Do absorption and realistic distraction influence performance of component task surgical procedure?

Department of Information Systems and Management, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands.
Surgical Endoscopy (Impact Factor: 3.31). 09/2009; 24(4):902-7. DOI: 10.1007/s00464-009-0689-7
Source: PubMed

ABSTRACT Surgeons perform complex tasks while exposed to multiple distracting sources that may increase stress in the operating room (e.g., music, conversation, and unadapted use of sophisticated technologies). This study aimed to examine whether such realistic social and technological distracting conditions may influence surgical performance.
Twelve medical interns performed a laparoscopic cholecystectomy task with the Xitact LC 3.0 virtual reality simulator under distracting conditions (exposure to music, conversation, and nonoptimal handling of the laparoscope) versus nondistracting conditions (control condition) as part of a 2 x 2 within-subject experimental design.
Under distracting conditions, the medical interns showed a significant decline in task performance (overall task score, task errors, and operating time) and significantly increased levels of irritation toward both the assistant handling the laparoscope in a nonoptimal way and the sources of social distraction. Furthermore, individual differences in cognitive style (i.e., cognitive absorption and need for cognition) significantly influenced the levels of irritation experienced by the medical interns.
The results suggest careful evaluation of the social and technological sources of distraction in the operation room to reduce irritation for the surgeon and provision of proper preclinical laparoscope navigation training to increase security for the patient.

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    ABSTRACT: Background Distraction and interruption are endemic in the clinical environment and contribute to error. This study assesses whether simulation-based training with targeted feedback can improve undergraduate management of distractions and interruptions to reduce error-making. Design A prospective non-randomised controlled study. Methods 28 final year medical students undertook a simulated baseline ward round. 14 students formed an intervention group and received immediate feedback on distractor management and error. 14 students in a control group received no feedback. After 4 weeks, students participated in a post-intervention ward round of comparable rigour. Changes in medical error and distractor management between simulations were assessed with Mann-Whitney U tests using SPSS V.21. Results At baseline, error rates were high. The intervention group committed 72 total baseline errors (mean of 5.1 errors/student; median 5; range 3-7). The control group exhibited a comparable number of errors-with a total of 76 observed (mean of 5.4 errors/student; median 6; range 4-7). Many of these errors were life-threatening. At baseline distractions and interruptions were poorly managed by both groups. All forms of simulation training reduced error-making. In the intervention group the total number of errors post-intervention fell from 72 to 17 (mean 1.2 errors/student; median 1; range 0-3), representing a 76.4% fall (p<0.0001). In the control group the total number of errors also fell-from 76 to 44 (mean of 3.1 errors/student; median 3; range 1-5), representing a 42.1% reduction (p=0.0003). Conclusions Medical students are not inherently equipped to manage common ward-based distractions to mitigate error. These skills can be taught-with simulation and feedback conferring the greatest benefit. Curricular integration of simulated ward round experiences is recommended.
    BMJ quality & safety 11/2014; 24(2). DOI:10.1136/bmjqs-2014-003272 · 3.28 Impact Factor
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    ABSTRACT: To develop a behavioural observation method to simultaneously assess distractors and communication/teamwork during surgical procedures through direct, on-site observations; to establish the reliability of the method for long (>3 h) procedures.
    BMJ quality & safety 07/2014; 23(11). DOI:10.1136/bmjqs-2014-002860 · 3.28 Impact Factor

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