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Surgical Endoscopy

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Open Access 01-09-2012

Conscious monitoring and control (reinvestment) in surgical performance under pressure

Authors: Neha Malhotra, Jamie M. Poolton, Mark R. Wilson, Karen Ngo, Rich S. W. Masters

Published in: Surgical Endoscopy | Issue 9/2012

Abstract

Background

Research on intraoperative stressors has focused on external factors without considering individual differences in the ability to cope with stress. One individual difference that is implicated in adverse effects of stress on performance is “reinvestment,” the propensity for conscious monitoring and control of movements. The aim of this study was to examine the impact of reinvestment on laparoscopic performance under time pressure.

Methods

Thirty-one medical students (surgery rotation) were divided into high- and low-reinvestment groups. Participants were first trained to proficiency on a peg transfer task and then tested on the same task in a control and time pressure condition. Outcome measures included generic performance and process measures. Stress levels were assessed using heart rate and the State Trait Anxiety Inventory (STAI).

Results

High and low reinvestors demonstrated increased anxiety levels from control to time pressure conditions as indicated by their STAI scores, although no differences in heart rate were found. Low reinvestors performed significantly faster when under time pressure, whereas high reinvestors showed no change in performance times. Low reinvestors tended to display greater performance efficiency (shorter path lengths, fewer hand movements) than high reinvestors.

Conclusion

Trained medical students with a high individual propensity to consciously monitor and control their movements (high reinvestors) displayed less capability (than low reinvestors) to meet the demands imposed by time pressure during a laparoscopic task. The finding implies that the propensity for reinvestment may have a moderating effect on laparoscopic performance under time pressure.

Based on previous studies in the motor skill learning domain [13, 28] a post-hoc median split on 31 participants (leading to 12 high reinvestors and 15 low reinvestors) provided sufficient power for the study.

Arora S, Hull L, Sevdalis N, Tierney T, Nestel D, Woloshynowych M, Darzi A, Kneebone R (2010) Factors compromising safety in surgery: stressful events in the operating room. Am J Surg 199:60–65PubMedCrossRef

Prabhu A, Smith W, Yurko Y, Acker C, Stefanidis D (2010) Increased stress levels may explain the incomplete transfer of simulator-acquired skill to the operating room. Surgery 147:640–645PubMedCrossRef

Sexton J, Thomas EJ, Helmreich RL (2000) Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ 320:745–749PubMedCrossRef

Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R (2010) The impact of stress on surgical performance: a systematic review of the literature. Surgery 147:318–330PubMedCrossRef

Holzman RS, Cooper JB, Gaba DM, Philip JH, Small SD, Feinstein D (1995) Anesthesia crisis resource management: real life simulation training in operating room crises. J Clin Anesth 7:675–687PubMedCrossRef

Hassan I, Weyers P, Maschuw K, Dick B, Gerdes B, Rothmund M, Zielke A (2006) Negative stress-coping strategies among novices in surgery correlate with poor virtual laparoscopic performance. Br J Surg 93:1554–1559PubMedCrossRef

Berguer R, Smith WD, Chung YH (2001) Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc 15:1204–1207PubMedCrossRef

Bohm B, Rotting N, Schwenk W, Grebe S, Mansmann U (2001) A prospective randomized trial on heart rate variability of the surgical team during laparoscopic and conventional sigmoid resection. Arch Surg 136:305–310PubMedCrossRef

Tendulkar AP, Victorino GP, Ching TJ, Bullard MK, Liu TH, Harken AH (2005) Quantification of surgical resident stress “on call”. J Am Coll Surg 201:560–564PubMedCrossRef

10.

Moorthy K, Munsz Y, Dosis A, Bann S, Darzi A (2003) The effect of stress inducing conditions on the performance of a laparoscopic task. Surg Endosc 17:1481–1484PubMedCrossRef

11.

Wetzel CM, Kneebone RL, Woloshynowych M, Nestel D, Moorthy K, Kidd J, Darzi A (2006) The effects of stress on surgical performance. Am J Surg 191:537–543CrossRef

12.

