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Lee A, Torkamani-Azar M, Zheng B, Bednarik R. Unpacking the Broad Landscape of Intraoperative Stressors for Clinical Personnel: A Mixed-Methods Systematic Review. J Multidiscip Healthc 2023; 16:1953-1977. [PMID: 37484819 PMCID: PMC10361288 DOI: 10.2147/jmdh.s401325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose The main goals of this mixed-methods systematic review are to identify what types of intraoperative stressors for operating room personnel have been reported in collected studies and examine the characteristics of each intraoperative stressor. Methods With a systematic literature search, we retrieved empirical studies examining intraoperative stress published between 2010 and 2020. To synthesize findings, we applied two approaches. First, a textual narrative synthesis was employed to summarize key study information of the selected studies by focusing on surgical platforms and study participants. Second, a thematic synthesis was employed to identify and characterize intraoperative stressors and their subtypes. Results Ninety-four studies were included in the review. Regarding the surgical platforms, the selected studies mainly focused on minimally invasive surgery and few studies examined issues around robotic surgery. Most studies examined intra-operative stress from surgeons' perspectives but rarely considered other clinical personnel such as nurses and anesthetists. Among seven identified stressors, technical factors were the most frequently examined followed by individual, operating room environmental, interpersonal, temporal, patient, and organizational factors. Conclusion By presenting stressors as multifaceted elements affecting collaboration and interaction between multidisciplinary team members in the operating room, we discuss the potential interactions between stressors which should be further investigated to build a safe and efficient environment for operating room personnel.
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Affiliation(s)
- Ahreum Lee
- Samsung Electronics Co. Ltd., Suwon, Gyeonggi-do, Republic of Korea
| | | | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Canada
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Armbrust L, Lenz M, Elrod J, Kiwit A, Reinshagen K, Boettcher J, Boettcher M. Factors Influencing Performance in Laparoscopic Suturing and Knot Tying: A Cohort Study. Eur J Pediatr Surg 2023; 33:144-151. [PMID: 36516961 DOI: 10.1055/s-0042-1742302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic suturing and knot tying are regarded as some of the most difficult laparoscopic skills to learn. Training is essential to reach proficiency, but available training opportunities are limited. Various techniques to improve training have been evaluated. It appears that individual-related factors affect initial performance and response to training. Thus, the current study aimed to assess factors influencing laparoscopic-suturing and knot-tying performances. METHODS All patients were trained one-on-one (teacher-student) for 3 hours. Patients were tested before training (bowel anastomosis model) and directly after training (congenital diaphragmatic hernia or esophageal atresia model) to evaluate transferability. Primary endpoints were time, knot quality, precision, knot strength, and overall laparoscopic knotting performance. Moreover, factors such as (1) age, (2) gender, (3) handedness, (4) previous training or operative experience, (5) playing an instrument, (6) sportive activities, and (7) computer gaming which may influence the primary endpoints were assessed. RESULTS In total, 172 medical students or novice surgical residents were included. Training significantly improved all outcome parameters assessed in the current study. More than 50% of the patients reached proficiency after 3 hours of training. Personal factors like operative experience, playing music instruments, sportive activities, and computer gaming affected some outcome parameters. Handedness and gender affected initial performance but differences partially subsided after training. Younger participants showed a much better response to training. CONCLUSION In conclusion, several factors influence initial performance and response to the training of laparoscopic suturing and knot tying. Surgeons who want to improve their laparoscopic performance, should concentrate on playing a musical instrument and performing sports rather than playing videos gaming. It appears that training is a key and more practice opportunities should be incorporated into medical school and surgical curricula. Moreover, handedness may affect the outcome but only if the training concepts are not tailored to the dominant hand of the surgeon. Future training and surgical curricula should adapt to this and tailor their concepts accordingly.
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Affiliation(s)
- Lina Armbrust
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Moritz Lenz
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
- Department of Pediatric Surgery, University Medical Center Mannheim, Germany
| | - Antonia Kiwit
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Johannes Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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Han Y, Zheng B, Zhao L, Hu J, Zhang C, Xiao R, Wang C, Pu D. Impact of background music on the performance of laparoscopy teams. BMC MEDICAL EDUCATION 2022; 22:439. [PMID: 35672819 PMCID: PMC9172190 DOI: 10.1186/s12909-022-03503-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/27/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Acoustic conditions in the operating room have different impacts on surgeon's performance. Their effects on the performance of surgical teams are not well documented. We investigated if laparoscopic teams operating under pleasant acoustic conditions would perform better than under noisy conditions. METHODS We recruited 114 surgical residents and built 57 two-person teams. Each team was required to perform two laparoscopic tasks (object transportation and collaborative suturing) on a simulation training box under music, neutral, and noisy acoustic conditions. Data were extracted from video recordings of each performance for analysis. Task performance was measured by the duration of time to complete a task and the total number of errors, and objective performance scores. The measures were compared over the three acoustic conditions. RESULTS A music environment elicited higher performance scores than a noisy environment for both the object transportation (performance score: 66.3 ± 8.6 vs. 57.6 ± 11.2; p < 0.001) and collaborative suturing tasks (78.6 ± 5.4 vs. 67.2 ± 11.1; p < 0.001). Task times in the music and noisy environments was subtracted to produce a music-noisy difference time. Pearson correlation coefficient analysis showed a significant negative relationship between the team experience score and the music-noisy difference time on the object transportation (r = - 0.246, p = 0.046) and collaborative suturing tasks (r = - 0.248, p = 0.044). CONCLUSIONS As to individuals, music enhances the performance of a laparoscopy team while a noisy environment worsens performance. The negative correlation between team experience and music-noisy difference time suggests that laparoscopy teams composed of experienced surgeons are less likely affected by an acoustic distraction than the noisy teams. Team resistance to acoustic distraction may lead to a new way for assessing team skills.
