A comparison of evaluation, time pressure, and multitasking as stressors of psychomotor operative performance

Background: There is gathering interest in determining the typical sources of stress for an operating surgeon and the effect that stressors might have on operative performance. Much of the research in this field, however, has failed to measure stress levels and performance concurrently or has not acknowledged the differential impact of potential stressors. Our aim was to examine empirically the influence of different sources of stress on trained laparoscopic performance.

Methods: A total of 30 medical students were trained to proficiency on the validated Fundamentals of Laparoscopic Surgery peg transfer task, and then were tested under 4 counterbalanced test conditions: control, evaluation threat, multitasking, and time pressure. Performance was assessed via completion time and a process measure reflecting the efficiency of movement (ie, path length). Stress levels in each test condition were measured using a multidimensional approach that included the State-Trait Anxiety Inventory (STAI) and the subject's heart rate while performing a task.

Results: The time pressure condition caused the only significant increase in stress levels but did not influence completion time or the path length of movement. Only the multitasking condition significantly increased completion time and path length, despite there being no significant increase in stress levels. Overall, the STAI and heart rate measures were not correlated strongly.

Conclusion: Recommended measures of stress levels do not necessarily reflect the demands of an operative task, highlighting the need to understand better the mechanisms that influence performance in surgery. This understanding will help inform the development of training programs that encourage the complete transfer of skills from simulators to the operating room.