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Skill acquisition and stress adaptations following laparoscopic surgery training and detraining in novice surgeons.

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Title: Skill acquisition and stress adaptations following laparoscopic surgery training and detraining in novice surgeons.
Authors: Crewther, BT
Shetty, K
Jarchi, D
Selvadurai, S
Cook, CJ
Leff, DR
Darzi, A
Yang, GZ
Item Type: Journal Article
Abstract: BACKGROUND: Surgical training and practice is stressful, but adaptive changes in the stress circuitry (e.g. perceptual, physiological, hormonal, neural) could support skill development. This work examined skill acquisition and stress adaptations in novice surgeons during laparoscopic surgery (LS) training and detraining. METHODS: Twelve medical students were assessed for skill performance after 2 h (BASE), 5 h (MID) and 8 h (POST) of LS training in weeks 1-3, and then after 4 weeks of no training (RETEST). The stress outcomes included state anxiety, perceived stress and workload, heart rate (HR), heart rate variability (HRV), and salivary testosterone and cortisol concentrations. Functional near-infrared spectroscopy was used to assess cortical oxygenation change, as a marker of prefrontal cortex (PFC) activity. RESULTS: Skill performance improved in every session from BASE (p < 0.01), with corresponding decreases in state anxiety, stress, workload, low- and high-frequency HRV in the MID, POST and/or RETEST sessions (p < 0.05). Left and right PFC were symmetrically activated within each testing session (p < 0.01). The stress and workload measures predicted skill performance and changes over time (p < 0.05), with state anxiety, mean HR and the HRV measures also showing some predictive potential (p < 0.10). CONCLUSIONS: A 3-week LS training programme promoted stress-related adaptations likely to directly, or indirectly, support the acquisition of new surgical skills, and many outcomes were retained after a 4-week period without further LS training. These results have implications for medical training and education (e.g. distributed training for skill development and maintenance, stress resource and management training) and highlighted possible areas for new research (e.g. longitudinal stress and skill profiling).
Issue Date: 20-Oct-2015
Date of Acceptance: 19-Sep-2015
URI: http://hdl.handle.net/10044/1/59956
DOI: https://dx.doi.org/10.1007/s00464-015-4584-0
ISSN: 0930-2794
Publisher: Springer Verlag
Start Page: 1961
End Page: 2968
Journal / Book Title: Surgical Endoscopy
Volume: 30
Copyright Statement: © 2015 Springer Science and Business Media New York
Sponsor/Funder: Engineering & Physical Science Research Council (EPSRC)
National Institute for Health Research
Funder's Grant Number: EP/H009744/1
NF-SI-0510-10186
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
Prefrontal cortex
Testosterone
Cortisol
Saliva
Motor learning
Neural
OPERATING-ROOM
PERFORMANCE
SIMULATOR
CHALLENGE
THREAT
CORTEX
TASK
Clinical Competence
Cohort Studies
Heart Rate
Humans
Hydrocortisone
Laparoscopy
Male
Prefrontal Cortex
Stress, Psychological
Students, Medical
Task Performance and Analysis
Workload
Young Adult
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Division of Surgery
Computing
Faculty of Medicine



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