Mental and Physical Workloads in a Competitive Laparoscopic Skills Training Environment

Abstract

Surgical trainees undergo demanding training to achieve high surgical task proficiency. Abounding clinical and educational responsibilities mandate efficient and effective training. This research measured resident workload during laparoscopic skills training to identify excessive workload and how workload impacted task performance. Twenty-eight surgical trainees performed a standardized surgical training task and completed a workload questionnaire while observers measured physiological stress, posture risk assessment, and task performance. Participants self-reported mental demands, physical demands, temporal demands, performance, effort, and frustration. Effort (12±4) and frustration (12±5) were the highest subscales while physical demand (8±4) was the lowest. All participants were observed performing the task in at-risk postures, with 21% exhibiting risk levels requiring immediate intervention. Physical demand was associated with posture risk assessment scores (p<0.05). Mental demand was positively (R 2 =0.20, p<0.05) and frustration was negatively (R2=0.18, p<0.05) associated with skin conductance range. A point increase in physical demand was associated with a six second increase in performance time (β=6.0, p=0.01). These results support the fact that human factors and ergonomic tools can be used to relate surgical skills performance with workload, stress, and posture risks.

Stress in surgical educational environments: a systematic review

“…The technologies were used in studies involving simulation-based tasks with box trainers and other technologies, and interventions. Masseter tone [ 63 , 64 ] and acceleration [ 65 , 94 ] were the main metrics used.…”

“…Box trainers were used in 25 articles [ 21 , 23 , 24 , 58 , 66 , 68 – 70 , 72 , 73 , 80 , 88 , 89 , 91 , 92 , 94 , 96 – 98 , 108 , 109 , 112 , 113 , 119 , 120 ]. Monitoring methods used during training set-ups with box trainers included all described monitoring methods in this review.…”

“…Effect of stress on simulator-based performance (for box trainers and VR simulators) was analyzed in 31 studies [ 15 , 20 , 21 , 23 , 24 , 66 – 70 , 72 – 74 , 76 , 77 , 84 , 88 , 89 , 91 , 92 , 94 , 96 , 98 – 100 , 103 , 108 , 109 , 112 , 113 , 119 ]. The stress levels were assessed through measures of HR and HRV [ 15 , 20 , 23 , 24 , 66 – 70 , 73 , 74 , 76 , 77 , 84 , 88 , 91 , 109 , 112 , 119 ], respiration frequency [ 73 ], questionnaire [ 89 , 108 , 112 , 113 ], EDA [ 94 ], perinasal thermal imaging [ 96 – 98 ], gaze [ 100 ], EEG [ 99 ], and STAI [ 103 ]. In addition, the effect of mental training methods on surgical technical performance was assessed in 9 articles [ 69 – 71 , 73 , 80 , 82 , 89 , 90 , 92 ].…”

Research on Key Indicators in Modern Surgical Practice Assessment: Ergonomic Approach

“…A total of 28 surgical trainees performed a standardized surgical training task and completed a workload questionnaire while the observers measured physiological stress, posture risk assessment, and task performance. 20 The aim of the study 21 was to evaluate mental workload and fatigue in the fingers, a hand, an arm, and a shoulder in single-incision laparoscopic surgery (SILS) and multiport laparoscopy. The objective of the study 22 was to evaluate the muscular strain and cognitive stress induced by these 2 techniques during real operations conducted on a pig.…”

Objective assessment of surgeon kinematics during simulated laparoscopic surgery: a preliminary evaluation of the effect of high body mass index models

“…Firstly, the efficiency and efficacy of upper body kinematics were evaluated through mean linear jerk [11], mean angular speed and the cumulative displacement of body segments [12]. Secondly, global indicators of work done by the surgeon included the cumulative displacement of body segments together with the time required to complete the task [13]. The authors hypothesized that increased BMI would degrade surgeon kinematics and increase their dynamic workloads, and that the deterioration in these factors would be greatest for less experienced surgeons.…”