The effects of fatigue on robotic surgical skill training in Urology residents

This study reports on the effect of fatigue on Urology residents using the daVinci surgical skills simulator (dVSS). Seven Urology residents performed a series of selected exercises on the dVSS while pre-call and post-call. Prior to dVSS performance a survey of subjective fatigue was taken and residents were tested with the Epworth Sleepiness Scale (ESS). Using the metrics available in the dVSS software, the performance of each resident was evaluated. The Urology residents slept an average of 4.07 h (range 2.5-6 h) while on call compared to an average of 5.43 h while not on call (range 3-7 h, p = 0.08). Post-call residents were significantly more likely to be identified as fatigued by the Epworth Sleepiness Score than pre-call residents (p = 0.01). Significant differences were observed in fatigued residents performing the exercises, Tubes and Match Board 2 (p = 0.05, 0.02). Additionally, there were significant differences in the total number of critical errors during the training session (9.29 vs. 3.14, p = 0.04). Fatigue in post-call Urology residents leads to poorer performance on the dVSS simulator. The dVSS may become a useful instrument in the education of fatigued residents and a tool to identify fatigue in trainees

The role of cognitive abilities in laparoscopic simulator training

Learning minimally invasive surgery (MIS) differs substantially from learning open surgery and trainees differ in their ability to learn MIS. Previous studies mainly focused on the role of visuo-spatial ability (VSA) on the learning curve for MIS. In the current study, the relationship between spatial memory, perceptual speed, and general reasoning ability, in addition to VSA, and performance on a MIS simulator is examined. Fifty-three laparoscopic novices were tested for cognitive aptitude. Laparoscopic performance was assessed with the LapSim simulator (Surgical Science Ltd., Gothenburg, Sweden). Participants trained multiple sessions on the simulator until proficiency was reached. Participants showed significant improvement on the time to complete the task and efficiency of movement. Performance was related to different cognitive abilities, depending on the performance measure and type of cognitive ability. No relationship between cognitive aptitude and duration of training or steepness of the learning curve was found. Cognitive aptitude mediates certain aspects of performance during training on a laparoscopic simulator. Based on the current study, we conclude that cognitive aptitude tests cannot be used for resident selection but are potentially useful for developing individualized training programs. More research will be performed to examine how cognitive aptitude testing can be used to design training programs

Call-Shift Fatigue and Use of Countermeasures and Strategies by Certified Registered Nurse Anesthetists

Purpose: The purpose of this study was to examine whether Certified Registered Nurse Anesthetists (CRNAs) experience fatigue during call and to assess their use of fatigue avoidance strategies (practices that prevent fatigue) and fatigue countermeasures (practices that decrease fatigue) to mitigate its effects. Method: Using a cross sectional descriptive survey design, data were collected from a randomly selected sample of 323 practicing CRNAs who worked call shifts. Data analysis: Data were analyzed using descriptive and multivariate statistics. Results: The sample was fairly evenly distributed with slightly more female respondents, 55% (n = 179). Fifty four percent worked a weekday call of ≤16 hours; 75% worked weekend shifts \u3e17 hours. Nearly 43% described fatigue occurring \u27often\u27 (nearly every call), or \u27frequent\u27 (once/month), and 57% as \u27occasional\u27 (4 times/year), or \u27rare\u27 (once/year). Of 91 CRNAs who reported a patient care error, 63% reported frequent fatigue. The theory of unpleasant symptoms (Lenz et al., 1997) provided a conceptual pathway for fatigue influences: physiologic, psychological, and situational factors that can lead to health symptoms and affect performance. Open-ended descriptions of interventions were coded as physiologic, psychological, or situational tactics. \u27Fatigue prevention\u27 (sleeping longer, napping before call), was the primary fatigue avoidance strategy, while \u27nutrition\u27 (i.e. snacks, caffeine, etc.) was the primary fatigue countermeasure. Logistic regression results indicate the overall model of eight predictors was statistically reliable in distinguishing status of fatigue experience (–2 Log Likelihood = 385.08; Goodness of Fit = 3.59; x² (10) = 49.06, p = .000). Wald statistics indicate weekend call duration, fatigue avoidance strategy use, number of fatigue countermeasures used, and number of anesthesia days per week was significant in predicting fatigue status. Conclusion: This study presents findings related to the experience of fatigue and challenges the individual practitioner to be aware of fatigue\u27s effect on performance, supports a relationship between healthcare worker fatigue and patient error, and adds to the scientific knowledge regarding the use of fatigue avoidance strategies and countermeasures. Fatigue awareness and education programs to promote healthy sleep and alertness should be developed, implemented, and evaluated

Resiliency in the Operating Room: Exploring Trainee Stress During Surgery and the Role of Individual Resilience

Surgical trainees experience significant intraoperative stress, which can negatively impact performance and learning. Psychological resilience suggests why some individuals excel despite severe stress. This study explores the relationship between trainee resilience and intraoperative stress. A novel instrument was developed to assess Surgical TRainee Experiences of StresS in the Operating Room (STRESSOR). Focus groups and a literature review identified eight domains of intraoperative stress. STRESSOR was used in a survey of orthopaedic residents in Canada and surgical trainees at Western University. Resiliency was assessed using the 10-item Connor-Davidson Resiliency Scale. 171 responses were received for a 38 percent response rate. The STRESSOR instrument had strong reliability and construct validity using confirmatory factor analysis. Increasing resilience correlated with lower intraoperative stress. Trainees with higher stress or lower resilience were more likely to have considered leaving residency. Resiliency training may reduce intraoperative stress, potentially improving surgical performance and learning while reducing resident attrition

Design, validation and implementation of a virtual reality high fidelity laparoscopic appendicectomy curriculum

INTRODUCTION: The treatment for acute appendicitis is laparoscopic appendicectomy (LA), usually performed by trainees who face significant challenges to training. Simulation curricula are being increasingly utilised and optimised to accelerate learning and improve skill retention in a safe environment. The aim of this study is to produce and implement a virtual reality (VR) curriculum for laparoscopic appendicectomy (LA) on the high-fidelity LAP Mentor VR simulator. METHODOLOGY: Performance data of randomised experts and novices were compared to assess the construct validity of the LAP Mentor basic skills (BS) and LA modules. Face validity of the simulator and module was assessed by questionnaire. These results informed the construction of a VR LA curriculum on an evidence-based theoretical framework. The curriculum was implemented and evaluated by analysis of participant diaries. RESULTS: Thirty-five novices and 25 experienced surgeons performed either BS, five LA procedural tasks or the LA full procedure. Both modules demonstrated construct validity. The LA module was deemed moderately realistic and useful for developing laparoscopic psychomotor skills. Seven novice trainees completed the new LA curriculum (three others dropped out). Analysis of participants diaries revealed the presence of frustration, the benefits of feedback sessions and the advantages and pitfalls of open access. DISCUSSION: Evaluations of the implementation of similar curricula are rare and participant diaries led to critical insights. The curriculum was difficult and sometimes frustrating, mitigated by rewarding experiences and coaching. The latter facilitated deliberate practice. Scheduling issues were mitigated by open access. Limitations of the curricula include the invariability in the presentation of appendicitis, and the reason for dropouts are not known. CONCLUSION: Several BS and all LA tasks are construct-valid. A new VR LA curriculum was implemented and analysis of participant diaries yielded critical insights into real-world implementation. Future study should investigate its effect on real-world performance and patient outcomes

Measuring fatigue and stress in laparoscopic surgery: validity and reliability of the star-track test

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Mental and physical workload in laparoscopic surgery

Imperial Users onl