July 10, 2023
The moment comes and goes in a flash. First, gymnast Lise Leveille is standing in one corner of a huge blue exercise mat, pulling her posture straight and taking a deep breath; then she runs a few steps, backflips, and launches herself into a triple twist. In a wordless 3 seconds, the tumbling pass explains why she was at the 2000 Olympics in Sydney, Australia, as part of the Canadian national gymnastics team.1
Twenty-three years later, Lise Leveille, MD, MHSc, PhD, FRCSC, now a pediatric orthopaedic surgeon at British Columbia Children’s Hospital in Vancouver, Canada, said her time in top-level gymnastics has clear connections to her work as a surgeon: “I see it and feel it so much in my surgical career. Learning to become a surgeon is like training to be an elite athlete.”
The idea that a surgeon’s career can be positively shaped by the attributes or habits of high-level sportspeople is not confined to the rare elite athletes at work in the operating room. Rather, this idea has turned up in op-eds in surgery journals,2 a named lecture at Clinical Congress,3 even randomized clinical trials.4,5 Collectively, these articles and personal experiences suggest there are specific approaches to sports achievement that doctors, athletic and not so athletic, can borrow to improve and maintain their surgical performance.
Dr. James Bradley has been the head surgeon of the Pittsburgh Steelers for more than 30 years.
But are the habits of elite sportspeople truly exportable to the operating room? What elements of the elite athletes’ experience can improve the daily clinical work of surgeons who lack athletic experience?
Beyond the op-eds and peer-reviewed studies are the insights of two National Football League players, a New York City Ballet dancer, and Olympic gymnast Dr. Leveille—all of whom have developed thriving careers in surgery since leaving their athletic days behind.
In addition, there are the thoughts of an icon of the dance world, Wendy Whelan, who underwent hip surgery—an operation shown in a documentary on her life, “Restless Creature”6—shortly before retiring from New York City Ballet, where she had an incredible 30-year career as a dancer. She has since transitioned to her new role as Associate Artistic Director of New York City Ballet, as well as a teacher and repertory coach.
Dr. Lise Leveille, now a pediatric orthopaedic surgeon at British Columbia Children’s Hospital, was part of the Stanford University gymnastics team after the 2000 Summer Olympics in Sydney, Australia. (Credit: Stanford Athletics)
John E. Frank, MD, and James P. Bradley, MD, have both lived lives deeply immersed in athletic pursuits.
Dr. Frank was drafted by the San Francisco 49ers in 1984, at age 23, just after earning acceptance to several medical schools. He completed his first year as a medical student at his undergraduate alma mater, The Ohio State University in Columbus, during the offseason, after helping his team defeat the Miami Dolphins in Superbowl XIX.
After another 4 years in the NFL—and a second turn at the Superbowl, this time helping the 49ers conquer the Cincinnati Bengals—Dr. Frank announced his retirement from football. His decision was motivated in part by a lasting concern with the “matter-of-factness” with which the NFL addressed players’ injuries.
Thirty-four years later, Dr. Frank is a private-practice hair transplant surgeon in New York, New York, and Columbus, Ohio. His relationship with football is complex. He described his early life in the sport as “rigorous and focused on one hand, but also naïve and sheltered on the other,” and the aftermath of his athletic career as “a tremendous void,” akin to that of a soldier returned from war. Nonetheless, he has assiduously moved on from football since leaving professional play.7
In contrast, Dr. Bradley has never left football behind. A one-time Penn State All-American who was drafted by the Cincinnati Bengals, Dr. Bradley has been the head surgeon of the Pittsburgh Steelers for 32 years.
From his childhood in a family in which “athletics were everything,” to his thriving orthopaedic surgery practice serving athletes of all sports, skill levels, and ages, he remains thoroughly dedicated to sports and caring for sports medicine patients.
Whatever their contrasts, the two surgeons can both testify to the positive influence of sports. Dr. Bradley’s lifelong dedication implies what Dr. Frank stated outright: “The camaraderie, the hard work, the dedication, the teamwork, the self-sacrifice of being part of a team—all these things were tremendous values that I was drinking through a firehose and still to this day live my life by.”
His thoughts echoed those of Dr. Leveille and Likolani Brown Arthurs, MD, a former ballet dancer and current general surgery resident. All four cited the rigor of their athletic careers as a transformative force that began early in their lives and continued to shape them long after their elite play ended. And they all said that surgeons without any particular athletic achievement or interest can benefit from the insights that sports have brought them.
