Healthcare practitioners' experiences and perspectives of music in perinatal care in Ireland: An exploratory survey

INTRODUCTION

Evidence shows that music can promote the wellbeing of women and infants in the perinatal period. Ireland's National Maternity Strategy (2016-2026) suggests a holistic approach to woman's healthcare needs and music interventions are ideally placed as a non-pharmacological and cost-effective intervention to improve the quality of care offered to women and infants. This cross-sectional survey aimed to explore the healthcare practitioners' personal and professional experiences of using music therapeutically and its impact and barriers in practice. The survey also investigated practitioners' knowledge and attitudes towards the use of music as a therapeutic tool in perinatal care.

METHODS

A novel online survey was developed and distributed through healthcare practitioners' electronic mailing lists, social media, Perinatal Mental Health staff App, and posters at the regional maternity hospital during 26th June and 26th October 2020. Survey items included demographics, personal and professional use of music, and perspectives on music intervention in perinatal care.

RESULTS

Forty-six healthcare practitioners from across 11 professions were recruited and 42 were included in this study. 98 % of perinatal practitioners used music intentionally to support their wellbeing and 75 % referred to using music in their work. While 90 % found music beneficial in their practice, 15 % reported some negative effect. Around two-thirds of the respondents were familiar with the evidence on music and perinatal wellbeing and 95 % thought there was not enough guidance. 40 % considered music therapy an evidence-based practice and 81 % saw a role for music therapy in standard maternity service in Ireland. The qualitative feedback on how music was used personally and professionally, its' reported benefits, negative effects, and barriers are discussed.

DISCUSSION

This study offers insights into how healthcare practitioners viewed and applied music in perinatal practice. The findings indicate high interest and positive experiences in using music as a therapeutic tool in perinatal care which highlights the need for more evidence and guidance.

Exploring the Impact of Hand Dominance on Laparoscopic Surgical Skills Development Using Network Models

BACKGROUND

Laparoscopic surgery demands high precision and skill, necessitating effective training protocols that account for factors such as hand dominance. This study investigates the impact of hand dominance on the acquisition and proficiency of laparoscopic surgical skills, utilizing a novel assessment method that combines Network Models and electromyography (EMG) data.

METHODS

Eighteen participants, comprising both medical and non-medical students, engaged in laparoscopic simulation tasks, including peg transfer and wire loop tasks. Performance was assessed using Network Models to analyze EMG data, capturing muscle activity and learning progression. The NASA Task Load Index (TLX) was employed to evaluate subjective task demands and workload perceptions.

RESULTS

Our analysis revealed significant differences in learning progression and skill proficiency between dominant and non-dominant hands, suggesting the need for tailored training approaches. Network Models effectively identified patterns of skill acquisition, while NASA-TLX scores correlated with participants' performance and learning progression, highlighting the importance of considering both objective and subjective measures in surgical training.

CONCLUSIONS

The study underscores the importance of hand dominance in laparoscopic surgical training and suggests that personalized training protocols could enhance surgical precision, efficiency, and patient outcomes. By leveraging advanced analytical techniques, including Network Models and EMG data analysis, this research contributes to optimizing clinical training methodologies, potentially revolutionizing surgical education and improving patient care.

Broad Responses and Attitudes to Having Music in Surgery (The BRAHMS Study): An Australia and Aotearoa New Zealand Perspective

Background

Surgery is a stressful exercise, and the experience of occupational stress may have impacts on surgical performance, and surgeon well-being. Music is played in operating theatres (OTs) throughout the world, and while it may improve surgical performance, and reduce clinician stress within the OT, concerns exist over its distracting and noise-creating properties.

Methods

In this prospective observational study, between May to August 2022, Vascular, General and Paediatric surgeons and registrars in Australia and Aotearoa New Zealand (AoNZ) responded to a survey investigating the way they use music, and their perceptions and attitudes towards its effect on the OT environment. Binomial logistic regression and Chi squared tests of association were performed, accepting p < 0.05 as significant.

Results

In this cohort of 120 surgeons, 45 % were vascular specialists, 30 % were female and 59 % were consultant surgeons. The most commonly preferred music genres were easy listening and pop. Over 75 % of surgeons enjoyed having music in their OTs with the majority reporting it improved their temperament, how mentally fatiguing a procedure felt and how anxious or stressed they felt. Vascular surgeons were more likely to believe music had a positive influence on communication than their general and paediatric surgery colleagues (p < 0.01). Registrars had significantly higher odds of believing music had a positive effect on their temperament, and how stressed and anxious they felt when operating, when compared to consultants (p < 0.05).

Conclusions

This study provides a window into the surgeons' use of and attitudes towards intra-operative background music and its effect on stress and cognitive load in Australia and AoNZ. While overall, music is viewed positively by this cohort, there was some difference seen across specialties and level of experience. Further subjective and objective data in this field may provide useful information to guide hospital policy and inform pathways for clinician wellbeing.

