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. 2022 May-Jun;79(3):809-817.
doi: 10.1016/j.jsurg.2022.01.007. Epub 2022 Feb 3.

Mental 3D Visualization: Building Surgical Resilience for Performing High-Risk Procedures

Faith Mueller  1 , Margaret Brommelsiek  2 , Gary Sutkin  3
Affiliations

Mental 3D Visualization: Building Surgical Resilience for Performing High-Risk Procedures

Faith Mueller et al. J Surg Educ. 2022 May-Jun.

Abstract

Objective: Psychological resilience has been studied in several demanding professions, including the military and competitive sports, yet specific strategies for managing stress are not commonly addressed during surgical training. The objective of this study was to investigate how surgeons view performance under pressure during high-risk surgical steps.

Design: Using constructivist grounded theory, we conducted 12 individual semi-structured interviews with a theoretical sample teaching surgeons, representing 10 different specialties and a range of experience. We drew on Luthar's concept of resilience as positive adaptation, an active and flexible process in which critical choices are made in stressful situations. We asked about both protective and vulnerability factors contributing to resilience in high-risk surgery. We coded transcripts, transforming each category of codes into a visual schematic highlighting our findings related to performance under pressure and resilience, which we transformed into a conceptual model.

Setting: Truman Medical Center, Kansas City, MO, tertiary hospital.

Participants: Twelve teaching surgeons from 10 different surgical specialties.

Results: Mental 3D visualization is necessary for proper preoperative planning, enacting contingency plans in the face of intra-operative challenges, and managing emotions during high-risk surgery. Each of these factors informs staying calm under pressure and is necessary for building long-term surgical resilience. Negotiating challenges in high-risk surgery is contingent upon adapting to risk developed over time through surgical experience, mental 3D visualization, intentionality, and self-reflection.

Conclusions: Mental 3D visualization informs processes for staying calm under pressure and is essential for building long-term surgical resilience. We recommend that residency curricula offer progressive education on mental 3D visualization and foster intraoperative environments that promote adapting to risk.

Keywords: Resilience; intraoperative period; qualitative research; stress; three-dimensional maps.

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Conflict of interest statement

Declaration of interest None.

Figures

FIGURE 1.
FIGURE 1.
Conceptual model of surgical resilience, informed by mental 3D visualization, adapting to risk, and intentionality & self-reflection.
See this image and copyright information in PMC

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