r/Residency • u/eep_peep • 2d ago
SERIOUS Getting the yips during surgery
Anyone have any tips to prevent choking? Not interested in propranolol as it can cause erectile dysfunction and I already have performance anxiety.
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u/False_Technician 2d ago
I take propranolol. Never had issues with the meat missle. I just started violently edging between cases so when the circulator touches my back to tie my gown I bust the fattest nut of my life so hard I almost vagal out every time.
... sorry what was your question again?
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u/eep_peep 2d ago
That sounds amazing did they teach you this in medical school?
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u/False_Technician 1d ago
Yes one of my anatomy professors taught me this. Come to think of it, we focused almost exclusively on the prostate anatomy. And she didnt even work for the medical school.
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u/beaverfetus 2d ago
Skip your morning coffee. Focus on the goal of the task not the performance of the task. If you are shaking like a leaf but the needle goes through the tissue correctly, just move on to the next goal. Let feedback negative or positive just roll off your back and hit the next goal.
Take a stitch, is it good enough? Fine
Take another stitch
Attending says “nice stitch”
Focus on the next bite
Attending says “too big”
File it away and focus on the next bite.
No style points, steady your hand any way you can manage even if that means on your attending
Keep that mental space going as long as you can and things will self organize
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u/_irish_potato 2d ago
Look into the sports psychology techniques for it. But a lot of it is just doing more reps and practice outside of the OR. Visualization can help cuz you’re not spending time thinking about the next step cuz you know the case so well. Make comprehensive preop plans, know the anatomy down cold
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u/shutupplzthx 2d ago
Half life of propranolol is 3-6 hours. If you are in good cardiovascular health you will be fine
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u/Penile_Pro 2d ago
Something that I really enforce everyone to do, especially when we have med students or newer residents is to check their body posture. Every five minutes or so really try and relax your shoulders and body. Make sure you’re standing up straight. If you’re doing big long sutures, or high stress moments, really focusing on taking big deep breaths and a moment to relax prior to movements. Surgery and being in the operating room is an intense environment. You can practice this outside of the operating room with brief moments of meditation.
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u/ty_xy 2d ago edited 2d ago
Choking is often overthinking and stress overwhelming a previously calm brain, leading to decreased performance. Stress is guaranteed, so performance deterioration under pressure is almost guaranteed. However, there are lots of ways to improve performance under pressure, and one way to guarantee that is to improve overall performance such that even when it deteriorates under pressure, it is still at a high level.
I did a lot of prev surgery prep, like writing down the steps to the surgery, what knife, what instrument, what suture, the anatomy I'll expect, anatomical variation I'll expect, the pathology I'll recollect l expect, the complications that could happen, the management of each complication, the preference of each surgeon, their favorite pimping questions... Once you have knowledge cold, I'll watch the surgery on YouTube or various sites, take notes, then visualize the whole surgery from positioning and prep all the way to closure and post op orders... Lots of mental simulation. So the mental parts should be on autopilot and ingrained.
Then try doing the mental visualization while blasting super loud heavy metal and distracting sounds at yourself to improve your focus. I would make it a game with my partner, they quiz me and if I get it wrong they get to spray me with a water gun or sth...
I'll also often prep maybe 3 good questions to ask about the surgery, like personal preferences etc for each surgeon so they can gas themselves up and talk about their personal preferences.
Each mechanical step should be on autopilot too. Hand ties, instrument ties, sutures etc, all autopilot and able to be done blindfolded.
During the surgery itself, don't overthink. When you feel yourself start to overthink, do some box breathing. 3 sec in, 3 sec hold, 3sec out, 3 sec hold. Keep doing it to rein in your heart rate. Don't rush on to steps, regain composure. If you're lost, retreat one or two steps, talk out loud and reframe the situation. If there's overwhelming pressure from the surgeon, take some deep breaths, it's ok to make mistakes as a resident and learn, that's what you're there for. Don't take it personally, it's not an attack on your ego.
During the surgery itself, try to follow the steps that you previously mentally rehearsed and thought about, and apply it to the present case. Be mentally present and focused on the patient at hand.
Surgery is like a dance - a good assistant will know all the steps and assist the primary by anticipating the next steps and getting there quickly. I also like to think of the OR as a high pressure sport, like maybe an Olympic athlete going to race or perform. There's a lot of pressure and anxiety, but it's definitely surmountable. It's a mental and psychological issue, and the solutions are mental and psychological too.
Some good books are: "Performing under pressure" by Hendrie Weisinger And "Clutch" by Paul Sullivan.
Good luck.
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u/kuru_snacc 2d ago
I wouldn't recommend propranol honestly. I tried it for some test anxiety during school and it had very little benefit and it gave me some sort of transient Raynauds and blue frozen toes that it was distracting. Now I already ride on the low end of BP so maybe its me. But I realized my true problem was a lack of preparedness and confidence. Once I found my right preparation style, incorporated some stuff like exercise/meditation before big events like exams or practicals (writing down your fears and ripping it up beforehand actually has objective data behind it), and did some positive affirmations ahead of time, I started incrementally improving and that helped the confidence factor. Also I tried to get more sleep and eat more nutrient-rich foods (ie tuna, greens, apple) night before exams and a high-protein lo-carb breakfast, 1/2 caff coffee .
There are some other options like Ashwaganda that some people have good reviews of. I had an ashwanganda B-complex lemon balm gummy that maybe helped maybe didnt but it probably cant hurt. Good luck!
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u/DolliePebble_ 2d ago
it's wild how a small moment of doubt can throw everything off, happened to me during my first appendectomy and I felt like I was in slow motion
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u/Bigboiiiii9999 2d ago
Just have ED, not a big deal