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

2019 
Objective To measure the physiological stress response associated with high-fidelity endovascular team simulation. Design This is a prospective cohort study. Setting This study was performed at St Mary's Hospital (Imperial College London, London, UK), in a tertiary setting. 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 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 intra-operative stress, and reducing error.
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