Impact of fatigue on neurophysiologic measures of surgical residents.

Abstract:

BACKGROUND:To gain additional insight into the impact of fatigue on surgery resident proficiency, we set out to quantify its impact on behavioral and neurophysiologic measures. STUDY DESIGN:Simulations were first created using a visio-haptic joystick attached to a surgical instrument (tool) that allows realistic interactions. Before baseline (pre-call) and after call, 7 PGY1 surgery residents performed simulation tasks that required varying levels of psychomotor and cognitive skill. Residents completed 3 sessions per week for 4 weeks. Surgical proficiency was established using 5 metrics: hand movement smoothness; instrument movement smoothness; time to task completion; gesture level proficiency and cognitive errors. Data (percent change from baseline, pre-call) were analyzed using repeated measures ANOVA. While performing these tasks, the residents also wore an EEG cap (B-Alert; Advanced Brain Monitoring), the data from which provided second to second insight into the effects of workload, distraction, and attention on task performance. Mean (±SD) pre-call and post-call values for each were analyzed using repeated measures ANOVA. RESULTS:Residents experienced significant (p < 0.014) post-call erosions in surgical proficiency, punctuated by dramatic increases in cognitive errors. EEG-based attention scores showed a significant (p < 0.014) concomitant decrement of 40%; distraction/drowsiness scores increased by 91%; and workload score increased by 51%. CONCLUSIONS:Fatigue adversely affects PGY1 resident surgical proficiency and neurophysiologic performance.

journal_name

J Am Coll Surg

authors

Kahol K,Smith M,Brandenberger J,Ashby A,Ferrara JJ

doi

10.1016/j.jamcollsurg.2011.03.028

subject

Has Abstract

pub_date

2011-07-01 00:00:00

pages

29-34; discussion 34-6

issue

1

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(11)00232-8

journal_volume

213

pub_type

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