The role of reinvestment in performance of simulated laparoscopic surgery under time pressure

Abstract

OBJECTIVE: To examine the impact of ‘reinvestment’ on laparoscopic performance under a common intra-operative stressor, time pressure. Background Study of the breakdown of performance under stress has been gaining momentum in the motor skill learning domain as well as domains like aviation and anesthesia, but this has not been the case in the domain of surgery until recently. Research on intra-operative stressors has focused on external factors without considering individual differences in the ability to cope with stress. One individual difference that is implicated in adverse effects of stress on performance is ‘reinvestment’, the propensity for conscious monitoring and control of movements. METHODS: Thirty-one medical students were divided into high and low reinvestment groups based on their scores on the Movement Specific Reinvestment Scale. Participants were first trained to proficiency on a peg transfer task and then tested on the same task in a control and time pressure condition. In the control condition, participants were simply asked to do their best, as they had in training. In the time pressure condition, participants were informed that operating surgeons sometimes are required to perform under time constraints and they should try to complete the task faster than their best time in training (of which they were informed).Outcome measures included generic performance and process measures. Stress levels were assessed using heart rate and the State Trait Anxiety Inventory (STAI). RESULTS: High and low reinvesters demonstrated increased anxiety levels from control to time pressure conditions as indicated by their STAI scores, although no differences in heart rate were found. Low reinvesters performed significantly faster when under time pressure, whereas high reinvesters showed no change in performance times. Low reinvesters tended to display greater performance efficiency (shorter path lengths, fewer hand movements) than high reinvesters. Conclusion Trained medical students with a high individual propensity to consciously monitor and control their movements (high reinvesters) displayed less capability (than low reinvesters) to meet the demands imposed by time pressure during a laparoscopic task. The finding implies that the propensity for reinvestment may have a moderating effect on laparoscopic performance under time pressure.