Abstract
Background
While operating, surgeons are required to make cognitive decisions and often are interrupted to attend to questions from other members of the health care team. Technical automatization may be achieved by experienced surgeons such that these distractions have little effect on performance of either the surgical or the cognitive task. This study assessed the effect of adding a distracting cognitive task on performance of a basic laparoscopic skill by novice and experienced surgeons.
Methods
In this study, 31 novice (medical students in postgraduate years [PGYs] 1–2) and 9 experienced (fellows/attendants and PGYs 4–5) laparoscopic surgeons practiced the Fundamentals of Laparoscopic Surgery (FLS) laparoscopic peg transfer task until their scores stabilized. The mean normalized score after five repetitions then was recorded. The subjects also were tested on the number of mathematical addition questions they could answer in 1 min. This was repeated five times, with the mean number of questions attempted and the accuracy (% correct) recorded. The laparoscopic and addition tasks then were performed concurrently five times. Data, presented as mean ± standard deviation, were analyzed using Student’s t-test. A p value less than 0.05 was considered statistically significant.
Results
After practice to stable peg transfer performance, the baseline peg transfer score was higher in the experienced group (98 ± 6 vs 87 ± 12; p < 0.01). There were no baseline differences between the groups in the number of math questions attempted in 1 min (10 ± 2 vs 9 ± 2; p = 0.55) or the number of correct answers (9 ± 3 vs 8 ± 3; p = 0.36). The comparison of baseline performance and dual-task performance showed that the experienced surgeons had no decline in peg transfer score (98 ± 6 vs 97 ± 6; p = 0.48), number of questions attempted in 1 min (10 ± 2 vs 9 ± 3; p = 0.32), or number of correct answers (9 ± 3 vs 8 ± 3; p = 0.46). In contrast, dual-tasking among the novices was associated with a decrease in the number of questions attempted (9 ± 2 vs 8 ± 2; p < 0.01) and the number of correct answers (8 ± 3 vs 7 ± 2; p = 0.02), and with no change in the peg transfer score (87 ± 12 vs 88 ± 8; p = 0.38) compared with baseline.
Conclusions
Distraction significantly decreased a novice’s ability to process cognitively based math problems, whereas there was no effect on experienced subjects. This occurred despite the fact that the novice group had practiced to high-level peg transfer scores at baseline. This suggests that the experienced surgeons had achieved automatization of the peg transfer basic surgical skill to a level that cognitive distraction did not affect performance of either task. The experienced surgeons were able to attend equally to both tasks, whereas the novices attended to the surgical task at the expense of some aspects of cognitive task performance.
Similar content being viewed by others
References
Healey AN, Sevdalis N, Vincent CA (2006) Measuring intraoperative interference from distraction and interruption observed in the operating theatre. Ergonomics 49:589–604
Pashler H, Johnston JC, Ruthruff E (2001) Attention and performance. Annu Rev Psychol 52:629–651
Van Selst MV, Ruthruff E, Johnston JC (1999) Can practice eliminate the psychological refractory period effect? J Exp Psychol 25:1268–1283
Moothy K, Munz Y, Undre S, Darzi A (2004) Objective evaluation of the effect of noise on the performance of a complex laparoscopic task. Surgery 136:25–30
Goodell KH, Cao CG, Schwaitzberg SD (2006) Effects of cognitive distraction on performance of laparoscopic surgical tasks. J Laparoendosc Adv Surg Tech 16:94–98
Strayer DL, Drews FA, Crouch DJ (2006) A comparison of the cell phone driver and the drunk driver. Human Factors 48:381–391
Schneider W, Shriffrin RM (1977) Controlled and automatic human information processing: I. Detection, search, and attention. Psychol Rev 84:1–66
Derossis AM, Bothwell J, Sigman HH, Fried GM (1998) The effect of practice on performance in a laparoscopic simulator. Surg Endosc 12:1117–1120
Feldman LS, Hagarty SE, Ghitulescu G, Stanbridge D, Fried GM (2004) Relationship between technical skills and subjective in-training evaluations in surgical residents. J Am Coll Surg 198:105–110
Peters JH, Fried GM, Swanstrom LL, Soper NJ, Sillin LF, Schirmer B, Hoffman K (2004) Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery 135:21–27
Fraser SA, Klassen DR, Feldman LS, Ghitulescu GA, Stanbridge D, Fried GM (2003) Evaluating laparoscopic skills: setting the pass/fail score for the MISTELS system. Surg Endosc 17:964–967
Peters JH, Fried GM, Swanstrom LL, Soper NJ, Sillin LF, Schirmer B, Hoffman K (2004) Development and validation of a comprehensive program of simulation in laparoscopy. Surg 135:21–27
Fried GM, Feldman LS, Vassiliou MC, Fraser SA, Stanbridge D, Ghitulescu G, Andrew CG (2004) Proving the value of simulation in laparoscopic surgery. Ann Surg 240:518–528
Welford AT (1967) Single-channel operation in the brain. Acta Psychol 27:5–22
Hecht R, Crewther D, Crewther S (2004) Rate of learning and symptotic performance in an automatization task and the relation to reading. Percept Motor Skills 99:1103–1121
Hazeltine E, Teague D, Ivry R (2002) Simultaneous dual-task performance reveals parallel response reaction after practice. J Exp Psychol Hum Percept Perform 527–545
Shapiro RA, Berland T (1972) Noise in the operating room. N Engl J Med 287:1236–1238
Hodge B, Thompson JF (1990) Noise pollution in the operating theatre. Lancet 335:891–894
McDonald J, Orlick T, Letts M (1995) Mental readiness in surgeons and its links to performance excellence in surgery. J Ped Orthopedics 15:691–697
Council Directive 93/104/EC (1993) Official J Eur Commun L307:18–24
Leach DC (2004) A model for GME: shifting from process to outcomes: a progress report from the Accreditation Council for Graduate Medical Education. Med Educ 38:12–14
Feanny MA, Scott BG, Mattox KL, Hirshberg A (2005) The impact of the 80-hour work week on resident emergency operative experience. Am J Surg 190:947–949
Stefanidis D, Korndorffer JR, Sierra R, Touchard C, Dunne JB, Scott DJ (2005) Skill retention following proficiency-based laparoscopic simulator training. Surgery 138:165–169
Seymor NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance. Ann Surg 236:458–464
Acknowledgments
We thank Alysha J. Catracchia for her assistance in this study. This study was supported by an unrestricted educational grant from Tyco Healthcare Canada.
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Las Vegas, Nevada, USA, April 2007
Rights and permissions
About this article
Cite this article
Hsu, K.E., Man, FY., Gizicki, R.A. et al. Experienced surgeons can do more than one thing at a time: effect of distraction on performance of a simple laparoscopic and cognitive task by experienced and novice surgeons. Surg Endosc 22, 196–201 (2008). https://doi.org/10.1007/s00464-007-9452-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9452-0