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Stress-free training can improve surgical skill



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IMAGE: Ioannis Pavlidis, professor of Eckhard Pfeiffer and director of Computational Physiology at the University of Houston eliminated stressful environmental factors, leaving only the inherent challenge of surgical tasks, and …
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Credit: University of Houston

Researchers from the University of Houston and the Methodist Hospital report in Scientific reports The best way to train surgeons is to eliminate stress from residency programs and make surgery a hobby. In relaxed conditions outside of a formal educational setting, 15 first-year medical students, who aspired one day to become surgeons, mastered the microsurgical cutting and suturing skills in sessions of as little as five hours.

"It seems that by eliminating external stressors associated with the remarkably competitive and harsh lifestyle of surgical residences, stress levels during inanimate surgical training plummet," said Ioannis Pavlidis, professor at Eckhard Pfeiffer and director of the Laboratory. of Computational Physiology at UH. "In five short sessions, these students, who approached surgery for fun or as a hobby, made remarkable progress in reaching skill levels similar to those of experienced surgeons, at least in these exercises." Partners in the project, Anthony Echo and Dmitry Zavlin, surgeons at the Houston Methodist Institute for Reconstructive Surgery, gave brief instructions to students at the beginning of the program.

Once the students began cutting and suturing in their mobile microsurgical simulators, Pavlidis and his team tracked their stress levels by measuring the sweat responses near the nose through thermal imaging. The performance of the students in the surgical exercises was qualified by two experts, based on video recordings.

In previous work, researchers at Pavlidis and Methodist Hospital found that surgery residents showed high levels of stress during their formal training in surgical simulators. These high levels of stress precipitated the "fight or flight" responses, which resulted in quick and pointless actions that led to mistakes and the creation of a vicious circle during the surgical exercises.

In the present follow-up work, Pavlidis, Echo and Zavlin chose the trainees outside the surgical facility, without pressure or stakes, to examine what happens when environmental stress is neutralized and there is only the stress associated with the challenging nature of the surgical exercises. .

"We eliminated stressful environmental factors, leaving only the inherent challenge of surgical tasks, and found that anxiety measured physiologically in the form of sympathetic excitement was moderate and unchanged during the five training sessions," Pavlidis said. In contrast, Pavlidis reported in the previous study high levels of stress in residents of surgery and slow learning processes, where five training sessions did not improve skills. The main factor that distinguishes the two studies is the educational context and the associated stress.

In this study, where young surgical enthusiasts took surgical training without the impact of environmental anxiety, skills were quickly acquired. Then, once you acquire a skill like suture, you will not forget it, like on a bicycle.

"If you acquire a skill right when you are not very stressed, you will acquire it better and faster, because the fight or flight responses are not there to mess things up," Echo said. "And once you have it, the skill will not leave you, like a bicycle, once you learn to ride a bike, your bike," Pavlidis added.

Future surgery residents with the skill acquired at a more opportune time may focus on more advanced experiences within the operating room. "It is possible that paradigms similar to other craft professions will be applied, changing sacred training doctrines for generations," Pavlidis said.

Video of the surgical exercise and facial heat maps:
https: //wwwYoutube.com /watch? time_continue =10 & v =xkYBwmt9Xic

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