Perceptions on music and noise in the operating room: a cross-sectional study

Objectives. Noise in operating rooms (ORs) during surgery may affect OR personnel and pose a threat to patient safety. The sources of noise vary depending on the operation. This study aimed to investigate how OR staff perceived noise, whether music was considered noise and what its perceived effects were. Methods. Surgeons, anaesthesiologists, residents and nurses were interviewed. iPads were placed in the ORs to gather noise-level data. Results. Ninety-one interviews were conducted. Most participants (60.5%) reported the presence of noise and 25% the presence of music in the OR. Noise data from iPads registered levels ranging between 59.52 and 85.60 dB(A). χ2 analyses yielded significant results between participants' role and the perceived effects of noise (p = 0.02). Responses to open-ended questions were thematically categorized. Conclusions. Surgeons generally chose the music played in ORs and were likely positively inclined to its effects, while anaesthesiologists and nurses minded the lack of choice and were more likely to consider it as noise.

Effect of Background Music in the Operating Room on Surgical Outcomes: A Prospective Single-Blinded Case-Control Study

BACKGROUND

The effect of playing background music on surgical outcomes has been controversial. This prospective case-control study aims to evaluate the impact of music tempo in general surgical settings.

STUDY DESIGN

Six hundred consecutive patients with nonmetastatic breast cancer receiving breast cancer surgery have been recruited since April 2017. Patients were then assigned to 3 arms in consecutive order. The surgeon operated without music in study arm A; the surgeon operated with slow music in study arm B; and in study arm C, the surgeon operated with fast background music. Patients' clinical records were reviewed by an independent blinded assessor.

RESULTS

Baseline demographic data were comparable among the 3 study arms. Seven (3.5%) patients from study arm A developed minor complications (Clavien-Dindo class I and II); none developed major complications (Clavien-Dindo class III or above). Six (3.0%) patients from study arm B and C, respectively (slow/fast music groups), developed minor complications; none developed a major complication. Mean blood loss was also similar among the 3 study arms (5.1, 5.1, and 5.2 mL, respectively; p > 0.05). Operating time was significantly shorter in study arm C: 115 minutes (90-145), compared with 125 minutes (100-160) in study arm A (p < 0.0001) and 120 minutes (95-155) in study arm B (p = 0.0024). After a median follow-up of 40 months (3-56), 40 months (3-56), and 39.5 months (3-56), the local recurrence rates were 1.5%, 1%, and 1%, respectively (p > 0.05).

CONCLUSION

Playing music in the operating room is safe in general surgical settings in experienced hands.

Effect of Genre and amplitude of music during laparoscopic surgery

PURPOSE

Music is often played in operating theaters. In the literature, the effects of music on surgeons are controversial. We aimed to investigate the effect of different music genres and amplitudes on laparoscopic performance.

METHODS

Novice surgeons underwent a proficiency-based laparoscopic training curriculum. Participants were required to perform these tasks under three conditions: no music, with music in medium volume (45-50 dB) and in high volume (65-70 dB). Soft rock by the Beatles and hard rock by AC/DC were played. Task performance was evaluated by analyzing speed and accuracy.

RESULTS

With soft rock in medium volume, participants were faster in peg transfer (60.3 vs. 56.7 s, P = 0.012) and more accurate in suture with intracorporeal knot (79.2 vs. 54.0, P = 0.011) compared to without music. The total score was improved (383.4 vs. 337.9, P = 0.0076) by enhancing accuracy (79.5 vs. 54.0, P = 0.011). This positive effect was lost if the soft rock was played in high volume. With hard rock in medium volume, participants were faster performing precision cutting (139.4 vs. 235.8, P = 0.0009) compared to without music. Both balloon preparation and precision cutting were performed more rapidly (227.3 vs. 181.4, P = 0.003, 139.4 vs. 114.0, P < 0.0001) and the accuracy was maintained. Hard rock in high volume also resulted in increased speed (366.7 vs. 295.5, P < 0.0001) compared to without music. Thereby, the total scores of participants were enhanced (516.5 vs. 437.1, P = 0.002).

CONCLUSION

Our data reveal that the effect of music on laparoscopic performance might depend on the combination of music genre and amplitude. A generally well-accepted music genre in the right volume could improve the performance of novice surgeons during laparoscopic surgeries.

TRIAL REGISTRATION

DRKS00026759, register date: 18.10.2021 (retrospectively registered).

The Influence of Different Genres of Music on the Performance of Medical Students on Standardized Laparoscopic Exercises

PURPOSE

Whether and how music influences the performance of surgical procedures such as laparoscopy is unclear and can be feasibly determined using laparoscopic box training tools under standardized conditions. The aim of this prospective study is to evaluate the effect of different genres of music on the performance of laparoscopic novices.

METHODS

Between May 2018 and December 2018, n = 82 students (38 male, 44 female) from Heidelberg University Medical School performed 3 different laparoscopic exercises (A, B, C) from the "Luebecker Toolbox" with 2 repetitions each under standardized conditions. Time was recorded for each exercise. The students were assigned either to one of four groups, each of which was exposed to a compilation of music from 1 genre (hip hop, classical, rock, or mixed radio music), or to a fifth, control group, without exposure to music. The music was played at a constant sound pressure level of 70 decibels . Each group was compared with the others using a t-test for independent samples.

