Lessons from flight instructors illustrate the value of 'preflight' and 'postflight' checks

ByJohn D. Kelly IV, MD

Several years ago I attended an American Academy of Orthopaedic Surgeons lecture given by a military flight instructor. He compared preparation for flying missions to the preparation needed for surgery. I cannot think of a lecture that has more profoundly affected my approach to surgical preparation. Indeed, orthopedic surgeons can learn a great deal from fighter pilots.

Preflight check

I had no idea how involved and detailed an actual preflight check was before a combat mission. Before takeoff, the pilot goes through a rigorous checklist to ensure the safety and success of the flight. Instruments are checked and rechecked. Weather, route, fuel, airport and plane worthiness are all accounted for. The safety algorithm leaves no stone unturned and is well worth the time expended. The lives of the crew and the well-being of the plane are at stake.

We can apply this same principle to the operating room (OR). Discuss the case with the team and go over the steps in detail so they know what to expect. Go to the back table before the case commences and be certain that every instrument you are certain to use is already present and instruments you may use are already in the room.

This drill may sound like overkill, but believe me – it will save hours in the long run.

Postflight check

After a mission, the flight crew convenes and simply goes over the mission detailing what went well and, more importantly, areas in need of improvement. This exercise promotes continual streamlining of crew performance. There is always something to be learned in each mission.

Similarly, in an effort to enrich surgical performance, orthopedic surgeons are obliged to spend a few minutes with OR staff and to not only thank them for their efforts, but also render feedback on areas that did not go so smoothly. Importantly, listen to the staff and solicit their opinions about how to execute the case more effectively. Legendary joint surgeon Robert E. Booth, MD, has been known to offer a free dinner to any staff member who offers successful ideas to improve surgical efficiency.

Write it down

I have compiled a computer file for every surgical technique I perform. For example, in my “ACL Reconstruction” file, I write the steps I envision will be the most fluid and productive. When my “preflight” and “postflight” checks reveal an insight or I learn a new step or “trick,” I make an edit to the file. The mere act of writing consolidates my thinking and helps the steps to become more hardwired.

The constant quest for improvement can make our most wonderful of occupations even more exciting and challenging. I hope readers incorporate the lessons learned from the courageous fighter pilots who preserve our freedom. Good luck on your next surgical “mission.”