Experienced surgeons can do more than one thing at a time: effect of distraction on performance of a simple laparoscopic and cognitive task by experienced and novice surgeons

K E Hsu, F-Y Man, R A Gizicki, L S Feldman, G M Fried
Surgical Endoscopy 2008, 22 (1): 196-201

BACKGROUND: While operating, surgeons are required to make cognitive decisions and often are interrupted to attend to questions from other members of the health care team. Technical automatization may be achieved by experienced surgeons such that these distractions have little effect on performance of either the surgical or the cognitive task. This study assessed the effect of adding a distracting cognitive task on performance of a basic laparoscopic skill by novice and experienced surgeons.

METHODS: In this study, 31 novice (medical students in postgraduate years [PGYs] 1-2) and 9 experienced (fellows/attendants and PGYs 4-5) laparoscopic surgeons practiced the Fundamentals of Laparoscopic Surgery (FLS) laparoscopic peg transfer task until their scores stabilized. The mean normalized score after five repetitions then was recorded. The subjects also were tested on the number of mathematical addition questions they could answer in 1 min. This was repeated five times, with the mean number of questions attempted and the accuracy (% correct) recorded. The laparoscopic and addition tasks then were performed concurrently five times. Data, presented as mean +/- standard deviation, were analyzed using Student's t-test. A p value less than 0.05 was considered statistically significant.

RESULTS: After practice to stable peg transfer performance, the baseline peg transfer score was higher in the experienced group (98 +/- 6 vs 87 +/- 12; p < 0.01). There were no baseline differences between the groups in the number of math questions attempted in 1 min (10 +/- 2 vs 9 +/- 2; p = 0.55) or the number of correct answers (9 +/- 3 vs 8 +/- 3; p = 0.36). The comparison of baseline performance and dual-task performance showed that the experienced surgeons had no decline in peg transfer score (98 +/- 6 vs 97 +/- 6; p = 0.48), number of questions attempted in 1 min (10 +/- 2 vs 9 +/- 3; p = 0.32), or number of correct answers (9 +/- 3 vs 8 +/- 3; p = 0.46). In contrast, dual-tasking among the novices was associated with a decrease in the number of questions attempted (9 +/- 2 vs 8 +/- 2; p < 0.01) and the number of correct answers (8 +/- 3 vs 7 +/- 2; p = 0.02), and with no change in the peg transfer score (87 +/- 12 vs 88 +/- 8; p = 0.38) compared with baseline.

CONCLUSIONS: Distraction significantly decreased a novice's ability to process cognitively based math problems, whereas there was no effect on experienced subjects. This occurred despite the fact that the novice group had practiced to high-level peg transfer scores at baseline. This suggests that the experienced surgeons had achieved automatization of the peg transfer basic surgical skill to a level that cognitive distraction did not affect performance of either task. The experienced surgeons were able to attend equally to both tasks, whereas the novices attended to the surgical task at the expense of some aspects of cognitive task performance.

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