title: Experienced surgeons can do more than one thing at a time: effect of distraction on performance of a simple laparoscopic and cognitive task by experienced and novice surgeons.
abstract: BACKGROUND
  While operating, surgeons are required to make cognitive decisions and often are interrupted to attend to questions from other members of the health care team. Technical automatization may be achieved by experienced surgeons such that these distractions have little effect on performance of either the surgical or the cognitive task. This study assessed the effect of adding a distracting cognitive task on performance of a basic laparoscopic skill by novice and experienced surgeons.
  
  
  METHODS
  In this study, 31 novice (medical students in postgraduate years [PGYs] 1-2) and 9 experienced (fellows/attendants and PGYs 4-5) laparoscopic surgeons practiced the Fundamentals of Laparoscopic Surgery (FLS) laparoscopic peg transfer task until their scores stabilized. The mean normalized score after five repetitions then was recorded. The subjects also were tested on the number of mathematical addition questions they could answer in 1 min. This was repeated five times, with the mean number of questions attempted and the accuracy (% correct) recorded. The laparoscopic and addition tasks then were performed concurrently five times. Data, presented as mean +/- standard deviation, were analyzed using Student's t-test. A p value less than 0.05 was considered statistically significant.
  
  
  RESULTS
  After practice to stable peg transfer performance, the baseline peg transfer score was higher in the experienced group (98 +/- 6 vs 87 +/- 12; p < 0.01). There were no baseline differences between the groups in the number of math questions attempted in 1 min (10 +/- 2 vs 9 +/- 2; p = 0.55) or the number of correct answers (9 +/- 3 vs 8 +/- 3; p = 0.36). The comparison of baseline performance and dual-task performance showed that the experienced surgeons had no decline in peg transfer score (98 +/- 6 vs 97 +/- 6; p = 0.48), number of questions attempted in 1 min (10 +/- 2 vs 9 +/- 3; p = 0.32), or number of correct answers (9 +/- 3 vs 8 +/- 3; p = 0.46). In contrast, dual-tasking among the novices was associated with a decrease in the number of questions attempted (9 +/- 2 vs 8 +/- 2; p < 0.01) and the number of correct answers (8 +/- 3 vs 7 +/- 2; p = 0.02), and with no change in the peg transfer score (87 +/- 12 vs 88 +/- 8; p = 0.38) compared with baseline.
  
  
  CONCLUSIONS
  Distraction significantly decreased a novice's ability to process cognitively based math problems, whereas there was no effect on experienced subjects. This occurred despite the fact that the novice group had practiced to high-level peg transfer scores at baseline. This suggests that the experienced surgeons had achieved automatization of the peg transfer basic surgical skill to a level that cognitive distraction did not affect performance of either task. The experienced surgeons were able to attend equally to both tasks, whereas the novices attended to the surgical task at the expense of some aspects of cognitive task performance.
authors: Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, QC, Canada.
authors: K E
authors: KE
authors: Hsu
authors: F-Y
authors: FY
authors: Man
authors: R A
authors: RA
authors: Gizicki
authors: L S
authors: LS
authors: Feldman
authors: G M
authors: GM
authors: Fried
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology*; D002983:Clinical Competence; D003071:Cognition / Q000502:physiology*; D003162:Competency-Based Education; D004503:Education, Medical, Graduate; D018961:Educational Technology; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008505:Medical Staff, Hospital; D011336:Probability; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013647:Task Performance and Analysis
references: Surg Endosc. 1998 Sep;12(9):1117-20
references: 9716763
references: Annu Rev Psychol. 2001;52:629-51
references: 11148320
references: J Laparoendosc Adv Surg Tech A. 2006 Apr;16(2):94-8
references: 16646695
references: N Engl J Med. 1972 Dec 14;287(24):1236-8
references: 5084988
references: Ann Surg. 2002 Oct;236(4):458-63; discussion 463-4
references: 12368674
references: Ann Surg. 2004 Sep;240(3):518-25; discussion 525-8
references: 15319723
references: Hum Factors. 2006 Summer;48(2):381-91
references: 16884056
references: Percept Mot Skills. 2004 Dec;99(3 Pt 2):1103-21
references: 15739834
references: Surgery. 2004 Jul;136(1):25-30; discussion 31
references: 15232535
references: J Exp Psychol Hum Percept Perform. 1999 Oct;25(5):1268-83
references: 10531663
references: Surgery. 2005 Aug;138(2):165-70
references: 16153423
references: Med Educ. 2004 Jan;38(1):12-4
references: 14962020
references: Surgery. 2004 Jan;135(1):21-7
references: 14694297
references: Acta Psychol (Amst). 1967;27:5-22
references: 4863177
references: Ergonomics. 2006 Apr 15-May 15;49(5-6):589-604
references: 16717011
references: Am J Surg. 2005 Dec;190(6):947-9
references: 16307951
references: J Exp Psychol Hum Percept Perform. 2002 Jun;28(3):527-45
references: 12075886
references: Surg Endosc. 2003 Jun;17(6):964-7
references: 12658417
references: Lancet. 1990 Apr 14;335(8694):891-4
references: 1969991
references: J Pediatr Orthop. 1995 Sep-Oct;15(5):691-7
references: 7593587
references: J Am Coll Surg. 2004 Jan;198(1):105-10
references: 14698317