Surgery, like space travel, requires both technical and behavioral competency

David R. Williams, OC, OONT, MSc, MD, CM, FRCS

David R. Williams, OC, OONT, MSc, MD, CM, FRCS, a retired Canadian Space Agency astronaut and now president and chief executive officer, Southlake Regional Health Centre, Newmarket, ON, described the caliber of previous Martin Memorial lecturers as “out of this world” and said he was “pleased to be in that company.” Dr. Williams delivered the 2017 Martin Memorial Lecture, Personal Best: Reflections of a PhysicianAstronaut on Leadership and Teamwork, immediately following the Opening Ceremony on Monday.

Dr. Williams is one of the NASA (National Aeronautics and Space Administration) space program’s most accomplished astronauts, setting records in spacewalking,” said American College of Surgeons Regent Anthony Atala, MD,FACS, who introduced Dr. Williams. “The veteran of two space shuttle missions, he has logged more than 687hours in space, including three spacewalks, the highest number of spacewalks ever performed in a single mission. His work with NASA also continued on the ground when the space agency appointed him as Director of the Space and Life Sciences Directorate, making Dr. Williams the first non-American to hold a senior management position.

From space, you can see there are no boundaries separating countries,” said Dr.Williams, drawing a parallel to the ultimate goal of health care—providing high-quality care to all patients in need.

In space, as in surgery, the ability to meet the challenges of unexpected events is key, according to Dr. Williams. He described a mission aboard the space shuttle Endeavour where a heat shield tile was damaged during lift off, exposing a potentially vulnerable layer of aluminum. “We weren’t sure if we had to repair it or not,” Dr. Williams said. “The aluminum would be exposed to 300-degree heat during re-entry, but we knew we would be okay because aluminum pizza pans survive [at that temperature].”

The experience underscores the importance of remaining calm under pressure, but it also is an example of something else physicians should keep in mind when disseminating technical or complex information to others: “that we have to make data understandable,” he said.

Spaceflight and surgery “require a high level of technical competency, but they also require behavioral competency,” Dr. Williams said, including the ability to prevent a single error from initiating “a cascade of errors.” He cited the five-second rule as a coping strategy that many astronauts use: “When you make a mistake [in space], you have five seconds to get over it, to work through it, and then move on.” Dr. Williams said the same rule is applicable to the operating room or trauma bay to avoid losing focus.

Every time I was in space, I made mistakes,” admitted Dr.Williams. “But we made sure to have a zero fault-tolerant environment,” he said, which prevents team members from making additional errors and, ultimately, leads to success in space and in the operating room.

In his concluding remarks, Dr. Williams, a cancer survivor, spoke to attendees as a patient, quoting Sir William Osler, MD—a Canadian physician and a founder of the Johns Hopkins Hospital, Baltimore, MD— “A good physician treats the disease—a great physician treats the patient with the disease.”

The Martin Memorial Lecture was established in 1946 to honor Franklin H. Martin, MD, FACS, founder of the American College of Surgeons, and his wife, Isabelle Hollister Martin. The Martin Memorial Lecture is alternately nominated by the AdvisoryCouncil for Urological Surgery and the ACS Honors Committee.