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Tjønnås MS, Muller S, Våpenstad C, Tjønnås J, Ose SO, Das A, Sandsund M. Stress responses in surgical trainees during simulation-based training courses in laparoscopy. BMC MEDICAL EDUCATION 2024; 24:407. [PMID: 38610013 PMCID: PMC11010405 DOI: 10.1186/s12909-024-05393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Simulation-based training courses in laparoscopy have become a fundamental part of surgical training programs. Surgical skills in laparoscopy are challenging to master, and training in these skills induces stress responses in trainees. There is limited data on trainees' stress levels, the stress responses related to training on different laparoscopic simulators, and how previous experiences influence trainees' stress response during a course. This study investigates physiologic, endocrine and self-reported stress responses during simulation-based surgical skills training in a course setting. METHODS We conducted a prospective observational study of trainees attending basic laparoscopic skills training courses at a national training centre. During the three-day course, participants trained on different laparoscopic simulators: Two box-trainers (the D-box and P.O.P. trainer) and a virtual reality simulator (LAPMentor™). Participants' stress responses were examined through heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6). The correlation between previous laparoscopic experiences and stress response measurements was explored. RESULTS Twenty-four surgical trainees were included in the study. Compared to resting conditions, stress measures were significantly higher during simulation-training activity (the D-box (SDNN = 58.5 ± 23.4; LF/HF-ratio = 4.58 ± 2.71; STAI-6 = 12.3 ± 3.9, P < 0.05), the P.O.P trainer (SDNN = 55.7 ± 7.4; RMSSD = 32.4 ± 17.1; STAI-6 = 12.1 ± 3.9, P < 0.05), and the LAPMentor™ (SDNN = 59.1 ± 18.5; RMSSD = 34.3 ± 19.7; LF/HF-ratio = 4.71 ± 2.64; STAI-6 = 9.9 ± 3.0, P < 0.05)). A significant difference in endocrine stress response was seen for the simulation-training activity on the D-box (saliva cortisol: 3.48 ± 1.92, P < 0.05), however, no significant differences were observed between the three simulators. A moderate correlation between surgical experience, and physiologic and endocrine stress response was observed (RMSSD: r=-0.31; SDNN: r=-0.42; SD2/SD1 ratio: r = 0.29; Saliva cortisol: r = 0.46; P < 0.05), and a negative moderate correlation to self-reported stress (r=-0.42, P < 0.05). CONCLUSION Trainees have a significant higher stress response during simulation-training compared to resting conditions, with no difference in stress response between the simulators. Significantly higher cortisol levels were observed on the D-box, indicating that simulation tasks with time pressure stress participants the most. Trainees with more surgical experience are associated with higher physiologic stress measures, but lower self-reported stress scores, demonstrating that surgical experience influences trainees' stress response during simulation-based skills training courses.
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Affiliation(s)
- Maria Suong Tjønnås
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, N-7491, Norway.
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway.
| | - Sébastien Muller
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
| | - Cecilie Våpenstad
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
- Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, N-7491, Norway
- The National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy (MiDT), St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250, Prinsesse Kristinas Gate 5, Torgarden, Trondheim, NO-7006, Norway
| | - Johannes Tjønnås
- Department of Mathematics and Cybernetics, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO- 7465, Norway
| | - Solveig Osborg Ose
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
| | - Anita Das
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, N-7491, Norway
| | - Mariann Sandsund
- Department of Health Research, SINTEF Digital, SINTEF, P.O. Box 4760, Torgarden, Trondheim, NO-7465, Norway
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Spadoto-Dias D, Bueloni-Dias FN, Modotti WP, França MLM, Chihara RT, Chauvet P, Rabischong B, Botchorishvili R, Bourdel N, Canis M. The impact of laparoscopic gynecological surgery training on the technicity index of a developing country center. Acta Cir Bras 2023; 38:e382723. [PMID: 37610965 PMCID: PMC10443230 DOI: 10.1590/acb382723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/08/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE To compare laparoscopic gynecological surgery training between a developed country's reference center (host center) and a public reference service in a developing country (home center), and use the technicity index (TI) to compare outcomes and to determine the impact of laparoscopic gynecological surgery fellowship training on the home center's TI. METHODS The impact of training on the home center was assessed by comparing surgical performance before and after training. TI was assessed in 2017 in the host center, and before and after training in the home center. Epidemiological and clinical data, and information on reason for surgery, preoperative images, estimated intraoperative bleeding, operative time, surgical specimen weight, hospital stay length, complication and reintervention rates were collected from both institutions. Home center pre-training data were retrospectively collected between 2010 and 2013, while post-training data were prospectively collected between 2015 and 2017. A two-tail Z-score was used for TI comparison. RESULTS The analysis included 366 hysterectomies performed at the host center in 2017, and 663 hysterectomies performed at the home center between 2015 and 2017. TI in the host center was 82.5%, while in the home center it was 6% before training and 22% after training. There were no statistical differences in length of hospital stay, preoperative uterine volume, surgical specimen weight and complication rate between centers. However, significantly shorter mean operative time and lower blood loss during surgery were observed in the host center. CONCLUSIONS High-quality laparoscopic training in a world-renowned specialized center allowed standardizing laparoscopic hysterectomy procedures and helped to significantly improve TI in the recipient's center with comparable surgical outcomes.
