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Securing Surgical Exposure – Schlüssel zur chirurgischen Exzellenz *
Prof. Dr. Pascal Probst, Spital Thurgau
Die chirurgische Weiterbildung steht und fällt mit der operativen Exposition. Fallzahlen sind keine abstrakte Kennzahl, sie sind die Grundlage für jede Form von Entwicklung in der Chirurgie. Kompetenz, Proficiency und letztlich Exzellenz entstehen nicht durch Beobachtung, sondern durch Tun. Jede Operation ist eine Prüfung – und eine Gelegenheit.
Doch gerade diese Gelegenheiten drohen knapper zu werden. Während administrative Anforderungen und Effizienzdruck steigen, wird es für junge Ärztinnen und Ärzte zunehmend schwieriger, im Operationssaal aktiv zu lernen. Der Fallpool schrumpft – nicht selten unbemerkt und schleichend – mit unmittelbaren Folgen für die Qualität unserer Weiterbildung [1].
Dazu kommt ein weiterer Aspekt: Auch erfahrene Kolleginnen und Kollegen stehen heute unter einem völlig neuen Lerndruck. Die Einführung robotischer Systeme bedeutet für viele Senior Surgeons einen erneuten Eintritt in eine Lernkurve – mit all den Unsicherheiten, dem Zeitaufwand und der Konzentration auf eigene Fertigkeiten, die damit verbunden sind. Das ist verständlich und verdient Anerkennung. Gleichzeitig führt es aber dazu, dass Operationen fürs Teaching wegfallen oder in höhere Hierarchiestufen verschoben werden. Die Robotik wird in diesem Kontext von jüngeren Kolleginnen und Kollegen oft als Feind erlebt.
Dabei ist es gerade in solchen Momenten entscheidend, sich an die zentrale Verantwortung der chirurgischen Weiterbildung zu erinnern. Wer operativ sicher ist, kann und soll lehren. Denn Lehre gefährdet nicht die Patientensicherheit – sie sichert sie langfristig[2]. Neue Technologien dürfen daher nicht exklusiv, sondern müssen integrativ gedacht werden: als Instrumente, die Ausbildung ermöglichen, nicht erschweren.
Ein weiterer Punkt betrifft die Haltung zur eigenen Entwicklung. Zu oft wird in der Chirurgie die Idee vermittelt, Exzellenz sei ein Zustand – dabei ist sie ein Prozess. Nur wer selbst bereit ist, sich weiterzuentwickeln, kann auch andere mitnehmen. Dazu gehört Planung, Zielorientierung und das aktive Schaffen von Lernmomenten. Bildungsqualität entsteht nicht zufällig – sie ist das Ergebnis bewusster Entscheidungen.
Abschliessend lässt sich sagen: Die Sicherung chirurgischer Exposition ist keine technische Frage. Sie ist eine Frage der Kultur, der Haltung und der strukturellen Organisation unseres Alltags. Wer chirurgische Exzellenz will, muss operative Weiterbildung ermöglichen – heute, nicht morgen!
Referenzen
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).
* Zusammenfassung des Vortrags vom Donnerstag 22.05.2025 am SCS Kongress in der 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.