RESULTS

Exposure to music generally led to better performance compared with the control group. Compared with exposure to mixed radio music or to rock, significantly better performance could be demonstrated for exposure to classical music in Exercise B, with an average exposure time of 127 s needed (± 21.4; p < 0.05). No significant differences could be demonstrated for Exercise A, though for classical music, best performance was possible with 120 s (±17.3) of exposure. In Exercise C, hip hop triggered significantly better performance than rock or radio music (p < 0.05).

CONCLUSIONS

At an sound pressure level of 70 decibels, exposure to classical music or hip hop appears to have beneficial effects on training performance for surgical novices under standardized conditions.

The Effects of Preferred Music on Laparoscopic Surgical Performance: A Randomized Crossover Study

Introduction

Music can have a positive effect on stress and general task performance. This randomized crossover study assessed the effects of preferred music on laparoscopic surgical performance in a simulated setting.

Methods

Sixty medical students, inexperienced in laparoscopy, were included between June 2018 and November 2018. A randomized, 4-period, 4-sequence, 2-treatment crossover study design was used, with each participant acting as its own control. Participants performed four periods, consisting of five peg transfer tasks each period, on a laparoscopic box trainer: two periods while wearing active noise-cancelling headphones and two periods during music exposure. Participants were randomly allocated to a sequence determining the order of the four periods. The parameters time to task completion, path length and normalized jerk were assessed. Mental workload was assessed using the Surgical Task Load Index questionnaire. Also, heart rate and blood pressure were assessed.

Results

Participants performed the peg transfer task significantly faster [median difference: − 0.81 s (interquartile range, − 3.44–0.69) p = 0.037] and handled their instruments significantly more efficient as path length was reduced [median difference, − 52.24 mm (interquartile range, − 196.97–89.81) p = 0.019] when exposed to music. Also, mental workload was significantly reduced during music [median difference, − 2.41 (interquartile range, − 7.17–1.83) p = 0.021)]. No statistically significant effect was observed on heart rate and blood pressure.

Conclusion

Listening to preferred music improves laparoscopic surgical performance and reduces mental workload in a simulated setting.

Trial registration

Trial registration number: NCT04111679.

Classical but Not Rap Music Significantly Improves Transferability and Long-Term Acquisition of Laparoscopic Suturing Skills: A Randomized Controlled Trial

INTRODUCTION

 Acoustic distractions have been shown to increase the level of stress and workload in the operating room (OR). Noise significantly reduces surgical performance, but experienced surgeons are able to reduce the acoustic perception of their surroundings to maintain a high level of performance in complex surgical tasks. However, music has been shown to improve learning and performance of complex motor skills. The aim of this study was to evaluate the influence of music on transferability and long-term acquisition of laparoscopic suturing skills.

MATERIALS AND METHODS

 To evaluate the effects of music on training, subjects were asked to perform four surgeon's square knots on a bowel model within 30 minutes-prior and post 3 hours of hands-on training. To examine long-term skills, the same students were asked to perform a comparable, but more complex, task (four slip knots in a model of esophageal atresia) 6 months post initial training, as a follow-up measurement. Total time, knot stability (evaluated via tensiometer), suture accuracy, knot quality (Muresan scale), and laparoscopic performance (Munz checklist) were assessed.

RESULTS

 Twenty-four students were included in the study; after simple randomization, 16 were trained while exposed to music (eight to Bach and eight to Bushido) and eight with traditional methods. Seven were lost due to follow-up. Both groups had comparable baseline characteristics and significantly improved after training, in all parameters assessed in this study. Subjects that trained with classical music were superior in terms of speed (p = 0.006), knot quality (p = 0.014), and procedural performance (p = 0.034) compared with controls.

CONCLUSION

 Music during acquisition of complex motor skills, like laparoscopic suturing and knot tying, is superior to traditional training. Especially music considered nondisturbing significantly improved speed, knot quality, and performance. Thus, incorporation of pleasant music into surgical skills training and the OR should be considered.

Satisfaction or Distraction: Exposure to Nonpreferred Music May Alter the Learning Curve for Surgical Trainees

OBJECTIVE

There is growing evidence supporting the benefits of preferred music on task performance, however there is a paucity of data regarding the potential impact on surgical and procedural learners. This study aims to assess the effects of nonpreferred music on surgical and procedural learners.

DESIGN

This was a single-blinded, randomized crossover trial in which each participant completed a survey regarding their demographic information and music preferences. Each participant then completed 3 training tasks, and 2 repetitions of the evaluative task while listen to music. Tasks were completed using a Da Vinci Skills Simulator Si.

SETTING

All tasks were completed in a live operating room at the University of Kansas Hospital, a tertiary care center.

