The hopes of a nation rest on one man as he prepares to take a kick with 30 seconds left in a game, the pressure is immense. The player does not disappoint and the try is converted. Millions roar with delight and admiration. The pressure on that person in that moment is unimaginable, even watching it you feel the tension.
What you don’t see is that they have prepared for this eventuality. They have rehearsed this moment and developed coping mechanisms. They have prepared and rehearsed and are ready for the pressure.
Have you ever watched a bobsleigher mentally prepare for a race? Or a formula one driver? Or any sportsperson at a high level prepare for a big event. They are “in the zone”. They perform at the highest levels with high stakes and millions of eyes on them and they excel and exceed those expectations.
Arguably, the pressure on a surgeon or trainee in the operating room are similar. The nurses are talking, the anaesthetist is laughing loudly and the rectum is not coming out easily; a piece of retractor digs painfully into your side when you suddenly get torrential bleeding that wells up obscuring your view just as the medical student on the StMark’s says she’s going to faint. At that moment we batten down the mental hatches and cope, we do not launch the StMark’s across the room or start swearing, or indeed swearing more than you are already.
The stakes are high, not just life and death although that is often a consideration; but continence, sexual function, bowel continuity (absence of a stoma) and other equally important outcomes depend on our ability to perform under pressure.
Unlike for example, premier league footballers these coping skills are not formally taught to us, we do not have a team around us helping us mentally prepare for operations but perhaps we should adopt some of the lessons learnt in professional sport to help us become better surgeons and crucially, better trainers and trainees.
Even in amateur sports many people are obsessed with improving their performance. The proliferation of books on this subject are evidence that even the humblest of sportsmen and women wish to achieve their maximum potential, or at least remove any psychological obstacles.
Traditionally and stereotypically surgeons are portrayed as being confident and composed in every situation. In theatre we act the part as expected of us and do not hesitate or crack under pressure.
Squashing Ants is the term used by sports psychologists (ANT’s being automatic negative thoughts) to overcome our doubts and negative thoughts. “I can’t do that operation on my own” or “I can’t get this tumour out” are dismissed with positive rebukes for each negative thought.
It takes practice, especially if, like me, you are prone to catastrophising and worrying that you can’t do something. For each “ant” you squash it with a good thought; for me this would be “I know I can do this operation and if I need help I will call for it”.
Visualisation is another sports technique that should be applied more in surgical training. Running through the operation verbally with a trainer and mentally alone prior to a case is very useful. Imagining intraoperative challenges and how you would respond to these helps build confidence and maximise learning, I think.
I’m off to squash some ants!