Impact of stress factors on an ophthalmic simulation-based surgical program

Introduction

Stress factors influence surgical procedures. This study aims to assess the impact of stress factors on surgical performance in ophthalmology simulation. Specifically, the study aims to identify which exercises are most affected by stress and to examine the relationship between stress levels, surgical complexity, and technical skills.

Material and methods

A prospective study of a cohort of 13 ophthalmology residents, at Vall Hebron University Hospital. All study participants received basic training before the study to become familiar with the simulator and surgical maneuvers. Once completed, the participants were invited to perform 3 defined exercises (E1, E2, and E3, increasing difficulty level from 1 to 3) in relaxed conditions. Afterwards, the same exercises were performed again under a stressful environment. The stress was created introducing physical, auditory, and interruptions factors. The results in technical skills were evaluated through the relaxation and stress scores, as well as the time required to complete the exercises under relaxation and stress conditions. A detailed metric was used to assess the variables in relation to stress situations, including physical stress, haste, the presence of background music, and scheduled interruptions.

The results are expressed by median and interquartile range. To compare them, Wilcoxon test for paired samples and the Whitney U Test were performed. The results were stratified by year of residence (1–2 years vs 3–4 years).

Results

The stress score was significantly lower in the 3 exercises compared to the relax score (75 vs 86, 52 vs 90, 55 vs 61, respectively, p > .05). Time to perform the exercises was less predictable and was even lower in stressful situations with no statistical differences. Under stress, both younger and older residents scored worse on the more complex exercises.

Conclusion

Stress affects surgery with simulators. The most difficult exercises are the most likely to be affected by stress. These results suggest that through ophthalmic simulators ophthalmologists have the opportunity to train surgical stress and therefore improving patient safety.