PARTICIPANTS

Medical students at the University of Kansas Medical Center were recruited by email to participate. In total, 31 medical students completed the experience.

RESULTS

Thirty-one participants participated in this study. Group 2 (preferred music first, nonpreferred music second) showed no significant change in their test scores (72.73 vs 74.33, p = 0.34). However, Group 1 (nonpreferred music first, then preferred music) showed significant improvement between trial runs (70.31 vs 81.88, p < 0.001). There was no significant difference between the initial runs for each group. When analyzed irrespective of group assignment, there was a significant increase in scores for preferred music vs nonpreferred music (77.45 vs 72.26 p = 0.025).

CONCLUSIONS

Participants showed expected improvement with task repetition. This improvement may have been offset by exposure to nonpreferred music during repeat runs. Our findings suggest that the impact of music was nearly as large as the impact of prior exposure to the task. This may have implications for environmental conditions during resident procedural training, especially early in residency training when new tasks are being introduced and the skill level of the learner is still low.

Impact of Acoustic and Interactive Disruptive Factors during Robot-Assisted Surgery-A Virtual Surgical Training Model

The use of virtual reality trainers for teaching minimally invasive surgical techniques has been established for a long time in conventional laparoscopy as well as robotic surgery. The aim of the present study was to evaluate the impact of reproducible disruptive factors on the surgeon's work. In a cross-sectional investigation, surgeons were tested with regard to the impact of different disruptive factors when doing exercises on a robotic-surgery simulator (Mimic Flex VR^TM). Additionally, we collected data about the participants' professional experience, gender, age, expertise in playing an instrument, and expertise in playing video games. The data were collected during DRUS 2019 (Symposium of the German Society for Robot-assisted Urology). Forty-two surgeons attending DRUS 2019 were asked to participate in a virtual robotic stress training unit. The surgeons worked in various specialties (visceral surgery, gynecology, and urology) and had different levels of expertise. The time taken to complete the exercise (TTCE), the final score (FSC), and blood loss (BL) were measured. In the basic exercise with an interactive disruption, TTCE was significantly longer (p < 0.01) and FSC significantly lower (p < 0.05). No significant difference in TTCE, FSC, or BL was noted in the advanced exercise with acoustic disruption. Performance during disruption was not dependent on the level of surgical experience, gender, age, expertise in playing an instrument, or playing video games. A positive correlation was registered between self-estimation and surgical experience. Interactive disruptions have a greater impact on the performance of a surgeon than acoustic ones. Disruption affects the performance of experienced as well as inexperienced surgeons. Disruption in daily surgery should be evaluated and minimized in the interest of the patient's safety.

The effect of preferred music on mental workload and laparoscopic surgical performance in a simulated setting (OPTIMISE): a randomized controlled crossover study

BACKGROUND

Worldwide, music is commonly played in the operation room. The effect of music on surgical performance reportedly has varying results, while its effect on mental workload and key surgical stressor domains has only sparingly been investigated. Therefore, the aim is to assess the effect of recorded preferred music versus operating room noise on laparoscopic task performance and mental workload in a simulated setting.

METHODS

A four-sequence, four-period, two-treatment, randomized controlled crossover study design was used. Medical students, novices to laparoscopy, were eligible for inclusion. Participants were randomly allocated to one of four sequences, which decided the exposure order to music and operation room noise during the four periods. Laparoscopic task performance was assessed through motion analysis with a laparoscopic box simulator. Each period consisted of ten alternating peg transfer tasks. To account for the learning curve, a preparation phase was employed. Mental workload was assessed using the Surgery Task Load Index. This study was registered with the Netherlands Trial Register (NL7961).

RESULTS

From October 29, 2019 until March 12, 2020, 107 participants completed the study, with 97 included for analyzation. Laparoscopic task performance increased significantly during the preparation phase. No significant beneficial effect of music versus operating room noise was observed on time to task completion, path length, speed, or motion smoothness. Music significantly decreased mental workload, reflected by a lower score of the total weighted Surgery Task Load Index in all but one of the six workload dimensions.

CONCLUSION

Music significantly reduced mental workload overall and of several previously identified key surgical stressor domains, and its use in the operating room is reportedly viewed favorably. Music did not significantly improve laparoscopic task performance of novice laparoscopists in a simulated setting. Although varying results have been reported previously, it seems that surgical experience and task demand are more determinative.

