A Quality Improvement Study on Avoidable Stressors and Countermeasures Affecting Surgical Motor Performance and Learning

Abstract

OBJECTIVE To explore how the two most important components of surgical performance - speed and accuracy - are influenced by different forms of stress and what the impact of music on these factors is. SUMMARY BACKGROUND DATA Based on a recently published pilot study on surgical experts, we designed an experiment examining the effects of auditory stress, mental stress, and music on surgical performance and learning, and then correlated the data psychometric measures to the role of music in a novice surgeon’s life. METHODS 31 surgeons were recruited for a crossover study. Surgeons were randomized to four simple standardized tasks to be performed on the Surgical SIM VR laparoscopic simulator, allowing exact tracking of speed and accuracy. Tasks were performed under a variety of conditions, including silence, dichotic music (auditory stress), defined classical music (auditory relaxation), and mental loading (mental arithmetic tasks). Tasks were performed twice to test for memory consolidation and to accommodate for baseline variability. Performance was correlated to the Brief Musical Experience Questionnaire (MEQ). RESULTS Mental loading influences performance with respect to accuracy, speed, and recall more negatively than does auditory stress. Defined classical music might lead to minimally worse performance initially, but leads to significantly improved memory consolidation. Furthermore, psychologic testing of the volunteers suggests that surgeons with greater musical commitment, measured by the MEQ, perform worse under the mental loading condition. CONCLUSION Mental distraction and auditory stress negatively affect specific components of surgical learning and performance. If used appropriately, classical music may positively affect surgical memory consolidation. It also may be possible to predict surgeons’ performance and learning under stress through psychological tests on the role of music in a surgeon’s life. Further investigation is necessary to determine the cognitive processes behind these correlations.

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

“…needed for attention (Table 3). Just as the field studies had shown auditory distractions to be much more prevalent and impactful than visual distractions, in experimental studies the introduction of auditory distractors have been much more common, appearing in 9 of the present studies [8, 27–33, 35]. For instance, Feuerbacher et al [35] introduced sounds such as noise from a dropped metal tray, while Moorthy et al [31], Siu et al [29], and Suh et al [8] introduced prerecorded OR noise (at 80–85dB in the first two studies and 50–90dB in the latter two studies).…”

“…This yielded a total of 102 empirical papers – eleven (11) papers presented findings from observations of distractions in the operating room or from laboratory studies of the effect of distractions on surgical performance [3, 8, 10, 14, 24–26, 28, 33–35]. A follow-up search replaced “distraction” with “noise” which yielded 752 empirical papers for review – in total five (5) of which were new and topically appropriate [27, 29–32].…”

“…Four studies showed the negative impact on error rates or accuracy [27, 28, 33, 35]. Four studies showed the negative impact on speed or time to task completion [27, 29, 32–33]. Finally, two studies showed the negative impact on economy of motion [27, 29].…”

“…The findings from these studies have been mixed, although overall they have indicated a more negative impact on performance than visual distractors. For instance, three studies have shown an increase in time to task completion [8, 32, 34], two studies have shown a reduction in overall speed [8, 33], two studies have shown a reduction in accuracy [32, 33], and one study has shown a reduction in economy of motion [14]. However, one study has shown no effect on speed and errors due to mental distractions for experts and novices [10], and another study found no impact on time to task completion or errors for experts or novices [14].…”

The Association of Shelter Veterinarians’ 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs

“…[281][282][283][284][285] In addition, effective leadership is associated with improvements in staff and patient safety and can mitigate employee work stress and increase job satisfaction. 283,[285][286][287] This has crucial implications in the context of HQHVSN programs because employee stress and work dissatisfaction are known risk factors for musculoskeletal pain [288][289][290][291] and decreased surgical performance 292,293 as well as for depression and suicidal ideation among veterinarians. 294 Leadership skills can be taught, and leadership training is an effective intervention that should be considered for anyone entering a leadership position.…”