Honing a surgeon's decision making skills in the presence of mechanical tasks.

BACKGROUND: Although surgeons perform procedures and tasks under a significant amount of cognitive load, current simulators focus on training psychomotor skills in isolation. This may limit the transfer of learned skills to actual surgical environments. METHODS: Visuohaptic simulations were created that required participants to hone psychomotor skills in the presence of cognitive load. A control group (n = 7) trained on conventional skills simulator and their performance was compared with the experimental group (n = 7) in terms of learning curves and performance on a transfer task. RESULTS: The experimental group performed significantly better than the control group in terms of both learning curves and performance on the transfer task. CONCLUSIONS: Simulations that combine psychomotor and cognitive skills training are more effective than simulators that focus on psychomotor skills in isolation.

Effect of fatigue on psychomotor and cognitive skills.

BACKGROUND: Previous studies have explored the effect of fatigue on general psychomotor proficiency. However, studies specifically addressing the effect of fatigue on surgical residents' cognitive skills during simulated surgical exercises are lacking. METHODS: Thirty-seven surgical residents in both the precall and the postcall condition were tested for psychomotor and cognitive skill evaluation on a virtual-reality simulator with haptic feedback and hand-motion recording. To evaluate surgical skills, hand- and tool-movement smoothness, cognitive errors, and time to completion for specific tasks were analyzed. RESULTS: In addition increased cognitive errors, a significant decrease (P < .01) was recorded in the proficiency variables of memory, attention, and intermodal coordination tasks when residents were in the postcall condition. CONCLUSIONS: Fatigue and sleep deprivation cause a significant deterioration in the surgical residents' cognitive skills as measured by virtual reality simulation. Psychomotor skills are also negatively impacted during tasks that require a combination of psychomotor and cognitive skills.