The Silent Operation Theatre Optimisation System (SOTOS©) to reduce noise pollution during da Vinci robot-assisted laparoscopic radical prostatectomy

To reduce noise pollution and consequently stress during robot-assisted laparoscopic radical prostatectomy (RALP) the aim of our study was to evaluate the silent operation theatre optimisation system (SOTOS) in its effectiveness. In the operating room (OR) the noise level is between 80 and 85 decibel (dB). Noise corresponds to a major stress factor for surgical teams and especially surgeons. The use of the da Vinci surgical system entails an additional aspect of noise in the OR. The SOTOS surgical team used wired or wireless headphone/microphone combinations to communicate. We measured sound pressure levels in two different locations in the OR and the heart rate of every surgical team member as an indicator of the stress level. We further captured subjective acceptance of SOTOS as well as perioperative data such as surgical time. We prospectively randomised 32 RALP patients into two study arms. Sixteen surgeries were performed using SOTOS and 16 without (control). Overall, the mean sound pressure level in the SOTOS group was 3.6 dB lower compared to the control (p < 0.001). The highest sound pressure level measured was 96 dB in the control group. Mean heart rates were 81.3 beats/min for surgeons and 90.8 beats/min for circulating nurses. SOTOS had no statistically significant effect on mean heart rates of the operating team. Subjective acceptance of SOTO was high. Our prospective evaluation of SOTOS in RALP could show a significant noise reduction in the OR and a high acceptance by the surgical stuff.

Effects of music therapy on occupational stress and burn-out risk of operating room staff

The operating theatre staff is exposed to various constraints such as excessive working hours, severe medical conditions and dreadful consequences in case of malpractice. These working conditions may lead to high and chronic levels of stress, which can interfere with medical staff well-being and patients quality of care. The aim of this study is toassess the impact of music therapy on stress levels and burnout risk on the operating room staff. This is a pre-experimental study including the operating rooms staff of urology and maxillofacial surgery in the academic hospital of Sahloul Sousse (Tunisia) over a period of six weeks. The study consisted of three phases. The first was an initial assessment of stress level with a predefined survey. The second included three music therapy sessions per day over one month. The third was an immediate stress level reassessment following the intervention. Stress levels were evaluated using the Perceived Stress Scale version PSS-10 and the Maslach Burnout Inventory. The overall response rate was 73.9%.The average age of the study population was 37.8 ± 7.7 years with a female predominance (64.7%). After the music therapy program, Perceived Stress Scale average score decreased from 22 ± 8.9 to 16 ± 7.9 (p = 0.006). Concerning the burnout, only the average score of emotional exhaustion decreased significantly from 27 ± 10.8 to 19.2 ± 9.5 (p = 0.004). Music therapy is an innovative approach that seems to reduce operating theatre staff stress. It must be considered as a non pharmacological, simple, economic and non invasive preventive tool.

The influence of music on the surgical task performance: A systematic review

INTRODUCTION

Music is commonly played in operating theatres. Music was shown to diminish stress of the surgical team along with reducing the patient's anxiety before surgery. On the other hand, it has been revealed that music might give rise to negative effects of divided attention causing distraction in surgical routines. Therefore, we aimed to systematically review the effect of music on the surgeon's task performance.

METHODS

A systematic review was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. A literature search using PubMed/Medline, ScienceDirect and Google Scholar, was performed by means of the search terms: "music and operating theatre", as well as "music and surgery". The search was limited to citations in English from year 2009-2018. Search items were considered from the nature of the articles, date of publication, forum of publication, aims and main findings in relation to use of music in operating theatres. Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were applied. Studies were included based on predetermined inclusion criteria where after the papers' quality assessments and evidence grading were completed by two independent reviewers. The protocol was registered with the PROSPERO register of systematic reviews.

RESULTS

Out of 18 studies that formed the base for evidence evaluations, 6 studies were assessed as having high quality and 8 studies of moderate quality. Five studies, provided both strong and moderate scientific evidence for a positive effect of music on surgeon's task performance. In contrast, strong scientific evidence for a negative effect of music on surgeon's task performance also was revealed in 2 high-quality studies. Nevertheless, the positive effect of music on the surgical task performance was significantly higher when compared to its negative effect (p < 0.0001).

CONCLUSION

Certain music elements affect the surgical task performance in a positive or negative way. The total and significant outcome of the present study was that the positive effect of music on surgeon's task performance, overrides its negative effect. Classic music when played with a low to medium volume can improve the surgical task performance by increasing both accuracy and speed. The distracting effect of music should also be put in consideration when playing a loud or high-beat type of music in the operating theatres.

The effects of playing music during surgery on the performance of the surgical team: A systematic review

BACKGROUND

Music is an economical, advantageous and reliable means of reducing stress or stress-related problems.

OBJECTIVE

The present study aims to evaluate the effects of playing music during surgery on the performance of the surgical team through a systematic review of published studies.

METHODS

The relevant databases of Medline/PubMed, Scopus and Science Direct were searched up to July 2018 to find related articles. The comprehensive literature search was reduced to 19 articles that met inclusion criteria.

RESULTS

The articles comprised 13 studies and reported on the positive effects of music on the performance of the surgical team. The effects included a more relaxing and pleasant environment, more accurate and precise performance of tasks, a decrease in the mental workload and task completion time, increased situation awareness, a reduction in stress and anxiety and improved memory consolidation. Five studies reported on the negative effects of music during surgery as being a negative impact on task completion, poor auditory performance and increased likelihood of having to repeat requests. The remaining article reported no significant differences between groups compared.