After a 30-year career as a dancer with the New York City Ballet, Wendy Whelan is now the Associate Artistic Director of the dance company.
For Dr. Arthurs, professional dance, although not a competitive sport per se, was an athletic pursuit: “I remember my doctors saying that dancers had the same injuries as the other professional athletes they treated, which rang true, as we go through the same level of rigorous training, both mentally and physically.”
Dr. Arthurs joined the New York City Ballet after high school and stayed a member of the corps de ballet for 15 years, completing her undergraduate degree part-time while dancing professionally.
Now in her first year of a general surgery residency at NYU Langone in New York City, she said her dance career compares well to her present one: “I feel that the rigorous nature of my previous career, having to go in every day, have a practice that you sort of work on endlessly and try to reach that perfection, is something that really does carry well into the life of a surgeon.”
That said, the two careers differ. For example, dance involved a persistent emphasis on practice, even during periods of intensive performance: “You are constantly practicing even when you are performing. For ballet, you go in and have a ballet class. Even prima ballerinas go in and have a class every day.”
In contrast, Dr. Arthurs noted, her residency offers “some practical labs,” but with less frequency than ballet’s skill-focused practice sessions. Adding more labs, she said, “would be very beneficial for us, especially for first-year residents. I felt that in dance you got better by doing the same thing every day.”
Dr. Frank noted the same approach was present in football: “The drill work, the repetitive action, those are extremely valuable. It was this mantra of reps, reps, repetition. The repetitive maneuvers—I think of the technical skills of surgery.”
However, a sport can permit repetition in a way that surgery may not. Dr. Leveille noted: “You’re not allowed to do 50 in a row, like an athlete could, because that many patients won’t present with a specific problem at one time. It’s almost harder, because you don’t have access to the unlimited repetition that is crucial for skill development.”
Indeed, academic literature reflects efforts to transcend that exact problem. Of all possible sports-to-surgery insights, deliberate practice may be the most well-studied. Myriad research, including randomized clinical trials,4,5 have shown that when surgeons in training complete deliberate practice designed to allow for unlimited repetition (often through virtual or augmented reality, simulation, and task trainers), they can outperform those with standard, OR-based training only. While long-lasting improvement and effects on patient outcomes are less well-documented,8 findings suggest that adding habitual deliberate practice to surgeons’ training or daily routines is likely valuable.
Dr. John Frank had a 5-year pro career with the San Francisco 49ers before finishing medical school and becoming a hair restoration surgeon.
The idea that surgeons should have coaches may have first been popularized by general and endocrine surgeon Atul A. Gawande, MD, MPH, FACS, who wrote in a 2011 New Yorker article, “I’d paid to have a kid just out of college look at my [tennis] serve. So why did I find it inconceivable to pay someone to come into my operating room and coach me on my surgical technique?”9
Coaching has shown up in many articles since then. In a 2021 op-ed,1 Richard Tapper, MMedSci, FRACS, a one-time Olympic swimmer who now practices colorectal surgery in New Zealand, prompted readers to imagine a newly recruited professional athlete being asked to work as surgeons do: “You show up to the grounds on the first day only to find out your team has no coach. ‘We think you are good to go,’ the management says. ‘You’ve reached the top and don’t need further coaching. You can organize yourselves, decide which position you play and what the plays are. Oh, and by the way, there are no practices, just show up on Saturday and give it your best.’ This sounds ridiculous, but this is pretty much what we do in surgery.”
While “ridiculous” is not how the surgeon-athletes interviewed for this article described an absence of coaching, all four endorsed coaching as valuable. Each could name multiple individuals who had offered support in both their athletic and surgical careers.
Dr. Arthurs said her current mentor has been a “constant champion for me” and uses an approach similar to coaching: “She wants you to come up with a plan and talk through it, even as an intern. She will educate even about the small things, like how to hold the scalpel.”
Dr. Frank added: “I wish there were more coaches, because the athletic coaches were there to support in difficult times. They were there if you weren’t performing or weren’t being recognized for your performances. I don’t know if that’s as readily available in medical education.”
As the idea of coaching has spread, a body of research has emerged on this, too, including several systematic reviews and meta-analyses.10-13 In general, they have reported that coaching can be objectively helpful to surgeons in training who are working on new skills. The consistently positive findings, despite variable coaching techniques, end points, and specific measurements in different studies, hint at the same insight that surgeons consistently endorse: coaching can be powerfully beneficial.
