title: Immersive training: breaking the bubble and measuring the heat.
abstract: BACKGROUND
  Minimal access surgery and, lately, single-incision laparoscopic procedures are challenging and demanding with regard to the skills of the surgeon performing the procedures. This article presents the results of an investigation of the performance and attention focus of 21 medical interns and surgical residents training in an immersive context. That is, training 'in situation', representing more realistically the demands imposed on the surgeons during minimal access surgery.
  
  
  METHODS
  Twenty-one medical interns and surgical residents participated in simulation trainings in an integrated operating room for laparoscopic surgery. Various physiological measures of body heat expenditure were gathered as indicators of mental strain and attention focus.
  
  
  RESULTS
  The results of the Mann-Whitney test indicated that participants with a poor performance in the two laparoscopic cholecystectomy cases had a significantly (U = 3, p = 0.038) higher heat flux at the start of the procedure (mean 107.08, standard deviation [SD] 24.34) than those who excelled in the two cases (mean 62.64, SD 23.41). Also, the average frontal head temperature of the participants who failed at the task was significantly lower (mean 33.27, SD 0.52) than those who performed well (mean 33.92, SD 0.27).
  
  
  CONCLUSIONS
  Surgeons cannot operate in a bubble; thus, they should not be trained in one. Combining heat flux and frontal head temperature could be a good measure of deep involvement and attentional focus during performance of simulated surgical tasks.
authors.affiliation: Department of Information Systems and Management, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands, j.r.pluyter@gmail.com.
authors.forename: Jon R
authors.initials: JR
authors.lastname: Pluyter
authors.forename: Anne-F
authors.initials: AF
authors.lastname: Rutkowski
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Jakimowicz
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology*; D001831:Body Temperature / Q000502:physiology; D002983:Clinical Competence; D003071:Cognition / Q000502:physiology*; D003198:Computer Simulation; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education* / Q000523:psychology; D008297:Male; D009873:Operating Rooms; D016526:Workload; D055815:Young Adult