Association for Academic Surgery (AAS)

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Achieving Flow: Mastering Attention in Surgical Training and Beyond

Like so many, I enjoy listening to Podcasts. My go-tos are Freakonomics, Radiolab, This American Life, and Planet Money. As a big fan of the latter, I even own the Planet Money coffee mug and t-shirt with a cute squirrel holding a martini tee shirt and coffee mug – a reference to John Maynard Keynes’ concept of “animal spirits.” While on the hunt for something new to listen to and learn from, I recently stumbled upon an episode of The OptimalWork Podcast called “Mastering Your Attention to Work Optimally”** (and embarked down a fascinating rabbit hole of a podcast that for many of us might very well be worth exploring).

The hosts discussed that when we are doing something deliberately, anchored in the present by mindfulness or work, we activate a network in the brain called the Task Positive Network – this can be seen on functional MRI imaging. When we aren’t anchored in the present, another part of the brain lights up called the Default Mode Network. They also introduced another aspect of task attention they called the Regulator, which as I understood it, is what enables us to be aware of where our attention is a given moment.

I suppose as I was listening to this podcast episode my own Regulator wasn’t strong enough and my Default Mode Network kicked in. I started thinking about instances of almost magical stretches of time when I have been “zoned in” on what I was doing and in a “state of flow.” An example is when I am operating and nearly all of my attention and concentration is focused on the patient and surgery at hand. Of course, some part of my attention is always aware of the voices and sounds coming the operating room team members and from patient monitors in the background. (This is part of intraoperative performance on which we are asked to evaluate trainees called “situational awareness.”) On the whole though, it is rather remarkable how laser-focused we are in the operating room. Another example of a stretch of time when my Task Positive Network did a great job was during Thanksgiving week 2021 when I drafted, re-worked, edited, and submitted what turned out to be one of my first successful grant submissions and rather enjoyed the 5 days I spent in my office zoned in on this task.

Unfortunately, all of us in surgery, medicine, and probably modern society-at-large are plagued with innumerable instances of interrupted tasks, broken concentration, and competing calls for our attention. In some ways, surgical training had ingrained in me a sense of pride in being able to “multitask.” In the past, I thought of myself as highly capable and efficient, able to tackle multiple tasks simultaneously. I now recognize that in succumbing to the compulsion of addressing emails, pages, phone calls, and text messages as soon as I can, I was allowing my train of thought, focus, and attention to be interrupted and broken. This episode reinforced for me that “multitasking” isn’t actually a thing and that there is an “attention residue” cost of working like this. To return to and re-focus on the task interrupted requires an extra bit of time and effort. When we allow one task to be interrupted by another, there is a detrimental impact not only on the task interrupted but also on the interrupting task. We pay a price both in our efficiency and in the quality of our work.

What are some solutions? One change I am trying to make is to set aside dedicated stretches of time to check and respond to emails a limited number of times per day. Since my days as a trainee, I now recognize that there are very rarely any email, text, page, or phone messages that are truly urgent or emergent, especially on non-call days. Another change I’m trying to make is to limit the number of times I check my phones and devices. I’m not sure how many times a day I look at my personal and work phones but it certainly is not infrequent. I am American, after all, and on average in 2023, Americans checked their phones an average of 144 times a day (https://fortune.com/well/2023/07/19/how-to-cut-back-screen-time/)! This podcast episode also discussed some exercises to help us strengthen the Regulator, turn up our task attention, and to turn down our default/background attention to help us work more optimally.

As a final parting thought, I think I have found a new podcast to add to “My favorites.”

**link to podcast episode:

https://podcasters.spotify.com/pod/show/optimal-work/episodes/212–Mastering-Your-Attention-to-Work-Optimally-e2o5pdl

 

Emily Keung

Emily Keung

Dr. Keung is a surgeon-scientist who leads a translational research program studying the soft tissue sarcomas. She received her undergraduate degree from Harvard College and her medical degree from Harvard Medical School and completed general surgery residency and surgical critical care fellowship at Brigham and Women's Hospital and fellowship in Complex General Surgical Oncology at MD Anderson Cancer Center. She is a recipient of a Sarcoma Foundation of America Research Award, Society of Surgical Oncology Young Investigator Award, Society for Immunotherapy of Cancer Steven A. Rosenberg Scholar Award, and is a current participant of the MD Anderson Physician Scientist Program and the National Cancer Institute’s Early-Stage Surgeon Scientist Program.