Unconscious Bias: Why it Happens and How to Unlearn It

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Before you finish reading this paragraph, your brain has already made a judgment about someone.  Their accent , their appearance , their profession, or the way they expressed an idea.  You did not consciously choose to judge — and that is exactly how unconscious bias works. Unconscious bias refers to the automatic assumptions and mental shortcuts our brains use to process the world quickly. These biases are shaped by culture, media, upbringing, education, and personal experiences. They exist everywhere — across countries, professions, and social systems . The uncomfortable truth is this: even kind, educated, well-intentioned people have unconscious bias. What matters is not pretending we don’t have it, but learning how to recognize and unlearn it. “We don’t see things as they are; we see them as we are.” This article explores common examples of unconscious bias seen globally and practical ways anyone can overcome them. What Is Unconscious Bias?  Unconscious bias is not ...
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The Ultimate Mental Script for Surgeons: A Professional Guide for Students, Residents & Fellows

Mastering the Mental Game in Surgery

Surgery demands not only technical skills but also mental preparedness, attention to detail, and a calm, consistent mindset. 

For students, residents, and fellows, developing a reliable mental script can make the difference between stress and surgical precision. 

This skill should be learned as early as possible to have a structured approach to mental readiness before, during, and after surgery, based upon best practices in patient safety and operating room teamwork.

Mental preparation for surgeons in operating room


Why a Mental Script Matters in Surgical Practice

In high‑stakes environments such as the operating theatre, cognitive pressure can compromise decision‑making. 

A mental script serves as a structured internal guide that enhances focus, reduces errors, and improves patient outcomes. 

This is especially important where protocols like the WHO Surgical Safety Checklist prove that structured preparation significantly lowers surgical complications and mortality. 



Pre‑Operative Phase: Setting the Tone for Success

Before scrubbing in, surgeons should establish a calm and organized mindset.

1. Center Your Mind

Start with deep breathing:

“I am calm. I am focused. I am prepared.”

This primes the brain for sustained attention and reduces anxiety.


2. Anticipate and Visualize

Imagine the key anatomical landmarks and procedural steps. If possible, review the case and anticipate possible challenges. 

Many surgeons benefit from platform simulations like Touch Surgery for visual rehearsal of surgical tasks. 



3. Operational Safety Brief

Confirm that the surgical team has performed checks such as:

- Patient identity and consent

- Correct procedure and site marking

- Availability of essential instruments and imaging

These steps reflect the sign‑in phase of the WHO Surgical Safety Checklist, a globally recognized tool for reducing preventable surgical harm.

“Chance favors the prepared mind.” — Louis Pasteur



Intra‑Operative Phase: Staying Grounded and Attentive

Once the incision begins, the mental script shifts toward execution and adaptability.

1. One Step at a Time

Focus on deliberate action:

“I see clearly. I act deliberately.”

Break the procedure into discrete phases; this helps maintain situational awareness.


2. Communicate Continuously

Repeat key steps with your team. Effective communication isn’t just politeness — it’s safety practice. 

The time‑out phase in standard checklists encourages explicit confirmation of roles and potential complications.


3. Professional Mantras

To maintain composure:

“My hands are steady, my focus is sharp.”

“If something is unclear, I pause and reassess.”

Such affirmations reinforce confidence and reduce impulsive actions under pressure.



Post‑Operative Phase: Reflection and Closure

After wound closure, the focus shifts to evaluation and learning.

1. Complete the Checklist

Ensure that instruments and sponges are counted, specimens are labelled, and the patient is ready for transfer — completing the sign‑out phase of recommended safety protocols. 


2. Immediate Reflection

Ask yourself:

- What went well?

- Where did I hesitate?

- What can I improve next time?

- Documenting insights promotes continuous improvement.


3. Shift Mindset

Conclude with a reflective mantra:

I am grateful for the learning, and I release the stress from this case.

This helps separate experiences emotionally and prepare for future work.



Integrating Mental Scripts into Daily Practice

Routine Reinforcement

- Practice your mental script daily

- Debrief cases in group rounds

- Discuss complications openly

Patient safety literature suggests that team adherence to structured communication protocols improves outcomes and builds a positive safety culture.

“Practice does not make perfect. Only perfect practice makes perfect.”

— Vince Lombardi



FAQs: Mental Scripts for Surgeons

1. What exactly is a “mental script” in surgery?

A mental script is a structured set of internal cues or affirmations that guide your cognitive and emotional state at key phases of a surgical procedure.

2. How can trainees incorporate this into their routine?

Start small: focus on one phase (e.g., pre‑operative preparation) and gradually build scripts for intra‑operative and post‑operative phases.

3. Are mental scripts evidence‑based?

Yes — practices like checklists and pre‑operative briefings have been shown to reduce errors and complications across multiple studies. 

4. How long does it take to master a mental script?

Like any skill, it improves with repetition and reflection. Consistent use over weeks significantly enhances effectiveness.

5. Can mental scripts improve teamwork?

Absolutely — when surgeons verbalize structured cues and expectations, team communication improves, reducing hierarchical barriers and promoting safety.


Conclusion: Transforming Surgical Performance Through Mindset

Developing a mental script isn’t just about feeling better — it’s about operating smarter and safer. For students, residents, and fellows, adopting these practices early can accelerate your growth, strengthen teamwork, and improve patient outcomes. 

Use checklists, internal mantras, and structured reflection — and remember that mental preparedness is as important as technical skill in the modern surgical world.



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