Surgeons and Pilots: What Do We Have in Common?

Pilots undergo thorough training to fly commercially or privately. However, this training cannot always predict who will make errors and who will effectively handle emergencies. Several factors play a role in how these situations are handled, including communication with other personnel, the technical skill and mental state of the pilot, and external factors such as the weather. Extensive training is crucial so that in an emergency, the pilot can focus solely on the current situation rather than basic procedures. Still major errors or so called “human errors” are attributed to major catastrophes in aviation, for both commercial and private airplanes, whereas in surgery, we attribute “technical errors”, “error in judgment” to surgeons, and it is not uncommon to mix the outcomes with “patients’ disease” as major attribution to bad outcome. Imagine, if the pilots fly really old airplanes, with no updated software or hardware, likewise surgeons operate in the geriatric population which has, in addition to being old, several comorbidities. And we surgeons do this day in and day out, while pilots operate in airplanes that even if they are old, have updated engines and sophisticated software. Yet, performing complex surgery is similar to flying a plane in that both require extensive training, which can be challenging. Surgery can be dangerous and time-sensitive, and success depends not only on the surgeon’s technical skills but also on other factors. Both professions share common features and this chapter aims to explore the similarities and differences in decision-making between pilots and surgeons, focusing on situational awareness and sense-making. These concepts can help us understand the process of making dynamic decisions in high-pressure jobs.