D. Stefanidis1,2, N. E. Anton1, L. D. Howley1, M. Pimentel1, C. K. Davis1, C. Brown3 1Carolinas HealthCare System,Carolinas Simulation Center,Charlotte, NC, USA 2Carolinas HealthCare System,Department Of Surgery,Charlotte, NC, USA 3Head In The Game Inc,Charlotte, NC, USA
Introduction:
Stress has been shown to negatively impact surgical performance, and surgical novices are particularly susceptible to its effects. Mental skills are psychological strategies designed to enhance performance and reduce the impact of stress to consistently facilitate the ideal mental conditions that enable performers to perform their best. Mental skills have been used routinely in other high-stress domains (e.g., with Navy SEALs, military pilots, elite athletes, etc.) to facilitate optimal performance in challenging situations. We have developed a novel mental skills curriculum (MSC) to aid surgical trainees in optimizing their performance under stressful conditions. The purpose of this study was to determine the effectiveness of this MSC in reducing novices’ stress.
Methods:
The MSC was implemented with a convenience sample of surgical novices over 8 weeks. Two stress tests were administered prior to and after completion of the MSC to assess its effectiveness in reducing trainee stress. The Trier Social Stress Test (TSST) is a validated method of measuring participants’ stress responses; it was implemented by giving participants ten minutes to prepare for an impromptu presentation, and five minutes to present it in front of a medical education expert who would be assessing them. The O’Connor Tweezer Dexterity Test (OTDT) is a test of fine motor dexterity; participants competed against each other in small groups who would complete the test the fastest. Such competition has been shown to cause acute stress in performers.
To assess stress, heart-rate (HR), perceived stress (STAI-6), and perceived workload (NASA-TLX) were completed during all testing sessions.
Results:
Nine novices (age 23 ±7 years, 55% women) completed the MSC. While heart rate increased significantly during all tests, participants perceived less stress during the TSST and OTDT tests (p<.05) after completion of the MSC. In addition, they reported significantly less workload during the second OTDT administration (p<.05) and showed a trend towards faster completion of this test (see table 1).
Conclusion:
The novel mental skills curriculum implemented in this study was effective at reducing surgical novices’ perceived stress and workload based on two validated stress tests. Although not statistically significant, participants’ enhanced performance during the OTDT is encouraging. This curriculum may be valuable to help surgical trainees and surgeons reduce intraoperative stress and increase patient safety in the operating room. Additional study utilizing a larger sample size is currently underway at our institution to validate the effectiveness of this curriculum.
