title: The effect of divided attention on novices and experts in laparoscopic task performance.
abstract: BACKGROUND
  Attention is important for the skilful execution of surgery. The surgeon's attention during surgery is divided between surgery and outside distractions. The effect of this divided attention has not been well studied previously. We aimed to compare the effect of dividing attention of novices and experts on a laparoscopic task performance.
  
  
  METHODS
  Following ethical approval, 25 novices and 9 expert surgeons performed a standardised peg transfer task in a laboratory setup under three randomly assigned conditions: silent as control condition and two standardised auditory distracting tasks requiring response (easy and difficult) as study conditions. Human reliability assessment was used for surgical task analysis. Primary outcome measures were correct auditory responses, task time, number of surgical errors and instrument movements. Secondary outcome measures included error rate, error probability and hand specific differences. Non-parametric statistics were used for data analysis.
  
  
  RESULTS
  21109 movements and 9036 total errors were analysed. Novices had increased mean task completion time (seconds) (171 ± 44SD vs. 149 ± 34, p < 0.05), number of total movements (227 ± 27 vs. 213 ± 26, p < 0.05) and number of errors (127 ± 51 vs. 96 ± 28, p < 0.05) during difficult study conditions compared to control. The correct responses to auditory stimuli were less frequent in experts (68 %) compared to novices (80 %). There was a positive correlation between error rate and error probability in novices (r (2) = 0.533, p < 0.05) but not in experts (r (2) = 0.346, p > 0.05).
  
  
  CONCLUSIONS
  Divided attention conditions in theatre environment require careful consideration during surgical training as the junior surgeons are less able to focus their attention during these conditions.
authors.affiliation: Cuschieri Skills Centre, University of Dundee, Level 5 Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK, msuleri@yahoo.com.
authors.forename: Mudassar Ali
authors.initials: MA
authors.lastname: Ghazanfar
authors.forename: Malcolm
authors.initials: M
authors.lastname: Cook
authors.forename: Benjie
authors.initials: B
authors.lastname: Tang
authors.forename: Iain
authors.initials: I
authors.lastname: Tait
authors.forename: Afshin
authors.initials: A
authors.lastname: Alijani
mesh_terms: D000328:Adult; D001288:Attention; D002983:Clinical Competence; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D015203:Reproducibility of Results; D066231:Surgeons / Q000193:education* / Q000523:psychology; D013647:Task Performance and Analysis; D055815:Young Adult