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Affiliation(s)
- Daniel Spadoto-Dias
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – Department of Gynecology and Obstetrics – Botucatu (São Paulo), Brazil
| | - Flávia Neves Bueloni-Dias
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – Department of Gynecology and Obstetrics – Botucatu (São Paulo), Brazil
| | | | - Maria Laura Marconi França
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – Department of Gynecology and Obstetrics – Botucatu (São Paulo), Brazil
| | - Rodrigo Takeshi Chihara
- Universidade Estadual Paulista “Júlio de Mesquita Filho” – Department of Gynecology and Obstetrics – Botucatu (São Paulo), Brazil
| | - Pauline Chauvet
- University of Clermont Auvergne – Department of Surgical Gynecology – Clermont-Ferrand, France
| | - Benoit Rabischong
- University of Clermont Auvergne – Department of Surgical Gynecology – Clermont-Ferrand, France
| | - Revaz Botchorishvili
- University of Clermont Auvergne – Department of Surgical Gynecology – Clermont-Ferrand, France
| | - Nicolas Bourdel
- University of Clermont Auvergne – Department of Surgical Gynecology – Clermont-Ferrand, France
| | - Michel Canis
- University of Clermont Auvergne – Department of Surgical Gynecology – Clermont-Ferrand, France
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Tjønnås MS, Guzmán-García C, Sánchez-González P, Gómez EJ, Oropesa I, Våpenstad C. Stress in surgical educational environments: a systematic review. BMC MEDICAL EDUCATION 2022; 22:791. [PMID: 36380334 PMCID: PMC9667591 DOI: 10.1186/s12909-022-03841-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The effects of stress on surgical residents and how stress management training can prepare residents to effectively manage stressful situations is a relevant topic. This systematic review aimed to analyze the literature regarding (1) the current stress monitoring tools and their use in surgical environments, (2) the current methods in surgical stress management training, and (3) how stress affects surgical performance. METHODS A search strategy was implemented to retrieve relevant articles from Web of Science, Scopus, and PubMed. The 787 initially retrieved articles were reviewed for further evaluation according to the inclusion/exclusion criteria (Prospero registration number CRD42021252682). RESULTS Sixty-one articles were included in the review. The stress monitoring methods found in the articles showed heart rate analysis as the most used monitoring tool for physiological parameters while the STAI-6 scale was preferred for psychological parameters. The stress management methods found in the articles were mental-, simulation- and feedback-based training, with the mental-based training showing clear positive effects on participants. The studies analyzing the effects of stress on surgical performance showed both negative and positive effects on technical and non-technical performance. CONCLUSIONS The impact of stress responses presents an important factor in surgical environments, affecting residents' training and performance. This study identified the main methods used for monitoring stress parameters in surgical educational environments. The applied surgical stress management training methods were diverse and demonstrated positive effects on surgeons' stress levels and performance. There were negative and positive effects of stress on surgical performance, although a collective pattern on their effects was not clear.
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Affiliation(s)
- Maria Suong Tjønnås
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, N-7491, Trondheim, Norway.
