Pandit Anand S, de Gouveia Melissa, Horsfall Hugo Layard, Reka Arisa, Marcus Hani J
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom.
Front Surg. 2022 May 6;9:916228. doi: 10.3389/fsurg.2022.916228. eCollection 2022.
Human factors are increasingly being recognised as vital components of safe surgical care. One such human cognitive factor: inattention blindness (IB), describes the inability to perceive objects despite being visible, typically when one's attention is focused on another task. This may contribute toward operative 'never-events' such as retained foreign objects and wrong-site surgery.
An 8-week, mindfulness-based intervention (MBI) programme, adapted for surgeons, was delivered virtually. Neurosurgical trainees and recent staff-appointees who completed the MBI were compared against a control group, matched in age, sex and grade. Attention and IB were tested using two operative videos. In each, participants were first instructed to focus on a specific part of the procedure and assessed (attention), then questioned on a separate but easily visible aspect within the operative field (inattention). If a participant were 'inattentionally blind' they would miss significant events occurring outside of their main focus. Median absolute error (MAE) scores were calculated for both attention and inattention. A generalised linear model was fitted for each, to determine the independent effect of mindfulness intervention on MAE.
Thirteen neurosurgeons completed the mindfulness training (age, 30 years [range 27-35]; female:male, 5:8), compared to 15 neurosurgeons in the control group (age, 30 years [27-42]; female:male, 6:9). There were no significant demographic differences between groups. MBI participants demonstrated no significant differences on attention tasks as compared to controls (= -1.50, = 0.14). For inattention tasks, neurosurgeons who completed the MBI had significantly less errors (= -2.47, = 0.02), after adjusting for participant level and video differences versus controls. We found that both groups significantly improved their inattention error rate between videos (= -11.37, < 0.0001). In spite of this, MBI participants still significantly outperformed controls in inattention MAE in the second video following post-hoc analysis (MWU = 137.5, = 0.05).
Neurosurgeons who underwent an eight-week MBI had significantly reduced inattention blindness errors as compared to controls, suggesting mindfulness as a potential tool to increase vigilance and prevent operative mistakes. Our findings cautiously support further mindfulness evaluation and the implementation of these techniques within the neurosurgical training curriculum.
人为因素越来越被视为安全手术护理的重要组成部分。其中一种人类认知因素：注意力不集中盲视（IB），描述的是尽管物体可见，但个体却无法察觉，通常是当一个人的注意力集中在另一项任务上时。这可能会导致手术“决不应发生的事件”，如异物残留和手术部位错误。
为外科医生量身定制了一个为期8周的基于正念的干预（MBI）项目，并通过线上方式开展。将完成MBI的神经外科实习生和新入职员工与年龄、性别和级别相匹配的对照组进行比较。使用两段手术视频测试注意力和IB。在每段视频中，首先指导参与者专注于手术过程的特定部分并进行评估（注意力），然后就手术视野内一个单独但容易看到的方面进行提问（注意力不集中）。如果参与者存在“注意力不集中盲视”，他们会错过其主要关注点之外发生的重大事件。计算注意力和注意力不集中的中位数绝对误差（MAE）分数。为每个分数拟合一个广义线性模型，以确定正念干预对MAE的独立影响。
13名神经外科医生完成了正念训练（年龄30岁[范围27 - 35岁]；女性:男性为5:8），对照组有15名神经外科医生（年龄30岁[27 - 42岁]；女性:男性为6:9）。两组之间在人口统计学方面无显著差异。与对照组相比，MBI参与者在注意力任务上无显著差异（= -1.50，= 0.14）。对于注意力不集中任务，在调整参与者水平和视频差异与对照组相比后，完成MBI的神经外科医生的错误显著更少（= -2.47，= 0.02）。我们发现两组在两段视频之间的注意力不集中错误率均显著改善（= -11.37，< 0.0001）。尽管如此，在事后分析中，MBI参与者在第二段视频的注意力不集中MAE方面仍显著优于对照组（MWU = 137.5，= 0.05）。
与对照组相比，接受为期8周MBI的神经外科医生的注意力不集中盲视错误显著减少，这表明正念是提高警觉性和预防手术失误的一种潜在工具。我们的研究结果谨慎地支持进一步的正念评估以及在神经外科培训课程中实施这些技术。
