Surgeons and Pilots: What Do We Have in Common?

  • Rifat LatifiEmail author


Pilots undergo intensive training in order to fly commercially or privately. However, this training cannot always predict who will commit errors and who will handle emergency situations effectively. Numerous factors play a part in how these situations are handled. Some of these factors include communication with other personnel, the technical skill and mental state of the pilot, and external factors such as weather. A key component is extensive training, so that when an emergency occurs, s/he does not have to think about the basic procedures for their job. Instead, the pilot is able to focus solely on the current emergency and how to handle it. Performing complex surgery is much like flying a plane. Both take an enormous amount of training, which at times can be grueling. Surgery itself can be dangerous, time-pressured, and while much of it depends on technical skills of the surgeon, other factors and non-technical elements have major effects and are required to effectively execute an operation. There are a number of common features that both of these high-pressure, high-demand professions share. This chapter seeks to review the commonalities and differences between the decision-making among pilots and surgeons, by incorporating the concepts of situational awareness and sense-making, and how these phenomena can be applied to understanding the process of dynamic decision-making.


Pilots Surgeons Training Checklist Difficult decisions Situational awareness High-pressure jobs Surgical residency Situational sense-making 



There are no identifiable conflicts of interests to report.

The authors have no financial or proprietary interest in the subject matter or materials discussed in the manuscript.


  1. 1.
    Garfors G. Is it safe to fly? Globetrotting galore. Accessed 20 Oct 2015.
  2. 2.
    ABC News. In wake of emergency landings, pilot simulates situations. Accessed 20 Oct 2015.
  3. 3.
    Federal Aviation Administration (FAA). Federal Aviation Administration (FAA). Accessed 20 Oct 2015.
  4. 4.
    Gifford E, Galante J, Kaji AH, et al. Factors associated with general surgery residents’ desire to leave residency programs: a multi-institutional study. JAMA Surg. 2014;149(9):948–53.CrossRefPubMedGoogle Scholar
  5. 5.
    Cooksey AM, Momen N, Stocker R, Burgess SC. Identifying blood biomarkers and physiological processes that distinguish humans with superior performance under psychological stress. PLoS One. 2009;4(12):e8371.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Schedlowski M, Wiechert D, Wagner TO, Tewes U. Acute psychological stress increases plasma levels of cortisol, prolactin and TSH. Life Sci. 1992;50:1201–12051.CrossRefPubMedGoogle Scholar
  7. 7.
    Leino TK, Leppäluoto J, Ruokonen A, Kuronen P. Neuroendocrine responses to psychological workload of instrument flying in student pilots. Aviat Space Environ Med. 1999;70(6):565–70.PubMedGoogle Scholar
  8. 8.
    Endsley MR. Towards a theory of situation awareness in dynamic environments. Hum Factors. 1995;37:32–64.CrossRefGoogle Scholar
  9. 9.
    Endsley MR. A survey of situation awareness requirements in air-to-air combat fighters. Int J Aviat Psychol. 1993;3:157–68.CrossRefGoogle Scholar
  10. 10.
    Endsley MR. Measurement of situation awareness in dynamic systems. Hum Factors. 1995;37:65–84.CrossRefGoogle Scholar
  11. 11.
    Endsley MR. The application of human factors to the development of expert systems for advanced cockpits. In Proceedings of the 7th international symposium on aviation psychology. Columbus: Ohio State University; 1987, p. 167–71.Google Scholar
  12. 12.
    Durso FT, Sethumadhavan A. Situation awareness: understanding dynamic environments. Hum Factors J Hum Factors Ergon Soc. 2008;50:442–50.CrossRefGoogle Scholar
  13. 13.
    Mehtsun WT, et al. Surgical never events in the United States. Surgery. 2013;153(4):465–72.CrossRefPubMedGoogle Scholar
  14. 14.
    Gaba DM, Howard SK, Small SD. Situation awareness in anesthesiology. Hum Factors J Hum Factors Ergon Soc. 1995;37:20–33.CrossRefGoogle Scholar
  15. 15.
    Flin R, Youngson G, Yule S. How do surgeons make intraoperative decisions? Qual Saf Health Care. 2007;16:235–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Gutzwiller RS, Clegg BA. The role of working memory in levels of situation awareness. J Cogn Eng Decis Mak. 2013;7(2):141–54.CrossRefGoogle Scholar
  17. 17.
    Durso FT, Sethumadhavan A. Situation awareness: understanding dynamic environments. Hum Factors J Hum Factors Ergon Soc. 2008;50:44.Google Scholar
  18. 18.
    Bedny G, Meister D. Theory of activity and situation awareness. Int J Cogn Ergon. 1999;3:63–72.CrossRefGoogle Scholar
  19. 19.
    Smith D. Introduction to aeronautical decision making (2002). Accessed 8 Oct 2009 from World Wide Web: ADM.Google Scholar
  20. 20.
    Aircare. An aviator’s guide to good decision making. Wellington: Aircare; 2006.Google Scholar
  21. 21.
    Gawande A. The checklist manifesto: how to get things right. New York: Metropolitan Books, Henry Holt and Company, LLC; 2009.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of SurgeryWestchester Medical Center, New York Medical CollegeValhallaUSA
  2. 2.Department of SurgeryUniversity of ArizonaTucsonUSA

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