Association of Residents' Neural Signatures With Stress Resilience During Surgery

Modi, Hemel; Singh, Harsimrat; Fiorentino, Francesca; Orihuela‐Espina, Felipe; Athanasiou, Thanos; Yang, Guang‐Zhong; Darzi, Ara; Leff, Daniel

doi:10.1001/jamasurg.2019.2552

Cited by 22 publications

(26 citation statements)

References 60 publications

(123 reference statements)

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“…Furthermore, tDCS can improve early open knot-tying skills in medical students 21 , and may increase robotic suturing accuracy and knot-tensile strength (unpublished observations). Consistent reductions in subjective temporal stress were observed in these studies, an interesting finding given the well documented role of the prefrontal cortex in temporal stress resilience; this may account for some of the technical performance 11,12 . This is supported by evidence that tDCS leads to better working memory performance of cognitive tasks under stress 22 .…”

Section: Neuroenhancement By Neurostimulationsupporting

confidence: 75%

“…A decade of research examining dynamic learning‐related changes in surgeons found that activation of the prefrontal cortex is integral to the development of surgical skills, to enable surgeons to cope with day‐to‐day challenges. Stressors jeopardize these neural systems, resulting in deterioration of function that manifests externally as overt errors and inwardly as disordered cognition (such as poor decision‐making, reduced stress resilience and impaired working memory).…”

Section: Introductionmentioning

confidence: 99%

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Neuroenhancement in surgeons: benefits, risks and ethical dilemmas

Patel

Ashcroft

Darzi

et al. 2020

British Journal of Surgery

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Background Surgeons traditionally aim to reduce mistakes in healthcare through repeated training and advancement of surgical technology. Recently, performance‐enhancing interventions such as neurostimulation are emerging which may offset errors in surgical practice. Methods Use of transcranial direct‐current stimulation (tDCS), a novel neuroenhancement technique that has been applied to surgeons to improve surgical technical performance, was reviewed. Evidence supporting tDCS improvements in motor and cognitive performance outside of the field of surgery was assessed and correlated with emerging research investigating tDCS in the surgical setting and potential applications to wider aspects of healthcare. Ethical considerations and future implications of using tDCS in surgical training and perioperatively are also discussed. Results Outside of surgery, tDCS studies demonstrate improved motor performance with regards to reaction time, task completion, strength and fatigue, while also suggesting enhanced cognitive function through multitasking, vigilance and attention assessments. In surgery, current research has demonstrated improved performance in open knot‐tying, laparoscopic and robotic skills while also offsetting subjective temporal demands. However, a number of ethical issues arise from the potential application of tDCS in surgery in the form of safety, coercion, distributive justice and fairness, all of which must be considered prior to implementation. Conclusion Neuroenhancement may improve motor and cognitive skills in healthcare professions with impact on patient safety. Implementation will require accurate protocols and regulations to balance benefits with the associated ethical dilemmas, and to direct safe use for clinicians and patients.

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Section: Neuroenhancement By Neurostimulationsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Neuroenhancement in surgeons: benefits, risks and ethical dilemmas

Patel

Ashcroft

Darzi

et al. 2020

British Journal of Surgery

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“…All trainees reported greater task load under time pressure and showed decreased PFC activity, especially junior trainees. In a subsequent study, this group used fNIRS to examine brain activation differences between trainees who maintained a stable performance under time pressure and those who did not [ 65 ]. Resilient trainees showed greater bilateral ventral PFC activation, suggesting better attentional control and vigilance.…”

Section: Discussionmentioning

confidence: 99%

Use of neuroimaging to measure neurocognitive engagement in health professions education: a scoping review

Toy

Huh²,

Materi³

et al. 2022

Medical Education Online

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Purpose To map the current literature on functional neuroimaging use in medical education research as a novel measurement modality for neurocognitive engagement, learning, and expertise development. Method We searched PubMed, Embase, Cochrane, ERIC, and Web of Science, and hand-searched reference lists of relevant articles on April 4, 2019, and updated the search on July 7, 2020. Two authors screened the abstracts and then full-text articles for eligibility based on inclusion criteria. The data were then charted, synthesized, and analyzed descriptively. Results Sixty-seven articles published between 2007 and 2020 were included in this scoping review. These studies used three main neuroimaging modalities: functional magnetic resonance imaging, functional near-infrared spectroscopy, and electroencephalography. Most of the publications (90%, n = 60) were from the last 10 years (2011–2020). Although these studies were conducted in 16 countries, 68.7% (n = 46) were from three countries: the USA (n = 21), UK (n = 15), and Canada (n = 10). These studies were mainly non-experimental (74.6%, n = 50). Most used neuroimaging techniques to examine psychomotor skill development (57%, n = 38), but several investigated neurocognitive correlates of clinical reasoning skills (22%, n = 15). Conclusion This scoping review maps the available literature on functional neuroimaging use in medical education. Despite the heterogeneity in research questions, study designs, and outcome measures, we identified a few common themes. Included studies are encouraging of the potential for neuroimaging to complement commonly used measures in education research and may help validate/challenge established theoretical assumptions and provide insight into training methods. This review highlighted several areas for further research. The use of these emerging technologies appears ripe for developing precision education, establishing viable study protocols for realistic operational settings, examining team dynamics, and exploring applications for real-time monitoring/intervention during critical clinical tasks.

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“…The first main challenge for neuroergonomics is to implement an innovative methodology to avoid the pitfalls of reductionist approach leading to place participants facing repetitive and boring artificial tasks causing degradation of data due to attentional and motivational effects as well as investigating task load with realistic/real-world complex cognitive tasks, with studies ranging from pilots, air traffic controllers, surgeons, car drivers, teacher-students in classroom to pedestrians navigating outdoors (Ayaz et al, 2012;Mühl et al, 2014;McKendrick et al, 2016;Arico et al, 2017;Unni et al, 2017;Bevilacqua et al, 2018;Di Flumeri et al, 2018;Gateau et al, 2018;Callan and Dehais, 2019;Djebbara et al, 2019;Modi et al, 2019;Wunderlich and Gramann, 2020). Thus, the challenge for neuroergonomics is to design an engaging ecological paradigm while assuring a high experimental control level.…”

Section: Challenge 1: Methodological Considerationsmentioning

confidence: 99%