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Comparing technical dexterity of sleep-deprived versus intoxicated surgeons.

Mohtashami F, Thiele A, Karreman E, Thiel J - JSLS (2014 Oct-Dec)

Bottom Line: To study the effects of sleep deprivation on the surgical performance of surgeons, we compared simulated the laparoscopic skills of staff gynecologists "under 2 conditions": sleep deprivation and ethanol intoxication.However, the most difficult task took less time but was performed significantly worse compared with being sleep deprived.Notably, the evaluators did not recognize a lack of competence for the easier tasks when intoxicated; incompetence surfaced only in the most difficult task.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Saskatchewan, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada.

ABSTRACT

Background: The evidence on the effect of sleep deprivation on the cognitive and motor skills of physicians in training is sparse and conflicting, and the evidence is nonexistent on surgeons in practice. Work-hour limitations based on these data have contributed to challenges in the quality of surgical education under the apprentice model, and as a result there is an increasing focus on competency-based education. Whereas the effects of alcohol intoxication on psychometric performance are well studied in many professions, the effects on performance in surgery are not well documented. To study the effects of sleep deprivation on the surgical performance of surgeons, we compared simulated the laparoscopic skills of staff gynecologists "under 2 conditions": sleep deprivation and ethanol intoxication. We hypothesized that the performance of unconsciously competent surgeons does not deteriorate postcall as it does under the influence of alcohol.

Methods: Nine experienced staff gynecologists performed 3 laparoscopic tasks in increasing order of difficulty (cup drop, rope passing, pegboard exchange) on a box trainer while sleep deprived (<3 hours in 24 hours) and subsequently when legally intoxicated (>0.08 mg/mL blood alcohol concentration). Three expert laparoscopic surgeons scored the anonymous clips online using Global Objective Assessment of Laparoscopic Skills criteria: depth perception, bimanual dexterity, and efficiency. Data were analyzed by a mixed-design analysis of variance.

Results: There were large differences in mean performance between the tasks. With increasing task difficulty, mean scores became significantly (P < .05) poorer. For the easy tasks, the scores for sleep-deprived and intoxicated participants were similar for all variables except time. Surprisingly, participants took less time to complete the easy tasks when intoxicated. However, the most difficult task took less time but was performed significantly worse compared with being sleep deprived. Notably, the evaluators did not recognize a lack of competence for the easier tasks when intoxicated; incompetence surfaced only in the most difficult task.

Conclusions: Being intoxicated hinders the performance of more difficult simulated laparoscopic tasks than being sleep deprived, yet surgeons were faster and performed better on simple tasks when intoxicated.

No MeSH data available.


Related in: MedlinePlus

The effects of sleep deprivation and alcohol intoxication on bimanual dexterity in performing simulated laparoscopic tasks. Task 1, cup drop; task 2, rope passing; task 3, pegboard exchange. The bimanual dexterity was scored along a 5-point scale for 9 subjects and the mean plotted.
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Figure 6: The effects of sleep deprivation and alcohol intoxication on bimanual dexterity in performing simulated laparoscopic tasks. Task 1, cup drop; task 2, rope passing; task 3, pegboard exchange. The bimanual dexterity was scored along a 5-point scale for 9 subjects and the mean plotted.

Mentions: Other individual variables measured were errors (Figure 3), efficiency (Figure 4), depth perception (Figure 5), and bimanual dexterity (Figure 6). For every variable measured, the difference between tasks was significantly different (Table 1). Participants did significantly worse the harder the task they had to complete. However, for none of the outcome variables did the state of the participants differ significantly. The effect size in this case was r = 0.62, which is considered a large effect. In other words, participants were faster in the intoxicated state (Table 1).


Comparing technical dexterity of sleep-deprived versus intoxicated surgeons.

Mohtashami F, Thiele A, Karreman E, Thiel J - JSLS (2014 Oct-Dec)

The effects of sleep deprivation and alcohol intoxication on bimanual dexterity in performing simulated laparoscopic tasks. Task 1, cup drop; task 2, rope passing; task 3, pegboard exchange. The bimanual dexterity was scored along a 5-point scale for 9 subjects and the mean plotted.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232403&req=5

Figure 6: The effects of sleep deprivation and alcohol intoxication on bimanual dexterity in performing simulated laparoscopic tasks. Task 1, cup drop; task 2, rope passing; task 3, pegboard exchange. The bimanual dexterity was scored along a 5-point scale for 9 subjects and the mean plotted.
Mentions: Other individual variables measured were errors (Figure 3), efficiency (Figure 4), depth perception (Figure 5), and bimanual dexterity (Figure 6). For every variable measured, the difference between tasks was significantly different (Table 1). Participants did significantly worse the harder the task they had to complete. However, for none of the outcome variables did the state of the participants differ significantly. The effect size in this case was r = 0.62, which is considered a large effect. In other words, participants were faster in the intoxicated state (Table 1).

Bottom Line: To study the effects of sleep deprivation on the surgical performance of surgeons, we compared simulated the laparoscopic skills of staff gynecologists "under 2 conditions": sleep deprivation and ethanol intoxication.However, the most difficult task took less time but was performed significantly worse compared with being sleep deprived.Notably, the evaluators did not recognize a lack of competence for the easier tasks when intoxicated; incompetence surfaced only in the most difficult task.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Saskatchewan, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada.

ABSTRACT

Background: The evidence on the effect of sleep deprivation on the cognitive and motor skills of physicians in training is sparse and conflicting, and the evidence is nonexistent on surgeons in practice. Work-hour limitations based on these data have contributed to challenges in the quality of surgical education under the apprentice model, and as a result there is an increasing focus on competency-based education. Whereas the effects of alcohol intoxication on psychometric performance are well studied in many professions, the effects on performance in surgery are not well documented. To study the effects of sleep deprivation on the surgical performance of surgeons, we compared simulated the laparoscopic skills of staff gynecologists "under 2 conditions": sleep deprivation and ethanol intoxication. We hypothesized that the performance of unconsciously competent surgeons does not deteriorate postcall as it does under the influence of alcohol.

Methods: Nine experienced staff gynecologists performed 3 laparoscopic tasks in increasing order of difficulty (cup drop, rope passing, pegboard exchange) on a box trainer while sleep deprived (<3 hours in 24 hours) and subsequently when legally intoxicated (>0.08 mg/mL blood alcohol concentration). Three expert laparoscopic surgeons scored the anonymous clips online using Global Objective Assessment of Laparoscopic Skills criteria: depth perception, bimanual dexterity, and efficiency. Data were analyzed by a mixed-design analysis of variance.

Results: There were large differences in mean performance between the tasks. With increasing task difficulty, mean scores became significantly (P < .05) poorer. For the easy tasks, the scores for sleep-deprived and intoxicated participants were similar for all variables except time. Surprisingly, participants took less time to complete the easy tasks when intoxicated. However, the most difficult task took less time but was performed significantly worse compared with being sleep deprived. Notably, the evaluators did not recognize a lack of competence for the easier tasks when intoxicated; incompetence surfaced only in the most difficult task.

Conclusions: Being intoxicated hinders the performance of more difficult simulated laparoscopic tasks than being sleep deprived, yet surgeons were faster and performed better on simple tasks when intoxicated.

No MeSH data available.


Related in: MedlinePlus