trainees achieve peak performance.
Todd Albert, M.D., Surgeon-in-Chief Emeritus at HSS, explained the genesis of this novel study to OTW, “This work was prompted by Drs. Philip Louie and Michael McCarthy after discussions and a lecture on performance, leadership and burnout.”
Mind/Body in Orthopedic Training
Starting with a sports metaphor, the authors opened up their review by noting that “achieving peak performance in athletes highlights the intimate relationship between mental and physical capabilities. Surgical trainees face a similar environment where learning occurs in tandem with the performance of surgical techniques.”
“The concurrent development of mind and body highlights the complex interplay of training, highlighting the notion of deliberate practice. Deliberate practice is widely used by novice and professional athletes and musicians, as this exercise provides a structure for both self and outside critiques, which allows for further refinement.”
Mindfulness has been successfully used in athletics and performance arts, among other domains. The study authors recommend that through such mental training programs, surgical trainees can sharpen their self-awareness, mental toughness, emotional self-regulation, and surgical performance.
As for how programs might encourage trainees to engage in a mindfulness practice, Dr. Albert told OTW, “We should make it an important part of trainees’ time and the leadership of a particular program should recognize its importance and value.”
Goal Setting and Accountability
Consider what you most want to gain from your training, advise the authors, recommending the Specific, Measurable, Attainable, Realistic, and Timed (SMART) goal-setting technique.
“The inability to accomplish goals often occurs when the goals are neither achievable nor realistic,” say the researchers. “Once the goals are set, you need to constantly remind yourself of your goals. It may be helpful to write them down and place them where you can physically see them…When you hold yourself accountable to your goals, you are communicating to the universe (and to yourself) that the goal is a priority. This can take a combination of many forms as follows: telling a friend, joining an accountability group, hiring a coach, using technology (i.e., apps), or simply writing them down repeatedly.”
“The majority of trainees (if not all) set goals,” said Dr. Albert to OTW. “The variability comes in their dedication and organization in a defined plan for attainment of the goals.”
Simulation
Whether it’s a bioskills lab or virtual reality simulation, say the researchers, these efforts can result in enhanced surgical accuracy amongst trainees. “Trainees seeking efficient and effective training methods should critically assess areas of weakness and actively seek out opportunities addressing skill deficiencies…Mastering skill sets outside the OR affords residents to have capable and proficient hands promoting opportunities for expanded involvement in the OR.”
