An Evaluation of the Impact of High-Fidelity Endovascular Simulation on Surgeon Stress and Technical Performance

OBJECTIVE: To measure the physiological stress response associated with high-fidelity endovascular team simulation. DESIGN: This is a prospective cohort study. PARTICIPANTS: Thirty-five participants (10 vascular surgical residents, 4 surgical interns, 12 theatre nurses, 2 attending vascular surgeons, 6 medical students and 1 technician) were recruited from the Imperial Vascular Unit at St Mary's Hospital, Imperial College London by direct approach. All participants finished the study. RESULTS: Junior surgeons experienced significantly increased sympathetic tone (Low frequency/high frequency (LF/HF) ratio) during team simulation compared to individual simulation (6.01 +/- 1.68 vs. 8.32 +/- 2.84, p < 0.001). Within team simulation junior surgeons experienced significantly higher heart rate (beats per minute) than their senior counterparts (82 +/- 5.83 vs. 76 +/- 6.02, p = 0.033). Subjective workload scores (NASA Task Load Index [NASA-TLX]) correlated moderately and significantly with sympathetic tone in surgeons across all stages of simulation. (r= 0.39, p = 0.01). CONCLUSIONS: A discrete, measurable increase in stress is experienced by surgeons during high-fidelity endovascular simulation and differentially effects junior surgeons. High-fidelity team simulation may have a role to play in improving nontechnical skill, reducing intraoperative stress, and reducing error. Crown Copyright 2018 Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery. All rights reserved.