ABSTRACT
Surgeons use skills in a high-stakes environment where death can be the worst outcome for the patient. In aviation, pilots use their skill to fly where death can be the worst outcome for the passengers as well as for the pilot. In both cases, perfection is pursued in a high-stakes environment with a flawed tool: the human mind. There are some more parallels between a surgeon and a pilot. The aviator will fly a heavy, complex machine costing millions, navigate it through threedimensional space, manoeuvring it through hazardous environments, and return it intact to the ground. The surgeon will enter the patient’s body, navigate through complex anatomy, perform risky procedures and bring the patient safely out of the operating room. Though the specific tasks and skills are different, the challenges that pilots and surgeons face as they master their craft are remarkably similar.1 Just as there are similarities, there are differences. Perhaps the most remarkable are the differences that exist in their attitude to the effect of stress on their performance. Pilots seem to have more insight into the effects of stress on their performance and are proactive in making changes in their work accordingly. Most surgeons, on the other hand, do not wholeheartedly acknowledge the impact of stress on their performance. Although there may be awareness among some surgeons that a high level of stress is associated with poor dexterity, any link between the two has not been studied and proven strongly, thus not appreciated by many, which again reflects lack of regard for this issue
among surgeons. Here we will go through the evidence about the effect of stress on surgical performance.
