5 Musicians and Surgeons: Artists United by their Craft

Introduction

The surgeon scrubs in, technicians and other staff in tow. IV drips are adjusted, heart monitors buzz, and the anesthesia team is busily reviewing the patient’s file, while the circulating technicians double check that all instruments are present. Meanwhile, in a concert hall next door, a soloist tunes their instrument backstage as the orchestra warms up onstage, and the conductor rifles through the score one last time. While these professions are unique in their own ways, there are many similarities between both how these professionals are trained, the neurological pathways behind their training, the environment in which they perform, and the communication used to master their craft.

The topic of this literature review is the similarities between musicians and surgeons in terms of training and characteristics of the field and environment. First, described will be some similarities between the musical environment and surgical environment. Second, discussed will be how these similarities affect the training that musicians and surgeons receive. Finally, the craftmanship behind both fields will be reviewed, as well as how communication is vital to not only acquiring skill but to maintaining it as well.

Training received by musicians and surgeons

There are many similarities between how musicians and surgeons train and the associated aspects that are related, including environments that are very stressful and focused on a goal, many years of practice and training, and intense anxiety during performance (Conrad, Lee, Rui, & Vauthey, 2018, p. 894). These similar aspects amongst the surgical and musical environments and the training that these professionals receive allow for developing strong communication skills that are essential to the success of a performance, be it surgical or musical. Music interventions in the operating room are essentially costless and are noninvasive, and motion analysis of microsurgical skill is both “objective and quantitative” and can be reproduced if necessary (Chattopadhyay et al., 2017, p. 245). Playing preferred music in the OR lowers autonomic reactivity, directly affecting skill (Chattopadhyay et al., 2017, p. 245). Music interventions improved the surgeons’ scores at all skill levels and amount of training (Chattopadhyay et al., 2017, p. 244). Just as with musical performances, lessened fatigue leads to a better performance, be it in music or surgery (Linos & Moris, 2013, p. 721). “’Aggregation of marginal gains’” is a notion that states any small improvement in any of the steps of a larger task can add up to a sizeable significant improvement in overall results and performance, thus any interventions that can maximize performance on a small scale will lead to a large contribution to the overall task later on (Chattopadhyay et al., 2017, p. 244). This research clearly proves that there are many advantages surgically to those who play music outside of operating, and how it can improve their skills. In a study that looked at how playing musical instruments affected microsurgical technique, playing musical instruments showed a lowered SAMS score (a scoring system that shows “objective assessment of tissue handling, efficiency of time and motion, instrument handling, flow of task and forward planning”) (Hachach-Haram, Masud, Moustaki, & Pari-Naz, 2017, p. 982). This same scoring report was also used to assess video game playing, which did not have as high a SAMS score as playing musical instruments (Hachach-Haram, et al., 2017, p. 983). There are many skills common to playing musical instruments and performing surgery, including integrating sensory and motor information, motor performance, high concentration and mental rotation, eye-hand coordination, and visualizing items spatially (Hachach-Haram, et al., 2017, p. 983). Those who have musical training have an advantage over those who have no musical training, in terms of surgical technique (Hachach-Haram, et al., 2017, p. 983-984). Surgeons must work in a field that is very small and filled with very delicate tissue, similar to the small areas that musicians have to operate their fingers upon (Hachach-Haram, et al., 2017, p. 983-984). In addition to this, complex cognitive functions are required for playing music just as they are for performing surgery, thus it can be hypothesized that music making has an advantage to those who perform microsurgery (Hachach-Haram, et al., 2017, p. 983-984). In fact, those who play music who are training to be surgeons have an advantage in their training compared to those who do not have musical abilities and experience, thus the musicians are anticipated to perform stronger microsurgical technique (Hachach-Haram, et al., 2017, p. 984).

