An Evaluation of the Impact of High-Fidelity Endovascular Simulation on Surgeon Stress and Technical Performance

Abstract

Objective: To measure the physiological stress response associated with high-fidelity endovascular team simulation.

Design: This is a prospective cohort study.

Setting: This study was performed at St Mary's Hospital (Imperial College London, London, UK), in a tertiary setting.

Participants: Thirty-five participants (10 vascular surgical residents, 4 surgical interns, 12 theatre nurses, 2 attending vascular surgeons, 6 medical students and 1 technician) were recruited from the Imperial Vascular Unit at St Mary's Hospital, Imperial College London by direct approach. All participants finished the study.

Results: Junior surgeons experienced significantly increased sympathetic tone (Low frequency/high frequency (LF/HF) ratio) during team simulation compared to individual simulation (6.01 ± 1.68 vs. 8.32 ± 2.84, p < 0.001). Within team simulation junior surgeons experienced significantly higher heart rate (beats per minute) than their senior counterparts (82 ± 5.83 vs. 76 ± 6.02, p = 0.033). Subjective workload scores (NASA Task Load Index [NASA-TLX]) correlated moderately and significantly with sympathetic tone in surgeons across all stages of simulation. (r = 0.39, p = 0.01).

Conclusions: A discrete, measurable increase in stress is experienced by surgeons during high-fidelity endovascular simulation and differentially effects junior surgeons. High-fidelity team simulation may have a role to play in improving nontechnical skill, reducing intra-operative stress, and reducing error.

Keywords: Education; Endovascular; GRS-E; LF/HF; NASA Task Load Index; NASA-TLX; Simulation; Surgery; Systems-Based Practice; global rating scale of endovascular performance; low frequency/high frequency.