Behind The Curtain Surgical Judgment Beyond Cognition

T H E M INDFUL S U R G E O N Carol-anne Moulton, MBBS, MEd, PhD, FRACS

Surgical Judgment

T h e Moment

Moulton et al. (2007)

Slowing Down When You Should

Attention Threshold

Novice

Primary activity

Spare capacity

Expert

Primary activity

Spare capacity

Kahneman (1973)

Attention Threshold

Effortful

Primary activity

Spare capacity

Automatic

Primary activity

Spare capacity

Slowing Down

Qualitative

Manifestations

Moulton et al. (2010)

Inattentive Attentive

D r i f t i n g

“It’s the routine cases…that’s what happened here. It was an easy case. We were chatting and obviously not being as diligent as we should have been.”

Senior Surgeon, Interview

Drifting

Mindful Practice

Epstein et al. (2008)

Slowing Down

“…my efforts during these moments of crises were consumed with the anxiety I was feeling and intermixed with feelings of inadequacy, uncertainty, reputation and ego.”

Senior Surgeon

The Unspoken

Reflecting on Individual Factors in Surgical Adverse Events

Leung et al. (2012)

T h e Moment

“I remember all of my deaths . . .”

THE FALL Surgeons’ Reactions to Failure

Luu et al. 2013.

Unique Y o u a r e n o t

Emotional

“I almost crashed into four parked cars before I got out of the parking garage that day. I was so distraught … like I am not a guy that cries, but…”

(I-001)

Social Cognition Jin, et al. (2012)

Performativity Goffman (1959)

Slowing Down “…And then the staff showed up just outside the operating room to see how things were going, and I can see the fellow getting completely nervous and then completely changing and telling me “go faster”, “come on, you have to grab it”, when beforehand we were just going at a normal sort of slow pace... he got nervous, to the point that we ended putting the kidney upside down. So we had to take all the stitches out, and put it back in again. ”

(P008)

Implications

Towards a Surgical Decision

Vocabulary

Towards Surgeon

Wellness

Towards a More Mindful

Surgeon Epstein et al. (2008)

Ministry of Research and Innovation Early Researcher Award

Royal College of Physicians

and Surgeons of Canada Medical Education Research Grant

Physicians Services Incorporated

Health Professional Research Grant

THE MINDFUL SURGEON

Glenn Regehr Helen MacRae Lorelei Lingard

Annie Leung Shelly Luu Nathan Zilbert Jenny Jin Lisa Mark Carween Mui Jacob Gallinger Priyanka Patel Laurent St. Martin Sandra deMontbrun Shira Gold

Tina Martimianakis Simon Kitto Steven Gallinger Lucas Murnaghan Tulin Cil Vicki LeBlanc

The

Kick

Emotional

“I almost crashed into four parked cars before I got out of the parking garage that day. I was so distraught … like I am not a guy that cries, but…”

(I-001)

The

Fall

Was it my fault?

“Did I goof something or did I miss something? Is it a technical problem? So I relive the operation and I go through the critical parts of the operation.”

(I-003)

The Recovery

Short Term

“I’m going to learn from this. I’m not going to dismiss it and say, “Well, it’s the patient’s fault” or “It’s the nurse’s fault”, sort of learn from it whatever the problem was and move on.”

(I-003)

The

Impact

“Absolutely there is. No question in my mind.”

(I-011)

“Who sent you to me? Did you hear that I am an outlier?”

(I-008)

Long Term

“I think that each mistake I make, or each complication I have, or each patient I bury, I think has taken a little wee piece out of me.”

(I-008)

Emotional

“I almost crashed into four parked cars before I got out of the parking garage that day. I was so distraught … like I am not a guy that cries, but…”

(I-001)