Poolton JM, Wilson MR, Malhotra N, Ngo K, Masters RSW (2011) A comparison of evaluation, time pressure and multi-tasking as stressors of psychomotor surgical performance. Surgery 149:776–782PubMedCrossRef

13.

Maxwell JP, Masters RSW, Poolton JM (2006) Performance breakdown in sport: the roles of reinvestment and verbal knowledge. Res Q Exerc Sport 77:271–276PubMedCrossRef

14.

Kinrade NP, Jackson RC, Ashford KJ (2010) Dispositional reinvestment and skill failure in cognitive and motor tasks. Psychol Sport Exerc 11:312–319CrossRef

15.

Wan CY, Huon GF (2005) Performance degradation under pressure in music: an examination of attentional processes. Psychol Music 33:155–172CrossRef

16.

Eysenck MW (1992) Anxiety: the cognitive perspective. Psychology Press, Hove

17.

Eysenck MW, Derakshan N, Santos R, Calvo MG (2007) Anxiety and cognitive performance: attentional control theory. Emotion 7:336–353PubMedCrossRef

18.

Wilson MR, Vine SJ, Wood G (2009) The influence of anxiety on visual attentional control in basketball free throw shooting. J Sport Exerc Psychol 31:152–168PubMed

19.

Masters RSW, Maxwell J (2008) The theory of reinvestment. Int Rev Sport Exerc Psychol 1:160–183CrossRef

20.

Masters RSW (1992) Knowledge, knerves and know-how: the role of explicit versus implicit knowledge in the breakdown of a complex motor skill under pressure. Br J Psychol 83:343–358CrossRef

21.

Masters RSW, Polman RC, Hammond NV (1993) Reinvestment: a dimension of personality implicated in skill breakdown under pressure. Pers Indiv Differ 14:655–666CrossRef

22.

Chell BJ, Graydon JK, Crowley PL, Child M (2003) Manipulated stress and dispositional reinvestment in a wall-volley task: an investigation into controlled processing. Percept Mot Skills 97:435–448PubMed

23.

Masters RSW, Eves FF, Maxwell J (2005) Development of a movement specific reinvestment scale. In: Morris T, Terry P, Gordon S, Hanrahan S, Ievleva L, Kolt G, Tremayne P (eds), Proceedings of the ISSP 11th World Congress of Sport Psychology, Sydney, Australia, 14–19 August 2005

24.

Poolton JM, Maxwell JP, Masters RSW (2004) Rules for reinvestment. Percept Mot Skills 99:771–774PubMed

25.

Thuraisingam AI, Levine DF, Anderson JT (2006) Can research in sports and other motor skills help improve endoscopy training? Gastrointest Endosc 63:276–279PubMedCrossRef

26.

Masters RSW, Pall HS, MacMahon KMA, Eves FF (2007) Duration of Parkinson disease is associated with an increased propensity for “reinvestment”. Neurorehabil Neural Repair 21:123–126PubMedCrossRef

27.

Wong WL, Masters RSW, Maxwell JP, Abernethy AB (2008) Reinvestment and falls in community-dwelling older adults. Neurorehabil Neural Repair 22:410–414PubMed

28.

Zhu FF, Poolton JM, Wilson MR, Maxwell JP, Masters RSW (2011) Neural co-activation as a yardstick of implicit motor learning and the propensity for conscious control of movement. Biol Psychol 87:66–73PubMedCrossRef

29.

Ritter EM, Scott DS (2007) Design of a proficiency-based skills training curriculum for the fundamentals of laparoscopic surgery. Surg Innov 14:107–112PubMedCrossRef

30.

Arora S, Tierney T, Sevdalis N, Aggarwal R, Nestel D, Woloshynowych M, Darzi A, Kneebone R (2010) The Imperial Stress Assessment Tool (ISAT): a feasible, reliable and valid approach to measuring stress in the operating room. World J Surg 34:1756–1763PubMedCrossRef

31.

Andreatta PB, Hillard M, Krain LP (2010) The impact of stress factors in simulation-based laparoscopic training. Surgery 147:631–639PubMedCrossRef

32.