Whelan, the famed New York City Ballet ballerina turned Associate Artistic Director (who said of the labral tear repair surgery shown in her documentary,6 “It’s my favorite part of the film.”), did not describe coaching primarily as a skill-building effort. Rather, she emphasized improving career longevity by emphasizing continuous development and a positive attitude: “In coaching and being coached, there’s an openness to change and growth. And when you coach someone, you help them grow. Openness, positivity—those are the two things that I have found for myself were my best tools to keep my longevity going. When I can hone that in other people, I feel I’ve given them something valuable.”
Within the surgical profession, the practice is increasing in popularity and accessibility. Dr. Bradley noted that some surgical societies now offer coaching services. (The ACS supports the practice and has published further information on coaching approaches.14)
Dr. Bradley explained, “They will bring someone in to watch you operate and coach you along. Usually, the people who take them are when they’re first coming out” of school or residency.
“I know more and more surgeons who have coaches,” Dr. Leveille said.
Dr. Likolani Brown Arthurs spent 15 years dancing with the New York City Ballet. Now, she’s a general surgery resident at NYU Langone.
Beyond the technical skills necessary for specific procedures, three surgeon-athletes each suggested the same areas that they had learned through athletics and that coaching and deliberate practice might help all surgeons improve: hand-eye coordination and awareness of three-dimensional space.
Dr. Arthurs noted that her athletic background first gave her a boost as an organic chemistry student: “It was way easier for me to understand molecules in a 3-D space, from moving and dancing. I think it’s easier for me to conceptualize the surgery now.”
According to Dr. Bradley, “To be a surgeon, you have to think in 3-D. Someone with hand-eye coordination, you can make into a pretty good surgeon.”
Dr. Leveille said that athleticism was just one route to enhance these abilities, and experience with video games or carpentry might enhance the same hand-eye and visuospatial skills—and noted surgical residents without such backgrounds could learn them in the OR: “I think that you can get there, and it just takes a little more time and effort, just like an athlete. I think everyone has the ability to improve with repetitions and pattern recognition.”
Of course, when talking to former elite athletes, it is to be expected that their insights include thoughts on how physical well-being connects to other endeavors.
“I see a lot of unhealthy behaviors in surgery, in terms of the easy things: diet, regular sleep. As someone who wants to perform at an elite level, that should be built in,” said Dr. Arthurs.
Dr. Frank said that adding exercise to one’s routine can offer mental benefits as well. “I think beyond the physical benefits you get from exercising and from nutrition—that’s got to be part of the equation as well—I just think it’s the meditative effects that exercise and sports have on anyone. The opportunity to let everything else go and work on movement—I think that is the most powerful value of athletics that I can imagine. And I think that some of those things are reproducible with just meditation and deep breathing and just shutting down for a few minutes.”
Whelan noted a possible upside to exercise for surgeons serving athletes as patients. “For a doctor to push their body to another level in any kind of physical form is going to benefit them knowing how to work with an athlete or a physical artist. Feeling the elation that you get from exerting yourself is almost enough to give you more connection to that patient,” she said.
Ultimately, Dr. Leveille said, emulating a great athlete does not mean having to become one. Rather, she says, excellence of the kind she achieved in sports comes from passion.
“If you ask anyone who becomes an Olympian or reaches some elite level in their sport, they probably loved it. And because they loved it, they worked really hard at it. They spent time becoming excellent. I don’t think you have to have this prior experience. You just have to be matched in your interest and passion for something and then make sure you’re exercising your work ethic and apply yourself. I think those are the two most important ingredients of the recipe,” she shared.
It is a recipe she is still using. Eight years into her clinical career, Dr. Leveille said surgery is just as exciting to her as gymnastics once was.
"Sometimes a rare and challenging case comes along, and you spend hours preparing and planning," she said. "On the day of the surgery, you are a little nervous and excited. You walk into the operating room knowing you are well-prepared, and everything comes together beautifully—that high, after finishing the case and being pumped about how it went, is just like nailing a beam routine at the Olympics. I get the same thrill as a surgeon as I did as an athlete.”
M. Sophia Newman is the Medical Writer and Speechwriter in the ACS Division of Integrated Communications in Chicago, IL.