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Comparing Technical Dexterity of Sleep-Deprived Versus Intoxicated Surgeons

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 surgi...

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Autores principales: Mohtashami, Fariba, Thiele, Allison, Karreman, Erwin, Thiel, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Society of Laparoendoscopic Surgeons 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232403/
https://www.ncbi.nlm.nih.gov/pubmed/25408601
http://dx.doi.org/10.4293/JSLS.2014.00142
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author Mohtashami, Fariba
Thiele, Allison
Karreman, Erwin
Thiel, John
author_facet Mohtashami, Fariba
Thiele, Allison
Karreman, Erwin
Thiel, John
author_sort Mohtashami, Fariba
collection PubMed
description 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.
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spelling pubmed-42324032014-11-18 Comparing Technical Dexterity of Sleep-Deprived Versus Intoxicated Surgeons Mohtashami, Fariba Thiele, Allison Karreman, Erwin Thiel, John JSLS Scientific Papers 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. Society of Laparoendoscopic Surgeons 2014 /pmc/articles/PMC4232403/ /pubmed/25408601 http://dx.doi.org/10.4293/JSLS.2014.00142 Text en © 2014 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.
spellingShingle Scientific Papers
Mohtashami, Fariba
Thiele, Allison
Karreman, Erwin
Thiel, John
Comparing Technical Dexterity of Sleep-Deprived Versus Intoxicated Surgeons
title Comparing Technical Dexterity of Sleep-Deprived Versus Intoxicated Surgeons
title_full Comparing Technical Dexterity of Sleep-Deprived Versus Intoxicated Surgeons
title_fullStr Comparing Technical Dexterity of Sleep-Deprived Versus Intoxicated Surgeons
title_full_unstemmed Comparing Technical Dexterity of Sleep-Deprived Versus Intoxicated Surgeons
title_short Comparing Technical Dexterity of Sleep-Deprived Versus Intoxicated Surgeons
title_sort comparing technical dexterity of sleep-deprived versus intoxicated surgeons
topic Scientific Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232403/
https://www.ncbi.nlm.nih.gov/pubmed/25408601
http://dx.doi.org/10.4293/JSLS.2014.00142
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