There are many similarities with surgeons and musicians, including how they are trained and the environment in which they work. Surgeons work with surgical instruments and musicians work with musical instruments. Intense motor skills are required to increase performance in both areas. While they perform in similar capacities, there are many lessons that surgeons can learn from musicians that can improve their surgical training. For example, constant daily practice improves success, just how additional time away from practicing in the OR can increase mortality rates (Conrad, Lee, Rui, & Vauthey, 2018, p. 895). This time is referred to as temporal distance, and as it increases, it causes the “ability to recognize and address” emergency situations (Conrad et al., 2018, p. 895). A double standard appears as a result because a musician would not be advised to perform after returning from vacation without practicing right up until the performance, while a surgeon who returns from a trip would be allowed to operate as soon as they return, posing potential risks for patients’ lives (Conrad et al., 2018, p. 895). Another comparison is raised in dexterity; musicians, namely pianists, are often dexterous in both hands as training begins from a very early age, while the individual is still growing, thus asymmetry is less common in musicians (Conrad et al., 2018, p. 896). More research is needed on handedness in surgery in terms of how ambidexterity can benefit them (Conrad et al., 2018, p. 896). Furthermore, surgeons are not monitored while applying to surgical training programs, while musicians applying for positions in major orchestras must do routine live auditions to evaluate for “technical or performance skills” (Conrad et al., 2018, p. 896).

Training methods of surgeons and musicians impacting technique

There are many similarities in how music and surgery are performed, both physically and mentally. In fact, training hours in the United States are around 80 hours per week, some of the longest compared to other countries: 48 hours per week in Europe and 60 hours per week in New Zealand and Australia (Deshmukh, Kenny, & McCaskie, 2011, p. 463). McCaskie, Kenny, and Deshmukh (2011) state that “It is difficult to imagine any other fields of endeavor that require more precise and complex fine motor tasks to be performed under pressure than those of musicians and surgeons” (Deshmukh et al, 2011, p. 463). Motor performance is becoming increasingly prevalent in that it is being incorporated more and more into surgical training modalities, and one example of this is how musical skills are acquired (Deshmukh et al, 2011, p. 463). One key difference between surgical and musical training is that many musicians reach elite/expert status when they are young and their brains are still developing, a time when their brains have more plasticity, manifested in their increased dexterity, precise control of duration and force, and more independence in finger movements (Deshmukh et al, 2011, p. 463). Mirror neurons, used when the imitation method of learning is executed, are activated when an action is observed, thought of, expected, and conducted, proving that observation and mental practice, combined with physical practice, can be combined to increase knowledge and decrease training durations (Deshmukh et al, 2011, p. 464). The “law of effect”, defined as when associations are made between the instrumental response and the contextual stimuli, ensures that results are reinforced and installed into memory (Davis et al., 2015, p. 237). It is this law that enables surgeons and musicians to remember vital skills used daily in their tasks. Musical training can foster non-musical skill development just based on improving attention, executive function, language development, and visuospatial perception (Bradt et al., 2018, p. 1214). Since music puts large demands on combining circuits that work with both music and language, musical practice increases neural plasticity in pathways with speech processing (Bradt et al., 2018, p. 1216).

Furthermore, once a skill is learned, in order to maintain the level at which it is performed optimally, it needs to be practiced as frequently as possible under many different “environmental contingencies”; these include a rehearsal or performance, or simulation or live surgery (Deshmukh et al., 2011, p. 464). Achieving optimal performance is dependent upon three factors: maximizing correct responses, removing incorrect responses and encouraging transfer from practice/simulation to performance/actual surgery, and with practice, this can be done with the least amount of necessary cognitive load (Deshmukh et al., 2011, p. 464). It is because of this that surgeons and musicians are taught to train from the young age, and work to develop necessary skills that will help them in the future careers.

Professionals perform better at a task that amateurs are not able to do. This is often seen in both music and in surgery, where the professional can complete a more advanced surgery than an amateur or perform a very challenging piece that an amateur cannot play (Ericsson, 2004, p. 72). This is because the professionals possess a huge level of control over their task and can reproduce it with little to no deviations from the original (Ericsson, 2004, p. 72). It takes approximately ten years to become an expert at a skill or profession, further supporting the fact that experience is needed to obtain supreme performance levels (Ericsson, 2004, p. 72). In fact, hospitals of high volumes often have such large success rates because the surgeons performing the specific procedures are ones who do it very often (Ericsson, 2004, p. 75). Surgeons and musicians must train for a considerable amount of time, and even when they become professional, continuing education is essential to ensuring they are up to par with the newest surgical advancements and musical nuances.

