Elsevier

Surgery

Volume 163, Issue 4, April 2018, Pages 894-900
Surgery

Education
Enhancing surgical performance by adopting expert musicians' practice and performance strategies

https://doi.org/10.1016/j.surg.2017.09.011Get rights and content

Abstract

Background

Surgery is a performing art—each surgical procedure is a live performance that has immediate and irreversible consequences for both the performer and the audience. Surgeons operate with surgical instruments, whereas musicians perform with musical instruments. Both perform in high-stress, high-risk work environments, where small errors in motor performance or judgment can have immediate negative consequences. While there is abundant literature on musical performance and their impact on outcome, little similar research has been published in the field of surgery. We aimed at identifying expert musicians' practice and performance strategies that may aid surgeons to enhance their surgical performance.

Methods

In the study, 82 relevant English-language articles from 1974 to 2017 matched applicable search terms. Nominal Group Technique was applied to identify 5 key domains that comprise important parallels between surgical and expert musical performance.

Results

The 5 key domains identified were: (1) extensive training and deliberate practice, (2) dexterity and ambidexterity, (3) performance evaluation and competition, (4) performance-related injuries, and (5) performance anxiety. We found focused and mindful training in motor performance, not performing immediately after a hiatus from practice, training to improve the precision and responsiveness of the nondominant hand, continuous and critical self-evaluation, training in injury recognition and prevention, and pharmacologic factors to be of utmost importance.

Conclusion

Critical parallels exist between surgical and expert musical performance that may improve surgical outcomes by adopting musicians' strategies for combating physiological and psychologic performance-related issues. Raising surgeons' awareness for this subject content may improve surgical performance and patient outcomes, as well as help prevent occupational injuries.

Section snippets

Methods

PubMed was searched for English-language articles published between 1974 and 2017 using the search terms “surgical performance,” “surgical skill,” “surgeon hand dominance,” “surgeon dexterity,” “manual ambidexterity,” “pianist dexterity,” “musician deliberate practice,” “competition performance,” “musician musculoskeletal health,” “surgeon musculoskeletal health,” “musician hand injury,” “surgeon hand injury,” “musician performance anxiety,” “surgeon performance anxiety,” “performance stage

Results

A total of 82 relevant articles were identified. Five parallels were identified between surgical and musical performance (Fig). To achieve optimal performance, both expert surgeons and musicians may benefit from (1) extensive training, deliberate practice, (2) ambidexterity, and continuous performance evaluation. Both are susceptible to (3) performance-related injuries, (4) performance anxiety, and may draw on (5) pharmacologic measures, especially the use of β-blockers, to alleviate symptoms.

Coda/Conclusion

In this review, we have identified 5 key parallels between surgical performance and musical performance (Fig), and provided key recommendations to surgeons that may enhance surgical performance and potentially improve patient outcomes (Table). In summary, our examination of the existing literature on surgical and musical performance has led us to conclude that both professions demand serious commitment to extensive training and deliberate practice and a high level of ambidexterity. Furthermore,

Acknowledgment

We thank Nicholas Navin, PhD, and Stephanie Deming, B.A. (Bachelor of Arts), for their editorial support.

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    The University of Texas MD Anderson Cancer Center is supported in part by the National Institutes of Health/National Cancer Institute under award number P30CA016672.

    All authors claim no conflicts of interest or disclosures.

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