Reigniting the Flame: An Exploration of Flow in Surgery

Although distress and burnout in medical practice are widely acknowledged, less attention has been paid to the positive experiences that help keep physicians engaged. Cognitive flow (being "in the zone") is an intrinsically rewarding state in which individuals feel challenged and focused. To date, academic investigations of flow have largely been limited to the cognitive aspects of the phenomenon, limiting understanding of other elements, such as practice culture and environment. This study examines flow in surgical practice through a multifaceted lens. Guided by a constructivist grounded theory approach, semistructured interviews were conducted from June 2018 to May 2021 with staff surgeons at the University of Toronto. Purposive sampling was used to include a range of surgical disciplines and experience levels to produce a conceptual framework that captures the multifaceted experience of flow. Twenty staff surgeons from diverse specialties participated. A conceptual framework was developed for illustrating the different facets of flow, including the traditional view (cognitive) and an expanded view (physiologic, physical, affective, social, cultural, and environmental facets). Through the cognitive lens, participants appreciated how they could achieve the necessary mindset to experience flow and enjoy their work. The ability to feel in control, use creative approaches to solve problems, and possess the agency to continue to learn and improve invoked positive feelings about their work and practice. In the expanded view, it became evident that experiences of flow were much more multifaceted and complex. Beyond the individual, aspects such as the sociocultural environment shaped and comprised key aspects of the flow experience that surgeons found truly meaningful in their practice. Appreciating flow as a multifaceted phenomenon may assist in the identification and optimization of experiences that are central to encouraging lifelong career advancement and innovation while also helping protect against burnout and distress.