On today’s episode we’re focusing on mindset skills, emotional regulation and mental toughness and feel that orthopedic surgery with Dr. Winston Gwathmey, an orthopedic surgeon at UVA.

We start off our discussion today with an article from the September 2022 issue of the Journal of Surgical Research titled “Emotional Regulation in Surgery: Fostering Well-Being, Performance, and Leadership.” This article reviews the critical role of emotional regulation as a trainable cognitive skill that enhances surgical well-being, technical performance, and career longevity. It highlights how burnout and stress are pervasive in surgery and argues that individual-level emotional regulation training—paired with necessary system-level changes—can help surgeons cope with the inherent stressors of operative practice, complications, and high-stakes decision-making.

Through multiple institutional case studies, the paper illustrates practical strategies for implementing emotional regulation curricula within surgical training, including mindfulness-based programs, mental skills training, and broader well-being initiatives. Across all examples, successful adoption hinges on leadership support, stakeholder buy-in, iterative design, and embedding training into existing educational infrastructure. Ultimately, the authors advocate for an integrated national curriculum that combines cognitive skills training, application to technical performance, and preparation for independent practice to promote surgeon resilience and sustainable careers.

Then, from the July 2021 issue of the Journal of Surgical Research, we review an article titled “Mastering Stress: Mental Skills and Emotional Regulation for Surgical Performance and Life.” This article reviews how mental skills training and emotional regulation can enhance surgeons’ technical performance, well-being, and career longevity by mitigating the negative effects of stress. It explains the physiological and cognitive mechanisms of stress and highlights how chronic stress impairs decision-making and increases burnout. The authors present evidence that mindfulness, cognitive training, and mental rehearsal improve surgical skill acquisition, stress resilience, executive function, and performance under pressure.

The authors go on to outline common elements of successful programs. They also discuss barriers to implementation and propose a framework for integrating mental skills training across surgical education from basic instruction to independent practice. They ultimately advocate for the development of a national mental skills curriculum to promote surgeon well-being, reduce errors, strengthen leadership and teamwork, and improve patient and systems-level outcomes.

We are joined today by Dr. Winston Gwathmey, a board-certified orthopedic surgeon and a Professor of orthopedic surgery at the University of Virginia. He is the Medical Director for the Sports Medicine Clinic at UVA and is also one of the team physicians for both UVA and James Madison University. Dr. Gwathmey is the Program Director for the Orthopedic Surgery Residency Program at UVA and is very passionate about educating the next generation of orthopedic surgeons. He has won numerous teaching awards including the Mulholland Teaching award, the Charles W. Miller Resident Teaching award, and the Dean’s Award for Excellence in Medical Student Teaching. So, we’re very excited to have him on today to talk about this important topic.

158: Dr. Winston Gwathmey – Mindset in Surgery (Part I)