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Skov RAC, Lawaetz J, Strøm M, Van Herzeele I, Konge L, Resch TA, Eiberg JP. Machine learning enhances assessment of proficiency in endovascular aortic repair simulations. Curr Probl Surg 2024; 61:101576. [PMID: 39266132 DOI: 10.1016/j.cpsurg.2024.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/09/2024] [Accepted: 07/23/2024] [Indexed: 09/14/2024]
Affiliation(s)
- Rebecca Andrea Conradsen Skov
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark.
| | - Jonathan Lawaetz
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
| | - Michael Strøm
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Lars Konge
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
| | - Timothy Andrew Resch
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jonas Peter Eiberg
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark
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2
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Ingram I, Hughes MA. The Effect of External Distractions on Simulated Laparoscopic Performance. J Laparoendosc Adv Surg Tech A 2024. [PMID: 39263976 DOI: 10.1089/lap.2024.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
Background: Surgeons are exposed to unavoidable distractions while operating. Distractions can cause stress, and stress can impair cognition and motor skills to the detriment of surgeon performance. This study assessed the impact of distractions on surgeon stress levels and surgeon performance during simulated laparoscopic tasks. Methods: Twelve surgical trainees completed a peg-thread transfer task three times on a laparoscopic simulator in a neutral environment. Six trainees then completed the task three more times in an environment overlain with distractions commonly found in the operating theatre. Six others completed three more tasks in a neutral environment. Stress was measured by recording heart rate and by assessing responses to the NASA Task Load Index. Performance was measured using instrument tracking metrics and time to complete the task. Results: The distracted participants reported significantly higher effort, frustration, and physical demand than the neutral group, as measured by the NASA Task Load Index, (P = .001, .031, and .044, respectively). The neutral group completed their final task significantly faster compared with baseline (P = .049), while the distracted group failed to show this improvement. The distracted group showed higher hand discordance, suggesting reduced ambidexterity. Conclusion: Distraction negatively impacted some aspects of performance and resulted in subjective increased stress. In future, simulation may have a role in "stress inoculation," enabling surgeons to maintain performance, despite distractions.
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Affiliation(s)
- Isabel Ingram
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark A Hughes
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Narasimha S, Obuseh M, Anton NE, Chen H, Chakrabarty R, Stefanidis D, Yu D. Eye tracking and audio sensors to evaluate surgeon's non-technical skills: An empirical study. APPLIED ERGONOMICS 2024; 119:104320. [PMID: 38797012 DOI: 10.1016/j.apergo.2024.104320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/06/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
Non-Technical Skills (NTS) of medical teams are currently measured using subjective and resource-intensive ratings given by experts. This study explores if objective NTS assessment approaches with eye-tracking and audio sensors can measure teamwork and communication skills in surgery. Eight surgeons participated in a simulated two-phase surgical scenario developed to assess their NTS. Sensor-based audio, eye tracking and video data were collected and analyzed along with rating from the NOTSS scale. Different levels of communication were detected by the sensor data during the two phases of the simulated surgery. Sensor data detected leadership qualities among surgeons based on speech metrics, and eye tracking offered additional evidence about gaze patterns related to NTS. This objective approach to NTS measurement captured differences in communication in greater detail as opposed to a single collective rating obtained using current assessment tools.
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Affiliation(s)
| | - Marian Obuseh
- School of Industrial Engineering, Purdue University, USA
| | - Nicholas Eric Anton
- School of Industrial Engineering, Purdue University, USA; School of Medicine, Indiana University, USA
| | - Haozhi Chen
- School of Industrial Engineering, Purdue University, USA
| | | | | | - Denny Yu
- School of Industrial Engineering, Purdue University, USA
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Xue M, Liu P, Zhang J, Sun Y, Fang Y, Yang J, Zeng C, Huang B, Chen X, Xie M, Ye Z. Does a Video-Based and 3D Animation Hybrid Learning System Improve Teaching Outcomes in Orthopedic Surgery? A Randomized Controlled Trial. JOURNAL OF SURGICAL EDUCATION 2024; 81:1305-1319. [PMID: 38944585 DOI: 10.1016/j.jsurg.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/03/2024] [Accepted: 05/15/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE This study aims to evaluate the instructional efficacy of a 3D Surgical Training System (3DSTS), which combines real surgical footage with high-definition 3D animations, against conventional surgical videos and textbooks in the context of orthopedic proximal humerus fracture surgeries. DESIGN Before the experiment, 89 participants completed a pre-educational knowledge assessment. They were then randomized into 3 groups: the 3DSTS group (n = 30), the surgical video (SV) group (n = 29), and the textbook group (n = 30). After their respective teaching courses, all participants took a posteducational assessment and completed a perceived cognitive load test. The 3DSTS group also filled out a satisfaction survey. Once all assessments were finished, the SV and textbook groups were introduced to the 3DSTS course and subsequently completed a satisfaction survey. All statistical analyses were executed using IBM SPSS version 24 (IBM Corp., Armonk, NY). For data fitting normal distribution, we employed one-way analysis of variance (one-way ANOVA) and Tukey HSD tests, whereas, for non-normally distributed data, we used Kruskal-Wallis H tests and Dunn's tests. The significance level for all tests was set at p < 0.05. SETTING Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China. PARTICIPANTS About 89 doctors who undergoing standardized residents training. RESULT The initial assessment scores among the three groups were comparable, showing no significant statistical difference. Post-education revealed a marked difference in the scores, with the 3DSTS group outperforming both the SV and textbook groups. Specifically, the 3DSTS group exhibited statistically greater improvement in areas such as procedural steps, and specialized surgical techniques compared to the SV and textbook groups. During the 3DSTS teaching process, participants reported the least perceived cognitive load and expressed strong satisfaction, highlighting that the instructional materials are well-prepared, and considering this teaching method superior and more innovative than previous courses they had encountered. CONCLUSION The 3D Surgical Training System, integrating real videos with 3D animations, significantly enhances orthopedic surgery education over conventional methods, providing improved comprehension, lower cognitive load, and standardized learning outcomes. Its efficacy and high participant satisfaction underscore its potential for broader adoption in surgical disciplines. This study is registered with ClinicalTrials. gov ID: ChiCTR2300074730.
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Affiliation(s)
- Mingdi Xue
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intelligent Medical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengran Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intelligent Medical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayao Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intelligent Medical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yudong Sun
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Fang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intelligent Medical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaming Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intelligent Medical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng Zeng
- School of Computer, Wuhan University, Wuhan, China
| | - Biqiang Huang
- Digital Medical R&D Transformation Center of People's Medical Publishing House, Chengdu, China
| | - Xiaoliang Chen
- People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Ningxia Hui Autonomous Region, China
| | - Mao Xie
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intelligent Medical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhewei Ye
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Intelligent Medical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Rao A, Ratner M, Zhang J, Wiske C, Garg K, Maldonado T, Sadek M, Jacobowitz G, Berland T, Teter K, Rockman C. The substantial burden of iatrogenic vascular injury on the vascular surgery workforce at an academic medical center. J Vasc Surg 2024; 80:373-378. [PMID: 38641255 DOI: 10.1016/j.jvs.2024.04.037] [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: 02/16/2024] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE Vascular surgeons are often called upon to provide emergent surgical assistance to other specialties for iatrogenic complications, both intraoperatively and in the inpatient setting. The management of iatrogenic vascular injury remains a critical role of the vascular surgeon, especially in the context of the increasing adoption of percutaneous procedures by other specialties. This study aims to characterize consultation timing, management, and outcomes for iatrogenic vascular injuries. METHODS This study identified patients for whom vascular surgery was consulted for iatrogenic vascular complications from February 1, 2022, to May 12, 2023. Patient information, including demographic information, injury details, and details of any operative intervention, was retrospectively collected from February 1, 2022, to October 13, 2022, and prospectively collected for the remainder of the study period. Analyses were performed with R (version 2022.02.03). RESULTS There were 87 patients with consultations related to iatrogenic vascular injury. Of these, 42 (46%) were female and the mean age was 59 years (±18 years). The most common consulting services were cardiology (32%), cardiothoracic surgery (26%), general surgery (8%), and neurointerventional radiology (10%). Reasons for consultation included hemorrhage (36%), limb ischemia (36%), and treatment of pseudoaneurysm (23%). A total of 24% of consults were intraoperative, 20% of consults related to extracorporeal membrane oxygenation cannulation, and 16% of consults related to ventricular assist devices including left ventricular assist device and intra-aortic balloon pump. The majority of these consult requests (60%) occurred during evening and night hours (5 PM to 7 AM). Emergent intervention was required in 62% of cases and consisted of primary open surgical repair of arterial injury (54%), endovascular intervention (21%), and open thromboembolectomy (15%). Overall, in-hospital mortality for the patient cohort was 20% and the reintervention rate was 23%, reflecting the underlying complexity of the illness and nature of the vascular injury in this patient group. CONCLUSIONS Vascular surgeons play an essential role in managing emergent life-threatening hemorrhagic and ischemic iatrogenic vascular complications in the hospitalized setting. The complications require immediate bedside or intraoperative consult and often emergent open surgical or endovascular intervention. Furthermore, many of these require urgent management in the evening or overnight hours, and therefore the high frequency of these events represents a potential significant resource utilization and workforce issue to the vascular surgery workforce.
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Affiliation(s)
- Abhishek Rao
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY.
| | - Molly Ratner
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Jason Zhang
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Clay Wiske
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Thomas Maldonado
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Mikel Sadek
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Glenn Jacobowitz
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Todd Berland
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Katherine Teter
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
| | - Caron Rockman
- Division of Vascular and Endovascular Surgery, NYU School of Medicine, New York, NY
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Georgiou K, Boyanov N, Thanasas D, Sandblom G, Linardoutsos D, Enochsson L. Saliva stress biomarkers in ERCP trainees before and after familiarisation with ERCP on a virtual simulator. Front Surg 2024; 11:1364195. [PMID: 38952438 PMCID: PMC11215138 DOI: 10.3389/fsurg.2024.1364195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024] Open
Abstract
Background Stress during the early ERCP learning curve may interfere with acquisition of skills during training. The purpose of this study was to compare stress biomarkers in the saliva of trainees before and after familiarisation with ERCP exercises on a virtual simulator. Methods Altogether 26 endoscopists under training, 14 women and 12 men, completed the three phases of this study: Phase 1. Three different ERCP procedures were performed on the simulator. Saliva for α-amylase (sAA), Chromogranin A (sCgA), and Cortisol (sC) were collected before (baseline), halfway through the exercise (ex.), and 10 min after completion of the exercise (comp.); Phase 2. A three-week familiarisation period where at least 30 different cases were performed on the virtual ERCP simulator; and Phase 3. Identical to Phase 1 where saliva samples were once again collected at baseline, during, and after the exercise. Percentage differences in biomarker levels between baseline and exercise (Diffex) and between baseline and completion (Diffcomp) during Phase 1 and Phase 3 were calculated for each stress marker. Results Mean % changes, Diffex and Diffcomp, were significantly positive (p < 0.05) for all markers in both Phase 1 and Phase 3. Diffex in Phase 1 was significantly greater than Diffex in Phase 3 (p < 0.05) for sAA and sCgA. Diffcomp for sAA in Phase 1 was significantly greater than Diffcomp in Phase 3 (p < 0.05). No significant differences were found in sC concentration between Phases 1 and 3. Conclusion This study shows that familiarisation with the ERCP simulator greatly reduced stress as measured by the three saliva stress biomarkers used with sAA being the best. It also suggests that familiarisation with an ERCP simulator might reduce stress in the clinical setting.
