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Temporal stress in the operating room: brain engagement promotes "coping" and disengagement prompts "choking"

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Title: Temporal stress in the operating room: brain engagement promotes "coping" and disengagement prompts "choking"
Authors: Modi, HN
SIngh, H
Orihuela-Espina, F
Athanasiou, T
Fiorentino, F
Yang, GZ
Darzi, A
Leff, DR
Item Type: Journal Article
Abstract: 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.
Issue Date: 9-May-2017
Date of Acceptance: 25-Apr-2017
URI: http://hdl.handle.net/10044/1/48320
DOI: 10.1097/SLA.0000000000002289
ISSN: 1528-1140
Publisher: Lippincott, Williams & Wilkins
Start Page: 683
End Page: 691
Journal / Book Title: Annals of Surgery
Volume: 267
Issue: 4
Copyright Statement: © 2017 Wolters Kluwer Health, Inc. All rights reserved. This is a non-final version of an article published in final form at: https://insights.ovid.com/crossref?an=00000658-900000000-96106
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Engineering & Physical Science Research Council (EPSRC)
Engineering & Physical Science Research Council (EPSRC)
Engineering & Physical Science Research Council (EPSRC)
National Institute of Health Research
Funder's Grant Number: RDB04 79560
RD207
EP/M000257/1
EP/N027132/1
EP/P012779/1
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
brain imaging
cognitive load
functional near-infrared spectroscopy
functional neuroimaging
stress
surgical performance
surgical skill
temporal demand
time pressure
NEAR-INFRARED SPECTROSCOPY
PREFRONTAL CORTEX
WORKING-MEMORY
DECISION-MAKING
TASK
PERFORMANCE
ACTIVATION
FUNDAMENTALS
ATTENTION
VALIDITY
Adaptation, Psychological
Adult
Attention
Clinical Competence
Female
Functional Neuroimaging
Heart Rate
Hemodynamics
Humans
Internship and Residency
Laparoscopy
Male
Middle Aged
Operating Rooms
Perception
Prefrontal Cortex
Stress, Psychological
Students, Medical
Suture Techniques
Task Performance and Analysis
Time Factors
Workload
Prefrontal Cortex
Humans
Laparoscopy
Suture Techniques
Adaptation, Psychological
Stress, Psychological
Perception
Task Performance and Analysis
Attention
Heart Rate
Time Factors
Internship and Residency
Clinical Competence
Students, Medical
Adult
Middle Aged
Operating Rooms
Workload
Female
Male
Hemodynamics
Functional Neuroimaging
11 Medical and Health Sciences
Surgery
Publication Status: Published
Online Publication Date: 2018-04
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine
Institute of Global Health Innovation
Faculty of Engineering