Performance Optimization

  • Nicholas E. Anton
  • Eric Bean
Part of the Comprehensive Healthcare Simulation book series (CHS)


Expert surgical performance is characterized by high-level motor performance, the ability to concentrate for long periods of time, discriminating awareness of clinical situations, and several cognitive factors (e.g., mental preparedness, self-confidence, etc.). These abilities, developed through extensive experience, deliberate practice, and study, enable expert surgeons to manage challenging clinical situations effectively.

In addition to the well-researched benefit to technical skills proficiency, surgical simulation training may offer inexperienced surgeons, who are susceptible to experience performance degradations during difficult clinical situations, an opportunity to develop cognitive (e.g., mental imagery, relaxation strategies, attention management, etc.) and team-based skills (e.g., effective communication, leadership, etc.). These skills are often overlooked in traditional surgical training but are critical elements of expert surgical performance. Thus, simulation training may be an effective method to help trainees and non-expert surgeons reduce the learning curve to attain these trainable elements of surgical expertise and optimize their surgical performance.

The research on cognitive and team-based skills training in high-pressure domains like the military, aviation, and elite athletics indicates that this training can effectively enhance learners’ performance. While the research on nontechnical skills training in surgical education is still burgeoning, the results provide support that this type of training can enhance trainees’ and practicing surgeons’ performance. Accordingly, implementing cognitive and team-based skills during trainees’ simulation training should be a priority in the future of surgical education.


Surgery Performance optimization Nontechnical skills Cognitive skills Performance psychology 



Army Center for Enhanced Performance


Agency for Healthcare Research and Quality


Center for Enhanced Performance


Comprehensive Soldier and Family Fitness program


Laparoscopic cholecystectomy


Mental imagery


Mental skills curriculum


Objective structured assessment of technical skills


Stress-management and resilience training


State-Trait Anxiety Inventory


Team Strategies and Tools to Enhance Performance and Patient Safety


US Military Academy


Virtual reality


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nicholas E. Anton
    • 1
  • Eric Bean
    • 2
    • 3
  1. 1.Department of SurgeryIndiana University School of MedicineIndianapolisUSA
  2. 2.Get a Strong MindEncinitasUSA
  3. 3.HigherEchelon, IncSan DiegoUSA

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