Background noise lowers the performance of anaesthesiology residents’ clinical reasoning when measured by script concordance

Enser, Maya; Moriceau, Jean-Marc; Abily, Julien; Occhiali, Emilie; Besnier, Emmanuel; Clavier, Thomas; Lefevre-Scelles, Antoine; Bertrand, Denis; Compère, Vincent

doi:10.1097/eja.0000000000000624

Cited by 27 publications

(15 citation statements)

References 38 publications

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“…We chose to perform the study in medical students who were inexperienced with laparoscopy in order to reduce potential previous experience influencing laparoscopic task performance. Studies evaluating noise in the OR found higher subjective distraction levels in assisting surgeons with less experience compared to the main, more experienced surgeons [48], while the negative impact on clinical reasoning was lower when anesthesiological residents were more experienced [49]. It has been theorized that more experienced surgeons can block out noise and music more effectively [10], theoretically decreasing potential effect size and increasing the required number of participants.…”

Section: Discussionmentioning

confidence: 99%

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

Oomens

Kleinrensink

et al. 2020

Surg Endosc

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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.

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Section: Discussionmentioning

confidence: 99%

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

Oomens

Kleinrensink

et al. 2020

Surg Endosc

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“…[ 15 ] It has been proven that background noise inside the OR affects clinical reasoning, especially in junior residents. [ 11 ] It has also been shown that noise can generally have psychological and physiological effects on humans, especially when performing critical tasks. [ 32 ] We argue that outside cognitive distractions, such as described in our study, should be occasionally applied during lab training to provide a more realistic environment and to ensure that a satisfactory level of skill is achieved to provide resilience to the inevitable outside interference experienced during actual clinical surgery in the OR.…”

Section: Discussionmentioning

confidence: 99%

The impact of neurosurgical procedure on cognitive resources: Results of bypass training

2018

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Background:Neurosurgeons are exposed to unavoidable distractions in their natural operating environment. Distractions can affect both the surgeon's concentration and the safety and duration of the surgery. Such distraction can be studied by applying a simultaneous cognitive task during a surgical procedure.Methods:We used a previously described cognitive task: a forward (DF) and backward digit (DB) repetition task to interfere with the surgeon's attention during a training bypass. A pilot study was performed to find suitable digit repetition lengths. For the main experiment, we used four-digit strings. The test task was alternated across two consecutive sutures (n = 153, 8 bypasses), followed by two consecutive control sutures without digit repetition. The duration and the number of correct answers for the digit repetition task were compared to a baseline digit repetition without simultaneous surgery.Results:During the bypass surgery, digit repetitions (especially DB) became slower (P < 0.0001). More errors were made during DB compared to DF only during simultaneous bypass (P < 0.0001). However, we found no effect of digit repetition tasks on individual suture times (P = 0.823).Conclusions:The ability to engage in simultaneous tasks while performing surgery is diminished. A surgeon with extensive training can withstand external distraction without an effect on performance; however, this is achieved by partially ignoring the simultaneous task. Our data support that during surgery other cognitive tasks should be avoided to ensure safety.

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“…3,[15][16][17][18][19][20] Excessive noise in the health care environment may minimize the ability to communicate effectively, make it difficult to understand content, and contribute to miscommunication 15,21 that could potentially lead to an error. [22][23][24] The Environmental Protection Agency (EPA) recommends that the level of continuous background noise in hospitals not exceed 45 decibels (dB) during the day. The World Health Organization recommends that environmental noise levels not exceed 30 dB.…”

Section: Rationalementioning

confidence: 99%

AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care

2020

AORN Journal

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Background noise lowers the performance of anaesthesiology residents’ clinical reasoning when measured by script concordance

Abstract: Our study suggests that noise affects clinical reasoning of anaesthesiology residents especially junior residents when measured by SCT. This observation supports the hypothesis that noise should be prevented in operating rooms especially when junior residents are providing care.

Cited by 27 publications

References 38 publications

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

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

The impact of neurosurgical procedure on cognitive resources: Results of bypass training

AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care

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