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Affiliation(s)
- Ying Han
- West China Medical Simulation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Bin Zheng
- Department of Surgery, University of Alberta, Alberta, Canada
| | - Linyong Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China, 610041
| | - Jiankun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China, 610041
| | - Chao Zhang
- West China Medical Simulation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Ran Xiao
- West China Medical Simulation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Chunyan Wang
- West China Academic Exchange Center of Health and Medicine, Chengdu, Sichuan Province, People's Republic of China, 610041
| | - Dan Pu
- West China Medical Simulation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Boettcher J, Mietzsch S, Wenkus J, Mokhaberi N, Klinke M, Reinshagen K, Boettcher M. The Spaced Learning Concept Significantly Improves Acquisition of Laparoscopic Suturing Skills in Students and Residents: A Randomized Control Trial. Eur J Pediatr Surg 2021; 31:518-524. [PMID: 33186998 DOI: 10.1055/s-0040-1721041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Spaced learning consists of blocks with highly condensed content that interrupted by breaks during which distractor activities, such as physical activity, are performed. The concept has been shown to be superior in complex motor skill acquisition like laparoscopic suturing and knot tying. Preliminary studies have solely been conducted with medical students. Therefore, it remained unanswered if the spaced learning concept would also work for pediatric surgery residents. MATERIALS AND METHODS The study aimed to evaluate the effectiveness of spaced learning, students, and residents were asked to perform four surgeons' square knots on a bowel model within 30 minutes prior and post 3 hours of hands-on training. To examine the long-term skills, the same subjects were asked to perform a comparable, but more complex task 12 months later without receiving training in the meantime. Total time, knot stability, suture accuracy, knot quality, and laparoscopic performance were assessed. Additionally, motivation was accessed by using the questionnaire on current motivation. Differences were calculated using mixed analysis of variance, Mann-Whitney U test, and multivariate analysis of covariance. RESULTS A total of 20 medical students and 14 residents participated in the study. After randomization, 18 were trained using the spaced learning concept and 16 via conventional methods. Both groups had comparable baseline characteristics and improved significantly after training in all assessed measures. The spaced learning concept improved procedure performance as well as knot quality and stability in both students and residents. However, residents that trained via spaced learning showed significantly better long-term results regarding knot quality and speed in comparison to students. Although anxiety was significantly reduced in both training groups over time, residents were significantly more interested regarding knot tying than students. CONCLUSION This study dispels any remaining doubt that the spaced learning concept might only work for medical students. It appears that the spaced learning concept is very suitable for residents in acquiring complex motor skills. It is superior to conventional training, resulting in improved procedural performance as well as knot quality and speed. Hence, tailored training programs should not only be integrated early on in students' curricula but also in surgical training programs.
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Affiliation(s)
- Johannes Boettcher
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Mietzsch
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Wenkus
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nariman Mokhaberi
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michaela Klinke
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Nees LK, Grozinger P, Orthmann N, Rippinger N, Hennigs A, Sohn C, Domschke C, Wallwiener M, Rom J, Riedel F. The Influence of Different Genres of Music on the Performance of Medical Students on Standardized Laparoscopic Exercises. JOURNAL OF SURGICAL EDUCATION 2021; 78:1709-1716. [PMID: 33812805 DOI: 10.1016/j.jsurg.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Whether and how music influences the performance of surgical procedures such as laparoscopy is unclear and can be feasibly determined using laparoscopic box training tools under standardized conditions. The aim of this prospective study is to evaluate the effect of different genres of music on the performance of laparoscopic novices. METHODS Between May 2018 and December 2018, n = 82 students (38 male, 44 female) from Heidelberg University Medical School performed 3 different laparoscopic exercises (A, B, C) from the "Luebecker Toolbox" with 2 repetitions each under standardized conditions. Time was recorded for each exercise. The students were assigned either to one of four groups, each of which was exposed to a compilation of music from 1 genre (hip hop, classical, rock, or mixed radio music), or to a fifth, control group, without exposure to music. The music was played at a constant sound pressure level of 70 decibels . Each group was compared with the others using a t-test for independent samples. RESULTS Exposure to music generally led to better performance compared with the control group. Compared with exposure to mixed radio music or to rock, significantly better performance could be demonstrated for exposure to classical music in Exercise B, with an average exposure time of 127 s needed (± 21.4; p < 0.05). No significant differences could be demonstrated for Exercise A, though for classical music, best performance was possible with 120 s (±17.3) of exposure. In Exercise C, hip hop triggered significantly better performance than rock or radio music (p < 0.05). CONCLUSIONS At an sound pressure level of 70 decibels, exposure to classical music or hip hop appears to have beneficial effects on training performance for surgical novices under standardized conditions.
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Affiliation(s)
- Lisa Katharina Nees
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Philipp Grozinger
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Natalie Orthmann
- Asklepios Hospital Hamburg-Barmbek, Department of Gynecology and Obstetrics, Hamburg, Germany
| | - Nathalie Rippinger
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - André Hennigs
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Christof Sohn
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Christoph Domschke
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Markus Wallwiener
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany
| | - Joachim Rom
- Frankfurt-Hoechst Hospital, Department of Gynecology and Obstetrics, Frankfurt, Germany
| | - Fabian Riedel
- Heidelberg University Hospital, Department of Gynecology and Obstetrics, Heidelberg, Baden-Württemberg, Germany.
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