Department of Surgical Critical Care, Brooke Army Medical Center, Fort Sam Houston, TX. Electronic address: https://twitter.com/aangusmd.
Department of Surgery, William Beaumont Hospital, Royal Oak, MI.
Surgery. 2022 Nov;172(5):1352-1357. doi: 10.1016/j.surg.2022.07.010. Epub 2022 Sep 9.
Surgery is an outcome-based specialty where maintaining peak performance is crucial to patient care. There are a variety of identified surgeon stressors that can have an impact on performance, but one factor unique to surgical residents is the observation by an attending surgeon. This study explored how the perceived authority of the observer had an impact on the participants' physiologic markers of stress and task completion times.
Eighteen general surgery residents performed the Fundamentals of Laparoscopic Surgery skills intracorporeal knot-tying and peg transfer tasks in a crossover study design while under the observation of an attending and a neutral observer. Heart rate variability, mean R-R interval, the time between R spikes on an EKG, minimum heart rate, maximum heart rate, average heart rate, and time to task completion were recorded. Analyses were completed via 2 × 2 analysis of variance with repeated measures.
When observed by an attending, participants demonstrated higher minimum, average, and maximum heart rates (P = .046, = .007, and < .001, respectively) than when observed by a neutral observer. Attending observation also significantly shortened time to task completion, relative to neutral observation (P = .022).
Attending observation is linked to increased objective measures of stress at the time of performance with decreased task completion times. Educational efforts to optimize the response to stress during learning may lead to better outcomes.
外科是一门以结果为导向的专业，保持最佳表现对于患者护理至关重要。有各种已确定的外科医生压力源会对表现产生影响，但对于外科住院医师来说，一个独特的因素是主治医生的观察。本研究探讨了观察者的感知权威如何影响参与者的应激生理标志物和任务完成时间。
18 名普通外科住院医师在交叉研究设计中进行了腹腔镜手术技能的基本腔内打结和销钉转移任务，同时由主治医生和中立观察者进行观察。记录心率变异性、平均 R-R 间隔、心电图上 R 波之间的时间、最小心率、最大心率、平均心率以及任务完成时间。通过 2×2 重复测量方差分析进行分析。
当参与者被主治医生观察时，他们的最小、平均和最大心率均高于被中立观察者观察时（P=0.046、=0.007 和 <0.001）。与中立观察相比，主治医生观察还显著缩短了任务完成时间（P=0.022）。
主治医生的观察与表现时的客观应激测量增加有关，任务完成时间减少。优化学习期间对压力的反应的教育努力可能会带来更好的结果。
