You have more in common with Olympic athletes than you think. You're both highly trained and do physically and mentally demanding work. You may not be performing for billions of viewers, but your stakes are higher, sometimes life or death.
How do Olympians deal? They work with top sports psychologists to build mental skills for high-stress moments — and their techniques work. Those same techniques can help you perform at your peak, too.
"There's a lot we can learn, and have learned, from how they approach performance optimization in elite sports," said Dimitrios Stefanidis, MD, PhD, a professor of surgery at Indiana University School of Medicine, Indianapolis.
We spoke to several experts, including sports psychologists who work with Olympic athletes, to find out what mental techniques can help physicians perform their best under pressure, too.
Off-Hours Training
- Try a "control" exercise. Grab a pen and paper, and try this exercise right now: Draw a small circle, and inside it write down the things you can control about your work, such as your attitude, effort, preparation, actions, and mindset, said Alan Chu, PhD, a sport psychology professor at the University of North Carolina at Greensboro and a member of the US Olympic & Paralympic Committee's mental performance registry.
Draw a bigger circle around the first one and fill it with what you can influence, like communication with your team (where you can choose your words but not the response). Finally, draw a third, even bigger circle around the first two. "The outer circle is the one that is most important to realize — the things that you cannot control," Chu said. For athletes, that might be the weather or referees. For you, it could be your patient's medical history or their insurance requirements.
Take a picture and revisit it before big procedures, practicing Chu's "three f-words" (no, not that f-word): Focus on controlling what you can, forgive yourself when something you influence goes wrong, and forget the things you can't control. Over time, this will become automatic, just as dribbling does for a soccer player or auscultation does for a doctor.
- Argue with yourself on behalf of yourself. Like an elite athlete, you're a high achiever — so you may tend to be hard on yourself. Positive self-talk can help you manage difficult moments, but it takes practice, said sports psychologist Christopher Stanley, PhD, lead psychology performance consultant for USA Track & Field for the 2024 Paris Olympic Games.
Stanley asks athletes to journal daily. When they doubt themselves, he has them log evidence to the contrary. If a sprinter ran slower than normal 1 day, that doesn't mean they aren't fast — they have plenty of counterexamples from practice. "When we get to that critical performance space, in the hours or minutes leading up to a competition, we have spent time refuting these things," Stanley said.
Preperformance Routine
- Engage your "imaginary" senses. Before a match, Chu's tennis players do a 15-minute visualization where they smell the court (clay courts in Paris), hear the hum of the crowd, and mentally rehearse serves and shots. "I will have the athlete imagine that multiple times," Chu said. "They get the reps mentally in their mind, so they're more likely to replicate them in the actual match."
That might sound like pseudo-science, but research backs it up: Brain studies suggest that imagining a task activates similar brain regions as actually doing the task. That could explain why mental imagery may activate and strengthen motor neural connections, helping your brain build a "motor plan" to produce certain actions, like flexing your muscles or pinching your fingers.
Stefanidis uses the technique before complex or challenging operations. "I will play the procedure in my head, how it will unfold, before I do the surgery," he said. He also considers how he might respond to bleeding or other complications. This helps build cognitive flexibility, the ability to adjust to changing or unplanned scenarios.
Mental imagery "is an important method to learn, practice, and improve specific physical skills," said psychologist Michael J. Asken, PhD, Senior Organizational Performance Consultant in the Department of Surgery at University of Pittsburgh Medical Center (UPMC) Pinnacle Hospitals, Harrisburg , Pennsylvania. "It is especially important for preparing to respond effectively in surgical emergencies."
Focus on all five senses and use a first-person perspective (as if you're doing the procedure, not watching it). And keep doing it. Practice will help you get better at this, said Asken.
- Break down tasks into cues. This is called cue utilization — "a way of simplifying more complex tasks," Stanley said. You can use these cues to refocus and redirect yourself in challenging moments.
A marathoner might pick the midpoint of a race or the moment they catch up with a competitor. A javelin thrower might anchor to the feeling in their muscles during each of three phases: Run, prepare, and throw. Focusing on cues can help you filter out distractions, Stanley said.
It works for hands-on medical procedures, too. "We break down a procedure into specific steps, and we focus the attention on the specific steps," said Stefanidis. "You go to that step if you find yourself lost."
- Protect your energy. Athletes want to please their fans. Physicians want to help their patients. But if you need some quiet time before a demanding endeavor, like an overbooked day of appointments, take it.
"It is okay to protect your own space in those moments," Stanley said. Athletes sometimes feel awkward or rude about ignoring family members, training partners, or competitors before a competition. "Give yourself permission to protect that space," Stanley said, "because no one else will necessarily be there to do that."
In-the-Moment Tactics
- Be a goldfish. When athletes focus on winning instead of the game, their performance can suffer. "When you focus on the past or the future, you tend to feel more pressure," Chu said.
To stay in the moment, borrow a trick from the popular TV show Ted Lasso: Be a goldfish with a 10-second memory. Many of the athletes Chu works with (especially fans of the Apple TV+ comedy) say the word "goldfish" — literally, out loud — to remind themselves to forget what just happened and keep moving.
Another option: Pick any word or image that works for you and say or imagine it every time you need to focus. "If I've conditioned myself every time I think of a palm tree to relax or forget about negative thoughts, then that's likely to bring me to a point where I'm just focused on what I'm doing," said Stefanidis.
- WIN after a setback. After an unexpected problem or mistake, ask yourself WIN: What's important now? (This technique is often credited to former Notre Dame coach Lou Holtz.)
"What's most important now is probably not beating myself up, not [continuing to get] frustrated," said Chu. "Because if I keep getting frustrated, it's not helpful for my motivation, for my career, for my performance."
And it's not helpful for your patient, either. "There are situations where you find yourself in uncharted territory because all humans are not the same," said Stefanidis. "There's variability in anatomy; there's variability in conditions…something goes wrong."
In those moments, Stefanidis thinks I need to concentrate on fixing the problem. Now everything else is irrelevant.
Postgame Analysis
- Review your performance. Athletes watch postgame tape to identify opportunities for improvement. Physicians can do the same with video-based coaching.
Video-based coaching — when a highly experienced colleague reviews footage of your work and provides constructive feedback on, say, surgical technique or patient communication — is more common for residents but is also gaining popularity for advanced professional growth and continuing education.
The American Board of Medical Specialties has recommended it for practicing surgeons. And research suggests it may be valuable for other specialties as well, as a way to help improve clinician's communication skills.
Your "coach" might say, "I use my stapler this way [instead of the way you're using it] because I find that this helps me to do the task better," Stefanidis said. "And maybe I, if I'm the receiver of the feedback, I'm thinking: Oh, maybe I'll try that next time when I do this and see if it works better for me, too."
Check if your institution offers this education technique.
- Access your environment. Mindset techniques can help you a lot, but they can't change your environment.
"A lot of times, we will think about the responsibility of the individual to handle setbacks, to handle pressure, to have a good attitude," said Chu. But "the environment impacts you."
Consider a value "alignment check," said Chu. List your top five core values (maybe compassion, leadership, joy, or wealth). For each value, rate how fulfilled it is on a scale of 1-10. Then, envision how that might change if you switched teams or employers.
"If the alignment looks better in a different environment, understand what it would take to change the environment and any drawback that comes with that," he said.
A change in environment may help you depressurize more than any solo technique could.