CONCLUSIONS

Most studies reported positive effects of music on the surgical team during surgery. These results indicate that it may be possible to improve the performance of the surgical team during surgery while playing controlled music.

The effect of music on simulated surgical performance: a systematic review

Introduction

Beneficial effects of music have been described on several cognitive domains, task performance, stress, anxiety and pain. Greater surgical skill is a factor that has been associated with improved patient outcome. The aim of this systematic review is to assess the effect of music on surgical performance.

Methods

An exhaustive literature search was performed. The following databases were searched: Embase, Medline Ovid, Web of Science, Cochrane CENTAL, PsycINFO Ovid, CINAHL EBSCOhost, ERIC EBSCOhost and Google Scholar. All prospective studies that assessed the effect of a music intervention compared to either another auditory condition or silence on surgical performance were included in a qualitative synthesis. The study was registered in the PROSPERO-database (CRD42018092021).

Results

The literature search identified 3492 articles of which 9 studies (212 participants) were included. Beneficial effects of music were reported on time to task completion, instrument handling, quality of surgical task performance and general surgical performance. Furthermore, a beneficial effect of music on muscle activation was observed.

Conclusion

Although beneficial effects of music on surgical performance have been observed, there is insufficient evidence to definitively conclude that music has a beneficial effect on surgical performance in the simulated setting. Future studies should be conducted using greater numbers of participants focusing on a more limited range of tasks, as well as validation in the live operating environment.

Cognitive load theory for training health professionals in the workplace: A BEME review of studies among diverse professions: BEME Guide No. 53

AIM

Cognitive load theory (CLT) is of increasing interest to health professions education researchers. CLT has intuitive applicability to workplace settings, yet how CLT should inform teaching, learning, and research in health professions workplaces is unclear.

METHOD

To map the existing literature, we performed a scoping review of studies involving cognitive load, mental effort and/or mental workload in professional workplace settings within and outside of the health professions. We included actual and simulated workplaces and workplace tasks.

RESULT

Searching eight databases, we identified 4571 citations, of which 116 met inclusion criteria. Studies were most often quantitative. Methods to measure cognitive load included psychometric, physiologic, and secondary task approaches. Few covariates of cognitive load or performance were studied. Overall cognitive load and intrinsic load were consistently negatively associated with the level of experience and performance. Studies consistently found distractions and other aspects of workplace environments as contributing to extraneous load. Studies outside the health professions documented similar findings to those within the health professions, supporting relevance of CLT to workplace learning.

CONCLUSION

The authors discuss implications for workplace teaching, curricular design, learning environment, and metacognition. To advance workplace learning, the authors suggest future CLT research should address higher-level questions and integrate other learning frameworks.

Systematic Review of Factors Influencing Surgical Performance: Practical Recommendations for Microsurgical Procedures in Neurosurgery

BACKGROUND

Microneurosurgical techniques involve complex manual skills and hand-eye coordination that require substantial training. Many factors affect microneurosurgical skills. The goal of this study was to use a systematic evidence-based approach to analyze the quality of evidence for intrinsic and extrinsic factors that influence microneurosurgical performance and to make weighted practical recommendations.

METHODS

A literature search of factors that may affect microsurgical performance was conducted using PubMed and Embase. The criteria for inclusion were established in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) statement.

RESULTS

Forty-eight studies were included in the analysis. Most of the studies used surgeons as participants. Most used endoscopic surgery simulators to assess skills, and only 12 studies focused on microsurgery. This review provides 18 practical recommendations based on a systematic literature analysis of the following 8 domains: 1) listening to music before and during microsurgery, 2) caffeine consumption, 3) β-blocker use, 4) physical exercise, 5) sleep deprivation, 6) alcohol consumption before performing surgery, 7) duration of the operation, and 8) the ergonomic position of the surgeon.

CONCLUSIONS

Despite the clear value of determining the effects of various factors on surgical performance, the available body of literature is limited, and it is not possible to determine standards for each surgical field. These recommendations may be used by neurosurgical trainees and practicing neurosurgeons to improve microsurgical performance and acquisition of microsurgical skills. Randomized studies assessing the factors that influence microsurgical performance are required.

The Effects of Music on Microsurgical Technique and Performance: A Motion Analysis Study

BACKGROUND

Music is commonly played in operating rooms (ORs) throughout the country. If a preferred genre of music is played, surgeons have been shown to perform surgical tasks quicker and with greater accuracy. However, there are currently no studies investigating the effects of music on microsurgical technique. Motion analysis technology has recently been validated in the objective assessment of plastic surgery trainees' performance of microanastomoses. Here, we aimed to examine the effects of music on microsurgical skills using motion analysis technology as a primary objective assessment tool.

METHODS

Residents and fellows in the Plastic and Reconstructive Surgery program were recruited to complete a demographic survey and participate in microsurgical tasks. Each participant completed 2 arterial microanastomoses on a chicken foot model, one with music playing, and the other without music playing. Participants were blinded to the study objectives and encouraged to perform their best. The order of music and no music was randomized. Microanastomoses were video recorded using a digitalized S-video system and deidentified. Video segments were analyzed using ProAnalyst motion analysis software for automatic noncontact markerless video tracking of the needle driver tip.

