title: Debriefing decreases mental workload in surgical crisis: A randomized controlled trial.
abstract: Mental workload is the amount of mental effort involved in performing a particular task. Crisis situations may increase mental workload, which can subsequently negatively impact operative performance and patient safety. This study aims to measure the impact of learning through debriefing and a systematic approach to crisis on trainees' mental workload in a simulated surgical crisis.
  
  
  
  Twenty junior surgical residents participated in a high-fidelity, simulated, postoperative crisis in a surgical ward environment (pretest). Participants were randomized to either an instructor-led debriefing, including performance feedback (intervention; n = 10) or no debriefing (control; n = 10). Subjects then immediately managed a second simulated crisis (post-test). Mental workload was assessed in real time during the scenarios using a previously validated, wireless, vibrotactile device. Mental workload was represented by subject response times to the vibrations, which were recorded and analyzed using the Mann-Whitney U test.
  
  
  
  Participants in the debriefing arm had a significantly reduced median response time in milliseconds (post-test minus pretest -695, quartile range -2,136 to -297) compared to participants in the control arm (42, -1,191 to 763), (between-arm difference P = .049).
  
  
  
  Debriefing after simulated surgical crisis situations may improve performance by decreasing trainee's mental workload during a subsequent simulated surgical crisis.
authors.affiliation: Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: sboet@toh.ca.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Boet
authors.affiliation: Department of Surgery, St Michael's Hospital, University of Toronto, Division of General Surgery, Toronto, Ontario, Canada.
authors.forename: Bharat
authors.initials: B
authors.lastname: Sharma
authors.affiliation: Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ashlee-Ann
authors.initials: AA
authors.lastname: Pigford
authors.affiliation: Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Hladkowicz
authors.affiliation: Institute of Biomaterials and Biomedical Engineering, St Michael's Hospital, University of Toronto, Division of General Surgery, Toronto, Ontario, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Rittenhouse
authors.affiliation: Department of Surgery, St Michael's Hospital, University of Toronto, Division of General Surgery, Toronto, Ontario, Canada.
authors.forename: Teodor
authors.initials: T
authors.lastname: Grantcharov
mesh_terms: D002983:Clinical Competence; D013502:General Surgery / Q000193:education*; D000070856:High Fidelity Simulation Training / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D005222:Mental Fatigue / Q000517:prevention & control*; D011446:Prospective Studies; D016526:Workload