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Affiliation(s)
- Konstantinos Georgiou
- 1st Department of Propaedeutic Surgery, Hippocrateion Athens General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikola Boyanov
- Medical Simulation Training Centre, Research Institute of Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Dimitrios Thanasas
- Medical Physics Laboratory Simulation Centre, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Dimitrios Linardoutsos
- 1st Department of Propaedeutic Surgery, Hippocrateion Athens General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lars Enochsson
- Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden
- Department of Clinical Science, Interventions and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
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Howie EE, Ambler O, Gunn EG, Dias RD, Wigmore SJ, Skipworth RJ, Yule SJ. Surgical Sabermetrics: A Scoping Review of Technology-enhanced Assessment of Nontechnical Skills in the Operating Room. Ann Surg 2024; 279:973-984. [PMID: 38258573 PMCID: PMC11086675 DOI: 10.1097/sla.0000000000006211] [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] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical nontechnical skills and investigate the implications for enhancing surgical performance. BACKGROUND Surgeons need high-quality, objective, and timely feedback to optimize performance and patient safety. Digital tools to assess nontechnical skills have the potential to reduce human bias and aid scalability. However, we do not fully understand which of the myriad of digital metrics of performance assessment have efficacy for surgeons. METHODS A systematic review was conducted by searching PubMed, EMBASE, CINAHL, and PSYCINFO databases following PRISMA-ScR guidelines. MeSH terms and keywords included "Assessment," "Surgeons," and "Technology". Eligible studies included a digital assessment of nontechnical skills for surgeons, residents, and/or medical students within an operative context. RESULTS From 19,229 articles screened, 81 articles met the inclusion criteria. The studies varied in surgical specialties, settings, and outcome measurements. A total of 122 distinct objective, digital metrics were utilized. Studies digitally measured at least 1 category of surgical nontechnical skill using a single (n=54) or multiple objective measures (n=27). The majority of studies utilized simulation (n=48) over live operative settings (n=32). Surgical Sabermetrics has been demonstrated to be beneficial in measuring cognitive load (n=57), situation awareness (n=24), communication (n=3), teamwork (n=13), and leadership (n=2). No studies measured intraoperative decision-making. CONCLUSIONS The literature detailing the intersection between surgical data science and operative nontechnical skills is diverse and growing rapidly. Surgical Sabermetrics may provide a promising modifiable technique to achieve desirable outcomes for both the surgeon and the patient. This study identifies a diverse array of measurements possible with sensor devices and highlights research gaps, including the need for objective assessment of decision-making. Future studies may advance the integration of physiological sensors to provide a holistic assessment of surgical performance.
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Affiliation(s)
- Emma E. Howie
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Olivia Ambler
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Eilidh G.M. Gunn
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Roger D. Dias
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
- Human Factors and Cognitive Engineering Lab, STRATUS Centre for Medical Simulation, Brigham & Women’s Hospital, Boston, MA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Stephen J. Wigmore
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Richard J.E. Skipworth
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
| | - Steven J. Yule
- Clinical Surgery, University of Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, Scotland
- Edinburgh Surgical Sabermetrics Group, University of Edinburgh, Edinburgh, Scotland
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Peabody J, Ziesmann MT, Gillman LM. Comparing the stress response using heart rate variability during real and simulated crises: a pilot study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:465-475. [PMID: 37432495 DOI: 10.1007/s10459-023-10246-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 05/21/2023] [Indexed: 07/12/2023]
Abstract
Medical personnel often experience stress when responding to a medical emergency. A known stress-response is a measurable reduction in heart rate variability. It is currently unknown if crisis simulation can elicit the same stress response as real clinical emergencies. We aim to compare heart rate variability changes amongst medical trainees during simulated and real medical emergencies. We performed a single center prospective observational study, enrolling 19 resident physicians. Heart rate variability was measured in real time, using a 2-lead heart rate monitor (Bodyguard 2, Firstbeat Technologies Ltd) worn during 24 h critical care call shifts. Data was collected at baseline, during crisis simulation and when responding to medical emergencies. 57 observations were made to compare participant's heart rate variability. Each heart rate variability metric changed as expected in response to stress. Statistically significant differences were observed between baseline and simulated medical emergencies in Standard Deviation of the N-N interval (SDNN), Root mean square standard deviation of the N-N interval (RMSSD), Percentage of successive R-R intervals that differ by more than 50 ms (PNN50), Low Frequency (LF) and Low Frequency: High Frequency ratios (LF:HF). No statistically significant differences between simulated and real medical emergencies were identified in any heart rate variability metrics. We have shown using objective results, that simulation can elicit the same psychophysiological response as actual medical emergencies. Therefore, simulation may represent a reasonable way to practice not only essential skills in a safe environment but has the additional benefit of creating a realistic, physiological response in medical trainees.
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Affiliation(s)
- Jeremy Peabody
- Undergraduate Medical Education, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Markus T Ziesmann
- Section of General Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, GF439 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
| | - Lawrence M Gillman
- Section of General Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, GF439 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
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Lefetz O, Baste JM, Hamel JF, Mordojovich G, Lefevre-Scelles A, Coq JM. Robotic surgery and work-related stress: A systematic review. APPLIED ERGONOMICS 2024; 117:104188. [PMID: 38301320 DOI: 10.1016/j.apergo.2023.104188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
Despite robot-assisted surgery (RAS) becoming increasingly common, little is known about the impact of the underlying work organization on the stress levels of members of the operating room (OR) team. To this end, assessing whether RAS may impact work-related stress, identifying associated stress factors and surveying relevant measurement methods seems critical. Using three databases (Scopus, Medline, Google Scholar), a systematic review was conducted leading to the analysis of 20 articles. Results regarding OR team stress levels and measurement methods were heterogeneous, which could be explained by differing research conditions (i.e., lab. vs. real-life). Relevant stressors such as (in)experience with RAS and quality of team communication were identified. Development of a common, more reliable methodology of stress assessment is required. Research should focus on real-life conditions in order to develop valid and actionable knowledge. Surgical teams would greatly benefit from discussing RAS-related stressors and developing team-specific strategies to handle them.
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Affiliation(s)
- Ophélie Lefetz
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France.
| | - Jean-Marc Baste
- Faculté de Médecine et de Pharmacie, Université de Rouen, 22 Boulevard Gambetta, CS, 76183, Rouen Cedex 1, France; Rouen University Hospital, Department of general and thoracic surgery, F-76000, Rouen, France; Normandie Univ, UNIROUEN, INSERM, U1096, Rouen University Hospital, Rouen, France
| | | | - Gerardo Mordojovich
- Clínica Alemana de Santiago, Av. Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile; Hospital de la Fuerza Aérea de Chile, Santiago, Chile; Universidad Mayor de Santiago, Santiago, Chile
| | - Antoine Lefevre-Scelles
- Rouen University Hospital, Department of intensive care, anesthesia and perioperative medicine, F-76000, Rouen, France; Rouen University Hospital, Emergency Care Training Center (CESU-76A) of Emergency medical service (SAMU-76A), F-76000, Rouen, France
| | - Jean-Michel Coq
- Univ Rouen Normandie, CRFDP, UR 7475, F-76000, Rouen, France
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Heuser M, Gonzalez-Uarquin F, Nuber M, Brockmann MA, Baumgart J, Baumgart N. A 3D-Printed Dummy for Training Distal Phalanx Amputation in Mice. Animals (Basel) 2024; 14:1253. [PMID: 38672401 PMCID: PMC11047469 DOI: 10.3390/ani14081253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
The development of realistic dummies for training the distal phalanx amputation (DPA) technique in mouse pups is a promising alternative to reduce and replace animals in training for research and teaching. To test this, we obtained micro-CT data from postnatal day-five mouse pups, meticulously segmented them, and converted them into a 3D mesh format suitable for 3D printing. Once the dummy was printed, it was evaluated during actual training courses in two different groups: in the first group, users received no dummies to train the DPA, and in the second group, users were trained with three dummies. To assess the effectiveness of the dummy, we conducted a survey followed by an expert veterinarian evaluation. Our results showed that DPA is a complex procedure, and it is commonly poorly performed. When implementing the dummies, users who were not provided with dummies to practice only had an 8.3% success rate in DPA, while users provided with three dummies had a 45.5% success rate, respectively. Despite additional research being needed, our dummy offered improved practical training by providing a safe and effective alternative in line with ethical considerations while demonstrating the feasibility of using 3D printing technology to promote the 3Rs in experimental research.
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Affiliation(s)
- Miriam Heuser
- Translational Animal Research Center, University Medical Centre, Johannes Gutenberg-Universität Mainz, 55122 Mainz, Germany; (F.G.-U.); (M.N.); (J.B.); (N.B.)
| | - Fernando Gonzalez-Uarquin
- Translational Animal Research Center, University Medical Centre, Johannes Gutenberg-Universität Mainz, 55122 Mainz, Germany; (F.G.-U.); (M.N.); (J.B.); (N.B.)
| | - Maximilian Nuber
- Translational Animal Research Center, University Medical Centre, Johannes Gutenberg-Universität Mainz, 55122 Mainz, Germany; (F.G.-U.); (M.N.); (J.B.); (N.B.)
| | - Marc A. Brockmann
- Clinic and Polyclinic for Neuroradiology, University Medical Centre, Johannes Gutenberg-Universität Mainz, 55131 Mainz, Germany;
| | - Jan Baumgart
- Translational Animal Research Center, University Medical Centre, Johannes Gutenberg-Universität Mainz, 55122 Mainz, Germany; (F.G.-U.); (M.N.); (J.B.); (N.B.)
| | - Nadine Baumgart
- Translational Animal Research Center, University Medical Centre, Johannes Gutenberg-Universität Mainz, 55122 Mainz, Germany; (F.G.-U.); (M.N.); (J.B.); (N.B.)
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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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Constable MD, Shum HPH, Clark S. Enhancing surgical performance in cardiothoracic surgery with innovations from computer vision and artificial intelligence: a narrative review. J Cardiothorac Surg 2024; 19:94. [PMID: 38355499 PMCID: PMC10865515 DOI: 10.1186/s13019-024-02558-5] [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: 07/01/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
When technical requirements are high, and patient outcomes are critical, opportunities for monitoring and improving surgical skills via objective motion analysis feedback may be particularly beneficial. This narrative review synthesises work on technical and non-technical surgical skills, collaborative task performance, and pose estimation to illustrate new opportunities to advance cardiothoracic surgical performance with innovations from computer vision and artificial intelligence. These technological innovations are critically evaluated in terms of the benefits they could offer the cardiothoracic surgical community, and any barriers to the uptake of the technology are elaborated upon. Like some other specialities, cardiothoracic surgery has relatively few opportunities to benefit from tools with data capture technology embedded within them (as is possible with robotic-assisted laparoscopic surgery, for example). In such cases, pose estimation techniques that allow for movement tracking across a conventional operating field without using specialist equipment or markers offer considerable potential. With video data from either simulated or real surgical procedures, these tools can (1) provide insight into the development of expertise and surgical performance over a surgeon's career, (2) provide feedback to trainee surgeons regarding areas for improvement, (3) provide the opportunity to investigate what aspects of skill may be linked to patient outcomes which can (4) inform the aspects of surgical skill which should be focused on within training or mentoring programmes. Classifier or assessment algorithms that use artificial intelligence to 'learn' what expertise is from expert surgical evaluators could further assist educators in determining if trainees meet competency thresholds. With collaborative efforts between surgical teams, medical institutions, computer scientists and researchers to ensure this technology is developed with usability and ethics in mind, the developed feedback tools could improve cardiothoracic surgical practice in a data-driven way.
