Mohtashami Fariba, Thiele Allison, Karreman Erwin, Thiel John
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Saskatchewan, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada.
Department of Academic Family Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada.
JSLS. 2014 Oct-Dec;18(4). doi: 10.4293/JSLS.2014.00142.
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.
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.
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.
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.
关于睡眠剥夺对住院医师认知和运动技能影响的证据稀少且相互矛盾，而对于执业外科医生，尚无此类证据。基于这些数据的工作时间限制给学徒模式下的外科教育质量带来了挑战，因此，人们越来越关注基于能力的教育。尽管在许多职业中，酒精中毒对心理测量表现的影响已得到充分研究，但对手术表现的影响却鲜有记载。为了研究睡眠剥夺对外科医生手术表现的影响，我们比较了“两种情况下”妇科医生模拟腹腔镜技能的情况：睡眠剥夺和乙醇中毒。我们假设，无意识熟练的外科医生在轮班后表现不会像受酒精影响时那样变差。
九名经验丰富的妇科医生在箱式训练器上按难度递增顺序（杯子掉落、绳索穿过、钉板交换）进行三项腹腔镜任务，先是处于睡眠剥夺状态（24小时内睡眠不足3小时），随后处于合法醉酒状态（血液酒精浓度>0.08mg/mL）。三名腹腔镜外科专家使用腹腔镜技能全球客观评估标准对匿名视频片段进行在线评分：深度感知、双手灵巧性和效率。数据采用混合设计方差分析进行分析。
任务之间的平均表现存在很大差异。随着任务难度增加，平均得分显著降低（P<.05）。对于简单任务，除时间外，睡眠剥夺组和醉酒组参与者在所有变量上的得分相似。令人惊讶的是，醉酒的参与者完成简单任务所需时间更短。然而，最困难的任务完成时间更短，但与睡眠剥夺相比，表现明显更差。值得注意的是，评估者在醉酒时并未意识到在较简单任务上缺乏能力；能力不足仅在最困难的任务中显现。
与睡眠剥夺相比，醉酒对外科医生模拟腹腔镜困难任务的表现阻碍更大，但醉酒时外科医生在简单任务上速度更快且表现更好。
