Association for surgical education
Effect of fatigue on psychomotor and cognitive skills

Presented at the Association for Surgical Education Joint Meeting, Capitol Hill, Washington, DC, April 11–14, 2007
https://doi.org/10.1016/j.amjsurg.2007.10.004Get rights and content

Abstract

Background

Previous studies have explored the effect of fatigue on general psychomotor proficiency. However, studies specifically addressing the effect of fatigue on surgical residents’ cognitive skills during simulated surgical exercises are lacking.

Methods

Thirty-seven surgical residents in both the precall and the postcall condition were tested for psychomotor and cognitive skill evaluation on a virtual-reality simulator with haptic feedback and hand-motion recording. To evaluate surgical skills, hand- and tool-movement smoothness, cognitive errors, and time to completion for specific tasks were analyzed.

Results

In addition increased cognitive errors, a significant decrease (P < .01) was recorded in the proficiency variables of memory, attention, and intermodal coordination tasks when residents were in the postcall condition.

Conclusions

Fatigue and sleep deprivation cause a significant deterioration in the surgical residents’ cognitive skills as measured by virtual reality simulation. Psychomotor skills are also negatively impacted during tasks that require a combination of psychomotor and cognitive skills.

Section snippets

Materials and Methods

All experiments were conducted with the approval of the Banner Good Samaritan Medical Center Institutional Review Board. Baseline demographic data were obtained from 37 trauma surgery and obstetric/gynecologic (OB/GYN) residents (19 women and 18 men), 25 of whom were junior-level (ie, postgraduate [PGY]-1 or 2) house officers and 12 of whom were senior level (PGY3 or higher) residents. The OB/GYN and general surgery residents were pooled in the same group for the study because the specific aim

Data Analysis

The designed software captured and stored the 5 proficiency measures. Fatigue ratings were captured through the questionnaire. Iterations of exercises performed precall were compared with iterations of exercises performed postcall. Analysis of variance (ANOVA) was employed to study the difference between the 5 proficiency measures of surgical skills independently of one another. These measures enabled study of the overall effect of night call on subjects’ surgical skill; P < .05 was considered

Results

Figures 2a through 2e depict the ANOVA plots of the 5 measures of proficiency, each of which demonstrated a significant difference in performance when the residents were in the postcall compared with the precall condition. An intriguing result was that time taken to complete the tasks significantly improved when the residents were in the postcall condition. Subanalysis was performed to study the differences between precall and postcall performance for exercises that primarily involved

Comments

Previous studies on fatigue and night call have employed standard simulator tasks and actual procedures for measurement of the effect of fatigue on surgical proficiency. Studies have often yielded mixed results. The present study is uniquely placed in that its research methodology presents and measures proficiency during tasks in which the residents had to combine both psychomotor and cognitive skills. This is an important contribution because traditional research methodology has focused on the

Conclusions and Future Work

The current study provides evidence that surgical proficiency as assessed among junior- and senior-level residents is significantly impeded when they are fatigued. This effect is manifested by increased number of cognitive errors and decreased psychomotor efficiency and overall task performance. Cognitive skills are more affected than psychomotor skills; however, impeded cognitive performance may also lead to limited psychomotor proficiency. The decrement is significant in surgeons at all

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