A quality improvement study on avoidable stressors and countermeasures affecting surgical motor performance and learning

Abstract

Objective: To explore how the 2 most important components of surgical performance--speed and accuracy-are influenced by different forms of stress and what the impact of music is on these factors.

Background: On the basis of a recently published pilot study on surgical experts, we designed an experiment examining the effects of auditory stress, mental stress, and music on surgical performance and learning and then correlated the data psychometric measures to the role of music in a novice surgeon's life.

Methods: Thirty-one surgeons were recruited for a crossover study. Surgeons were randomized to 4 simple standardized tasks to be performed on the SurgicalSIM VR laparoscopic simulator (Medical Education Technologies, Inc, Sarasota, FL), allowing exact tracking of speed and accuracy. Tasks were performed under a variety of conditions, including silence, dichotic music (auditory stress), defined classical music (auditory relaxation), and mental loading (mental arithmetic tasks). Tasks were performed twice to test for memory consolidation and to accommodate for baseline variability. Performance was correlated to the brief Musical Experience Questionnaire (MEQ).

Results: Mental loading influences performance with respect to accuracy, speed, and recall more negatively than does auditory stress. Defined classical music might lead to minimally worse performance initially but leads to significantly improved memory consolidation. Furthermore, psychologic testing of the volunteers suggests that surgeons with greater musical commitment, measured by the MEQ, perform worse under the mental loading condition.

Conclusions: Mental distraction and auditory stress negatively affect specific components of surgical learning and performance. If used appropriately, classical music may positively affect surgical memory consolidation. It also may be possible to predict surgeons' performance and learning under stress through psychological tests on the role of music in a surgeon's life. Further investigation is necessary to determine the cognitive processes behind these correlations.

Figures

Figure 1. Flow chart explaining the study design

Novice surgeons were randomized to complete simple surgical tasks on a laparoscopy simulator while exposed to four conditions: 1. Silence, 2. Dichotic Music, 3. Mental Loading, and 4. Classical Music. Permutations of the task were created to account for a learning effect. Each task was performed twice to test after a break for a learning effect. The data was correlated to the Brief Music Experience Questionnaire.

Figure 2. Data for Time until Task completion (Speed)

The data for time is depicted for the 4 conditions silence, dichotic music, mental loading and classical music. 1 and 2 on the x-axis behind the various conditions represent completion of the task for the first time (1) and then for second time (2) following a short break.

Figure 3. Data for Tip Trajectory of the Surgical Instrument (Accuracy)

The data for accuracy is depicted for the 4 conditions silence, dichotic music, mental loading and classical music. 1 and 2 on the x-axis behind the various conditions represent completion of the task for the first time (1) and then for second time (2) following a short break

Figure 4. Relative improvement for time depicted as change from baseline for the four conditions

Notice that the greatest relative improvement occurs while listening to relaxing classical music

Figure 5. Relative improvement for accuracy depicted as change from baseline for the four conditions

Again, notice that the greatest relative improvement occurs while listening to relaxing classical music