Our conversation started off on my original question of how does a Coach teach a player to have simultaneous situational awareness, but be able to maintain focus on their intended receiver? Pilots practice load shedding to avoid distractions by inconsequential gauges but need to maintain situational awareness at the same time- of course they do this by allocating attention to one person specifically to assure that both the pilot and copilot are not focused on the same problem, averting the attention from a more significant one. Well, I got a great answer:
“In football we do a lot of presnap evaluation. You call the play and the receivers know exactly where they are supposed to be. The quarterback assesses the defense to see if they are going to be routed where he thinks they will be and if something happens and you are uncertain, you call an audible”.
“It takes a lot of prep and identification of the defense structure before the snap”
“It is all about teamwork and trust. It is a learned process. You practice till you are sure your receiver is going to be in the exact window of opportunity he is supposed to be in. He is supposed to be there at the exact time you expect him there. That window of opportunity may be the size of house in high school, but in college it shrinks to the size of a room and if you make it to the pros, that window of opportunity is the size of a basketball.”
“it is likely the same in surgery as one is in training, the type of cases become more complex, so your skill set must increase, and the windows of opportunity to succeed become smaller and smaller as you tackle more difficult procedures. Like surgery as the levels get tighter, the windows of opportunity to succeed are smaller”. (Brilliant man)
“Before the snap the quarterback expects that his receiver will be where he is supposed to be, so he no longer worries about where the receiver is after the play (huddle or audible) is called. He now spends time looking for that one person in the defense who tells him the defense is where he thinks they should be. A great defensive coach can disguise his defense and take advantage of that tiny window of opportunity. When a quarterback throws an interception and you see they looked perplexed, eight times out of ten, it is because the receiver was in the wrong location and the defense took advantage over that. The quarterback is NOT looking for the receiver but throwing exactly where the receiver is supposed to be. When a mistake happens it is because the receiver is supposed to run 7 yards but ran 8 or 10 instead. It is all about the timing. Now, where the receiver is supposed to be, there is a defender there. Other times the defender did not do what the quarterback predicted. He miscalculated what the defender’s intentions were. Some teams are REALLY good at this. In some cases the quarterback can pick up that the intended receiver is not open so they must then rely on the back side receiver to be open.”
Ok that was interesting, no doubt, but does that pertain to surgery? Well somewhat yes. We know what surgery we plan to do and we know what we need, but certainly if the team is not mentally in synch with us, the opportunity for a mistake to occur happens. If we huddle briefly before the case (it takes 30 seconds) then if someone is not fully on board, we can figure that out and avoid unnecessary distractions during the case. We ought to call audibles during the case when the situation changes, but we become overly afraid that the audible we call is misinterpreted, it can be taken out of context and broadcasted erroneously around the hospital (Dr. Lipshy said he thought he injured the ureter….!!!) which I have seen done. Having said that, when we are sure there may be a problem, an audible needs to be called as a critical pause so we can be sure everyone is focused and not distracted by inconsequential things. Well I tried to tie it into surgery, but likely failed.
DEALING WITH FAILURE:
I quickly came up with a question that I had not thought of: “how does one brush off their mistakes (their bad outcomes) and come back to work on the next possession?” I immediately remembered a conversation regarding risk taking and risk avoidance, I had with Dr. Moulton back in December on their paper: “Taking a chance or playing it safe: reframing risk assessment within the surgeon’s comfort zone.” Certainly having a bad outcome in surgery can shape our mentality about tackling a similarly difficult case in the future- that is, we become risk aversive.
“Risk tasking after a bad encounter—that’s an “age old question”, the great ones, the Peyton’s and Tom Brady’s have a balance. They obviously have a certain element of self-confidence based on their skills. The higher the skills the more risk you are willing to take. In some quarterbacks, it is based on self-esteem and they figure out later they don’t have the skills. That Quarterback has no anticipation, and eventually they begin to hesitate and fail or they have too much confidence and are being cocky and that will catch up to them.”
“Some quarterbacks are at risk for blocking if they have too many mistakes after taking risk and that can shut you down”.
“I taught my young sons to learn there are layers to skill sets- you must have footwork, ‘if my feet are not in the right position, then the ball handling won’t matter’. They learned that a good quarterback needs a lot of layers of fundamental skills that need to be in place before you gain the mental part. You need the basic skills of footwork, then ball handling and then the mental parts.”
OK, well that is even more like surgery. If you learn and rely on your basic surgical skills first then when you gain the knowledge you should be able to handle the stress of a setback. If all you have is the knowledge but not a bank of skill sets, then you could be in trouble especially if your peer support crumbles.
LEADERSHIP TRAINING IN COACHING: SKILLS FOR A LIFETIME
This then brought up my thoughts about leadership and mentorship: what type of coaching mentality works best? You have the paternal nurturing figure of some coaches as opposed to the stricter fearing tactics of other coaches.
Coach McCoy stated that it “has to do with recruiting to that exact level. Surprisingly it is typically opposite how the kid was brought up. You have to have the right kid in the right environment. The way they react to the different styles is different. A kid in a tough strict environment may actually do better in a paternal environment, while a kid brought up in loosely controlled family environment may be better off in a very strict controlled coaching style.”
In the end all coaches must be more “concerned about what happens with the athlete after the football is over for them. You must work to mold an adult who can function in the world no matter what they chose to become. If all you worry about is your successes, then you may have missed the opportunity to mold the student into a functioning member of society. You must be there to nurture them some, or you have failed.”
“This is where the Coaches leadership training comes in. The coach must teach the boys leadership skills they can use on the field and off. We at the Flippen group utilized professional development raising high performance professionals. We focus leadership- command control and structure vs relational control. This works in all environments. A good coach or leader needs to keep a fine balance between the two. If I have too much command control that can be overwhelming and end up being a constraint to the people around me, then I need to work on my perception on my team. It’s not always about where I see myself, but where others see me.”
“After coaching for 28 years, including my boys Colt and Case, I realized the potential to use my love of teaching leadership skills for use in other areas. The Flippen group uses measures of BEHAVIOR TENDENCIES (self-control, nurturing, deference level, etc ) as a profiling process and not PERSONALITIES (Meyers Briggs)- personality profiles do not induce change but move you to a like personality or teach you how to deal with other personalities– I looked at what are the constraints preventing our being the best? When the going gets tough, we tend to focus not on our weakness but focus on our reliance on our strength too much. Well, maybe that strength was actually what led us in the wrong direction, or maybe if I understood my weaknesses I could capitalize on that or utilize another person who is stronger in that area for us to succeed. We don’t focus on changing your personality, but changing your behavior.”
Ah, well this brought to mind several things…. We as surgical teachers should focus more on providing the surgical trainees with the skill sets needed to be leaders in whatever environment they are in. Just this week we learned that the APDS is asking our Program directors to assume more responsibility for our students when they have completed training….Well, that is in actuality what a Coach should be doing with his or her athletes…. Sure racking up five national championships brings in alumnus dollars, but teaching the players to leaders in society, PRICELESS, and that should be a focus in our training programs. I understand that many sites have avid leadership programs (Dukes Feagin leadership program for one) but every resident should be able to state that not only can they function in the hospital without supervision, but that they have the capacity to lead at their Hospital.
KENNETH A. LIPSHY, MD, FACS