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Affiliation(s)
- Merryn D Constable
- Department of Psychology, Northumbria University, Newcastle-upon-Tyne, UK.
| | - Hubert P H Shum
- Department of Computer Science, Durham University, Durham, UK
| | - Stephen Clark
- Department of Applied Sciences, Northumbria University, Newcastle-upon-Tyne, UK
- Consultant Cardiothoracic and Transplant Surgeon, Freeman Hospital, Newcastle upon Tyne, UK
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Chrouser KL, Partin MR, Gainsburg I, White KM. Examining the surgical stress effects (SSE) framework in practice: A qualitative assessment of perceived sources and consequences of intraoperative stress in surgical teams. Am J Surg 2024; 228:133-140. [PMID: 37689567 DOI: 10.1016/j.amjsurg.2023.08.024] [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: 05/16/2023] [Revised: 07/19/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Surgical adverse events persist despite extensive improvement efforts. Emotional and behavioral responses to stressors may influence intraoperative performance, as illustrated in the surgical stress effects (SSE) framework. However, the SSE has not been assessed using "real world" data. METHODS We conducted semi-structured interviews with all surgical team roles at one midwestern VA hospital and elicited narratives involving intraoperative stress. Two coders inductively identified codes from transcripts. The team identified themes among codes and assessed concordance with the SSE framework. RESULTS Throughout 28 interviews, we found surgical stress was ubiquitous, associated with a variety of factors, including adverse events. Stressors often elicited frustration, anger, fear, and anxiety; behavioral reactions to negative emotions frequently were perceived to degrade individual/team performance and compromise outcomes. Narratives were consistent with the SSE framework and support adding a process outcome (efficiency) and illustrating how adverse events can feedback and acutely increase job demands and stress. CONCLUSION This qualitative study describes narratives of intraoperative stress, finding they are consistent with the SSE while also allowing minor improvements to the current framework.
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Affiliation(s)
- Kristin L Chrouser
- Minneapolis VA Healthcare System, 1 Veterans Dr, Minneapolis, MN, 55417, USA; Department of Urology, University of Michigan, 2800 Plymouth Rd, NCRC Building 16, #147S, Ann Arbor, MI, 48109-2800, USA.
| | - Melissa R Partin
- Minneapolis VA Healthcare System, 1 Veterans Dr, Minneapolis, MN, 55417, USA; Department of Urology, University of Michigan, 2800 Plymouth Rd, NCRC Building 16, #147S, Ann Arbor, MI, 48109-2800, USA; Hennepin Healthcare Research Institute, 701 Park Ave, Ste PP7.700, Minneapolis, MN, 55415, USA.
| | - Izzy Gainsburg
- Harvard Kennedy School, 79 John F. Kennedy St, Cambridge, MA, 02138, USA; Department of Psychology, University of Michigan, 1004 East Hall, 530 Church St Ann Arbor, MI, 48109, USA.
| | - Katie M White
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
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D'Angelo ALD, Rivera M, Rasmussen TE, Nelson MH, Behm KT, Kelley SR, D'Angelo JD. Implementation of a Brief Evidence-Based Intraoperative Coping Curriculum. JOURNAL OF SURGICAL EDUCATION 2023; 80:1737-1740. [PMID: 37679289 DOI: 10.1016/j.jsurg.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND RATIONALE Recent research has called for further resident training in coping with errors and adverse events in the operating room. To the best of our knowledge, there currently exists no evidence-based curriculum or training on this topic. MATERIALS AND METHODS Synthesizing three prior studies on how experienced surgeons react to errors and adverse events, we developed the STOPS framework for handling surgical errors and adverse events (Stop, Talk to your team, Obtain help, Plan, Succeed). This material was presented to residents in two teaching sessions. RESULTS AND CONCLUSION In this paper, we describe the presentation of, and the uniformly positive resident reaction to, the STOPS framework: an empirically based psychological tool for surgeons who experience operative errors or adverse events.
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Affiliation(s)
| | - Mariela Rivera
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Megan H Nelson
- Division of General Surgery, Mayo Clinic, Phoenix, Arizona
| | - Kevin T Behm
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, Minnesota
| | - Scott R Kelley
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, Minnesota
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Deluche E, Salle H, Leobon S, Facchini-Joguet T, Fourcade L, Taibi A. ACACIAS 1: The physiological and subjective impacts of high fidelity simulation of the breaking of bad news. J Visc Surg 2023; 160:323-329. [PMID: 37005112 DOI: 10.1016/j.jviscsurg.2023.03.006] [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] [Indexed: 04/03/2023]
Abstract
STUDY OBJECTIVE Breaking bad news (BN) is difficult and necessitates targeted training. To be effective, training may call for High Fidelity Simulation (HFS). This prospective study was conducted to objectively assess the impact of HFS as a tool conducive to the development of clinical competence in situations involving the delivery of bad news. METHODS This feasibility study was conducted from January to May 2021 and included students in medical oncology and digestive surgery. The subjective and objective impacts of HFS were evaluated by means of a self-administered questionnaire and a wristband, Affect-tag, which recorded several indicators: emotional power (EP), emotional density (DE) and cognitive load (CL) in students undergoing training. RESULTS Forty-six (46) students with a median age of 25 years (21-34 years) were included. While the participants were effectively and emotionally involved in the HFS training, they were not completely overwhelmed by their emotions, a possible occurrence in this type of program. After two training programs, the students presented with lower EP (P<0.001) and higher DE (P=0.005), while their CL remained stable (P=0.751). The information given in the self-administered questionnaires and the evaluations by outside professionals (actor, nurse, psychologist…) highlighted improved skills. CONCLUSION Taking into account the emotional parameters observed and the questionnaires collected, HFS can be considered as a suitable and effective tool in the breaking of bad news.
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Affiliation(s)
- E Deluche
- Department of Medical Oncology, Limoges University Hospital, Limoges, France; Digital Health Education Department, Faculty of Medicine, University of Limoges, Limoges, France.
| | - H Salle
- Department of Neurosurgery, Limoges University Hospital, Limoges, France
| | - S Leobon
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | | | - L Fourcade
- Digital Health Education Department, Faculty of Medicine, University of Limoges, Limoges, France; Department of Pediatric Visceral Surgery, Limoges University Hospital, Children's Hospital, Limoges, France
| | - A Taibi
- Department of Digestive, General and Endocrinology Surgery, Limoges University Hospital, Limoges, France
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Jalali M, Esmaeili R, Habibi E, Alizadeh M, Karimi A. Mental workload profile and its relationship with presenteeism, absenteeism and job performance among surgeons: The mediating role of occupational fatigue. Heliyon 2023; 9:e19258. [PMID: 37662723 PMCID: PMC10474409 DOI: 10.1016/j.heliyon.2023.e19258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/22/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Surgeons are one of the most significant jobs in the health care system that plays an important role in the patients' health promotion and their treatment. In the current study, the effect of mental workload on the work performance of surgeons was tested by considering the mediating effect of fatigue on this relationship. Method This study was done analytically on 165 surgeons working in the operating rooms of hospitals in Iran. To determine of mental workload, the SURG-TLX method was used. The job performance was measured using the short version of the job performance questionnaire provided by the World Health Organization (WHO-HPQ), and accordingly relative presenteeism, relative absenteeism and job performance variables were calculated. The Swedish Occupational Fatigue Inventory (SOFI) questionnaire was used to determine occupational fatigue. A conceptual model was built to determine the direct and indirect relationship between mental workload and job performance, and the mediating effect of occupational fatigue on the relationship between mental workload and job performance was tested using structural equation modeling (SEM). Results Out of 165 distributed questionnaires, 140 questionnaires were completed and delivered to the researchers (85% response rate). The mean ± standard deviations of mental workload, fatigue, and work performance were 16.57 ± 5.83, 6.32 ± 2.86, and 0.65 ± 0.28, respectively. The results of model fit indexes revealed that all indexes are within the acceptable range. Regarding this model, the direct effect of mental workload on job performance was not significant (β = -0.21; p = 0.072). A significant positive relationship was observed between mental workload and fatigue (β = 0.36; p < 0.001). The direct effect of fatigue on job performance was also the opposite and statistically significant (β = -0.39; p < 0.001). Finally, results indicated that the effect of mental workload on work performance mediated by occupational fatigue. Conclusion Surgeons suffer a high level of mental workload during their work, and this factor can have a negative effect on surgeons' job performance. The effect of mental workload on job performance in surgeons can be detected, directly and indirectly, through the mediating effect of occupational fatigue. Improving the mental and physical conditions of the work environment can reduce occupational fatigue and improve surgeons' job performance.
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Affiliation(s)
- Mahdi Jalali
- Department of Occupational Health Engineering, School of Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
- Department of Occupational Health and Safety Engineering, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Esmaeili
- Department of Occupational Health and Safety Engineering, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ehsanollah Habibi
- Department of Occupational Health and Safety Engineering, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Alizadeh
- Department of Health, Safety and Environment (HSE), Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Karimi
- Department of Occupational Health and Safety Engineering, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Williams EC, MacDonald S, Fox WC, Leitsinger T, Farres H, Sandhu SJS, Brigham T, Meschia JF, Erben Y. A Scoping Review of Simulation-Based Training Paradigms for Carotid Artery Endarterectomy and Carotid Artery Stenting. Ann Vasc Surg 2023; 95:271-284. [PMID: 37236535 DOI: 10.1016/j.avsg.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/07/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Surgical simulation has come to the forefront to enhance the training of residents. The aim of our scoping review is to analyze the available simulation-based carotid revascularization techniques, including carotid endarterectomy (CEA) and carotid artery stenting (CAS) and suggest critical steps for evaluating competency in a standardized fashion. METHODS A scoping review of all reports on simulation-based carotid revascularization techniques including CEA and CAS was performed in PubMed/MEDLINE, Scopus, Embase, Cochrane, Science Citation Index Expanded, Emerging Sources Citation Index, and Epistemonikos databases. Data were collected according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The English language literature was searched from January 1, 2000 to January 9, 2022. The outcomes evaluated included measures of assessment of operator performance. RESULTS Five CEA and 11 CAS manuscripts were included in this review. The methods of assessments employed by these studies to judge performance were comparable. The 5 CEA studies sought to validate and demonstrate improved performance with training or distinguish surgeons by their experience level, either through assessing operative performance or end-product results. The 11 CAS studies used 1 of 2 types of commercial simulators and focused on determining the efficacy of simulators as teaching tools. By examining the steps of the procedure associated with preventable perioperative complications, it provides a reasonable framework for determining which elements of the procedure should be emphasized most. Furthermore, using potential errors as a basis for assessment of competency could reliably distinguish operators based on level of experience. CONCLUSIONS Competency-based simulation training is becoming more relevant as our surgical training paradigm shifts with the increased scrutiny within training programs of work-hour regulations and the need to develop a curriculum to assess our trainees' ability to perform specific operations competently during their stipulated training period. Our review has given us an insight into the current efforts in this space regarding 2 specific procedures that are key for all vascular surgeons to master. Although many competency-based modules are available, there is a lack of standardization in the grading/rating system of what surgeons consider vital steps of each procedure to assess these simulation-based modules. Therefore, the next steps of curriculum development should be based on standardization efforts for the different protocols available.
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Affiliation(s)
- Elizabeth C Williams
- University of West Virginia School of Medicine, West Virginia University, Charleston, WV
| | | | | | | | - Houssam Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL
| | | | - Tara Brigham
- Mayo Clinic Libraries, Mayo Clinic, Jacksonville, FL
| | | | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL.
