title: Impact of fatigue on neurophysiologic measures of surgical residents.
abstract: BACKGROUND
  To gain additional insight into the impact of fatigue on surgery resident proficiency, we set out to quantify its impact on behavioral and neurophysiologic measures.
  
  
  METHODS
  Simulations were first created using a visio-haptic joystick attached to a surgical instrument (tool) that allows realistic interactions. Before baseline (pre-call) and after call, 7 PGY1 surgery residents performed simulation tasks that required varying levels of psychomotor and cognitive skill. Residents completed 3 sessions per week for 4 weeks. Surgical proficiency was established using 5 metrics: hand movement smoothness; instrument movement smoothness; time to task completion; gesture level proficiency and cognitive errors. Data (percent change from baseline, pre-call) were analyzed using repeated measures ANOVA. While performing these tasks, the residents also wore an EEG cap (B-Alert; Advanced Brain Monitoring), the data from which provided second to second insight into the effects of workload, distraction, and attention on task performance. Mean (±SD) pre-call and post-call values for each were analyzed using repeated measures ANOVA.
  
  
  RESULTS
  Residents experienced significant (p < 0.014) post-call erosions in surgical proficiency, punctuated by dramatic increases in cognitive errors. EEG-based attention scores showed a significant (p < 0.014) concomitant decrement of 40%; distraction/drowsiness scores increased by 91%; and workload score increased by 51%.
  
  
  CONCLUSIONS
  Fatigue adversely affects PGY1 resident surgical proficiency and neurophysiologic performance.
authors.affiliation: Human Machine Symbiosis Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Phoenix, AZ, USA. Kanav@asu.edu
authors.forename: Kanav
authors.initials: K
authors.lastname: Kahol
authors.forename: Marshall
authors.initials: M
authors.lastname: Smith
authors.forename: Jared
authors.initials: J
authors.lastname: Brandenberger
authors.forename: Aaron
authors.initials: A
authors.lastname: Ashby
authors.forename: John J
authors.initials: JJ
authors.lastname: Ferrara
mesh_terms: D001288:Attention / Q000502:physiology; D002983:Clinical Competence; D003071:Cognition / Q000502:physiology*; D004569:Electroencephalography; D005221:Fatigue / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D010535:Laparoscopy; D008297:Male; D008568:Memory / Q000502:physiology; D009043:Motor Activity; D009048:Motor Skills / Q000502:physiology*; D013647:Task Performance and Analysis; D016526:Workload