Elsevier

Surgery

Volume 147, Issue 5, May 2010, Pages 631-639
Surgery

Simulation-Based Surgical Education
The impact of stress factors in simulation-based laparoscopic training

https://doi.org/10.1016/j.surg.2009.10.071Get rights and content

Background

This study aimed to quantify learner reactions manifesting from a realistic contextual stressor while training with a laparoscopic simulator, and to identify learner-derived stress-modifying behaviors. Stress factors are known to affect cognitive and psychomotor performance. Simulation-based medical training typically occurs in environments that are relatively stress free compared with the applied context. Training is most effective when it occurs in a highly faithful context, so the inclusion of typical clinical stressors in simulated laparoscopic learning environments may be beneficial.

Methods

Preclinical medical students (N = 27) completed tasks using a laparoscopic simulator under the following 2 conditions: faculty direct observation (stressor) and unobserved (no stressor). The data included simulator performance, blood pressure, real-time heart rates, videotaped behavior, and pre/post surveys of latent anxiety and stress factors associated with participating in the research (eg, STAI 9).

Results

Physiologic and behavioral manifestations of stress were observed for all participants during the stressor condition and during poor performance on simulator tasks. Stress was highest during periods of poor performance under the stressor condition. Focusing on the task itself mitigated stress reactions and improved performance on the simulator.

Conclusion

Stress reactions can be induced in a laboratory setting where simulation-based training occurs. Stressors imposed on the learner during simulation-based training may help support the acquisition of stress management skills that are necessary in the applied clinical setting. A ramped-up sequence of acquiring technical skills and clinical decision making, followed by stress management techniques, may lead to a more efficient transfer of learning from the simulated context to the clinical area.

Section snippets

Methods

The purpose of this study was to explore the degree to which difficulties with a surgical task, the presence of an authority figure, and the interaction between the presence of authority figure and task difficulties induced an affective response (stress) in learners using a laparoscopic surgical simulator for training. We use the term affective response to subsume a discrete emotional reaction to triggering stimuli.

The research had 2 goals: first, to quantify the effects of direct observation

Results

We found no significant difference between the presimulator and postsimulator usage blood pressures for any of the subjects. Quantitative analyses of stress-induced differential heart rates among subjects using a laparoscopic simulator are shown in Table I. No significant difference was found between the baseline (preuse) and postuse heart rates, which indicates that subjects returned to their initial affective state after simulator use. No significant difference was found between baseline and

Discussion

Through a mixed-method research design, we evaluated the effects of direct observation by an authority figure (evaluator) on trainee performance using a laparoscopic surgical simulator and examined the interaction between a trainee's performance on the simulator and his/her affective state. We found that both the presence of an evaluator and poor performance on the simulator led to the expression of stress-related behaviors and slightly increased heart rates; however, the combination of

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    Supported by the Internal University of Michigan.

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