RESULTS

Nine residents and 3 plastic surgery fellows were tested. Reported microsurgical experience ranged from 1 to 10 arterial anastomoses performed (n = 2), 11 to 100 anastomoses (n = 9), and 101 to 500 anastomoses (n = 1). Mean age was 33 years (range, 29-36 years), with 11 participants right-handed and 1 ambidextrous. Of the 12 subjects tested, 11 (92%) preferred music in the OR. Composite instrument motion analysis scores significantly improved with playing preferred music during testing versus no music (paired t test, P <0.001). Improvement with music was significant even after stratifying scores by order in which variables were tested (music first vs no music first), postgraduate year, and number of anastomoses (analysis of variance, P < 0.01).

CONCLUSIONS

Preferred music in the OR may have a positive effect on trainees' microsurgical performance; as such, trainees should be encouraged to participate in setting the conditions of the OR to optimize their comfort and, possibly, performance. Moreover, motion analysis technology is a useful tool with a wide range of applications for surgical education and outcomes optimization.

Effect of music on surgical skill during simulated intraocular surgery

OBJECTIVE

To evaluate the effect of Mozart music compared to silence on anterior segment surgical skill in the context of simulated intraocular surgery.

DESIGN

Prospective stratified and randomized noninferiority trial.

PARTICIPANTS

Fourteen ophthalmologists and 12 residents in ophthalmology.

METHODS

All participants were asked to perform 4 sets of predetermined tasks on the EyeSI surgical simulator (VRmagic, Mannheim, Germany). The participants completed 1 Capsulorhexis task and 1 Anti-Tremor task during 3 separate visits. The first 2 sets determined the basic level on day 1. Then, the participants were stratified by surgical experience and randomized to be exposed to music (Mozart sonata for 2 pianos in D-K448) during either the third or the fourth set of tasks (day 2 or 3). Surgical skill was evaluated using the parameters recorded by the simulator such as "Total score" and "Time" for both tasks and task-specific parameters such as "Out of tolerance percentage" for the Anti-Tremor task and "Deviation of rhexis radius from 2.5 mm," "Roundness," and "Centering" for the Capsulorhexis task. The data were analyzed using the Wilcoxon signed-rank test.

RESULTS

No statistically significant differences were noted between exposure and nonexposure for all the Anti-Tremor task parameters as well as most parameters for the Capsulorhexis task. Two parameters for the Capsulorhexis task showed a strong trend for improvement with exposure to music ("Total score" +23.3%, p = 0.025; "Roundness" +33.0%, p = 0.037).

CONCLUSION

Exposure to music did not negatively impact surgical skills. Moreover, a trend for improvement was shown while listening to Mozart music.

The razor's edge: Australian rock music impairs men's performance when pretending to be a surgeon

OBJECTIVE

Over the past few decades there has been interest in the role of music in the operating theatre. However, despite many reported benefits, a number of potentially harmful effects of music have been identified. This study aimed to explore the effects of rock and classical music on surgical speed, accuracy and perceived distraction when performing multiorgan resection in the board game Operation.

DESIGN

Single-blind, three-arm, randomised controlled trial.

SETTING

Imperial Festival, London, May 2016.

PARTICIPANTS

Members of the public (n = 352) aged ≥ 16 years with no previous formal surgical training or hearing impairments.

METHODS

Participants were randomised to listen through noise-cancelling headphones to either the sound of an operating theatre, rock music or classical music. Participants were then invited to remove three organs from the board game patient, Cavity Sam, using surgical tweezers.

MAIN OUTCOME MEASURES

Time taken (seconds) to remove three organs from Cavity Sam; the number of mistakes made in performing the surgery; and perceived distraction, rated on a five-point Likert-type scale from 1 (not at all distracting) to 5 (very distracting).

RESULTS

Rock music impairs the performance of men but not women when undertaking complex surgical procedures in the board game Operation, increasing the time taken to operate and showing a trend towards more surgical mistakes. In addition, classical music was associated with lower perceived distraction during the game, but this effect was attenuated when factoring in how much people liked the music, with suggestions that only people who particularly liked the music of Mozart found it beneficial.

CONCLUSIONS

Rock music (specifically Australian rock music) appears to have detrimental effects on surgical performance. Men are advised not to listen to rock music when either operating or playing board games.

Face and construct validation of a next generation virtual reality (Gen2-VR) surgical simulator

INTRODUCTION

Surgical performance is affected by distractors and interruptions to surgical workflow that exist in the operating room. However, traditional surgical simulators are used to train surgeons in a skills laboratory that does not recreate these conditions. To overcome this limitation, we have developed a novel, immersive virtual reality (Gen2-VR) system to train surgeons in these environments. This study was to establish face and construct validity of our system.

