Surgeons' performance during critical situations: competence, confidence, and composure

Background: Little is known about surgeons' performance during critical situations. We hypothesized that there are methods and techniques used by surgeons that facilitate performance during critical situations. Methods: Surgical faculty and senior general surgery residents from a single academic health center were surveyed. Results: Twenty-six surgeons participated. With respect to critical situations, the surgeons felt confident (96%), expected to be successful (96%), and most did not find these situations particularly stressful (62%). The majority reported using learned skills (92%) and agree their skills can be taught (82%). Practice and preparation were reported as very important (89%). A majority use pre-emptive visualization (68%). Competence, confidence, composure, preparation, and experience were most commonly listed as characteristics or behaviors that should be encouraged in aspiring surgeons. Anger, panic, indecision, fear, and chaos were the most commonly listed characteristics that should be discouraged. Conclusions: Surgeons' response to performance under pressure is complex; however, surgeons report using simple, learned techniques that seem to be targeted toward eliminating the "fight or flight" sympathetic nervous system response.