# Lessons in Performing Under Pressure: Insights from a Pediatric Airway Surgeon

Certain medical professions are marked by life-and-death decisions, where the capacity to act resolutely under duress is pivotal for determining whether the result is a victory or a moment of regret. Dr. William O. Collins, a pediatric otolaryngologist and airway surgeon at the University of Florida, explores the hurdles, insights, and methods he has developed throughout his career to excel in these critical moments. His reflections, showcased on *The Podcast by KevinMD*, serve as both a beacon and a motivation for healthcare professionals facing the demands of their domains.

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## **Confronting Pressure: A Surgeon’s Viewpoint**

Dr. Collins shares experiences where keeping one’s composure transcends mere professional pride, emerging as an essential skill that has direct implications for patient lives. In pediatric airway surgery, emergencies frequently arise unexpectedly, necessitating not only technical expertise but also mental fortitude.

He shares how his approach has transformed over time, transitioning from emotional distress in early-career crises to a more clinical and concentrated outlook. “I really just focus on the task at hand,” Dr. Collins remarks, highlighting how channeling emotions and methodically addressing each issue has enabled him to respond more adeptly to emergencies through the years.

One high-pressure scenario he describes is an EXIT procedure (*Ex Utero Intrapartum Treatment*), wherein surgeons establish an airway for a newborn while the infant remains connected to the placenta. Dr. Collins’s ability to maintain composure and analytical thinking during such interventions has not only preserved lives but has also inspired others to approach pressure proactively.

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## **Insights on Thriving in Critical Situations**

Dr. Collins shares several techniques for preparing for and succeeding in stressful environments. These insights, drawn from personal experience, have broader relevance for medical practitioners:

### **1. The Importance of Preparation**
Preparation is crucial, regardless of whether the emergency is anticipated or spontaneous. For planned and elective cases, thorough communication with anesthesiologists and surgical teams is necessary to formulate a plan, ensure all required tools are available, and mentally rehearse potential complications. In addition to technical effectiveness, Dr. Collins keeps meticulous records of past complex cases, considering what has been effective and what has not.

**Takeaway:** Establishing a routine of documentation and reflection enriches learning, particularly for newer practitioners, by providing insights that textbooks alone cannot offer.

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### **2. Experience is Essential**
“There are no shortcuts,” asserts Dr. Collins. He underlines that skill in managing high-pressure situations originates not from merely reading or attending lectures but from encountering these moments firsthand. With time, repeated interaction with stressful conditions enhances both technical proficiency and mental acuity.

Less experienced practitioners may at times feel inundated, but every challenging situation contributes to a deepening pool of knowledge and tranquility. Even failures, though painful, become invaluable learning experiences. Dr. Collins recalls a harrowing early-career incident where a patient was lost during surgery. While it was heartbreaking, the lessons gained have been instrumental in saving many future lives and underscored the vital necessity of resilience in a surgeon’s journey.

**Takeaway:** Gain experience isn’t about dodging mistakes—it’s centered on learning from them. Each tough case expands a collection of insights for achieving future success.

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### **3. Confronting the Fear of Failure**
The psychological burden of failure can be paralyzing, especially in a profession where failure can signify the loss of life. Dr. Collins stresses the necessity of overcoming the fear of failure, identifying it as a pivotal point in his career. Releasing this fear enabled him to think more lucidly and focus on addressing the immediate issue instead of being hindered by hypothetical worst-case scenarios.

By distinguishing the task from emotional influences—such as concerns about lawsuits, parental dissatisfaction, or personal performance—Dr. Collins illustrates that triumph hinges on concentrating solely on the present moment.

**Takeaway:** Liberating yourself from fear isn’t synonymous with apathy; it involves concentrating on concrete actions rather than succumbing to anxiety.

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### **4. Practice and Simulate Under Pressure**
While athletes and astronauts dedicate extensive hours to training for high-stress moments, Dr. Collins expresses concern about the deficiency of similar structured preparation in medicine. Much of medical practice outside of residency or educational programs happens on the job, allowing minimal time for simulated crises or focused mental training.

Promoting simulated scenarios, especially for novice surgeons, could mitigate the tension experienced in unpredictable situations. Techniques such as visualization, widely utilized by elite sports professionals, remain under-exploited yet could provide a bridge between preparation and confidence.

**Takeaway:** Even if formal simulation opportunities are lacking, practitioners can independently learn techniques like visualization and seek mentorship to review and analyze cases to enhance instinctual responses.

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### **5. Collaborative Decision-Making and Mental Approach**
Dr. Collins underscores the significance of cooperative decision-making with