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Abahuje E, Reddy S, Rosu C, Lin KA, Mack L, Valukas C, Shapiro M, Alam HB, Halverson A, Bilimoria K, Coleman J, Stey AM. Relationship Between Residents' Physiological Stress and Faculty Leadership Skills in a Department of Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:1129-1138. [PMID: 37336667 DOI: 10.1016/j.jsurg.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/21/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Leadership skills of team leaders can impact the functioning of their teams. It is unknown whether attending surgeons' leadership skills impact residents' physiological stress. This study sought to (1) assess the relationship between attending surgeons' leadership skills and residents' physiological stress and (2) to characterize lifestyle behaviors associated with resident physiological stress. We hypothesized that strong attending leadership skills would be associated with low resident physiological stress. STUDY DESIGN This prospective observational cohort study was conducted at a single urban, academic medical center in the US, over 12 months. Residents were enrolled during their rotation of 1 to 2 months on the Trauma and ICU services. The primary predictor was the attending surgeons' leadership skills that were measured using a weekly survey filled out by residents, using the Surgeons' Leadership Inventory (SLI). The SLI uses a 4-point Likert scale to measure surgeons' leadership skills across eight domains. The primary outcome was residents' physiological stress, which was measured by their Heart Rate Variability (HRV). We recorded the residents' HRV with a WHOOP strap that was continuously worn on the wrist or the bicep. We used multivariate repeated measures gamma regression to assess the relationship between attending leadership skills and residents' physiological stress, adjusting for hours of sleep, age, and service. RESULTS Sixteen residents were enrolled over 12 months. The median attending surgeons' leadership score was 3.8 (IQR: 3.2-4.0). The median residents' percent of maximal HRV was 70.8% (IQR: 56.7-83.7). Repeated measure gamma regression model demonstrated a minimal nonsignificant increase of 1.6 % (95% CI: -5.6, 8.9; p-value = 0.65) in the percent of maximal HRV (less resident physiological stress) for every unit increase in leadership score. There was an increase of 2.9% (95% CI= 1.6, 4.2; p-value < 0.001) in the percent of maximal HRV per hour increase in sleep and a significant decrease of 10.9% (95% CI= -16.8, -5.2; < 0.001) in the percent of HRV when working in the ICU compared to the Trauma service. CONCLUSION This study revealed that more residents' sleep was associated with lower physiological stress. Attending surgeons' leadership skills were not associated with residents' physiological stress.
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Affiliation(s)
- Egide Abahuje
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Massachusetts General Hospital, Institute of Health Professions, Boston, Massachusetts.
| | - Susheel Reddy
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Claudia Rosu
- Massachusetts General Hospital, Institute of Health Professions, Boston, Massachusetts
| | - Katherine A Lin
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lara Mack
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Catherine Valukas
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Shapiro
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Hasan B Alam
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy Halverson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karl Bilimoria
- Department of Surgery, School of Medicine, Indian University, Indianapolis, Indiana
| | - Jamie Coleman
- Department of Surgery, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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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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Ji J, Langley B, Zordan R, van Dijk J, Thies HHG, Brahmbhatt A, Torcasio C, Cunningham N. Heart rate responses in critical care trainees during airway intubation: a comparison between the simulated and clinical environments. BMC Emerg Med 2023; 23:66. [PMID: 37301951 PMCID: PMC10257286 DOI: 10.1186/s12873-023-00832-8] [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: 11/25/2022] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE This study aimed to compare the heart rate response to stress during airway intubations in clinical practice and a simulated environment. METHODS Twenty-five critical care registrars participated in the study over a 3-month period. Heart rate data during intubations was recorded by a FitBit® Charge 2 worn by each participant during their clinical practice, and during a single simulated airway management scenario. The heart rate range was calculated by subtracting the baseline working heart rate (BWHR) from the maximum functional heart rate (MFHR). For each airway intubation performed participants recorded an airway diary entry. Data from intubations performed in the clinical environment was compared to data from a simulated environment. Heart rate changes were observed in two ways: percentage rise (median) across the 20-min intubation period and; percentage rise at point of intubation (median). RESULTS Eighteen critical care registrars completed the study, mean age 31.8 years (SD = 2.015, 95% CI = 30.85-32.71). Throughout the 20-min peri-intubation recording period there was no significant difference in the median change in heart rates between the clinical (14.72%) and simulation (15.96%) environment (p = 0.149). At the point of intubation there was no significant difference in the median change in heart rate between the clinical (16.03%) and the simulation (25.65%) environment groups (p = 0.054). CONCLUSION In this small population of critical care trainees, a simulation scenario induced a comparable heart rate response to the clinical environment during intubation. This provides evidence that simulation scenarios are able to induce a comparable physiological stress response to the clinical environment and thus facilitates effective teaching of a high-risk procedure in a safe manner.
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Affiliation(s)
- Jackson Ji
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Bridget Langley
- Department of Anaesthesia and Acute Pain Medicine, St Vincent’s Hospital, Melbourne, Australia
| | - Rachel Zordan
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Education and Learning, St Vincent’s Hospital Melbourne, Melbourne, Australia
| | - Julian van Dijk
- Education and Learning, St Vincent’s Hospital Melbourne, Melbourne, Australia
| | | | - Anjalee Brahmbhatt
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Anaesthesia and Acute Pain Medicine, St Vincent’s Hospital, Melbourne, Australia
| | - Clarissa Torcasio
- Education and Learning, St Vincent’s Hospital Melbourne, Melbourne, Australia
| | - Neil Cunningham
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Emergency Medicine, St Vincent’s Hospital, Melbourne, Australia
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Amirthanayagam A, Zecca M, Barber S, Singh B, Moss EL. Impact of minimally invasive surgery on surgeon health (ISSUE) study: protocol of a single-arm observational study conducted in the live surgery setting. BMJ Open 2023; 13:e066765. [PMID: 36882245 PMCID: PMC10008445 DOI: 10.1136/bmjopen-2022-066765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION The rapid evolution of minimally invasive surgery has had a positive impact on patient outcomes; however, it is reported to be associated with work-related musculoskeletal symptoms (WMS) in surgeons. Currently there is no objective measure to monitor the physical and psychological impact of performing a live surgical procedure on the surgeon. METHODS AND ANALYSIS A single-arm observational study with the aim of developing a validated assessment tool to quantify the impact of surgery (open/laparoscopic/robotic-assisted) on the surgeon. Development and validation cohorts of major surgical cases of varying levels of complexity performed by consultant gynaecological and colorectal surgeons will be recruited. Recruited surgeons wear three Xsens DOT monitors (muscle activity) and an Actiheart monitor (heart rate). Salivary cortisol levels will be taken and questionnaires (WMS and State-Trait Anxiety Inventory) completed by the participants preoperatively and postoperatively. All the measures will be incorporated to produce a single score that will be called the 'S-IMPACT' score. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the East Midlands Leicester Central Research Ethics Committee REC ref 21/EM/0174. Results will be disseminated to the academic community through conference presentations and peer-reviewed journal publications. The S-IMPACT score developed within this study will be taken forward for use in definitive multicentre prospective randomised control trials.
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Affiliation(s)
| | - Massimiliano Zecca
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, UK
| | - Shaun Barber
- Leicester Clinical Trials Unit, University of Leicester, Leicester, Leicestershire, UK
- NIHR Research Design Service East Midlands, Leicester, UK
| | - Baljit Singh
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
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22
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The physiology of intraoperative error: using electrokardiograms to understand operator performance during robot-assisted surgery simulations. Surg Endosc 2023:10.1007/s00464-023-09957-0. [PMID: 36862171 DOI: 10.1007/s00464-023-09957-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/12/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND No platform for objective, synchronous and on-line evaluation of both intraoperative error and surgeon physiology yet exists. Electrokardiogram (EKG) metrics have been associated with cognitive and affective features that are known to impact surgical performance but have not yet been analyzed in conjunction with real-time error signals using objective, real-time methods. METHODS EKGs and operating console point-of-views (POVs) for fifteen general surgery residents and five non-medically trained participants were captured during three simulated robotic-assisted surgery (RAS) procedures. Time and frequency-domain EKG statistics were extracted from recorded EKGs. Intraoperative errors were detected from operating console POV videos. EKG statistics were synchronized with intraoperative error signals. RESULTS Relative to personalized baselines, IBI, SDNN and RMSSD decreased 0.15% (S.E. 3.603e-04; P = 3.25e-05), 3.08% (S.E. 1.603e-03; P < 2e-16) and 1.19% (S.E. 2.631e-03; P = 5.66e-06), respectively, during error. Relative LF RMS power decreased 1.44% (S.E. 2.337e-03; P = 8.38e-10), and relative HF RMS power increased 5.51% (S.E. 1.945e-03; P < 2e-16). CONCLUSIONS Use of a novel, on-line biometric and operating room data capture and analysis platform enabled detection of distinct operator physiological changes during intraoperative errors. Monitoring operator EKG metrics during surgery may help improve patient outcomes through real-time assessments of intraoperative surgical proficiency and perceived difficulty as well as inform personalized surgical skills development.
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23
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Carnevali L, Bignami E, Gambetta S, Barbetti M, Procopio M, Freyrie A, Carbognani P, Ampollini L, Sgoifo A. Cardiac autonomic and cortisol stress responses to real operations in surgeons: relationship with individual psychobiological characteristics and experience. Biopsychosoc Med 2023; 17:5. [PMID: 36810132 PMCID: PMC9942282 DOI: 10.1186/s13030-023-00266-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/09/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Surgeons are exposed to high levels of intraoperative stress, which could compromise their psychological well-being in the long term. This study aimed at exploring the effects of real operations on the activity of stress response systems (i.e., cardiac autonomic function and hypothalamic-pituitary-adrenal axis) during and in the aftermath of surgery, and the moderating role of individual psychobiological characteristics and different levels of experience (senior vs expert surgeons). METHODS Heart rate, heart rate variability, and salivary cortisol measures (as indexes of cardiac autonomic and hypothalamic-pituitary-adrenal axis activity, respectively) were assessed during real operations and in the perioperative period in a sample of surgeons (n = 16). Surgeons' psychometric characteristics were collected using questionnaires. RESULTS Real operations triggered both cardiac autonomic and cortisol stress responses which were independent from surgeons' level of experience. Intraoperative stress responses did not affect cardiac autonomic activity during the following night but were associated with a blunted cortisol awakening response. Moreover, senior surgeons reported higher levels of negative affectivity and depressive symptoms than expert surgeons prior to the surgery. Lastly, the magnitude of heart rate responses to surgery positively correlated with scores on negative affectivity, depression, perceived stress, and trait anxiety scales. CONCLUSION This exploratory study allows to put forward the hypotheses that in surgeons cardiac autonomic and cortisol stress responses to real operations (i) may be associated with specific individual psychological characteristics regardless of the level of experience, (ii) and may have a longer lasting impact on hypothalamic-pituitary-adrenal axis function with potential implications for surgeons' physical and psychological well-being.
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Affiliation(s)
- Luca Carnevali
- Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy.
| | - Elena Bignami
- grid.10383.390000 0004 1758 0937Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sara Gambetta
- grid.10383.390000 0004 1758 0937Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Margherita Barbetti
- grid.10383.390000 0004 1758 0937Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Matteo Procopio
- grid.10383.390000 0004 1758 0937Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Freyrie
- grid.10383.390000 0004 1758 0937Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Carbognani
- grid.10383.390000 0004 1758 0937Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luca Ampollini
- grid.10383.390000 0004 1758 0937Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Sgoifo
- grid.10383.390000 0004 1758 0937Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
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Muacevic A, Adler JR. A Systematic Review of Heart Rate Variability as a Measure of Stress in Medical Professionals. Cureus 2023; 15:e34345. [PMID: 36865953 PMCID: PMC9974008 DOI: 10.7759/cureus.34345] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 03/04/2023] Open
Abstract
Understanding the physiological effects of responding to crises is a critical component in understanding how to manage and prepare medical professionals to be crisis responders. Heart rate variability (HRV) is the variation in rate between a succession of R-R intervals. This variation is not only affected by physiological processes such as respiration or metabolic rate but is also directly controlled by the autonomic nervous system. As such, heart rate variability has been proposed as a noninvasive tool to measure the physiological stress response. The aim of this systematic review is to consolidate heart rate variability literature in the context of medical emergencies to determine if heart rate variability changes predictably from baseline when responding to medical crises. This may demonstrate utility as an objective, noninvasive measure of stress response. A systematic literature review of six databases yielded 413 articles, 17 of which met our inclusion criteria of being written in English, measuring HRV in healthcare providers, and measuring HRV in real or simulated medical resuscitations or procedures. Articles were then analyzed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. Out of the 17 articles reviewed, 11 demonstrated statistically significant results showing heart rate variability responding in a predictable manner to stress. Three articles utilized a medical simulation as the stressor, six used medical procedures, and eight used medical emergencies encountered during clinical work. Overall, a predictable trend in heart rate variability metrics of standard deviation from the mean value of normal-to-normal (N-N) intervals (SDNN), root mean square of the successive differences (RMSSD), mean number of times per time interval in which the change in successive normal sinus (N-N) intervals exceeds 50 ms (PNN50), low frequency % (LF%), and low-frequency-to-high-frequency ratio (LF/HF) was observed when responding to stress. This systematic literature review showed that heart rate variability among healthcare providers responding to stressful scenarios follows a predictable pattern of change and expands our understanding of the physiology of stress in healthcare providers. This review supports the use of HRV to monitor stress during high-fidelity simulation to ensure that appropriate physiological arousal is achieved during the training of medical personnel.
