Determining the Effect of External Stressors on Laparoscopic Skills and Performance Between Obstetrics and Gynecology Residents

Abstract

Study objective: To evaluate the effect of stress on laparoscopic skills between obstetrics and gynecology residents.

Design: Observational prospective cohort study.

Design classification: Prospective cohort.

Setting: Urban teaching university hospital.

Participants (patients): Thirty-one obstetrics and gynecology residents, postgraduate years 1 to 4.

Intervention: We assessed 4 basic laparoscopic skills at 2 sessions. The first session was the baseline; 6 months later the same skills were assessed under audiovisual stressors. We compared the effect of stress on accuracy and efficiency between the 2 sessions.

Measurements and main results: A linear model was used to analyze time. Under stress, residents were more efficient in 3 of the 4 modules. Ring transfer (hand-eye coordination and bimanual dexterity), p = 0.0304. Ring of fire (bimanual dexterity and measure of depth perception), p = 0.0024 and dissection glove (respect of delicate tissue planes), p = 0.0002. Poisson regression was used to analyze the total number of penalties. Residents were more likely to acquire penalties under stress. Ring transfer, p = 0.0184 and cobra (hand-to-hand coordination), p = 0.0487 yielded a statistically significant increase in penalties in the presence of stressors. Dissection glove p = 0.0605 yielded a nonsignificant increase in penalties.

Conclusion: Our work confirmed that while under stress residents were more efficient, this translated into their ability to complete tasks faster in all the tested skills. Efficiency, however, came at the expense of accuracy.

Keywords: Practice-Based Learning and Improvement; Systems-Based Practice; education; laparoscopy; residency; residents; simulation; stress.