title: Effect of short-term pretrial practice on surgical proficiency in simulated environments: a randomized trial of the "preoperative warm-up" effect.
abstract: BACKGROUND
  Surgery is a skill-driven discipline. While other high-stake professions with comparable cognitive and psychomotor skill requirements often use warm-up exercises for achieving better proficiency, the effects of such practice have not been investigated sufficiently in surgical tasks.
  
  
  METHODS
  Subjects performed standardized exercises as a preoperative warm-up, after which the standardized exercises were repeated in a randomized order. In a variation to investigate the generalizability of preoperative warm-up, the experimental group was allowed to warm-up with the standardized exercises, after which a different task (electrocautery simulation) was performed. To investigate the effect of warm-up on fatigue, participants were involved in eight sessions (four before night call, four after night call), after which the tasks were repeated. Results were analyzed using ANOVA to plot differences between warm-up and followup condition.
  
  
  RESULTS
  All outcomes measures demonstrated statistically significant improvements after all of the post-warm-up exercises (p < 0.01), and were seen in all groups with differing experience levels. In addition, the simple warm-up exercises led to a significant increase in proficiency in followup electrocautery task for the experimental group when compared with the control group (p < 0.0001). There was also significant improvement in performance of the fatigued group to approximately baseline performance (p < 0.05), although they were not able to reach their optimal potential performance.
  
  
  CONCLUSIONS
  Preoperative warm-up for 15 to 20 minutes with simple surgical exercises leads to a substantial increase in surgical skills proficiency during followup tasks.
authors.affiliation: Department of Biomedical Informatics, Arizona State University, Tempe, AZ, USA.
authors.forename: Kanav
authors.initials: K
authors.lastname: Kahol
authors.forename: Richard M
authors.initials: RM
authors.lastname: Satava
authors.forename: John
authors.initials: J
authors.lastname: Ferrara
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Smith
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001143:Arousal; D002983:Clinical Competence; D003071:Cognition; D003162:Competency-Based Education / Q000379:methods* / Q000639:trends*; D004502:Education, Medical, Continuing / Q000379:methods / Q000639:trends; D004503:Education, Medical, Graduate / Q000379:methods / Q000639:trends; D005221:Fatigue; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D009048:Motor Skills; D011597:Psychomotor Performance; D012449:Safety; D013514:Surgical Procedures, Operative / Q000193:education*; D055815:Young Adult