Department of Biosurgery, Imperial College London, London, United Kingdom.
Ann Surg. 2010 Jan;251(1):171-6. doi: 10.1097/SLA.0b013e3181b3b2be.
This study investigates the effects of surgeons' stress levels and coping strategies on surgical performance during simulated operations.
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.
During the non-crisis simulation, a high coping score and experience significantly enhanced EPA (beta1, 0.279; 0.009-0.460; P= 0.04; beta2, 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: beta, 0.537; 2.079-8.543; OSATS: beta, 0.707; 8.708-17.860; OTAS: beta, 0.654; 13.090-30.483; P< 0.01). Coping significantly enhanced nontechnical skills (beta, 0.302; 0.117-1.624, P= 0.03).
Clinicians' stress and coping influenced surgical performance during simulated operations. Hence, these are critical factors for the quality of health care.
本研究旨在调查外科医生的压力水平和应对策略对模拟手术中手术表现的影响。
30 名外科医生分别完成了非危机和危机模拟手术场景。通过多项措施评估外科医生的压力水平：压力的自我评估和观察者评估、心率、心率变异性和唾液皮质醇。定性探索应对策略并量化为应对评分。手术经验作为附加预测因素。结果测量包括使用客观结构化手术技能评估（OSATS）的技术手术技能、使用手术观察团队评估（OTAS）的非技术手术技能以及使用操作终产物评估（EPA）的操作终产物质量。使用单变量和多变量线性回归来评估预测变量对每个性能测量的独立影响。
在非危机模拟中，高应对评分和经验显著提高了 EPA（beta1，0.279；0.009-0.460；P=0.04；beta2，0.571；4.328-12.669，P<0.001；分别）。在危机模拟中，发现高经验和低压力的交互作用对所有绩效指标都有显著的有益影响（EPA：beta，0.537；2.079-8.543；OSATS：beta，0.707；8.708-17.860；OTAS：beta，0.654；13.090-30.483；P<0.01）。应对显著提高了非技术技能（beta，0.302；0.117-1.624，P=0.03）。
临床医生的压力和应对策略影响模拟手术中的手术表现。因此，这些是医疗保健质量的关键因素。
