What Otolaryngologists Can Learn from Athletes

Visualization is a tool elite athletes commonly use to support their performance. Before a race, meet, or competition, they imagine the event (and their actions) in great detail. They engage in mental rehearsal, repeatedly imagining and envisioning success. This practice both boosts their confidence and improves their physical performance, with published research showing that internalized rehearsal may strengthen the cognitive and motor circuits associated with the imagined actions (Open Neuroimag J. doi: 10.2174/1874440000802010005).

A recent randomized trial of surgical trainees found that mental rehearsal improved laparoscopic knot-tying precision and reduced leaks, with neuroimaging suggesting the gains were driven by reduced reliance on conscious executive control and more efficient activation of motor cortex networks (Front Hum Neurosci. doi: 10.3389/fnhum.2024.1386005). The trainees assigned to mental rehearsal were given a standardized mental imagery script to follow, one that walked them through the exact steps of suturing and instructed them to imagine instrument positioning and hand movements, as well as how the task might feel.

That kind of specificity is key to effective visualization, said Madison Martins, PsyD, a licensed clinical and sports psychologist (and former D1 equestrian).

“When many people think of visualization, they often just think of sight,” she said. “But in order to really activate the same parts of the brain as motor execution, we want to build in as many senses as possible—all five, if possible.”

Surgeons should think about what they see, hear, and feel in the OR. Dr. Martins recommends thinking through an entire procedure and considering variables as the case progresses. “You might feel fresh at first, but your legs might feel a bit more fatigued halfway through,” she said. “So, how do you then focus your attention on the helpful, right thing instead of drawing attention to that fatigue and making it worse?”

Detailed mental rehearsal allows athletes and surgeons to anticipate, prepare for, and practice responses to difficult moments—particularly when paired with regular, deliberate practice of relaxation and mindfulness techniques, which regulate the stress response, preserve attentional control, and support precise motor execution under pressure.

“It’s teaching not only mastery of the technique or strategy, but also the management of stress and how to operate through it,” Dr. Martins said.

Focus Under Pressure

A regular meditation or mindfulness practice can also enhance surgeons’ (and athletes’) ability to remain calm in challenging circumstances. Dr. Miller said he used meditation as part of his triathlon and surgical preparation, often listening to meditations (using one of the many available meditation apps) during his 30-minute walk to and from work. Now, he meditates about once a week.