title: Conscious monitoring and control (reinvestment) in surgical performance under pressure.
abstract: BACKGROUND
  Research on intraoperative stressors has focused on external factors without considering individual differences in the ability to cope with stress. One individual difference that is implicated in adverse effects of stress on performance is "reinvestment," the propensity for conscious monitoring and control of movements. The aim of this study was to examine the impact of reinvestment on laparoscopic performance under time pressure.
  
  
  METHODS
  Thirty-one medical students (surgery rotation) were divided into high- and low-reinvestment groups. Participants were first trained to proficiency on a peg transfer task and then tested on the same task in a control and time pressure condition. Outcome measures included generic performance and process measures. Stress levels were assessed using heart rate and the State Trait Anxiety Inventory (STAI).
  
  
  RESULTS
  High and low reinvestors demonstrated increased anxiety levels from control to time pressure conditions as indicated by their STAI scores, although no differences in heart rate were found. Low reinvestors performed significantly faster when under time pressure, whereas high reinvestors showed no change in performance times. Low reinvestors tended to display greater performance efficiency (shorter path lengths, fewer hand movements) than high reinvestors.
  
  
  CONCLUSIONS
  Trained medical students with a high individual propensity to consciously monitor and control their movements (high reinvestors) displayed less capability (than low reinvestors) to meet the demands imposed by time pressure during a laparoscopic task. The finding implies that the propensity for reinvestment may have a moderating effect on laparoscopic performance under time pressure.
authors.affiliation: Institute of Human Performance, University of Hong Kong, Hong Kong. nehamal@hku.hk
authors.forename: Neha
authors.initials: N
authors.lastname: Malhotra
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Poolton
authors.forename: Mark R
authors.initials: MR
authors.lastname: Wilson
authors.forename: Karen
authors.initials: K
authors.lastname: Ngo
authors.forename: Rich S W
authors.initials: RS
authors.lastname: Masters
mesh_terms: D002983:Clinical Competence; D003243:Consciousness; D003657:Decision Making; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000592:standards*; D013315:Stress, Psychological; D013337:Students, Medical / Q000523:psychology*