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25
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McQueen SA, Hammond Mobilio M, Moulton CA. Pulling our lens backwards to move forward: an integrated approach to physician distress. MEDICAL HUMANITIES 2022; 48:404-410. [PMID: 34417324 DOI: 10.1136/medhum-2020-012100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 06/13/2023]
Abstract
The medical community has recently acknowledged physician stress as a leading issue for individual wellness and healthcare system functioning. Unprecedented levels of stress contribute to physician burnout, leaves of absence and early retirement. Although recommendations have been made, we continue to struggle with addressing stress. One challenge is a lack of a shared definition for what we mean by 'stress', which is a complex and idiosyncratic phenomenon that may be examined from a myriad of angles. As such, research on stress has traditionally taken a reductionist approach, parsing out one aspect to investigate, such as stress physiology. In the medical domain, we have traditionally underappreciated other dimensions of stress, including emotion and the role of the environmental and sociocultural context in which providers are embedded. Taking a complementary, holistic approach to stress and focusing on the composite, subjective individual experience may provide a deeper understanding of the phenomenon and help to illuminate paths towards wellness. In this review article, we first examine contributions from unidimensional approaches to stress, and then outline a complementary, integrated approach. We describe how complex phenomena have been tackled in other domains and discuss how holistic theory and the humanities may help in studying and addressing physician stress, with the ultimate goal of improving physician well-being and consequently patient care.
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Affiliation(s)
| | - Melanie Hammond Mobilio
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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26
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Pappada S, Owais MH, Aouthmany S, Rega P, Schneiderman J, Toy S, Schiavi A, Miller C, Guris RD, Papadimos T. Personalizing simulation-based medical education: the case for novel learning management systems. Simul Healthc 2022. [DOI: 10.54531/mngy8113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Simulation-based medical education (SBME) is often delivered as one-size-fits-all, with no clear guidelines for personalization to achieve optimal performance. This essay is intended to introduce a novel approach, facilitated by a home-grown learning management system (LMS), designed to streamline simulation program evaluation and curricular improvement by aligning learning objectives, scenarios, assessment metrics and data collection, as well as integrate standardized sets of multimodal data (self-report, observational and neurophysiological). Results from a pilot feasibility study are presented. Standardization is important to future LMS applications and could promote development of machine learning-based approaches to predict knowledge and skill acquisition, maintenance and decay, for personalizing SBME across healthcare professionals.
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Affiliation(s)
- Scott Pappada
- 1Department of Anesthesiology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Mohammad Hamza Owais
- 3Department of Electrical Engineering and Computer Science, College of Engineering, University of Toledo, Toledo, OH, USA
| | - Shaza Aouthmany
- 4Department of Emergency Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Paul Rega
- 4Department of Emergency Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Jeffrey Schneiderman
- 6College of Medicine and Life Sciences, EMS Education, University of Toledo, Toledo, OH, USA
| | - Serkan Toy
- 7Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Adam Schiavi
- 8Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christina Miller
- 8Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rodrigo Daly Guris
- 9Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas Papadimos
- 1Department of Anesthesiology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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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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Angus AA, Howard KK, Jawanda H, Callahan R, Ziegler KM, Roach VA. The effect of an attending versus neutral observer on peg transfer and intracorporeal knot-tying laparoscopic tasks. Surgery 2022; 172:1352-1357. [PMID: 36096964 DOI: 10.1016/j.surg.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/20/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgery is an outcome-based specialty where maintaining peak performance is crucial to patient care. There are a variety of identified surgeon stressors that can have an impact on performance, but one factor unique to surgical residents is the observation by an attending surgeon. This study explored how the perceived authority of the observer had an impact on the participants' physiologic markers of stress and task completion times. METHODS Eighteen general surgery residents performed the Fundamentals of Laparoscopic Surgery skills intracorporeal knot-tying and peg transfer tasks in a crossover study design while under the observation of an attending and a neutral observer. Heart rate variability, mean R-R interval, the time between R spikes on an EKG, minimum heart rate, maximum heart rate, average heart rate, and time to task completion were recorded. Analyses were completed via 2 × 2 analysis of variance with repeated measures. RESULTS When observed by an attending, participants demonstrated higher minimum, average, and maximum heart rates (P = .046, = .007, and < .001, respectively) than when observed by a neutral observer. Attending observation also significantly shortened time to task completion, relative to neutral observation (P = .022). CONCLUSION Attending observation is linked to increased objective measures of stress at the time of performance with decreased task completion times. Educational efforts to optimize the response to stress during learning may lead to better outcomes.
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Affiliation(s)
- Andrew A Angus
- Department of Surgical Critical Care, Brooke Army Medical Center, Fort Sam Houston, TX. https://twitter.com/aangusmd
| | - Kathryn K Howard
- Department of Surgery, William Beaumont Hospital, Royal Oak, MI.
| | - Harkirat Jawanda
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Rose Callahan
- Department of Surgery, William Beaumont Hospital, Royal Oak, MI
| | - Kathryn M Ziegler
- Department of Surgery, William Beaumont Hospital, Royal Oak, MI. https://twitter.com/KateZiggs
| | - Victoria A Roach
- Division of Healthcare Simulation Science, University of Washington, Seattle, WA. https://twitter.com/vicbomb
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STOPS: A Coping Framework for Surgeons Who Experience Intraoperative Error. Ann Surg 2022; 276:288-292. [PMID: 35797637 DOI: 10.1097/sla.0000000000005447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the steps faculty surgeons take upon experiencing intraoperative error and synthesize these actions to offer a framework for coping with errors. BACKGROUND While intraoperative errors are inevitable, formal training in error recovery is insufficient and there are no established curricula that teach surgeons how to deal with the intraoperative error. This is problematic because insufficient error recovery is detrimental to both patient outcomes and surgeon psychological well-being. METHODS We conducted a thematic analysis. One-hour in-depth semistructured interviews were conducted with faculty surgeons from 3 hospitals. Surgeons described recent experiences with intraoperative error. Interviews were transcribed and coded. Analysis allowed for development of themes regarding responses to errors and coping strategies. RESULTS Twenty-seven surgeons (30% female) participated. Upon completion of the analysis, themes emerged in 3 distinct areas: (1) Exigency, or a need for training surgical learners how to cope with intraoperative errors, (2) Learning, or how faculty surgeons themselves learned to cope with intraoperative errors, and (3) Responses, or how surgeons now handle intraoperative errors. The latter category was organized into the STOPS framework: Intraoperative errors could produce STOPS: Stop, Talk to your Team, Obtain Help, Plan, Succeed. CONCLUSIONS AND RELEVANCE This study provides both novel insight into how surgeons cope with intraoperative errors and a framework that may be of great use to trainees and faculty alike.
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Torkamani-Azar M, Lee A, Bednarik R. Methods and Measures for Mental Stress Assessment in Surgery: A Systematic Review of 20 Years of Literature. IEEE J Biomed Health Inform 2022; 26:4436-4449. [PMID: 35696473 DOI: 10.1109/jbhi.2022.3182869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Real-time mental stress monitoring from surgeons and surgical staff in operating rooms may reduce surgical injuries, improve performance and quality of medical care, and accelerate implementation of stress-management strategies. Motivated by the increase in usage of objective and subjective metrics for cognitive monitoring and by the gap in reviews of experimental design setups and data analytics, a systematic review of 71 studies on mental stress and workload measurement in surgical settings, published in 2001-2020, is presented. Almost 61% of selected papers used both objective and subjective measures, followed by 25% that only administered subjective tools - mostly consisting of validated instruments and customized surveys. An overall increase in the total number of publications on intraoperative stress assessment was observed from mid-2010 s along with a momentum in the use of both subjective and real-time objective measures. Cardiac activity, including heart-rate variability metrics, stress hormones, and eye-tracking metrics were the most frequently and electroencephalography (EEG) was the least frequently used objective measures. Around 40% of selected papers collected at least two objective measures, 41% used wearable devices, 23% performed synchronization and annotation, and 76% conducted baseline or multi-point data acquisition. Furthermore, 93% used a variety of statistical techniques, 14% applied regression models, and only one study released a public, anonymized dataset. This review of data modalities, experimental setups, and analysis techniques for intraoperative stress monitoring highlights the initiatives of surgical data science and motivates research on computational techniques for mental and surgical skills assessment and cognition-guided surgery.
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Haffar A, Krueger CA, Goh GS, Lonner JH. Total Knee Arthroplasty With Robotic Surgical Assistance Results in Less Physician Stress and Strain Than Conventional Methods. J Arthroplasty 2022; 37:S193-S200. [PMID: 35184931 DOI: 10.1016/j.arth.2021.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Poor surgical ergonomics and physiological stress have been shown to impair surgical performance and cause injuries. The prevalence of musculoskeletal pain among arthroplasty surgeons is inordinately high. This study compared surgeon stress and strain during robotic-assisted total knee arthroplasty (rTKA) and conventional TKA (cTKA). METHODS Continuous cardiorespiratory and ergonomic data of a single surgeon were measured during 40 consecutive unilateral TKAs (20 rTKAs, 20 cTKAs) using a smart garment and wearable sensors. Heart rate (HR), HR variability, respiratory rate, minute ventilation, and calorie expenditure were used as surrogate measures for physiological stress. Intraoperative ergonomics were assessed by measuring cervical and lumbar flexion, extension and rotation, and shoulder abduction/adduction. RESULTS Mean operative time was longer for rTKA (48.2 ± 9 vs 31.8 ± 7 min, P < .001). Calories expended per minute was lower for rTKA (2.53 vs 3.50, P < .001). Total calorie expenditure in rTKA cases 11-20 was significantly lower than the first 10 (107.1 ± 27 vs 137.6 ± 24, P = .015), and lower than cTKA (112.3 ± 37). Mean HR was lower for rTKA (81.5 ± 4 vs 90.1 ± 5, P < .001). Minute ventilation was also lower for rTKA (14.9 ± 1 vs 17.0 ± 1.0 L/min, P < .001). Mean lumbar flexion as well as the percentage of time spent in a demanding flexion position >20° were significantly lower during rTKA (P < .001). CONCLUSION rTKA resulted in less surgeon physiologic stress, energy expenditure per minute, and postural strain compared to cTKA. Robotic assistance may help to increase surgical efficiency and reduce physician workload, but further studies are needed to determine whether these benefits will reduce musculoskeletal pain and injury among surgeons.
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Affiliation(s)
- Amer Haffar
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Chad A Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Hardie JA, Hunn D, Mitchell TE, Brennan PA. Patient, Procedure, People (PPP): recognising and responding to intraoperative critical events. Ann R Coll Surg Engl 2022; 104:409-413. [PMID: 34939840 PMCID: PMC9157965 DOI: 10.1308/rcsann.2021.0193] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intraoperative critical events are rarely experienced by individual surgeons but are commonly experienced at a workforce level. Finding unfamiliar or unexpected pathology, anatomy, haemorrhage or an iatrogenic organ or structure injury cannot be completely eliminated in the complex surgical environment. It is vital that an appropriate, safe response to these infrequent events takes place to prevent possible further harm to patients. This paper introduces 'Patient, Procedure, People', a tool adapted from aviation threat and error management (TEM) training. It allows surgical teams to improve situational awareness (SA), communicate effectively, flatten team hierarchy gradients and improve decision-making before responding to critical events. We review factors contributing to poor decision-making, with resulting errors. These include loss of SA (tunnel vision), acute stress reactions (fight-flight or freeze-hide) and limbic hijacking (surprise and startle events). Events may cause workload to increase beyond cognitive capacity, further exacerbating the situation. After completing initial actions to achieve a temporary 'place of safety', surgical teams may use the tool to effectively manage threat or mitigate error. Aviation is a high-reliability organisation that has pioneered human factors research and training. Airline pilots undergo regular simulated emergencies assessment, including mandatory human factors assessment. Although the complexities of the operating theatre do not currently lend themselves to high-fidelity simulation as in aviation, valuable transferrable lessons can be learnt from aviation's approach to TEM.