METHODS AND PROCEDURES

The study was a within-subjects design, with subjects repeating a virtual peg transfer task under three different conditions: Case I: traditional VR; Case II: Gen2-VR with no distractions and Case III: Gen2-VR with distractions and interruptions. In Case III, to simulate the effects of distractions and interruptions, music was played intermittently, the camera lens was fogged for 10 s and tools malfunctioned for 15 s at random points in time during the simulation. At the completion of the study subjects filled in a 5-point Likert scale feedback questionnaire. A total of sixteen subjects participated in this study.

RESULTS

Friedman test showed significant difference in scores between the three conditions (p < 0.0001). Post hoc analysis using Wilcoxon signed-rank tests with Bonferroni correction further showed that all the three conditions were significantly different from each other (Case I, Case II, p < 0.0001), (Case I, Case III, p < 0.0001) and (Case II, Case III, p = 0.009). Subjects rated that fog (mean 4.18) and tool malfunction (median 4.56) significantly hindered their performance.

CONCLUSION

The results showed that Gen2-VR simulator has both face and construct validity and that it can accurately and realistically present distractions and interruptions in a simulated OR, in spite of limitations of the current HMD hardware technology.

The Value of Audio Devices in the Endoscopy Room (VADER) study: a randomised controlled trial

OBJECTIVE

To evaluate the effect of Star Wars music (SWM) compared with endoscopist-selected popular music (PM) on quality outcomes in colonoscopy.

DESIGN AND SETTING

A single-centre, prospective, randomised controlled trial conducted in an endoscopy suite within a quaternary-centre gastroenterology unit, Melbourne, Australia.

MAIN OUTCOME MEASURES

The primary outcome measures were procedure time, polyp detection rate (PDR) and adenoma detection rate (ADR). The secondary outcome measure was adenomas per colonoscopy (APC).

RESULTS

103 colonoscopies were analysed: 58 in the SWM group and 45 in the PM group. Bowel preparation was assessed as good or excellent in 57% of the SWM group compared with 69% of the PM group (P < 0.01). The PDR was significantly higher in the SWM group than in the PM group (60% v 35%; P = 0.006). Similarly, the ADR was significantly higher in the SWM group than in the PM group (48% v 27%; P = 0.01). The APC in the SWM group was 84% compared with 35% in the PM group (P = 0.01).

CONCLUSION

SWM compared with PM improves key quality outcomes in colonoscopy, despite poorer bowel preparation.

A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training

BACKGROUND

Distractions during surgical procedures have been linked to medical error and team inefficiency. This systematic review identifies the most common and most significant forms of distraction in order to devise guidelines for mitigating the effects of distractions in the OR.

METHODS

In January 2015, a PubMed and Google Scholar search yielded 963 articles, of which 17 (2 %) either directly observed the occurrence of distractions in operating rooms or conducted a laboratory experiment to determine the effect of distraction on surgical performance.

RESULTS

Observational studies indicated that movement and case-irrelevant conversation were the most frequently occurring distractions, but equipment and procedural distractions were the most severe. Laboratory studies indicated that (1) auditory and mental distractions can significantly impact surgical performance, but visual distractions do not incur the same level of effects; (2) task difficulty has an interaction effect with distractions; and (3) inexperienced subjects reduce their speed when faced with distractions, while experienced subjects did not.

CONCLUSION

This systematic review suggests that operating room protocols should ensure that distractions from intermittent auditory and mental distractions are significantly reduced. In addition, surgical residents would benefit from training for intermittent auditory and mental distractions in order to develop automaticity and high skill performance during distractions, particularly during more difficult surgical tasks. It is unclear as to whether training should be done in the presence of distractions or distractions should only be used for post-training testing of levels of automaticity.

The Mozart effect on task performance in a laparoscopic surgical simulator

The Mozart Effect is a phenomenon whereby certain pieces of music induce temporary enhancement in "spatial temporal reasoning." To determine whether the Mozart Effect can improve surgical performance, 55 male volunteers (mean age = 20.6 years, range = 16-27), novice to surgery, were timed as they completed an activity course on a laparoscopic simulator. Subjects were then randomized for exposure to 1 of 2 musical pieces by Mozart (n = 21) and Dream Theater (n = 19), after which they repeated the course. Following a 15-minute exposure to a nonmusical piece, subjects were exposed to one of the pieces and performed the activity course a third time. An additional group (n = 15) that was not corandomized performed the tasks without any exposure to music. The percent improvements in completion time between 3 successive trials were calculated for each subject and group means compared. In 2 of the tasks, subjects exposed to the Dream Theater piece achieved approximately 30% more improvement (26.7 ± 8.3%) than those exposed to the Mozart piece (20.2 ± 7.8%, P = .021) or to no music (20.4 ± 9.1%, P = .049). Distinct patterns of covariance between baseline performance and subsequent improvement were observed for the different musical conditions and tasks. The data confirm the existence of a Mozart Effect and demonstrate for the first time its practical applicability. Prior exposure to certain pieces may enhance performance in practical skills requiring spatial temporal reasoning.