Association for surgical educationEffect of fatigue on 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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