The delivery of high-quality health care at the lowest possible cost is no longer an aspiration; it is the expectation. It takes more than just excellent clinical skills to drive exemplary physician achievement for surgeons and anesthesia specialists, you need strong mental skills.
The importance of mindset, and the mental skills that comprise it, has been a staple of training in high-expectation, high-risk occupations for some time now. Often evolving from sports psychology, the military, police and firefighters understand the potential benefit of mental skills to elite performance in high-stress situations. This recognition is also suggested to be important in training for medical emergencies and surgery.
More than 20 years ago, surgeons agreed that mental skills are a large component of performance excellence. More recently, this perspective has been reinforced in the surgical literature for performance and procedural preparation. Mental imagery may be the most frequently cited technique, but critical skills such as emotion regulation, negative thought stopping, affirmations, self-talk, breathing techniques and others are also effective, as are individual, group and comprehensive curricular approaches.
In an attempt to objectively document the growing surgical focus on the value of training and use of mental skills through the frequency of relevant publications, Michael J. Asken, PhD, Elizabeth Morgan, MLS, and R. Scott Owens, MD surveyed the surgical literature from 1990 to May 2021 for articles published on this topic.
A search of the literature was conducted in the databases PubMed, Web of Science and Google Scholar. Two thousand articles were retrieved and assessed for specific relevance. Their analysis was limited to articles that focused on psychological performance concepts and skills such as mental training, mental practice, mental skills and mental toughness.
There has been steadily increasing growth, with a positively accelerating trend in the past decade, of publications related to mental skills for training and performance in surgery.
Putting the Right Mindset into Positive Action
In the field of perioperative pain management, the implementation of multimodal analgesia in the pre-, intra- and postoperative periods is an effective and proven method of accomplishing the delivery of cost-effective, high-quality care. Although slight variations exist, “multimodal analgesia” can be defined as the use of several classes of analgesics with varying mechanisms of action used together to improve pain control, decrease over-reliance on opioids for analgesia, and reduce side effects associated with each class.
Because the characteristics of pain vary both between patients and within a given patient at different times, it is unreasonable to expect a single category of analgesics to adequately treat all pain. Strong mental skills are a large component of performance excellence when working in high-pressure and quick decision making conditions.
Consistency and standardization are important when implementing a multimodal analgesia pathway for a particular surgery. Standardization based on evidence allows for the largest number of patients to receive the best treatments available. Flexibility with protocols is also needed, allowing for tailoring of pain management to the individual patient. A positive mindset for thinking outside the box may be necessary if a complication arises or a commonly used agent suddenly becomes unavailable. Anesthesiologists must expand their knowledge and clinical experience to include agents that have not been traditionally used, and so perioperative plans must be designed with flexibility.
Providing better pain control and using other modalities that result in lower opioid doses should theoretically put surgeons and other prescribing physicians in a better position to reduce doses, write shorter prescriptions or both for patients after they leave the hospital.
Given the innovative integration of mental skills training in other disciplines and the encouraging impact of mental skills and such training on surgical performance (and careers), this increasing interest and emphasis is welcome and should be disseminated and encouraged in all surgical education and training.
Sources:
The Surgical Mindset – Increasing Interest in Mental Skills for Training, Performance Excellence. generalsurgerynews.com
Multimodal Analgesia: The Foundation of a Successful Perioperative Experience. anesthesiologynews.com