title: Drilling sounds are used by surgeons and intermediate residents, but not novice orthopedic trainees, to guide drilling motions.
abstract: BACKGROUND
  The purpose of our study was to investigate the impact of distracting noise on the performance on a simulated orthopedic bone drilling skill when that noise blocks routine auditory feedback associated with the sounds of the drill.
  
  
  METHODS
  Medical students (n=11), intermediate residents (postgraduate years 3-5, n=10) and surgeons (n=8) each drilled 20 bicortical holes in a femur bone from a lamb: 10 holes without and 10 holes with the presence of distracting noise. We quantified surgical outcome in the form of plunge depth using computer-assisted objective methods.
  
  
  RESULTS
  Novice participants plunged more than did the intermediate trainees and surgeons (p<0.001). With the addition of distracting noise, the plunges of both intermediate residents and surgeons were affected.
  
  
  CONCLUSIONS
  Distracting noise impairs orthopedic bone drilling performance, and the ability to use drilling sounds to guide drilling motions is part of surgical expertise.
authors.affiliation: Department of Kinesiology, University of Waterloo, Waterloo, Ontario.
authors.forename: Monate
authors.initials: M
authors.lastname: Praamsma
authors.forename: Heather
authors.initials: H
authors.lastname: Carnahan
authors.forename: David
authors.initials: D
authors.lastname: Backstein
authors.forename: Christian J H
authors.initials: CJ
authors.lastname: Veillette
authors.forename: David
authors.initials: D
authors.lastname: Gonzalez
authors.forename: Adam
authors.initials: A
authors.lastname: Dubrowski
mesh_terms: D000818:Animals; D001288:Attention; D002983:Clinical Competence; D004501:Education, Medical; D005180:Faculty, Medical; D005260:Female; D005269:Femur / Q000601:surgery*; D006309:Hearing; D006801:Humans; D007396:Internship and Residency; D008297:Male; D023421:Models, Animal; D009622:Noise / Q000009:adverse effects*; D009983:Orthopedic Equipment; D019637:Orthopedic Procedures / Q000379:methods*; D010897:Pitch Discrimination; D012756:Sheep; D013016:Sound; D013337:Students, Medical; D013647:Task Performance and Analysis