The effect of stress and coping on surgical performance during simulations

Wetzel, C.M., Black, S.A., Hanna, G.B., Athanasiou, T., Kneebone, R.L., Nestel, D., Wolfe, J.H.N. and Woloshynowych, M. 2010. The effect of stress and coping on surgical performance during simulations . Annals of Surgery. 251 (1), pp. 171-176. https://doi.org/10.1097/SLA.0b013e3181b3b2be

TitleThe effect of stress and coping on surgical performance during simulations
TypeJournal article
AuthorsWetzel, C.M., Black, S.A., Hanna, G.B., Athanasiou, T., Kneebone, R.L., Nestel, D., Wolfe, J.H.N. and Woloshynowych, M.
Abstract

Objective:
This study investigates the effects of surgeons' stress levels and coping strategies on surgical performance during simulated operations.
Methods:
Thirty surgeons carried out each a non-crisis and a crisis scenario of a simulated operation. Surgeons' stress levels were assessed by several measures: self-assessments and observer ratings of stress, heart rate, heart rate variability, and salivary cortisol. Coping strategies were explored qualitatively and quantified to a coping score. Experience in surgery was included as an additional predictor. Outcome measures consisted of technical surgical skills using Objective Structured Assessment of Technical Skill (OSATS), nontechnical surgical skills using Observational Teamwork Assessment for Surgery (OTAS), and the quality of the operative end product using End Product Assessment (EPA). Uni- and multivariate linear regression were used to assess the independent effects of predictor variables on each performance measure.
Results:
During the non-crisis simulation, a high coping score and experience significantly enhanced EPA (β1, 0.279; 0.009–0.460; P= 0.04; β2, 0.571; 4.328–12.669, P< 0.001; respectively). During the crisis simulation, a significant beneficial effect of the interaction of high experience and low stress on all performance measures was found (EPA: β, 0.537; 2.079–8.543; OSATS: β, 0.707; 8.708–17.860; OTAS: β, 0.654; 13.090–30.483; P< 0.01). Coping significantly enhanced nontechnical skills (β, 0.302; 0.117–1.624, P= 0.03).
Conclusions:
Clinicians' stress and coping influenced surgical performance during simulated operations. Hence, these are critical factors for the quality of health care.

JournalAnnals of Surgery
Journal citation251 (1), pp. 171-176
ISSN0003-4932
Year2010
PublisherLippincott Williams & Wilkins
Digital Object Identifier (DOI)https://doi.org/10.1097/SLA.0b013e3181b3b2be
Web address (URL)https://journals.lww.com/annalsofsurgery/Abstract/2010/01000/The_Effects_of_Stress_and_Coping_on_Surgical.26.aspx
Publication dates
Published in printJan 2010

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