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Affiliation(s)
- JA Hardie
- Frimley Health NHS Foundation Trust, UK
| | | | | | - PA Brennan
- Portsmouth Hospitals University NHS Trust, UK
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Simons MC, Hunt JA, Anderson SL. What's the evidence? A review of current instruction and assessment in veterinary surgical education. Vet Surg 2022; 51:731-743. [PMID: 35543678 DOI: 10.1111/vsu.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/14/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
Veterinary surgical education is improved by studying the relevant literature. The aim of this literature review was to report the theory and methods used to provide surgical education to veterinary students; to discuss the training most likely to create a competent general practitioner; and to review assessment methods for simulated and live surgeries. The literature reviewed demonstrates that new graduates are expected to perform small animal sterilization, dental extraction, onychectomy, abscess treatment, aural hematoma repair, and mass removal with little or no supervision. Students require repetitive practice to reach competence; some practice can take place in a clinical skills laboratory on models or cadavers. When training novices, distributing practice over a longer time improves retention, but months without practice causes skills to decay. Suturing skills may be taught on models at a ratio of 1 instructor per 10 students. Veterinary students require 6-10 repetitions of each small animal sterilization surgery to reach competence; however, learning curves for other surgeries have not been established. Assessment of surgical skills has been undertaken using objective structured clinical examinations (OSCEs) and observed model and live surgeries. Additional validated rubrics are needed in the field. Surgical educators are urged to continue to search for innovative ways to foster deliberate practice, assess skill, and provide feedback for students.
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Affiliation(s)
- Micha C Simons
- Lincoln Memorial University College of Veterinary Medicine, Harrogate, Tennessee, USA
| | - Julie A Hunt
- Lincoln Memorial University College of Veterinary Medicine, Harrogate, Tennessee, USA
| | - Stacy L Anderson
- Lincoln Memorial University College of Veterinary Medicine, Harrogate, Tennessee, USA
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Vega EA, Salehi O, Loewenthal JV, Kutlu OC, Vellayappan U, Freeman R, Pomposelli F, Asbun HJ, Gayet B, Conrad C. Strategic response to bleeding in laparoscopic hepato-pancreato-biliary surgery: an intraoperative checklist. HPB (Oxford) 2022; 24:452-460. [PMID: 34598880 DOI: 10.1016/j.hpb.2021.08.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/08/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim is to develop and test the utility of an event-initiated, team-based check list to optimize the response to bleeding during laparoscopic HPB surgery. METHODS To build a checklist for managing bleeding events, we conducted a systematic review. Using nominal group technique (NGT), a checklist consisting of four domains was developed. Following team-based training of anesthesia and surgical staff, the checklist was implemented. HPB cases before and after implementation of the checklist were compared for adverse outcomes, bleeding complications, and transfusions. RESULTS NGT identified four domains: Communicate Control, Expose, and Repair under which the checklist was organized. Supplemental Video for a detailed review of how each domain was applied to a specific case example. We compared 169 HPB cases before to 53 cases after implementation. We found a significant decrease in mean EBL (from 518 ± 852.8 to 151.5 ± 221.7 ml (P = 0.001)) for cases performed after implementation of the checklist and a trends toward less volume of pRBC transfused (2.7 ± 2.5 vs 2.3 ± 1.7 units/per patient, P = 0.611) and transfusion rates (22% vs 11%, P = 0.703). CONCLUSION An event-initiated, team-based response to an adverse bleeding event during laparoscopic HPB surgery correlates with positive effects on bleeding management, and transfusion rates.
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Affiliation(s)
- Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Omid Salehi
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Julia V Loewenthal
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Onur C Kutlu
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Usha Vellayappan
- Department of Anesthesia, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Richard Freeman
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Frank Pomposelli
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Horacio J Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States
| | - Brice Gayet
- Department of Digestive Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States.
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Dubb SS, Oeppen RS, Svoboda T, Brennan PA. Human factors application for healthcare teams in low- and medium-income countries (LMIC) to help improve patient safety and performance. J Oral Biol Craniofac Res 2021; 12:77-79. [PMID: 34804791 DOI: 10.1016/j.jobcr.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022] Open
Abstract
Mistakes will always happen whether at work or in our personal lives. We can never completely eliminate error, but learning and disseminating lessons from these mistakes to others is essential. Human factors application for colleagues in healthcare, particularly in low- and medium-income countries (LMIC) can greatly improve patient safety and aid better team working and staff morale. Factors such as hunger, dehydration anger, and tiredness, all reduce personal performance and can raise the risk of personal error. It is vital that we understand and optimize interaction within the healthcare team members. As part of this, ineffective communication, steep hierarchy and loss of situational awareness can lead to compromised patient safety and potentially serious error. In this paper, we provide a brief overview of human factors for healthcare colleagues in LMIC. We highlight ways to reduce the chances of error and improve patient safety by recognizing and applying various human factors to our day to day practices.
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Affiliation(s)
- Sukhpreet Singh Dubb
- Maxillofacial Unit, Norfolk and Norwich University Hospitals Trust, Norwich, NR4 7UY, UK
| | - Rachel S Oeppen
- Department of Clinical Radiology, University Hospitals Southampton, Southampton, SO16 6YD, UK
| | - Tomas Svoboda
- Maxillofacial Unit, Portsmouth Hospitals University Trust, Portsmouth, PO6 3LY, UK
| | - Peter A Brennan
- Maxillofacial Unit, Portsmouth Hospitals University Trust, Portsmouth, PO6 3LY, UK
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36
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Boyanov N, Georgiou K, Thanasas D, Deneva T, Oussi N, Marinov B, Enochsson L. Use of saliva stress biomarkers to estimate novice male endoscopist's stress during training in a high-end simulator. Scand J Gastroenterol 2021; 56:1380-1385. [PMID: 34424793 DOI: 10.1080/00365521.2021.1965208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Simulated endoscopic training can be challenging and stressful for the novice trainee. The absence of a reliable stress detection method during simulated endoscopic training makes estimating trainees' mental stress difficult to quantify. This study concomitantly measures the responses of four saliva stress biomarkers and compares them to the video score (VS) achieved by novice endoscopists in a reproducibly stressful simulation environment. METHODS Thirty-six male endoscopy naïve surgery residents were enrolled. After an orientation phase, a saliva specimen was collected for cortisol (sC), alpha-amylase (sAA), Chromogranin A (sCgA), and immunoglobulin A (sIgA) measurements (baseline phase, BL). Thereafter, the simulation exercise phase (E) started, practicing in the Fundamentals of Endoscopic Surgery Skills module (GI-Bronch Mentor). Immediately after, a second saliva sample for measuring the above-cited biomarkers was collected. The whole experiment was videotaped, and the VS was calculated. The percentage (E-BL)diff of each of the four saliva biomarkers was calculated and examined for correlation to VS. RESULTS sCgAdiff showed the best correlation with VS, followed by sAAdiff. CONCLUSIONS sCgA and sAA, are saliva stress biomarkers that are easy to collect non-invasively and showed the best correlation with novice endoscopist's performance in our simulation setting, and therefore, they could be used for monitoring stress.
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Affiliation(s)
- Nikola Boyanov
- Medical Simulation Training Center at Research Institute of Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Konstantinos Georgiou
- 1st Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Thanasas
- Medical Physics Laboratory Simulation Center, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Tanya Deneva
- Central Clinical Laboratory, University Hospital St. George, Plovdiv, Bulgaria.,Department of Clinical Laboratory, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Ninos Oussi
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Blagoi Marinov
- Medical Simulation Training Center at Research Institute of Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Zheng Y, Leonard G, Tellez J, Zeh H, Majewicz Fey A. Identifying Kinematic Markers Associated with Intraoperative Stress during Surgical Training Tasks. ... INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS. INTERNATIONAL SYMPOSIUM ON MEDICAL ROBOTICS 2021; 2021:10.1109/ismr48346.2021.9661482. [PMID: 37408580 PMCID: PMC10321325 DOI: 10.1109/ismr48346.2021.9661482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Increased levels of stress can impair surgeon performance and patient safety during surgery. The aim of this study is to investigate the effect of short term stressors on laparoscopic performance through analysis of kinematic data. Thirty subjects were randomly assigned into two groups in this IRB-approved study. The control group was required to finish an extended-duration peg transfer task (6 minutes) using the FLS trainer while listening to normal simulated vital signs and while being observed by a silent moderator. The stressed group finished the same task but listened to a period of progressively deteriorating simulated patient vitals, as well as critical verbal feedback from the moderator, which culminated in 30 seconds of cardiac arrest and expiration of the simulated patient. For all subjects, video and position data using electromagnetic trackers mounted on the handles of the laparoscopic instruments were recorded. A statistical analysis comparing time-series velocity, acceleration, and jerk data, as well as path length and economy of volume was conducted. Clinical stressors lead to significantly higher velocity, acceleration, jerk, and path length as well as lower economy of volume. An objective evaluation score using a modified OSATS technique was also significantly worse for the stressed group than the control group. This study shows the potential feasibility and advantages of using the time-series kinematic data to identify the stressful conditions during laparoscopic surgery in near-real-time. This data could be useful in the design of future robot-assisted algorithms to reduce the unwanted effects of stress on surgical performance.
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Affiliation(s)
- Yi Zheng
- Yi Zheng and Ann Majewicz Fey are with the Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712 USA
| | - Grey Leonard
- Grey Leonard, Juan Tellez, Herbert Zeh and Ann Majewicz Fey are with the Department of Surgery, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Juan Tellez
- Grey Leonard, Juan Tellez, Herbert Zeh and Ann Majewicz Fey are with the Department of Surgery, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Herbert Zeh
- Grey Leonard, Juan Tellez, Herbert Zeh and Ann Majewicz Fey are with the Department of Surgery, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Ann Majewicz Fey
- Yi Zheng and Ann Majewicz Fey are with the Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712 USA
- Grey Leonard, Juan Tellez, Herbert Zeh and Ann Majewicz Fey are with the Department of Surgery, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
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Taaffe JP, Kabbani LS, Goltz CJ, Bath J, Mattos MA, Caputo FJ, Singh P, Vogel TR. Feasibility and Evaluation of Surgical Simulation with Developed Crisis Scenarios: A Comparison of Performance by Vascular Surgery Training Paradigms. JOURNAL OF SURGICAL EDUCATION 2021; 78:2110-2116. [PMID: 34172409 DOI: 10.1016/j.jsurg.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/03/2021] [Accepted: 05/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Surgical simulation is an integral component of training and has become increasingly vital in the evaluation and assessment of surgical trainees. Simulation proficiency determination has been traditionally based on accuracy and time to completion of various simulated tasks, but we were interested in assessing clinical judgment during a simulated crisis scenario. This study assessed the feasibility of creating a crisis simulator station for vascular surgery and evaluated the performance of vascular surgery integrated residents (0+5) and vascular surgery fellows (5+2) during a technical testing with an integrated crisis scenario. METHODS A Modified Delphi method was used to create vascular surgery crisis simulation stations containing a clinical scenario in conjunction with either an open or endovascular simulator. Senior level vascular surgery trainees from both integrated residencies (0+5) and traditional vascular surgery fellowships (5+2) were then evaluated on two simulation stations: 1) Elective carotid endarterectomy (CEA) where the crisis is a postoperative stroke and 2) Endovascular aneurysm repair (EVAR) for a ruptured abdominal aortic aneurysm (rAAA). Each simulation had a crisis scenario incorporated into the procedure. Assessment was completed using a performance assessment tool containing a Likert scale. Total score was calculated as a percentage. Scores were also sub-divided in the following four categories: Situation Recognition and Decision-making, Procedural Flow, Technical Skills, and Interpretation and Use of Imaging Skills. Student's t-test was used for analysis. RESULTS 40 senior-level trainees were evaluated (27 fellows and 13 integrated residents) completing 80 simulations. The CEA crisis simulation yielded similar results between both groups (0+5 vs. 5+2, p = 1.00). The 0+5 residents in vascular surgery were graded to be more proficient in the EVAR for rAAA crisis simulation and demonstrated significant differences in Total Score (p = 0.04), Procedural Flow (p=0.03), and Interpretation and Use of Imaging Skills (p = 0.02). CONCLUSIONS The creation of crisis-based simulation for trainees in vascular surgery is feasible and actionable. Integrated 0+5 residents performed similarly to 5+2 fellows on an open carotid endarterectomy (CEA) crisis simulation, but 0+5 residents scored significantly higher compared to traditional 5+2 fellows in an endovascular rAAA crisis simulation. Crisis simulation may offer better educational experiences and improved value compared to routine simulation. Further studies using different procedural models and clinical scenarios are needed to assess the validity of crisis simulation in vascular surgery and to better understand the performance disparities found between these training paradigms.
