Parallel Pursuits: Exploring the Intersection of Elite Sport and Surgery

Elite athletes and surgeons are minority groups in the general population, making up 0.01% and 0.008% of the population respectively [1, 2]. However, there appears to be a rare intersection between these groups. Previous authors have identified important skills and traits developed through sport which are transferrable to surgical training [3-6]. Colorectal surgeon and ex-Olympic swimmer Dr. Richard Tapper commented that both populations are highly motivated and skilled, perfectionists and work tirelessly to achieve their goals [6]. Some studies have even gone so far as to identify techniques used in coaching and training elite athletes that could be transferred to surgical training, in particular visualisation and cognitive training [7-9]. Despite this, only two of the nine Royal Australian College of Surgeons (RACS) specialties—vascular surgery and plastic surgery—give recognition to prior excellence in elite sports. Although previous literature does suggest that participation in elite sport does provide advantageous qualities in surgical trainees, few have commented directly on the experience of the athletes themselves. We conducted a qualitative survey of ex and current elite athletes who are now surgeons or surgical trainees within Australia. The survey aimed to identify skills and traits learned through elite sport, explore how these skills were applicable to surgery and discuss the parallels between sport and surgical training. Much of the previous literature focused on the role of the coach in sport and how this could be applied to surgical training [3, 10, 11]. Conversely, we asked about the role of receiving feedback in sport and surgical training. Twenty respondents met the inclusion criteria as having reached resident level (post graduate year two) or above and having represented their state or country in sport as an adult (18 years old). E-sports were excluded. Participants were identified within ex-athlete sporting groups, through social media and via informal referral, thus we acknowledge sampling bias. Five respondents were consultant surgeons, while 11 were surgical registrars (Figure 1). Seventeen participants had represented their country, with 9 of those competing at an Olympic or Senior World Championship level (Figure 2). Participants were pursuing surgery in Orthopaedics [7], Urology [5], Ear Nose and Throat [4], Obstetrics and Gynaecology [3] and Plastic surgery [1]. Sporting representation included rowing, athletics, triathlon, cycling and various others. Participants were asked 15 open-ended questions (Figure 3) to reduce the risk of steering participants toward predetermined responses, allowing their own priorities to emerge naturally [12]. Three main themes arose when asked what personal traits or skills participants believed they developed through elite sport: organisation and time management skills (11 respondents), teamwork and collaboration (11 respondents) and determination (9 respondents). Other common responses included coachability, perfectionism, resilience and proprioception. When participants were asked which of these had helped them in their career in surgery, the majority felt the ability to manage time effectively and be organised were key. Secondly, respondents noted that determination, perseverance and resilience were also crucial in both a sporting and a surgical career. The main parallel drawn between elite sport and surgery was the time commitment required for both areas in both the long and short term to become proficient. Secondly, many commented on the high-pressure and high-stakes nature of both disciplines, requiring time-sensitive decision making. An area of interest to this study was whether the respondents would report direct surgical applications of skills obtained from a career in sport, particularly if sport prepared them for the challenges of surgery. A key theme was the physical nature of sport in providing hand-eye coordination and proprioception, as well as stamina and general fitness. One participant felt concentration skills over a long period of time were very similar, drawing comparisons between completing an ironman and completing a long laparoscopic case, both requiring enduring concentration. Similarly, themes of resilience, persistence, training a skill, preparation and organisation permeated through many responses. One respondent stated ‘there is no surgical training program that is “harder” than the physical and mental requirements of elite sport. In the tough times… you can remind yourself that you have overcome more challenging scenarios from your sporting days’. The responses to discussing the role of feedback in sport were far more varied; however, all respondents acknowledged the importance of feedback in both fields. One main difference noted is that the outcome measures in surgery are very different compared to sport, with sporting outcomes being more objective and transparent, while surgical outcomes are more nuanced and patient focused. This can be linked to the way in which feedback is provided. Some respondents noted that surgical feedback is phrased more cautiously, given the risk of undertones of bullying and discrimination. Lastly, some respondents noted that they were better placed to receive and take on criticism and feedback, with one stating ‘rather than taking it personally I view it as an opportunity to improve my skillset’. One clear outcome of this survey was that it highlighted the potential benefits of adopting a coaching-style approach to feedback. All respondents noted the importance of feedback, with many recognising ‘feedback is easier to get through sport as the entire role of a coach is to provide feedback… feedback is harder to access in surgery and you have to be more proactive to seek it.’ It is well documented in the literature and indeed mentioned by Tapper in 2021 that a symbiotic relationship between coach and athlete, akin to a mentor, would be beneficial in the surgical field [3, 4, 6, 10, 11]. However, sometimes surgical trainees, particularly unaccredited trainees, must be self-guided in their own development. This therefore highlights the importance of trainees not only in seeking feedback but also consultants and seniors bestowing feedback on their juniors. Dr. Tapper highlighted four main areas of elite sport that translate into surgery: culture, coaching, teamwork and technology [6]. Whilst this study did not discuss the impact of technology on surgical training, it did certainly agree that the culture, coaching and team-based nature of sport has a significant place in the field of surgery. From the responses to our survey, there is no doubt that surgical trainees are hard-working, team-focused, diligent individuals. Yet are these traits that they learnt specifically from sport, or is it why they were drawn to surgery initially? Multiple respondents highlighted the time and dedication it takes to compete at a high level. This again begs the question of should previous involvement in elite sport be recognised in application to surgical training? Over half of our respondents agreed that participation in elite sport should be considered as part of the application process given the life experience, attributes and roundedness that it demonstrates in a candidate. Other respondents disagreed or were unsure, stating that they felt the skills you develop in sport are ‘already an advantage’ and would help you succeed in surgical training and a surgical career long term. The world of elite sport and surgical training are very similar, in that they attract individuals who are disciplined, passionate and resilient who are often leaders in their communities [3, 6, 13]. These traits combined with skills honed over a career in elite sport such as performance assessment, proprioception and concentration are highly valuable in surgical training. Additionally, adopting a coaching-inspired mentor-like approach could strengthen trainees' development and confidence using feedback constructively. Taken together, our findings highlight the distinctive strengths elite athletes bring to surgical training and underscore the potential value of elite athletes in surgical training. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.