PD19-11 SURGEON PERFORMANCE AND DISTRACTIONS IN THE OPERATING ROOM: A RANDOMIZED, CONTROLLED, CROSSOVER TRIAL

Abstract

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment III1 Apr 2015PD19-11 SURGEON PERFORMANCE AND DISTRACTIONS IN THE OPERATING ROOM: A RANDOMIZED, CONTROLLED, CROSSOVER TRIAL Ryan Speir, Timothy Brand, and Richard Greene Ryan SpeirRyan Speir More articles by this author , Timothy BrandTimothy Brand More articles by this author , and Richard GreeneRichard Greene More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.710AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgery is a complex interaction of cognitive and psychomotor skills that requires significant concentration to perform safely. The ability to maintain focus amidst the many distractions in the operating room (O.R.) is largely influenced by effective allocation of limited working memory resources. Distractions can overload working memory resources resulting in diminished performance. We hypothesize that O.R. distractions are significant and negatively impact surgeon performance. METHODS We conducted a prospective randomized controlled trial with ten resident and ten attending surgeons. Participants were required to meet proficiency benchmarks on the previously validated high fidelity virtual reality daVinci desktop simulator (dV Trainer, Mimic Technologies, Seattle WA) to minimize performance variability. Participants performed four simulated surgical tasks with increasing complexity on the dV Trainer. Participants performed each task four times in a cross-over design; twice with distraction (intervention) and twice without distraction (control). Distraction was provided by 85 decibels of background operating room noise and board-style medical questions. Surgical performance was then determined by total task time, economy of motion (EOM) and master work space range (MWSR). Data were analyzed using SPSS. RESULTS Distraction had a detrimental effect on surgeon performance. During the simpler tasks, pick and place jacks (PAPJ) and ring walk (RW), attending surgeons performance declined with distraction in EOM (175.41 vs 189.29, p=0.014) and MWSR (8.61 vs 9.51, p=0.02), respectively. Resident performance was not affected by distraction in the PAPJ and RW tasks for each metric, but on more difficult tasks like pegboard level 1, resident surgeons showed significant decline due to distraction on both EOM (447.1 vs 485.65, p=0.03) and MWSR (9.48 vs 10.59, p=0.007). On the most advanced task, pegboard level 3, neither group significantly declined however experts EOM (787.33 vs 757.13) and MWSR (13.15 vs 11.99) was superior. CONCLUSIONS We have shown that distractions during VR robotic task performance can adversely affect surgeon performance. Resident surgeons seem to be more affected by distraction as the complexity of task increases. With increasing complexity of tasks, attending surgeons were less affected by distraction. The results indicate the need to further examine the detrimental effect distractions have on surgical performance. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e396 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Speir More articles by this author Timothy Brand More articles by this author Richard Greene More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...