title: A quality improvement study on avoidable stressors and countermeasures affecting surgical motor performance and learning.
abstract: OBJECTIVE
  To explore how the 2 most important components of surgical performance--speed and accuracy-are influenced by different forms of stress and what the impact of music is on these factors.
  
  
  BACKGROUND
  On the basis of a recently published pilot study on surgical experts, we designed an experiment examining the effects of auditory stress, mental stress, and music on surgical performance and learning and then correlated the data psychometric measures to the role of music in a novice surgeon's life.
  
  
  METHODS
  Thirty-one surgeons were recruited for a crossover study. Surgeons were randomized to 4 simple standardized tasks to be performed on the SurgicalSIM VR laparoscopic simulator (Medical Education Technologies, Inc, Sarasota, FL), allowing exact tracking of speed and accuracy. Tasks were performed under a variety of conditions, including silence, dichotic music (auditory stress), defined classical music (auditory relaxation), and mental loading (mental arithmetic tasks). Tasks were performed twice to test for memory consolidation and to accommodate for baseline variability. Performance was correlated to the brief Musical Experience Questionnaire (MEQ).
  
  
  RESULTS
  Mental loading influences performance with respect to accuracy, speed, and recall more negatively than does auditory stress. Defined classical music might lead to minimally worse performance initially but leads to significantly improved memory consolidation. Furthermore, psychologic testing of the volunteers suggests that surgeons with greater musical commitment, measured by the MEQ, perform worse under the mental loading condition.
  
  
  CONCLUSIONS
  Mental distraction and auditory stress negatively affect specific components of surgical learning and performance. If used appropriately, classical music may positively affect surgical memory consolidation. It also may be possible to predict surgeons' performance and learning under stress through psychological tests on the role of music in a surgeon's life. Further investigation is necessary to determine the cognitive processes behind these correlations.
authors.affiliation: Harvard Medical School, Massachusetts General Hospital, Department of Surgery, Boston, MA 02114, USA. Cconrad1@partners.org
authors.forename: Claudius
authors.initials: C
authors.lastname: Conrad
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Konuk
authors.forename: Paul D
authors.initials: PD
authors.lastname: Werner
authors.forename: Caroline G
authors.initials: CG
authors.lastname: Cao
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Warshaw
authors.forename: David W
authors.initials: DW
authors.lastname: Rattner
authors.forename: Lars
authors.initials: L
authors.lastname: Stangenberg
authors.forename: Harald C
authors.initials: HC
authors.lastname: Ott
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
authors.forename: Diane L
authors.initials: DL
authors.lastname: Miller
authors.forename: Denise W
authors.initials: DW
authors.lastname: Gee
mesh_terms: D018592:Cross-Over Studies; D004501:Education, Medical; D004503:Education, Medical, Graduate; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000523:psychology*; D009147:Music Therapy; D058996:Quality Improvement; D013016:Sound; D013312:Stress, Physiological; D013315:Stress, Psychological; D013647:Task Performance and Analysis