Good to know
Securing Surgical Exposure – Key to surgical excellence *
Prof. Dr. Pascal Probst, Spital Thurgau
Surgical training stands and falls with surgical exposure. Case numbers are not abstract figures; they form the basis for every form of development in surgery. Competence, proficiency, and ultimately excellence do not come from observation, but from doing. Every operation is a test—and an opportunity.
However, these opportunities are becoming increasingly scarce. As administrative requirements and pressure to improve efficiency increase, it is becoming increasingly difficult for young doctors to actively learn in the operating room. The pool of cases is shrinking—often unnoticed and gradually—with immediate consequences for the quality of our continuing education [1].
There is another aspect to consider: even experienced colleagues are now under completely new pressure to learn. For many senior surgeons, the introduction of robotic systems means re-entering a learning curve—with all the uncertainties, time investment, and focus on their own skills that this entails. This is understandable and deserves recognition. At the same time, however, it means that operations for teaching purposes are being eliminated or shifted to higher hierarchical levels. In this context, robotics is often perceived as the enemy by younger colleagues.
In such moments, it is particularly important to remember the central responsibility of surgical training. Those who are confident in surgery can and should teach. Teaching does not jeopardize patient safety—it ensures it in the long term. New technologies should therefore not be viewed as exclusive, but rather as integrative: as tools that facilitate training rather than hinder it.
Another point concerns attitudes toward personal development. Too often in surgery, the idea is conveyed that excellence is a state—but it is actually a process. Only those who are willing to develop themselves can inspire others to do the same. This requires planning, goal orientation, and actively creating learning opportunities. Quality education does not happen by chance—it is the result of conscious decisions.
In conclusion, it can be said that ensuring surgical exposure is not a technical issue. It is a question of culture, attitude, and the structural organization of our everyday lives. If you want surgical excellence, you must enable further training in surgery—today, not tomorrow!
References
Grossen H et al. Future demand for visceral surgeons in Switzerland: an empirical study. Langenbecks Arch Surg. 2025 Aug 16;410(1):248.
2 Joana Rodrigues Ribeiro et al. The Influence of Surgical Teaching on Laparoscopic Cholecystectomy Outcomes: A Retrospective Propensity Score-Matched National Cohort Study. Under review.( 9.9.2025).
* Summary of the presentation given on Thursday, May 22, 2025, at the SCS Congress in the session: Guardians of the Scalpel: Securing excellence in surgical residency
BJS Session - Cultivating Excellence
A Fireside Chat with Ellen Petry Leanse and Dr. Rebecca Kraus
Recording of the «BJS Session - Cultivating Excellence» from the SCS Annual Meeting 2025.
Summary
Written by Ellen Petry Leanse and Dr. Rebecca Kraus
OPENING THE NOTHING BOX
Think about leadership – and life – and you’re actually thinking about the brain.
That theme was clear as Rebecca Kraus led a Fireside Chat with Ellen Petry Leanse, a Silicon Valley neuroscience educator and coach, at last week’s Swiss College of Surgeons Annual Meeting in Lausanne. Exploring themes like mindset, collaboration, and psychological safety, the conversation looked at ways of facing and preventing workplace conflict, harassment, hazing, and other unhealthy patterns, all through the lens of neuroscience.
“We explored how cognition is affected by emotional hijacks and the loss of psychological safety,” recalled Rebecca, President of the Swiss Society of Surgery. “Ellen showed how a sense of threat catalyzes a chemical reaction in the brain’s amygdala, reducing blood flow to the frontal regions of the cortex.
“This matters because those regions deliver some of our highest mental functions, including attention management, intentional thought, and impulse override. Clearly, these are functions every surgeon wants to reliably have available. Conditions that adversely affect emotions are always a concern. Yet in the case of surgical professions, they can actually create danger.”
Another focus of the talk was mutuality and the opportunity for people of different backgrounds, genders, or specialities to be better together. This led naturally to an exploration of the differences between female and male brains and how their different innate tendencies can lead to “better together” ways of working – in the presence, that is, of psychological safety.
That’s when Rebecca took Ellen by surprise with her own insights into neuroscience. She cited a video exploring the male brain’s gift of a “nothing box” – an allegorical term describing male brains’ ability to “shut down” into a quiet mode, a tendency Rebecca stated she wished she could access.
Ellen was quick to confirm that all healthy brains are more alike than they are different, yet acknowledged innate differences in how female and male brains prioritize and process information.
“Any healthy brain can learn and practice pretty much anything available to other brains,” she explained. “That said, the connection-oriented priorities of female brains might make a ‘Nothing Box’ less obviously available.”
Rebecca stated a wish to have easy access to a “Nothing Box,” a term used in the video to describe the male brain’s tendency to compartmentalize discrete information (in contrast to female brains’ tendency to connect information), or even to imagine what it might be like to have a quiet, still brain where “nothing” is going on.
Her perspective is consistent with comments made about the “Nothing Box” concept, including in this thoughtful piece:
“...women are never thinking about nothing. Women have anywhere from five to twenty-five thoughts going on at once, while men often have from zero to five thoughts going on at one time…men naturally compartmentalize their lives; whereas, for women, everything in their lives touches everything else.”
Excerpt from The Nothing Box, https://preengaged.com/the-nothing-box/
After exploring the “Nothing Box” concept, Ellen said, “When I viewed the video she sent and scouted the commentary around the concept, I was taken by surprise. Although I haven’t yet found research that substantiates a ‘Nothing’ state, it’s at least an excellent illustration for a significant difference in the functional orientation of female and male brains.
“Women’s brains tend to be both more connected, and connected in different ways, than male brains. That, and the functions of the more androgen-dominant left hemisphere, support a possibility that men compartmentalize information more than they interweave it, which is quite different from female brains. If only as a model for helping us understand one another better, I’m grateful to have learned about the concept from the conversation we shared.”
Rebecca added, “Sometimes it would be helpful for me – for all of us – to know how to simply sit in a chair thinking nothing, just being. Men can learn a lot from women, but women can gain a lot from practicing men´s ‘Nothing Box.’ I think all of us could benefit from this practice.”
Ellen, who has taught The Neuroscience of Creativity and Innovation at Stanford University and who leads workshops worldwide on brain-aware approaches to leadership and problem solving, has committed to writing a fuller analysis of the Nothing Box concept (and how anyone can activate it) for her LinkedIn newsletter, The Beacon.