Professional Experience Modulates the Effect of Impulsiveness on Laparoscopic Simulator Performance

Abstract

Objective

High impulsiveness is associated with adverse outcomes, such as dangerous driving leading to traffic accidents and decreased job performance in general. In surgical training, high impulsiveness is associated with increased damage during simulated laparoscopic tasks. The objective of this study is to investigate the impact of professional experience on the relation between impulsiveness and simulated laparoscopy.

Methods

In this single institution study, a total of 120 participants, of whom 78 inexperienced medical students and residents (≤ 10 laparoscopic procedures as primary surgeon), and 42 residents and attending surgeons experienced in laparoscopy (> 10 laparoscopic procedures as primary surgeon), performed 4 different, standardized laparoscopic tasks on the LapSim Virtual Reality trainer. Based on the UPPSP impulsive behavior scale, a scale to measure impulsiveness, we divided participants into equal sized high- and low impulsiveness groups for both experience groups. We used Mann–Whitney U tests to compare task duration and damage parameters between the low and high impulsiveness group, separately for inexperienced and experienced participants. Spearman's rank correlation tests were used to investigate the correlation of different facets of impulsiveness (positive and negative urgency, premeditation, perseverance and sensation seeking) on performance.

Results

Inexperienced participants with high impulsiveness demonstrated significantly faster task completion (z = 2.74, p < 0.01). Inexperienced participants of very high-impulsiveness (upper quartile) also caused significantly more tissue damage (z = 2.27, p = 0.02). Conversely, experienced surgeons exhibited no discernible performance variations based on impulsiveness for time (z = 1.42, p = 0.16) or tissue damage (z = −0.19, p = 0.85). For inexperienced participants the impulsiveness facets (lack of) premeditation and sensation seeking correlated with shorter task duration, while negative urgency, positive urgency, and (lack of) perseverance were associated with increased tissue damage. For the experienced participants no significant correlations were found between impulsiveness facets and simulator outcomes.

Conclusion

High impulsiveness results in shorter task duration but tend to increase tissue damage for laparoscopic simulator performance of inexperienced trainees. The performance of experienced surgeons remained unaffected by impulsiveness, indicating that professional experience may play a role in mitigating its influence.