Wilson Claire, Chahine Saad, Cristancho Sayra, Aquil Shahid, Mandurah Moaath, Levine Max, Sener Alp
Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Queen's University, Kingston, ON, Canada.
Can Urol Assoc J. 2021 Apr;15(4):E205-E209. doi: 10.5489/cuaj.6647.
The purpose of this study was to document the variability of faculty surgeon electrodermal activity (EDA) peaks during laparoscopic donor nephrectomy (LDN) to determine the effect of case difficulty and learner expertise on the stress response.
EDA for a single faculty surgeon was captured over 15 LDN cases using an Empatica E4 wristband. During each case, one of three transplant fellows (novice, intermediate, or expert level LDN expertise) participated. Difficulty was rated preoperatively as "low/moderate/high" by the faculty. EDA peaks were collected and analyzed; the frequency and magnitude of EDA peaks, case difficulty, and fellow expertise were compared using a two-way factorial ANOVA.
The main effects of learner expertise (F[2, 308]=11.27, p<0.001) and difficulty rating (F[2, 414]=15.13, p<0.001) were significant. The interaction between difficulty and expertise on faculty EDA peaks was also significant (F[3, 391]=14.29, p<0.001). The novice fellow resulted in higher faculty EDA levels compared to intermediate and expert fellows on low-difficulty cases, but not moderate- or high-difficulty cases.
This is the first report examining faculty surgeon EDA across cases of varying difficulty and varying learner expertise during a high-stakes operation. EDA levels were inversely proportional to the expertise of the learner and case difficulty, suggestive of a significant impact of learner autonomy on faculty stress response.
本研究的目的是记录腹腔镜供肾切除术（LDN）期间外科教员皮肤电活动（EDA）峰值的变异性，以确定病例难度和学习者专业知识对压力反应的影响。
使用Empatica E4腕带在15例LDN手术中采集一名外科教员的EDA数据。在每例手术中，三名移植专科住院医师（新手、中级或专家级LDN专业水平）中的一名参与。教员在术前将难度评为“低/中/高”。收集并分析EDA峰值；使用双向析因方差分析比较EDA峰值的频率和幅度、病例难度和专科住院医师的专业知识。
学习者专业知识（F[2, 308]=11.27，p<0.001）和难度评级（F[2, 414]=15.13，p<0.001）的主效应显著。难度和专业知识对外科教员EDA峰值的交互作用也显著（F[3, 391]=14.29，p<0.001）。在低难度病例中，与中级和专家级专科住院医师相比，新手专科住院医师导致外科教员的EDA水平更高，但在中度或高难度病例中并非如此。
这是第一份在高风险手术中，研究不同难度病例和不同学习者专业知识情况下外科教员EDA的报告。EDA水平与学习者的专业知识和病例难度成反比，提示学习者自主性对外科教员压力反应有显著影响。
