Objective:
To investigate the impact of time pressure (TP) on prefrontal
activation and technical performance in surgical residents during a laparo-
scopic suturing task.
Background:
Neural mechanisms enabling surgeons to maintain perform-
ance and cope with operative stressors are unclear. The prefrontal cortex
(PFC) is implicated due to its role in attention, concentration, and perform-
ance monitoring.
Methods:
A total of 33 residents [Postgraduate Year (PGY)1 – 2
¼
15,
PGY3– 4
¼
8, and PGY5
¼
10] performed a laparoscopic suturing task
under ‘‘self-paced’’ (SP) and ‘‘TP’’ conditions (TP
¼
maximum 2 minutes per
knot). Subjective workload was quantified using the Surgical Task Load
Index. PFC activation was inferred using optical neuroimaging. Technical
skill was assessed using progression scores (au), error scores (mm), leak
volumes (mL), and knot tensile strengths (N).
Results:
TP led to greater perceived workload amongst all residents (mean
Surgical Task Load Index score

SD: PGY1 – 2: SP
¼
160.3

24.8 vs TP
¼
202.1

45.4,
P
<
0.001; PGY3 – 4: SP
¼
123.0

52.0 vs TP
¼
172.5

43.1,
P
<
0.01; PGY5: SP
¼
105.8

55.3 vs TP
¼
159.1

63.1,
P
<
0.05).
Amongst PGY1– 2 and PGY3– 4, deterioration in task progression, error
scores and knot tensile strength (
P
<
0.05), and diminished PFC activation
was observed under TP. In PGY5, TP resulted in inferior task progression and
error scores (
P
<
0.05), but preservation of knot tensile strength. Furthermore,
PGY5 exhibited less attenuation of PFC activation under TP, and greater
activation than either PGY1 – 2 or PGY3 – 4 under both experimental con-
ditions (
P
<
0.05).
Conclusions:
Senior residents cope better with temporal demands and exhibit
greater technical performance stability under pressure, possibly due to
sustained PFC activation and greater task engagement. Future work should
seek to develop training strategies that recruit prefrontal resources, enhance
task engagement, and improve performance under pressure.