Arora S, Sevdalis N, Aggarwal R, Sirimanna P, Darzi A, Kneebone R (2010) Stress impairs psychomotor performance in novice laparoscopic surgeons. Surg Endosc 24:2588–2593PubMedCrossRef

33.

Marteau TM, Bekker H (1992) The development of a six-item short-form of the state scale of the Spielberger State Trait Anxiety Inventory (STAI). Br J Clin Psychol 31:301–306PubMedCrossRef

34.

Scott DJ, Ritter EM, Tesfay ST, Pimentel EA, Nagji A, Fried GM (2008) Certification pass rate of 100% for fundamentals of laparoscopic surgery skills after proficiency-based training. Surg Endosc 22:1887–1893PubMedCrossRef

35.

Datta V, Mackay S, Mandalia M, Darzi A (2001) The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg 193:479–485PubMedCrossRef

36.

Datta V, Mandalia M, Mackay S, Chang A, Cheshire N, Darzi A (2002) Relationship between skill and outcome in the laboratory-based model. Surgery 131:318–323PubMedCrossRef

37.

Maxwell JP, Masters RSW, Eves FF (2000) From novice to no know-how: a longitudinal study of implicit motor learning. J Sport Sci 18:111–120CrossRef

38.

Lazarus RS, Folkman S (1986) Cognitive theories of stress and the issue of circularity. In: Appley MH, Trumbull R (eds) Dynamics of stress: physiological, psychological and social perspectives. Plenum, New York, pp 63–80

39.

Yule S, Flin R, Paterson-Brown S, Maran N, Rowley D (2006) Development of a rating system for surgeons’ non-technical skills. Med Educ 40:1098–1104PubMedCrossRef

40.

Sarker SK, Chang A, Vincent C (2008) Decision making in laparoscopic surgery: a prospective, independent and blinded analysis. Int J Surg 6:98–105PubMedCrossRef

41.

Kinrade NP, Jackson RC, Ashford KJ, Bishop DT (2010) Development and validation of the decision-specific reinvestment scale. J Sport Sci 28:1127–1135CrossRef

42.

Masters RSW, Maxwell JP (2004) Implicit motor learning, reinvestment and movement disruption: what you don’t know won’t hurt you? In: Williams AM, Hodges NJ (eds) Skill acquisition in sport: research, theory and practice. Routledge, London, pp 207–228

43.

Masters RSW, Poolton JM, Maxwell JP (2007) Stable implicit motor processes despite aerobic locomotor fatigue. Conscious Cogn 17:335–338PubMedCrossRef

44.

Poolton JP, Masters RSW, Maxwell JP (2007) Passing thoughts on the evolutionary stability of implicit motor behaviour: performance retention under physiological fatigue. Conscious Cogn 16:456–468PubMedCrossRef

45.

Maxwell JP, Masters RSW, Kerr E, Weedon E (2001) The implicit benefit of learning without errors. Q J Exp Psychol 54:1049–1068

46.

Liao CM, Masters RSW (2001) Analogy learning: a means to implicit motor learning. J Sports Sci 19:307–319PubMedCrossRef

47.

Masters RSW, Poolton JM, Maxwell JP, Raab M (2008) Implicit motor learning and complex decision making in time-constrained environments. J Mot Behav 40:71–79PubMedCrossRef

48.

Masters RSW, Poolton JM, Abernethy B, Patil NG (2008) Implicit learning of movement skills for surgery. ANZ J Surg 78:1062–1064PubMedCrossRef

49.

Masters RSW, Lo CY, Maxwell JP, Patil NG (2008) Implicit motor learning in surgery: implications for multi-tasking. Surgery 143:140–145PubMedCrossRef

50.

Zhu FF, Poolton JM, Wilson MR, Hu Y, Maxwell JP, Masters RSW (2011) Implicit motor learning promotes neural efficiency during laparoscopy. Surg Endosc 25:2950–2955PubMedCrossRef

Title: Conscious monitoring and control (reinvestment) in surgical performance under pressure
Authors: Neha Malhotra
Jamie M. Poolton
Mark R. Wilson
Karen Ngo
Rich S. W. Masters
Publication date: 01-09-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 9/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2193-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Conscious monitoring and control (reinvestment) in surgical performance under pressure

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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