Ideas and Lessons for Surgical Training from Fighter Pilots

“Mental readiness is a combination of commitment, confidence, anticipation and positive thinking. What I have learned from my retraining is to regain confidence and also that one should never give up.” MR de Laval

• Multiple roles to fulfill – “”not simply pilots: They are instructors, supervisors, standards officers, flight safety officers, course directors, examiners, flight commanders, and much more…”
• “The flight sequence itself is comprised of three major events: the brief, the mission, and the debrief… Immediately following the flight, the pilot will attend a debrief wherein every possible detail of the flight will be reviewed, generally with most of the emphasis on mistakes made and how to correct those mistakes for future flights. Pilots are expected to implement any changes or corrections resulting from this debrief immediately, to avoid future mistakes or risks.”
• “In their continued training, pilots also noted stressors such as a feeling of constant assessment (specifically flying the F‐18 or when they were students) and receiving criticism. “
• “Pilots directed their commitment by maintaining a focus on their goal of becoming an excellent military pilot. Participants also acted on their commitment in specific and positive ways, by making decisions and selecting routes or routines that could possibly lead to their objective. Participants described commitment in terms of three objectives: commitment to their dream, commitment to preparation, and commitment to excellence.”
• Throughout their training and flying careers, participants described a strong commitment to learning about and preparing themselves for flight. Participant 1 described his attitude towards studying (when he was a student) as an obsession. He stated, “You lived, ate and breathed flying and studying”. Participants also expressed a keen desire to learn and made a habit of seeking out opportunities to do so. Participant 9 stated, “When I went through here [UPTS] I wasn’t a great student, I wasn’t like that Mr. Superior guy that came through here and had an easy time; I worked hard”
• “As students, their lives were consumed by the desire to learn and prepare for the next flight. Many described reviewing maneuvers and protocols until they were drilled into their minds. Participant 5 recalled that he would “chair fly the maneuver until I could do it in my sleep”. The commitment to this process enabled these pilots to spend exceptional amounts of time preparing”
• “They don’t care who you are, they don’t care when you got in; it’s all about skills and how much you’re willing to give to make it up there. Because at the end of the day, we’re all paid the same. So even though I’m at the top of my game right now, the guys that are just starting, that are Captains, are making roughly the same as me. . .Us, it’s not about money. It’s about pride; it’s about doing a good job.”
• These participants did not want to be good pilots; they wanted to be the best pilots possible.”
• “Participants described the development of their mental readiness as being driven by several important elements: reviewing written material (e.g., flight procedures and maneuvers), building their capacity (i.e., the ability to attend to multiple stimuli), learning from others, planning for unplanned events, and engaging in mental imagery (which included visual, auditory and kinesthetic components).”
• “One simple technique that four pilot instructors reported using and recommending to their own students was to engage in a secondary activity while reviewing protocols or performing mental imagery.”
• “Participants emphatically described the disappointment of learning of a delayed flight, the agony of prolonged waits (and sometimes multiple delays), as well as the difficulty of regaining the motivation and focus required to fly after winding down from their initial pre‐flight preparation and focus.”
• “Being in the moment also involved an element of anticipation and a connection with the flow of tasks. Participants were thinking ahead to what would happen next and preparing themselves before they needed to act. In this way, participants were able to move fluidly from one task to the next, without hesitation.”
• “Participants also mentioned relying on ATC to let them know if any other aircraft were close by. Knowing that the tower was keeping watch over the air traffic allowed the participants to focus their resources on the task with less concern for their surroundings.”
• “Experienced pilots described having the ability to subconsciously monitor the automatic mechanics of flying while also consciously shifting from one task to another and anticipating upcoming events.”
• “if you’re thinking about it, usually your brain’s not thinking as fast as the aircraft is moving, so when you make an action you’re already one step behind of where the opposite action needs to go in now”
• “When pilots were flying with a crew, they made a concerted effort to communicate with the crew and demonstrate their own composure so as to reassure others and maintain control of crew actions. Participants described maintaining a task focus, concentrating on what they could control and blocking out other unimportant stimuli.”
• “Participants did not spend time worrying about how they managed to find themselves in an emergency situation; they simply focused on what was required to resolve the situation in a safe and effective manner”
• “These pilots let go of irrelevant distractors and maintained focus on the task at hand. For others, human elements such as fatigue, workload, prior mistakes, and various environmental elements competed for their attention on a more regular basis.”
• “The most effective techniques used by these pilots were verbal cues and refocusing.”
• “For example, when attempting to complete a multi‐step procedure, or a maneuver that had been difficult for them in the past, participants sometimes spoke aloud the various steps, walking themselves along, as they progressed through the procedure”
• “refocusing generally involved three components: compartmentalization of the distractor, prioritization of the remaining tasks, and shifting focus to the new priority. Many participants used verbal cues to prompt or support this process”
• “The most common distractors from which participants struggled to recover were their own mistakes during the flight”
• “s. When faced with a large number of tasks, pilots may reach a point of task saturation where the task requirements exceed the pilot’s available processing capacity. At this time, pilots must stop attempting to manage all the tasks at once and start prioritizing or focusing only on what is most essential at that moment. If task saturation is not attended to immediately, a pilot can quickly lose control of the situation and wind up behind the aircraft.”
• “Participants described three major sources of confidence: personal abilities, fellow pilots, and safety precautions.”
• “Some guys just like to destroy you, so you just kind of sit there and suck it up. And then you have to be strong mentally when you go out the door, and take everything he said and put that in perspective and say ‘whatever. Yeah, I agree with this, this, but I don’t agree with that. And I’ll show you next time, I can do it’. So you gotta be strong mentally. “