Strong German Hearts 2023

Introduction

What do the special task forces of the Federal Police and heart surgeons have in common? Maybe the public impression of a burst in power. Or the great responsibility both specialties carry and the expertise in their respective field. The more you think about it, the more parallels become visible. Both professions belong to the highest risk-taker groups. Fundamental in both specialties are the necessary peak performances, both psychological and physical. Concentration, a sharp mind, being well-trained and the perfect handling of every situation even under high pressure, is what both aim for. To deliver these peak performances and to keep a clear head, substantial understanding of interpersonal behavior and a reflected communication are essential. This is why a team* of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) under the leadership of Professor Torsten Doenst, started a pilot project called “Strong German Hearts”. During this program, 14 selected residents from Germany and Switzerland were challenged to complete a differentiated structured schedule consisting of various psychological and surgical assessments over 36 h. Surgical handling, concentration and scientific abilities were tested periodically, interspersed with coaching sections by highly qualified trainers of the special task forces of the Federal Police.

Report

On a Thursday evening, 14 unsuspecting cardiac surgery trainees got together in Berlin. Introductions were made and expectations were exchanged. Some mentioned the thrill of the unknown as a thriving factor for their application, others the idea of working through a 36-h shift as an aim to finish the program. Alongside the motivated trainees, highly qualified and eager coaches, specialized trainers from the Federal Police, and supporters from the organizing team were present. The journey started the next morning at seven o’clock. Each candidate received a personal file including a detailed schedule and respective tasks for the psychological and concentration evaluations, which would be analyzed by the professionals.

Since both police work and surgery are team matters, each trainee was assigned a “buddy” for the duration of the program. Individual but identical basic psychological and surgical assessments were conducted at hours 0, 12, 24 and 36. These assessments consisted of questions regarding memorized patient data, the D2 Test of Attention and different suture and knotting techniques. Additionally, body temperature and a standardized mood barometer were assessed. On both days, the candidates profited from scientific advice and wrote an abstract based on provided data sets at hours 7 and 32 together with their buddy. After a keynote lecture by the professionals of the Federal Police, the first coaching session with the systemic coach of the special task forces and their consultant Dr. Günter Weber (Institut für Konfliktforschung & Krisenberatung [IfKK], Munich, Germany) started. The aim of the session was to give an introduction to leadership qualities on the one hand and coaching regarding interpersonal communication and teamwork, especially in challenging situations, on the other hand. The honesty and openness within the small groups exceeded our expectations. The coaches created a safe environment to talk about issues in daily clinical practice, address fears in a hierarchical system, and open up about potential self-doubt or any other personal struggles.

Figure 1. Strong German Hearts 2023 at the Langenbeck-Virchow-House in Berlin, Germany.

Figure 1. Strong German Hearts 2023 at the Langenbeck-Virchow-House in Berlin, Germany.

After an exciting first day and a late-night movie about the history of the BlalockThomas-Taussig shunt, the best was yet to come. What happens at midnight when you are on call? With almost certainty, there is that one emergent surgical patient coming—and this is exactly what happened during the night! Over a period of almost six hours, the trainees worked on various heart valve replacements, bypass techniques and at the very end, the infamous “UFO” procedure. During these hours, the group established this indescribable atmosphere where you try to motivate your tired buddy, sit quietly next to a colleague taking a power nap, share snacks or take a short break to breathe in fresh air. After the third basic assessment and the sunrise, we greeted the day with a short meditation. The last twelve hours were the hardest. During breaks people would stretch, do burpees, try to motivate each other and the phrase “come on, we can’t stop now!” was heard a few times. Finally, at eight o’clock sharp on Saturday night and after the fourth and final basic assessment, we had made it. Suddenly, everyone was wide awake and full of pride of making it all the way through the schedule as a team. After a toast to the program director, the supporters, coaches and colleagues, we had dinner accompanied by delightful and constructive talks about the program. At last, there was time for a long-awaited shower and some much-needed sleep. The next day, the group met for a debriefing over breakfast before departure. One month later, the group was honored during the opening ceremony of the annual meeting of the German Society for Thoracic and Cardiovascular Surgery. The individual analyses and evaluated personal files were handed out together with a certificate of completion.

Conclusion

While there are several reports comparing surgery to aviation [1,2,3] which describe the idea to adapt aviation-based teamwork skills to the operating room [4], there are no studies comparing the work of surgeons with the one of special task forces of the police. The “Strong German Hearts” program opens new possibilities for a fresh generation of cardiac surgeons. While the results of the impact of sleep deprivation on surgical handling and concentration are an important aspect of the project (and will be published in a separate manuscript), implementing coaching sessions in leadership, guidance, and teamwork into a surgical training program is a novel approach for health care executives and merits further investigation. Social behavior in the operating room is a popular study field. One study showed that the willingness to cooperate increased in a complex field such as cardiothoracic surgery, perhaps due to the complexity of procedures and the resulting necessity to rely on each other [5]. It is obvious that this can also be applied to the special task forces of the police. To emphasize this, the colleagues from the special task forces pointed out that in their field, the “team spirit commitment” should not to be underrated. Even if you are the physically fittest or an excellent shooter, you will not be considered if you cannot adapt to the team. Therefore, coaching and mentoring are obligatory components in their work environment. While of course, departments of cardiac surgery and special task forces are not infinitely comparable, the program seems to be a promising concept which could be used in cardiac surgery. In any case, it should be considered.

Figure 2. Peer-to-Peer teaching during a timed practical skills session.

Figure 2. Peer-to-Peer teaching during a timed practical skills session.

Figure 3. Set Up for all practical sessions. Each “buddy-pair” is accompanied by a mentor.

Figure 3. Set Up for all practical sessions. Each “buddy-pair” is accompanied by a mentor.

Particularly noteworthy is the “Strong German Hearts” team spirit after the program, with regular exchange of information, well-wishes, and possible get-togethers among members. The team spirit among the group may be so strong because we started this project to see if we could cope as individuals and finished it as a group. If asked what we actually gained from this course as individuals, it is hard to find one definitive answer. Why would one consider joining a 36-h program while there are political discussions about reducing working hours? Why consider this program if you can have a weekend off? Maybe it was the feeling of success, the self-determination to finish at your own level, or the exchange among like-minded people. One thing is clear: the “Strong German Hearts” experience exceeded our expectations as trainees and we are eager to support further meetings and trainings. To conclude with the words of Ulrich Wegener, a founding member of the counterterrorist force GSG 9 and its commander in the liberation of the hostages on board the Boeing 737 Landshut (Lufthansa flight 181) in Mogadishu, Somalia in 1977, “I was happy that for once we could show what we are able to do!”

* Prof. Dr. Torsten Doenst; PD Dr. Gloria Färber; Dr. Andreas Beckmann; Dr. Hristo Kirov; Dr. Túlio Caldonazo; Dr. Ulrich Schneider; Regina Iglauer-Sander M.A.; IfKK Günter Weber (internal systemic coach and yoga teacher GSG 9)