- SINTEF Digital, Health Department, Trondheim, Norway.
| | - Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Enrique Javier Gómez
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid (UPM), Madrid, Spain
| | - Cecilie Våpenstad
- SINTEF Digital, Health Department, Trondheim, Norway
- Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Tjønnås MS, Das A, Våpenstad C, Ose SO. Simulation-based skills training: a qualitative interview study exploring surgical trainees' experience of stress. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:33. [PMID: 36273197 PMCID: PMC9588224 DOI: 10.1186/s41077-022-00231-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Stress can affect the ability to acquire technical skills. Simulation-based training (SBT) courses allow surgical trainees to train their technical skills away from stressful clinical environments. Trainees' subjective experiences of stress during SBT courses on laparoscopic surgery remains understudied. Here, we explored the subjective stress experiences of surgical trainees during mandatory laparoscopic SBT courses. We aimed to obtain a broader understanding of which factors of the simulation training the trainees perceived as eliciting stress. METHODS A qualitative study with semistructured individual interviews was undertaken to explore trainees' subjective experiences of stress. Twenty surgical trainees participated while attending courses at a national training center for advanced laparoscopic surgery. Questions explored trainees' stress experiences during the SBT courses with a focus on perceived stressors related to laparoscopic simulation training on two box-trainers and one virtual reality simulator. Interview data were analyzed using inductive, qualitative content analysis methods to identify codes, categories, and themes. RESULTS Findings indicated that trainees have a variety of stress experiences during laparoscopic SBT. Three main themes were identified to be related to stress experiences: simulation task requirements, psychomotor skill levels and internal pressures, with subcategories such as task difficulty and time requirements, unrealistic haptic feedback and realism of graphics, inconsistent and poor technical performance, and self-imposed pressures and socio-evaluative threats. CONCLUSIONS Insights into surgical trainees' experience of stress during laparoscopic SBT courses showed that some stress experiences were directly related to simulation training, while others were of psychological nature. The technical and efficiency requirements of simulation tasks elicited stress experiences among trainees with less laparoscopic experience and lower levels of psychomotor skills. Self-imposed pressures played an integral part in how trainees mobilized and performed during the courses, suggesting that levels of stress might enhance laparoscopic simulation performance. For course facilitators aiming at optimizing future laparoscopic SBT courses, attending to the realism, providing clarity about learning objectives, and having awareness of individual differences among trainees' technical level when designing the simulation tasks, would be beneficial. Equally important to the laparoscopic SBT is to create a psychological safe learning space in order to reduce the internal pressures of trainees.
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Affiliation(s)
- Maria Suong Tjønnås
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, N-7491, Trondheim, Norway. .,SINTEF Digital, Department of Health Research, SINTEF, P.O. Box 4760 Torgarden, NO-7465, Trondheim, Norway.
| | - Anita Das
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, N-7491, Trondheim, Norway
| | - Cecilie Våpenstad
- SINTEF Digital, Department of Health Research, SINTEF, P.O. Box 4760 Torgarden, NO-7465, Trondheim, Norway.,Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, N-7491, Trondheim, Norway.,The national research center for Minimally invasive and Image-guided Diagnostics and Therapy (MiDT), St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 5, Postbox 3250 Torgarden, NO-7006, Trondheim, Norway
| | - Solveig Osborg Ose
- SINTEF Digital, Department of Health Research, SINTEF, P.O. Box 4760 Torgarden, NO-7465, Trondheim, Norway
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Carr S, McDermott BR, McInerney N, Hussey A, Byrne D, Potter S. Determining the Effect of External Stressors and Cognitive Distraction on Microsurgical Skills and Performance. Front Surg 2020; 6:77. [PMID: 32039230 PMCID: PMC6987403 DOI: 10.3389/fsurg.2019.00077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/20/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: Microsurgery is an essential element of Plastic Surgery practice. There is a paucity of studies assessing the impact of stress and cognitive distraction on technical microsurgical performance. The ability to complete cognitive and technical skills in parallel has not been assessed in a microsurgical setting. Aim: To test the hypothesis that cognitive distraction and external stressors negatively affect microsurgical performance in a high fidelity simulation setting. Materials/Methods: Fourteen surgeons across all levels of training undertook 2 microsurgical skills sessions, 1 month apart. Session one established baseline microsurgical skill. In session two, skills were assessed with the introduction of realistic operative room cognitive distractions (ORDIs). Outcome measures were efficiency and accuracy, measured by Time to Completion (TTC) and Anastomosis Lapse Index (ALI), respectively. Key Results: Fourteen participants (6 novices, 5 plastic surgery specialist trainees and 3 consultants) completed both microsurgical skills sessions. In total, 28-microvascular anastomosis were analyzed. Mean baseline TTC for the group was 20.36 min. With cognitive distraction and external stress mean TTC decreased to 17.87 min. Mean baseline ALI score for the group was 3.32 errors per anastomosis. The introduction of cognitive distraction and external stress increased the mean to 4.86 errors per anastomosis. Total errors per anastomosis increased from 91 errors at baseline to 137 errors with cognitive distraction and external stress. Under stress, participants were more efficient but had reduced anastomotic accuracy. Conclusion: Under stress, surgeons were more efficient, this translated into faster completion of a microsurgical anastomosis. Efficiency, however, came at the expense of accuracy.
