Cognitive Precision: Attentional Focus in Surgical Expertise

Background and Context
Surgeons must learn intricate motor control skills, often in pressurised environments, where consequences of sub-standard performance are considerable. Despite the importance of effective surgical training for successful patient outcomes, opportunities to apply insights from alternative fields (e.g., sport and exercise sciences and human performance) are underexplored. Millimetre errors in foot placement by climbers or millisecond misjudgements in rotation by gymnasts can lead to devastating consequences. In surgery, the costs can be similarly catastrophic, resulting in avoidable harm to patients. As in sports, surgical skills are honed as a function of deliberate practice guided by experts.
Psychomotor behavior literature indicates that the language used during instruction can steer attentional focus and determine movement quality (e.g., accuracy and efficiency of execution). Focus of attention can be classified as being internal (i.e., body-centred), such as the pressure and velocity exerted by the surgeon's hand during incision, or external (i.e., environment-centred), such as the intended scalpel trajectory. Surgical expertise is honed through extensive, deliberate practice guided by expert instruction, yet the potential benefits of this have yet to be realized. The present article aims to translate training science from sports to the operating room, bridging disciplines to facilitate a) more efficient training (and associated costs); b) development of data-driven performance metrics; c) identification of skills that are most robust under pressure, and d) continual improvement in patient outcomes.