Relationship between intraoperative teaching skills and surgeons’ cognitive load
Tóm tắt
The operating room (OR) has the potential to be a high-stress environment due to the multiple tasks that surgeons must complete. Surgeons in a training environment must balance the tasks of teaching and operating, which may impose a high cognitive load. It is not known how a surgeon's cognitive load is related to intraoperative teaching. The aim of this study was to investigate the relationship between surgeons’ cognitive load and intraoperative teaching skills. We conducted a mixed methods study at an urban academic hospital from February to October 2022. Following each operation, attending surgeons were asked to complete a quantitative survey instrument, the Surgeons’ Task Load Index (range 0–100), to report cognitive load during the operation. Surgical residents were asked to complete a four-item (5-point Likert Scale) questionnaire to report their perception of surgeons’ intraoperative teaching skills (setting learning goals, intraoperative teaching, autonomy, and continuous feedback). Spearman’s correlation was used to calculate the association between surgeons’ cognitive load scores and intraoperative teaching skills. Qualitative data were collected through non-participant observations and comments from the open-ended questions from the surgeons’ intraoperative teaching skills. Qualitative data were analyzed thematically with inductive and deductive logic. We enrolled 45 surgeons in the study. Correlation coefficients revealed that preoperatively setting learning goals were negatively correlated with surgeon cognitive load (r = – 0.54, p = 0.005) and positively correlated with autonomy (r = 0.71, p < 0.001) and intraoperative teaching (r = 0.72, p < 0.001). Intraoperative teaching (r = – 0.61, p = 0.001) and autonomy (r = – 0.52, p = 0.007) were negatively correlated with surgeons’ cognitive load. Continuous feedback (r = – 0.53, p = 0.006) was negatively correlated with surgeons’ cognitive load and positively correlated with autonomy (r = 0.8, p < 0.001). Qualitative data analysis identified that: (1) attending surgeons demonstrated effective and ineffective teaching behaviors, and (2) attending surgeons applied various strategies to decrease the cognitive load. Surgeons’ cognitive load negatively correlated with their intraoperative teaching skills. There is an opportunity to develop strategies and interventions to improve intraoperative teaching that support the need for surgeons to manage intraoperative workload.
Tài liệu tham khảo
Iwaszkiewicz M, Darosa DA, Risucci DA. Efforts to enhance operating room teaching. J Surg Educ. 2008;65(6):436–40.
Anton NE, Athanasiadis DI, Karipidis T, et al. Surgeon stress negatively affects their non-technical skills in the operating room. Am J Surg. 2021;222(6):1154–7.
Tjonnas MS, Guzman-Garcia C, Sanchez-Gonzalez P, Gomez EJ, Oropesa I, Vapenstad C. Stress in surgical educational environments: a systematic review. BMC Med Educ. 2022;22(1):791.
Pradarelli JC, Yule S, Panda N, et al. Surgeons’ Coaching Techniques in the Surgical Coaching for Operative Performance Enhancement (SCOPE) Program. Ann Surg. 2022;275(1):e91–8.
van Merrienboer JJ, Sweller J. Cognitive load theory in health professional education: design principles and strategies. Med Educ. 2010;44(1):85–93.
Howie EE, Dharanikota H, Gunn E, et al. Cognitive load management: an invaluable tool for safe and effective surgical training. J Surg Educ. 2023;80(3):311–22.
Fraser KL, Meguerdichian MJ, Haws JT, Grant VJ, Bajaj K, Cheng A. Cognitive Load Theory for debriefing simulations: implications for faculty development. Adv Simul (Lond). 2018;3:28.
Curum B, Khedo KK. Cognitive load management in mobile learning systems: principles and theories. J Comput Educ. 2020;8(1):109–36.
Bahari A. Challenges and affordances of cognitive load management in technology-assisted language learning: a systematic review. Int J Human-Comput Interact. 2022;39(1):85–100.
Anton NE, Huffman EM, Ahmed RA, et al. Stress and resident interdisciplinary team performance: results of a pilot trauma simulation program. Surgery. 2021;170(4):1074–9.
Weenk M, Alken APB, Engelen L, Bredie SJH, van de Belt TH, van Goor H. Stress measurement in surgeons and residents using a smart patch. Am J Surg. 2018;216(2):361–8.
Rieger A, Fenger S, Neubert S, Weippert M, Kreuzfeld S, Stoll R. Psychophysical workload in the operating room: primary surgeon versus assistant. Surg Endosc. 2014;29(7):1990–8.
Prichard RS, O’Neill CJ, Oucharek JJ, Holmes CY, Delbridge LW, Sywak MS. A prospective study of heart rate variability in endocrine surgery: surgical training increases consultant’s mental strain. J Surg Educ. 2012;69(4):453–8.
Kremer J, Reinhold M. Intraoperative stress in orthopaedic spine surgery : Attending surgeon versus resident. Orthopade. 2016;45(12):1039–44.
Kuhn EW, Choi YH, Schonherr M, et al. Intraoperative stress in cardiac surgery: attendings versus residents. J Surg Res. 2013;182(2):e43-49.
Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R. The impact of stress on surgical performance: a systematic review of the literature. Surgery. 2010;147(3):318–30 (330 e311-316).
Roberts NK, Williams RG, Kim MJ, Dunnington GL. The briefing, intraoperative teaching, debriefing model for teaching in the operating room. J Am Coll Surg. 2009;208(2):299–303.
Pradarelli JC, Yule S, Panda N, et al. Optimizing the Implementation of Surgical Coaching Through Feedback From Practicing Surgeons. JAMA Surg. 2021;156(1):42–9.
Eskander MF, Woelfel I, Harzman A, Cochran AL, Ellison EC, Phoenix CX. Education Morbidity and Mortality: Reviving Intraoperative Teaching and Learning. J Surg Res. 2021;264:462–8.
Anderson CI, Gupta RN, Larson JR, et al. Impact of objectively assessing surgeons’ teaching on effective perioperative instructional behaviors. JAMA Surg. 2013;148(10):915–22.
Hauge LS, Wanzek Ja Fau - Godellas C, Godellas C. The reliability of an instrument for identifying and quantifying surgeons' teaching in the operating room. (0002–9610 (Print)).
Creswell JW, Creswell JD. Research design: qualitative, quantitative, and mixed methods approaches. Sage Publications; 2017.
Carlson RV, Boyd KM, Webb DJ. The revision of the Declaration of Helsinki: past, present and future. Br J Clin Pharmacol. 2004;57(6):695–713.
Association WM. Ethical Principles for Medical Research Involving Human Subjects. https://www.wma.net/policies-post/wmadeclaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/. Published 2022. Updated 09/06/2022. Accessed 5 May 2023.
Dias RD, Ngo-Howard MC, Boskovski MT, Zenati MA, Yule SJ. Systematic review of measurement tools to assess surgeons’ intraoperative cognitive workload. Br J Surg. 2018;105(5):491–501.
Stata Statistical Software: Release 17 [computer program]. TX: College Station; 2021.
MAXQDA 2022[Computer Software] [computer program]. Version 2021. Berlin, Germany: VERBI Software; 2022.
Wilson MR, Poolton JM, Malhotra N, Ngo K, Bright E, Masters RS. Development and validation of a surgical workload measure: the surgery task load index (SURG-TLX). World J Surg. 2011;35(9):1961–9.
Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020;42(8):846–54.
Chatty L, Omurtag A, Roy R, Garbey M. Tracking mental workload by multimodal measurements during minimally invasive surgery training. Surgical endosc Other Interv Tech. 2017;31:S324.
Gao J, Liu S, Feng Q, et al. Subjective and objective quantification of the effect of distraction on physician’s workload and performance during simulated laparoscopic surgery. Med Sci Monit. 2019;25:3127–32.
Goldman LI. Stresses affecting surgical performance and learning I Correlation of heart rate, electrocardiogram, and operation simultaneously recorded on videotapes. J Surg Res. 1972;12(2):83–6.
Grantcharov PD, Boillat T, Elkabany S, Wac K, Rivas H. Acute mental stress and surgical performance. Bjs Open. 2019;3(1):119–25.
Harvey A, iera G, Nathens AB, LeBlanc VR. Impact of stress on resident performance in simulated trauma scenarios. J Trauma Acute Care Surg. 2012;72(2):497–503.
Wetzel CM, Black SA, Hanna GB, et al. The effects of stress and coping on surgical performance during simulations. Ann Surg. 2010;251(1):171–6.
Ayres P, Paas F. Cognitive load theory: new directions and challenges. Appl Cogn Psychol. 2012;26(6):827–32.
Saldanha FYL, Levites HA, Staffa SJ, Roussin C, Allori AC, Rogers-Vizena CR. Maximizing plastic surgery education impact: lessons from resident learning styles and experiential learning theory. (2169–7574 (Print)).
Anton NE, Mizota T, Whiteside JA, Myers EM, Bean EA, Stefanidis D. Mental skills training limits the decay in operative technical skill under stressful conditions: results of a multisite, randomized controlled study. Surgery. 2019;165(6):1059–64.
Anton NE, Howley LD, Pimentel M, Davis CK, Brown C, Stefanidis D. Effectiveness of a mental skills curriculum to reduce novices’ stress. J Surg Res. 2016;206(1):199–205.
Anton NE, Bean EA, Hammonds SC, Stefanidis D. Application of mental skills training in surgery: a review of its effectiveness and proposed next steps. J Laparoendosc Adv Surg Tech A. 2017;27(5):459–69.
Klein M, Andersen LP, Alamili M, Gogenur I, Rosenberg J. Psychological and physical stress in surgeons operating in a standard or modern operating room. Surg Laparos Endosc Percutan Tech. 2010;20(4):237–42.
Zakeri Z, Mansfield N, Sunderland C, Omurtag A. Physiological correlates of cognitive load in laparoscopic surgery. Sci Rep. 2020 Jul 31;10(1):12927. https://doi.org/10.1038/s41598-020-69553-3.