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Affiliation(s)
- John P Taaffe
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, Missouri
| | - Loay S Kabbani
- Department of Vascular Surgery, Henry Ford Hospital, Edith and Benson Ford Heart and Vascular Institute, Detroit, Michigan
| | - Christopher J Goltz
- Michigan Vascular Center and Michigan State University Department of Surgery, Flint, Michigan
| | - Jonathan Bath
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, Missouri
| | - Mark A Mattos
- Michigan Vascular Center and Michigan State University Department of Surgery, Flint, Michigan
| | - Francis J Caputo
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Priyanka Singh
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, Missouri
| | - Todd R Vogel
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, Missouri.
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Brennan PA, Jarvis S, Oeppen RS. European Association of Oral Medicine 2021 Conference - Crispian Scully Lecture: Applying Human Factors to Improve Patient Safety and Performance. J Oral Pathol Med 2021; 51:13-17. [PMID: 34704293 DOI: 10.1111/jop.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND This paper is a synopsis of the Crispian Scully Lecture, presented by one of the authors (PAB), at the 2021 European Association of Oral Medicine (EAOM) Conference in Lisbon, Portugal. It provides an overview of human factors that affect individuals and teams, highlighting ways to reduce the chances of error and improve patient safety. DISCUSSION AND CONCLUSION Error is an inevitable and 'normal' part of being human, and it can never be completely eliminated, though learning from mistakes is essential. Human factor application in health care can greatly improve patient safety and lead to better team working and staff morale. Personal factors including tiredness, hunger, dehydration and stress can all reduce performance and raise the risk of clinical error. It is also important to understand and optimise interaction within the clinical team. Poor communication, steep hierarchy and loss of situational awareness can all potentially compromise patient safety.
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Affiliation(s)
- Peter A Brennan
- Maxillofacial Unit, Portsmouth Hospitals University Trust, Portsmouth, UK
| | | | - Rachel S Oeppen
- Department of Clinical Radiology, University Hospitals Southampton, Southampton, UK
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Baste JM, Bottet B, Selim J, Sarsam M, Lefevre-Scelles A, Dusseaux MM, Franchina S, Palenzuela AS, Chagraoui A, Peillon C, Thouroude A, Henry JP, Coq JMM, Sibert L, Damm C. Implementation of simulation-based crisis training in robotic thoracic surgery: how to improve safety and performance? J Thorac Dis 2021; 13:S26-S34. [PMID: 34447589 PMCID: PMC8371544 DOI: 10.21037/jtd-2020-epts-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Jean-Marc Baste
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France.,MTC (Medical Training Center) Rouen, Normandie, France
| | - Benjamin Bottet
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | - Jean Selim
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Matthieu Sarsam
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | - Antoine Lefevre-Scelles
- MTC (Medical Training Center) Rouen, Normandie, France.,Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Marie-Melody Dusseaux
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Sébastien Franchina
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Anne-Sophie Palenzuela
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | - Abdeslam Chagraoui
- INSERM, U1239, Department of Medical Biochemistry, Rouen University Hospital, Normandie University, Rouen, France
| | - Christophe Peillon
- Department of General and Thoracic Surgery, UNIROUEN, Inserm U1096, Rouen University Hospital, Normandie University, Rouen, France
| | | | - Jean-Pierre Henry
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
| | - Jean-Michel M Coq
- MTC (Medical Training Center) Rouen, Normandie, France.,Psychology Department, UFR Human and Social Sciences, EA 7475, Normandie University, Rouen, France
| | - Louis Sibert
- MTC (Medical Training Center) Rouen, Normandie, France
| | - Cédric Damm
- Department of Anesthesia and Critical Care Medicine, UNIROUEN, Rouen University Hospital, Normandie University, Rouen, France
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Affiliation(s)
- Santosh G Honavar
- Editor, Indian Journal of Ophthalmology, Centre for Sight, Road No 2, Banjara Hills, Hyderabad, Telangana, India
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42
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A Novel Approach to Quantifying Acute Stress in Cataract Surgeons to Investigate the Relationship Between Surgeon Experience and Intraoperative Stress. J Cataract Refract Surg 2021; 48:549-554. [PMID: 34533918 DOI: 10.1097/j.jcrs.0000000000000798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022]
Abstract
Purpose To quantify intraoperative stress levels in cataract surgeons and investigate the relationship between intraoperative stress and surgeon experience. Setting Department of Ophthalmology, Hanusch Krankenhaus, Vienna, Austria. Design Prospective, observational case series. Methods Five ophthalmologists with surgery experiences of 70 to 15,000 previous surgeries volunteered for this study. Surgeons' heart rate and heart rate variability (HRV) were measured during a total of 45 cataract surgeries. Heart rate and HRV values were normalized to the minimal heart rate and maximal HRV of an overnight baseline measurement. The resulting normalized heart rate measure and HRV stress index are stress dependent and comparable between subjects. No case selection was performed. Results Less experienced surgeons showed higher HRV stress indices; differences between the surgeons with less than 180 and 500 surgeries and the two with 600 and 1,500 surgeries were significant ([alpha] =0.05). No significant difference in stress indices was found between the 1,500 and 15,000 surgeries subjects, suggesting that there may be a plateau effect after 1,500 surgeries. HRV stress indices and case times were negatively correlated with the logarithm of experience in number of previously performed surgeries (r2 = 0.67 and 0.52). No significant stress build-up over multiple successive surgeries was found ([alpha] =0.05). Conclusions The novel HRV stress index is a simple but powerful tool for quantifying intraoperative stress in cataract surgeons. Decreases in stress with increasing experience are congruent with previous works on general surgeon's stress and follow a similar timeline as previously published, proficiency-based learning curves for cataract surgery.
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Beattie KL, Hill A, Horswill MS, Grove PM, Stevenson ARL. Aptitude and attitude: predictors of performance during and after basic laparoscopic skills training. Surg Endosc 2021; 36:3467-3479. [PMID: 34370121 PMCID: PMC8351236 DOI: 10.1007/s00464-021-08668-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/24/2021] [Indexed: 11/26/2022]
Abstract
Background Manual dexterity and visual-spatial ability are considered key to the development of superior laparoscopic skills. Nevertheless, these abilities do not reliably explain all the variance found in the technical performance of surgical trainees. Consequently, we must look beyond these abilities to improve our understanding of laparoscopic skills and to better identify/develop surgical potential earlier on. Purpose To assess the individual and collective impact of physical, cognitive, visual, and psychological variables on performance during and after basic simulation-based laparoscopic skills training. Method Thirty-four medical students (laparoscopic novices) completed a proficiency-based laparoscopic skills training program (using either a 2D or 3D viewing mode). This was followed by one testing session, a follow-up testing session with new (yet similar) tasks, and a series of physical, cognitive, visual, and psychological measures. Results The statistical models that best predicted variance in training performance metrics included four variables: viewingmode (2D vs 3D), psychologicalflexibility, perceivedtaskdemands, and manualdexterity (bimanual). In subsequent testing, a model that included viewingmode and manualdexterity (assembly) best predicted performance on the pre-practiced tasks. However, for a highly novel, spatially complex laparoscopic task, performance was best predicted by a model that comprised viewingmode, visual-spatialability, and perceivedtaskdemands. At follow-up, manualdexterity (assembly) alone was the best predictor of performance on new (yet similar) tasks. Conclusion By focussing exclusively on physical/cognitive abilities, we may overlook other important predictors of surgical performance (e.g. psychological variables). The present findings suggest that laparoscopic performance may be more accurately explained through the combined effects of physical, cognitive, visual, and psychological variables. Further, the results suggest that the predictors may change with both task demands and the development of the trainee. This study highlights the key role of psychological skills in overcoming initial training challenges, with far-reaching implications for practice.
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Affiliation(s)
- Kirsty L Beattie
- School of Psychology, The University of Queensland, Brisbane, Australia.
| | - Andrew Hill
- School of Psychology, The University of Queensland, Brisbane, Australia
- Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia
- Minerals Industry Safety and Health Centre, Sustainable Minerals Institute, The University of Queensland, Brisbane, Australia
| | - Mark S Horswill
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Philip M Grove
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Andrew R L Stevenson
- School of Medicine, The University of Queensland, Brisbane, Australia
- Department of Colon and Rectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Deshauer S, McQueen S, Hammond Mobilio M, Mutabdzic D, Moulton CAE. Mental Skills in Surgery: Lessons Learned From Virtuosos, Olympians, and Navy Seals. Ann Surg 2021; 274:195-198. [PMID: 31469750 DOI: 10.1097/sla.0000000000003573] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The present study investigated the role of mental skills in surgery through the unique lens of current surgeons who had previously served as Olympic athletes, elite musicians, or expert military personnel. BACKGROUND Recent work has demonstrated great potential for mental skills training in surgery. However, as a field, we lag far behind other high-performance domains that explicitly train and practice mental skills to promote optimal performance. Surgery stands to benefit from this work. First, there is a need to identify which mental skills might be most useful in surgery and how they might be best employed. METHODS Using a constructivist grounded theory approach, semi-structured interviews were conducted with 17 surgeons across the United States and Canada who had previously performed at an elite level in sport, music, or the military. RESULTS Mental skills were used both to optimize performance in the moment and longitudinally. In the moment, skills were used proactively to enter an ideal performance state, and responsively to address unwanted thoughts or emotions to re-enter an acceptable performance zone. Longitudinally, participants used skills to build expertise and maintain wellness. CONCLUSIONS Establishing a taxonomy for mental skills in surgery may help in the development of robust mental skills training programs to promote optimal surgeon wellness and performance.
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Affiliation(s)
| | - Sydney McQueen
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Schneider D, Sax C, Sancho-Puchades M, Hämmerle CHF, Jung RE. Accuracy of computer-assisted, template-guided implant placement compared with conventional implant placement by hand-An in vitro study. Clin Oral Implants Res 2021; 32:1052-1060. [PMID: 34143522 PMCID: PMC8456923 DOI: 10.1111/clr.13799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
Objectives To compare free‐hand to computer‐assisted implant planning and placement (CAIPP) regarding planned to achieved implant position. Material and methods Forty‐eight cast/bone models were mounted in mannequin heads. On each side, a tooth gap of different sizes was created. In the test group (T), study implants were placed using a CAD‐CAM guide based on virtual planning. In the control (C), free‐hand implant placement was performed. After CBCT scanning, the implant position was compared with the planned position. Descriptive statistics were applied, and ANOVA was used to identify differences between groups and gaps. (p < .05). Results In C, mean lateral deviations at the implant base amounted to 0.7 mm (max. 1.8) (large gap) and 0.49 mm (1.22) (small gap). In T, 0.18 mm (0.49) and 0.24 mm (0.52) were recorded. At the apex, 0.77 mm (2.04) (large gap) and 0.51 mm (1.24) (small gap) were measured in C, and 0.31 mm (0.83)/0.34 mm (0.93) in T. Mean vertical deviations in C measured 0.46 mm (1.26) (large gap) and 0.45 mm (1.7) (small gap). In T, 0.14 mm (0.44) and 0.28 mm (0.78) were recorded. Mean angular deviations of 1.7° (3.2°) were observed in C (large gap) and 1.36° (2.1°) (small gap). In T, mean values were 1.57° (3.3°) and 1.32° (3.4°). Lateral and vertical deviations were significantly different between groups (not gaps), angular between gaps (not groups). Conclusions CAIPP protocols showed smaller deviations irrespective of the size of the tooth gap. In C, the gap size had an influence on the error in angulation only.