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Affiliation(s)
- Shane Carr
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Bronwyn Reid McDermott
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
| | - Niall McInerney
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Alan Hussey
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - D Byrne
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
| | - Shirley Potter
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
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Argentino GLS, Bueloni-Dias FN, Leite NJ, Peres GF, Elias LV, Bortolani VC, Padovani CR, Spadoto-Dias D, Dias R. The role of laparoscopy in the propaedeutics of gynecological diagnosis1. Acta Cir Bras 2019; 34:e20190010000010. [PMID: 30785511 PMCID: PMC6585922 DOI: 10.1590/s0102-865020190010000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 12/04/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose To evaluate agreement between pre- and post-laparoscopy gynecological
diagnosis in order to demonstrate the rationality of this minimally invasive
technique use in gynecological propaedeutics. Methods Retrospective chart review study conducted between March 2010 and October
2016 based on a convenience sample. 315 patients undergoing surgical
laparoscopy at the Center of Gynecologic Endoscopy and Family Planning of
Botucatu Medical School/UNESP. Pre- and postoperative diagnoses were
compared by the diagnosis agreement test considering the proportions of
events. Results Laparoscopy contributed to diagnosis in 59.6% of infertility cases
(P>0.05), in 93.7% of chronic pelvic pain of undetermined origin
(P<0.01) and conclusively elucidated the diagnosis of acute abdomen and
the ruling out of tubo-ovarian abcess (P<0.05). Laparoscopy also
increased the diagnosis of pelvic-abdominal adhesions in 76.7% (P>0.05).
Conclusion The use of laparoscopy considerably contributed to diagnostic elucidation,
especially in cases of undetermined chronic pelvic pain.
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Affiliation(s)
- Gislaine Laperuta Serafim Argentino
- Assistant Physician, Gynecological Endoscopy and Family Planning Sector, Department of Gynecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Flávia Neves Bueloni-Dias
- Clinical Assistant Professor, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP, Botucatu-SP, Brazil. Acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Nilton José Leite
- Assistant Physician, Gynecological Endoscopy and Family Planning Sector, Department of Gynecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Gustavo Filipov Peres
- Assistant Physician, Gynecological Endoscopy and Family Planning Sector, Department of Gynecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Leonardo Vieira Elias
- Assistant Physician, Gynecological Endoscopy and Family Planning Sector, Department of Gynecology and Obstetrics, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu-SP, Brazil. Conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Vitória Cristina Bortolani
- Resident, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP, Botucatu-SP, Brazil. Acquisition of data
| | - Carlos Roberto Padovani
- Full Professor, Department of Biostatistics, Botucatu Biosciences Institute, UNESP, Botucatu-SP, Brazil. Statistics analysis
| | - Daniel Spadoto-Dias
- Clinical Assistant Professor, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP, Botucatu-SP, Brazil. Acquisition, analysis and interpretation of data; technical procedures; manuscript preparation
| | - Rogério Dias
- Associate Professor III, Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP, Botucatu-SP, Brazil. Conception and design of the study, manuscript preparation
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