The art of craftmanship

Additionally, craftmanship is one element that defines musicians and surgeons alike and is essential to the integrity of these fields. Music takes individuals out of their comfort zones and forces them to practice endless hours a day (Bower, 2017, p. 972). Many analogies between the craftsmanship of musical instruments and the art of surgery can be made – instruments have changed in terms of appearance, function, and design, similar to surgical ones, and refinements can be taken into account in order to fine tune the product (an example being bow strokes on an instrument and aortic endograft deployment) (Bower, 2017, p. 974). Surgeons, just like musicians, become masters of their art and enjoy sharing their knowledge with future aspiring artists (Bower, 2017, p. 974). There is only one chance, during the performance or the surgery, to make the correct result, because any mistake can be catastrophic, resulting in a myriad of medical issues or a botched musical performance (Bower, 2017, p. 974). Just as in music, the instruments used are unforgiving; the master must have such supreme excellence of their craft that they do not make mistakes, as they are the solo performer in their surgery or musical piece (Bower, 2017, p. 974). What truly makes great masters of their craft is their diligence and persistence in training and practice needed in order to become excellent (Bower, 2017, p. 977).

The art of communication

Just like surgery, music is a method of communication; a short, emergency surgery is akin to a 32-measure solo or cadenza, where all attention is on the performer and not a single mistake can be made (Martellucci, 2017, p. 13). While surgeons are the leader of their team, they are not the only one whose skill determines the patient’s outcome, thus communication and respect are critical to both mitigating errors but to collaborating to make the best possible outcome for the patient (Martellucci, 2017, p. 13). A similar comparison can be made to musicians in an ensemble, where listening to each instrument and reacting to their part allows for a successful performance, and no instrument or part can be ignored. Tasks like music and surgery require not only group refinement (classroom study or rehearsals) but also solitary practice (scales and arpeggios or anastomoses practice) (Kopiez, Lehmann, Platz, & Wolf, 2014). Not only is the skill important to their job, but the attitude these artists have toward their work as well, and this is what makes both fields unique. In both fields, there is no room for error, and this mastery is what brings satisfaction to both surgeons and musicians alike. The strict nature of both fields is unique in that they both hold the future of someone in their hands; how well a patient recovers is completely dependent on the skill and communication of the surgeon and their team, just as a musician’s abilities is what determines if the audience will enjoy the music and be impacted by it in a positive way.

 Conclusion

Future qualitative research may include obtaining data from more practitioners who are both musicians and surgeons so that they may weigh in on the similarities between the two fields from their own personal perspective, providing not only valuable insight but also potential additions to surgical and musical training programs. Conversely, data can also be analyzed from musicians who work in clinical areas in order to broaden the depth of research available from this viewpoint. Different types of similarities between various surgeries and various genres of music may also be analyzed in order to elaborate on further comparison. Just as with music, there are multiple ‘genres’ of surgery, which manifest themselves in the many different surgical specialties. Research may be conducted to see if any specialty has any close ties with one genre of music or another, and how the trainings of different types of musicians (classical, jazz, pop, etc.) vary amongst surgeons who are also musicians.

Additionally, there are many neural pathways that are shared amongst musicians and surgeons. Children who want to become professional musicians begin music lessons at a very early age, with exponential growth in practice, skill, and exposure to music ensuring that they will have a fruitful career in music in the future. One may then wonder if similar practice can be applied to children that want to be surgeons; if this is the case, there is potential for implementing specific skills in childhood that can assist in developing surgical skill as an adult.

Both listening to music and engaging in music making has proven to have many positive advantages on surgeons’ training and medical practice. Data shows that how musicians and surgeons are trained is very similar, and that these similarities can be used to increase the effectiveness, productivity, and strength of surgery. The environment in which musicians and surgeons perform is very similar in terms of amount of practice needed, performance anxiety, working in a small space with delicate instruments, and dexterity. Their training directly affects their performance, just as how long and how productive a musicians’ practices will directly determine the strength and quality of their musical performance. The amount of similarities between the surgical and musical environments has been fleshed out, and it is these similarities that unite the masters of two distinct yet united crafts: music and medicine.

References

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