title: Stress impairs psychomotor performance in novice laparoscopic surgeons.
abstract: BACKGROUND
  Little is known about acute stress in surgery although it is recognized to impair human performance in safety-critical industries. This study aimed to establish a direct empirical link between stress and psychomotor performance of novice surgeons.
  
  
  METHODS
  Eighteen participants completed this cross-sectional study. Participants carried out laparoscopic tasks on a MIST-VR simulator. Validated dexterity parameters were obtained from MIST-VR (path length, time taken, number of errors). Stress was assessed using the validated Imperial Stress Assessment Tool (ISAT). This captured stress subjectively using the State Trait Anxiety Inventory (STAI) questionnaire and objectively using salivary cortisol and mean and maximum heart rate.
  
  
  RESULTS
  Regarding technical performance, median values obtained were 55.12 s (range = 22.9-99.8) for time taken, 4.83 (range = 3-7) for economy of motion, and 88.0 (range = 35-175) for number of errors made. Subjective stress (STAI) correlated with economy of motion (r = 0.53, p = 0.042) and number of errors (r = 0.51, p = 0.034). Objective stress (mean and maximum heart rate) correlated with time taken (r = 0.62, p = 0.004), economy of motion (r = 0.55, p = 0.048), and number of errors (r = 0.67, p = 0.012).
  
  
  CONCLUSIONS
  This is the first study to demonstrate through direct correlation that stress impairs surgical performance on a simulator. Training in managing stress may be required to minimize these deleterious consequences and improve patient care.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College, 10th Floor, QEQM Building, Praed Street, London, W2 1NY, UK. Sonal.Arora06@imperial.ac.uk
authors.forename: Sonal
authors.initials: S
authors.lastname: Arora
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Pramudith
authors.initials: P
authors.lastname: Sirimanna
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Roger
authors.initials: R
authors.lastname: Kneebone
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011597:Psychomotor Performance; D013315:Stress, Psychological / Q000150:complications; D014584:User-Computer Interface