Realistic Distractions and Interruptions That Impair Simulated Surgical Performance by Novice Surgeons

Abstract

Hypothesis: Although the risks for operating room distractions and interruptions (ORDIs) are acknowledged, most research on this topic is unrealistic, inconclusive, or methodologically unsound. We hypothesized that realistic ORDIs induce errors in a simulated surgical procedure performed by novice surgeons. Design, Setting, and Participants: Eighteen secondyear, third-year, and research-year surgical residents completed a within-subjects experiment on a laparoscopic virtual reality simulator. Based on 9 months of operating room observations, 4 distractions and 2 interruptions were designed and timed to occur during critical stages in simulated laparoscopic cholecystectomy. The control factor was the absence or presence of ORDIs, with order randomly counterbalanced across the subjects. Main Outcome Measures: The primary outcome measure was surgical errors measured by the simulator as damage to arteries, bile duct, or other organs. The second outcome measure was whether the participants remembered a prospective memory task assigned prior to the procedure and important to operative conduct. Results: Major surgical errors were committed in 8 of 18 simulated procedures (44%) with ORDIs vs only 1 of 18 (6%) without ORDIs (P = .02). Interrupting questions caused the most errors. Sidebar conversations were the next most likely distraction to lead to errors. Ten of 18 participants (56%) forgot the prospective memory task with ORDIs, while 4 of 18 (22%) forgot the task without ORDI (P =.04). All 8 surgical errors with ORDIs occurred after 1 PM (P =.001). Conclusions: Typical ORDIs have the potential to cause operative errors in surgical trainees. This performance deficit was prevalent in the afternoon.

QUIET PLEASE! Effect of distraction on simulated posterior segment surgical performance

“…For example, in their 2010 study involving 12 medical interns, Pluyter et al [11] found that being distracted while performing a virtual laparoscopic cholecystectomy procedure not only adversely affected the task performance but also increased the levels of irritation of the interns (as measured by the blood pressure and heart rate). Similar findings were made in another study involving 18 surgical residents performing a laparoscopic cholecystectomy on a simulator, which showed an increase in the number of major surgical errors in the group randomized to distractions and interruptions [12].…”

“…This is in contrast to previous studies that have demonstrated a poorer performance with distractions [11][12][13]. For example, in their 2010 study involving 12 medical interns, Pluyter et al [11] found that being distracted while performing a virtual laparoscopic cholecystectomy procedure not only adversely affected the task performance but also increased the levels of irritation of the interns (as measured by the blood pressure and heart rate).…”

How do interruptions affect clinician performance in healthcare? Negotiating fidelity, control, and potential generalizability in the search for answers

“…They help investigators clarify the conditions under which interruptions may or may not produce harm. Simulator-based investigations may be mounted in a full-scale healthcare simulation environment (Feuerbacher, Funk, Spight, Diggs, & Hunter, 2012;Liu, Grundgeiger, Sanderson, Jenkins, & Leane, 2009;Prakash et al, 2014) or in a part-task simulation environment (Magrabi, Li, Day, & Coiera, 2010). They typically involve clinicians as participants.…”

“…We highlight three simulation studies: (1) Feuerbacher et al's (2012) test of whether operating room distractions and interruptions would induce errors by novice surgeons, (2) Magrabi et al's (2010) test of whether the absence vs. presence of interruptions and task complexity would affect whether physicians make errors in prescribing medication using a computerized provider order entry system, and (3) Prakash et al (2014) study of whether interruptions cause oncology nurses to notice fewer errors during medication verification and commit more errors during medication administration.…”

“…All three studies included competent subject matter experts and seemed to provide all necessary tools for the tasks (see Table 1). In relation to situations, in the Feuerbacher et al (2012) and the Magrabi et al (2010) studies, interruptions were operationalized as the observer or experimenter intervening in the simulated scenario or task. We argue that interventions by the observer may interfere with the fidelity of the study, because the represented situation is not what a clinician would experience.…”