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Affiliation(s)
- David Schneider
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Caroline Sax
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Manuel Sancho-Puchades
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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The perceived benefit of intraoperative stress modifiers for surgeons: an experimental simulation study in volunteers. Patient Saf Surg 2021; 15:23. [PMID: 34051829 PMCID: PMC8164765 DOI: 10.1186/s13037-021-00294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background During surgery, surgeons often work under stressful conditions, which could affect patient safety. Reducing intraoperative stress for surgeons could benefit surgeons and subsequently patients. It is difficult to study stress and stress relief in real life situations due to the multitude of confounding factors. The aim of this study was to evaluate simulated intraoperative stressors on surgeons’ stress levels and the effect of an intervention (pause including a sugar-containing drink) during standardized experiments (simulated operations). Methods An experimental interventional study was conducted using a simulator. The healthy surgeon volunteers were randomized to intervention and control in a cross-over design. Primary endpoint was salivary cortisol difference between a pause including a sugar containing drink (intervention) and controls. Secondary endpoints were change in heart rate, change in self-perceived stress measured by the State Trait Anxiety Inventory (STAI), and experience of the intraoperative pause. Endpoints were calculated with a mixed effect analysis of covariance (ANCOVA) model. Results Seventeen surgeons performed 32 experiments. There was no statistically significant difference in salivary cortisol between simulations with and without a pause including a sugar-containing drink; percent reduction, 8% (0.92 (95%CI:0.72;1.18)), p-value = 0.469. The surgeons’ self-estimation of intervention was positive, but there was no statistically significant difference in heart rate or STAI. Conclusions The surgeons’ experience of a pause including a drink was positive but there were no differences in physiological outcomes of the intervention. Lessons learned from this study could contribute to optimizing design of future studies. Trial registration Clinicaltrials.gov NCT04626648, Registered November 6, 2020, retrospectively registered.
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Kent J, Fong A, Hall E, Fitzgibbons S, Sava J. Measurement of Trauma Caregiver Stress: Validation of Heart rate variability in a Real-World Surgical Setting. J Surg Res 2021; 265:252-258. [PMID: 33962103 DOI: 10.1016/j.jss.2021.02.019] [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: 10/28/2020] [Revised: 02/17/2021] [Accepted: 02/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute stress is a potentially modifiable risk-factor that contributes to errors in trauma care. Research on stress mitigation is limited by the lack of a validated objective measure of surgeon stress. We sought to validate HRV in a real-world surgical setting by comparison to the Subjective Units of Distress Score (SUDS), and correlation with self-reported peak stress moments. METHODS Attending and resident surgeons on the trauma team at a Level I Trauma Center wore armbands to measure HRV. Stress-associated blunting of HRV was analyzed using the standard deviation of N-N intervals (SDNN) and the root mean square of successive differences . Perceived stress was measured with the SUDS at random intervals and at perceived stress peaks. SUDS and HRV metrics were compared with a mixed effect regression model. Correlation between binned SUDS quartiles and HRV was evaluated. HRV at reported peak-stress moments were compared to shift baseline values. RESULTS Twelve participants were monitored for 340 h, producing 135 SUDS responses and 65 peak-stress time points. Regression analysis demonstrated no correlation between HRV and SUDS. With a binned approach, decreased SDNN was associated with an elevated SUDS (P = 0.03). The self-identified peak-stress moments correlated with decreases in both SDNN and root mean square of successive differences (P = 0.02; P < 0.01). CONCLUSIONS HRV by SDNN analysis correlated with heightened perceived stress, supporting its validity as a measure. However, the wide, frequent variation of HRV tracings within subjects, the sensitivity of HRV to of analytic technique, and the impact of confounders may limit its utility as an education or research tool. LEVEL OF EVIDENCE V Diagnostic test.
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Affiliation(s)
- Johnathan Kent
- Georgetown University School of Medicine, Washington, District of Columbia; University of Chicago Department of Surgery, Chicago Illinois.
| | - Allan Fong
- MedStar Institute for Innovation - National Center for Human Factors in Healthcare, Washington, District of Columbia
| | - Erin Hall
- Georgetown University School of Medicine, Washington, District of Columbia; MedStar Washington Hospital Center, Washington, District of Columbia
| | - Shimae Fitzgibbons
- Georgetown University School of Medicine, Washington, District of Columbia; Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Jack Sava
- Georgetown University School of Medicine, Washington, District of Columbia; MedStar Washington Hospital Center, Washington, District of Columbia
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Racy M, Barrow A, Tomlinson J, Bello F. Development and Validation of a Virtual Reality Haptic Femoral Nailing Simulator. JOURNAL OF SURGICAL EDUCATION 2021; 78:1013-1023. [PMID: 33162363 DOI: 10.1016/j.jsurg.2020.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/17/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To create a virtual reality (VR) femoral nailing simulator combining haptics and image intensifier functionality and then carry out validation studies to assess its educational value. DESIGN The simulator consisted of a 3D virtual environment, a haptic device and 3D printed drill handle and a VR headset. The environment was created using a video game development engine, interfaced with plugins to allow haptic feedback and image intensifier functionality. Two tasks were created within the simulator as part of an antegrade femoral intramedullary (IM) nail procedure: proximal guidewire entry and distal locking.For the validation study, participants performed the above tasks on the simulator. Metrics were collected including time taken, number of X-rays and tool distance travelled and used to assess construct validity. A questionnaire was then completed to assess authenticity and content validity. SETTING Simulator development in centre for simulation and engagement science laboratory. Validation study in a teaching hospital environment. PARTICIPANTS Orthopedic specialist trainees and consultants. RESULTS Surgeon experience (number of IM nails performed/postgraduate year) correlated with significantly improved task performance. More experienced surgeons took less time, used fewer X-rays and had greater economy of movement than less experienced surgeons. Authenticity and content validity were well rated, with criticisms primarily due to hardware limitations. CONCLUSIONS To our knowledge this is the first orthopedic simulator to combine immersive VR with haptics and full image intensifier functionality. By combining multiple aspects of surgical practice within a single device, we aimed to improve participant immersion and educational value. Our work so far has focused on technical skills, demonstrating good authenticity, content and construct validity, however our findings show promise in other applications such as nontechnical skill development and assessment.
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Affiliation(s)
- Malek Racy
- Imperial College London, Centre for Engagement and Simulation Science, Imperial College London, 3rd Floor Chelsea and Westminster Hospital (Academic Surgery), London, United Kingdom; Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, United Kingdom.
| | - Alastair Barrow
- Imperial College London, Centre for Engagement and Simulation Science, Imperial College London, 3rd Floor Chelsea and Westminster Hospital (Academic Surgery), London, United Kingdom
| | - James Tomlinson
- Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, United Kingdom
| | - Fernando Bello
- Imperial College London, Centre for Engagement and Simulation Science, Imperial College London, 3rd Floor Chelsea and Westminster Hospital (Academic Surgery), London, United Kingdom
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Morozova G, Martindale AB, Richards H, Stirling J, McIntyre C, Currie IS. The Vanguard Study: Human Performance Evaluation of UK National Organ Retrieval Service Teams Utilizing a Single Scrub Practitioner in Multiorgan Retrieval. Transplantation 2021; 105:1082-1089. [PMID: 32639406 DOI: 10.1097/tp.0000000000003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The National Organ Retrieval Service (NORS) 2015 review recommended a single scrub practitioner provide support simultaneously to abdominal and cardiothoracic teams in UK multiorgan retrieval. Previously, this model had been used only by the combined abdominal and cardiac team in Scotland. This study reports the impact on performance as part of the Vanguard project, which utilized the single scrub practitioner role with 5 NORS teams, to determine applicability United Kingdom wide. METHODS Participants comprised members of abdominal (n = 56) and cardiothoracic (n = 54) teams attending UK thoraco-abdominal retrievals. Data were collected by validated psychometric scales to assess individual workload, anxiety, confidence, demands/coping resources, and teamwork. Additional data were collected through open comments and quantitative data describing context and outcome of retrieval. RESULTS Abdominal and cardiothoracic teams showed different responses when using single (Vanguard) or dual scrub practitioners (Standard). Vanguard configuration was associated with significantly higher anxiety for abdominal but not cardiothoracic teams. Perceived workload increased for abdominal teams during Vanguard but decreased for cardiothoracic teams. Scrub practitioners reported elevated anxiety and decreased confidence in retrievals using Vanguard configuration. CONCLUSIONS This is the first large study examining human performance during organ retrieval in the United Kingdom. Despite previous regional success, this study showed a significant negative impact of the single scrub practitioner when extrapolated widely to UK teams. As a result of this study, NORS declined to implement the single scrub model. These data support the use of human performance analysis as an essential part of successful development in organ retrieval practice.
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Affiliation(s)
- Gala Morozova
- Human Performance Science Research Group, Institute of Sport, Physical Education and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom
| | - Amanda B Martindale
- Human Performance Science Research Group, Institute of Sport, Physical Education and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom
| | - Hugh Richards
- Human Performance Science Research Group, Institute of Sport, Physical Education and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Ian S Currie
- NHS Blood and Transplant, Bristol, United Kingdom
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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D'Angelo JD, Lund S, Busch RA, Tevis S, Mathis KL, Kelley SR, Dozois EJ, D'Angelo ALD. Coping with errors in the operating room: Intraoperative strategies, postoperative strategies, and sex differences. Surgery 2021; 170:440-445. [PMID: 33810853 DOI: 10.1016/j.surg.2021.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prior work has identified intraoperative and postoperative coping strategies among surgeons and has demonstrated surgical errors to have a significant impact on patient outcomes and physicians. Little research has considered which coping strategies are most common among surgeons and if there exist coping strategy differences among sex or training level. METHODS An electronic survey was distributed to surgical faculty and trainees at 3 institutions. Variables included coping techniques after making an error in the operating room. Participants were asked to report the effectiveness of their overall coping strategy. RESULTS A total of 168 participants (56% male, 45% faculty) experienced an operative error and answered questions regarding coping strategies. The only coping strategy significantly associated with positive ratings of coping effectiveness was, upon error, taking a step back and taking time to think and act (r = 0.17; P = .024). There were differences between men and women in both intra and postoperative coping strategies. Men (mean = 3.69/5, standard error = .09) viewed their overall coping strategy as more effective than women (mean = 3.38/5, standard error = .09), t(158.86) = 2.47; P = .015. CONCLUSION Although both male and female surgeons reported making errors in the operating room, differences exist in the strategies surgeons use to cope with these mistakes, and strategies differ in their ratings of effectiveness.
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Affiliation(s)
| | - Sarah Lund
- General Surgery, Mayo Clinic, Rochester, MN
| | - Rebecca A Busch
- Division Of Acute Care and Regional General Surgery, University of Wisconsin, Madison, WI
| | - Sarah Tevis
- Division of Surgical Oncology, University of Colorado, Aurora, CO
| | - Kellie L Mathis
- Division Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
| | - Scott R Kelley
- Division Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
| | - Eric J Dozois
- Division Colon and Rectal Surgery, Mayo Clinic, Rochester, MN
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