Training and working in high-stakes environments: lessons learned and problems shared by aviators and surgeons.

Surgeons and naval aviators are both trained to work in high-stakes environments. Any misadventure in either of their working worlds can lead to death. Yet the pathways to certification and implicit attitudes toward training are quite different in these 2 disciplines and provide an opportunity to compare and contrast the methodologies employed. At the 5th annual Innovations in the Surgical Environments Conference, senior and junior aviators and surgeons shared their experiences from the perspective of trainee and trainer and in the process presented an interesting study in parallels and contrasts. The US Navy follows a highly regimented training syllabus with graduated levels of responsibility designed to create the safest possible flying environment. Extensive preflight and postflight effort is required for each mission flown. Surgical training is also hierarchal in responsibility, but graduates demonstrate greater variability in their training experience. The surgical field can only fortify its emphasis on safety by seeking to provide the optimal training experiences necessary in the high-stakes environment of the operating theater. In doing so, surgeons may find reinvigorated commitment through study of the aviation industry's established methods of training and practice.