Laparoscopic Skill and Mental Workload Measured over Retention Interval

• Methods: Fourteen students (3 males, 12 females; ages 23Y28 years) from EasternVirginiaMedical School’sMaster of Surgical Assisting Program participated in this IRBapproved study. Participants practiced the peg transfer task from the FLS curriculum ona box simulator for 20Y30 minutes over 9Y15 weekly sessions. Their course schedulerequired all students to stop training after the 15th week irrespective of their performancelevel. They returned after a 1-month interval to resume training. The dependentmeasure was task completion time. The secondary task presented images of four balls ina simulated tunnel, superimposed at 50% transparency over the laparoscopic display sothat both tasks were in focal vision. Images were presented for 300 msec every 2Y4 sec.On half of the presentations, one ball changed its position. Participants had to detectthose changes by pressing a foot pedal. The dependent variables were the proportion ofcorrectly identified targets and false alarms.Hypothesis: Performing laparoscopy places heavy demands on visual attention andrequires extensive practice to achieve proficiency. Recently, some researchers havemeasured the mental workload imposed by laparoscopy using the secondary tasktechnique.1,2 According to multiple resource theory, pools of attentional resources aredistinguished by perceptual/cognitive processing stages, verbal and spatial processingcodes, and sensory modality with the vision separated into focal and peripheralchannels.3 Thus, a secondary task that competes for the same resources as a primarytask will cause interference and can be sensitive to differences in mental workload. Inthis study,mental workload was assessed with a secondary task that uses the same visualspatial resources as laparoscopy.We studied effects of refraining from practice during a1-month interval. We expected to see a decline in performance after the delay, but ourgoal was to see if decline would be present in the workload measure.Results: Three sets of tests were performed: the data for the last two training trials (Nand N-1), the last training trial (N) and the initial retention test after the delay interval,and the initial retention test vs. a final test after 30 minutes of retraining (see Table 1).All means were evaluated with dependent t tests (alpha = .05). There were no differencesbetween the last two training trials on any measure. The peg task completiontimes were significantly longer on the initial test compared to the last training trial,t(13) = 2.36, p G .05. There were no differences between the initial and final test on anymeasure (p 9 .05).Conclusion: The results show minimal effects on the peg transfer task from the FLSprogram over a 1-month retention interval. Mean completion times were significantlylonger after the delay interval, but only by 6 seconds (or less than 10%). There were nosignificant differences on the secondary task. Thus, the slower performance times werenot accompanied by any appreciable changes in mental workload. These results showthat 9 Y 15 training sessions were sufficient to establish robust skills for the peg transfertask and that these skills were fairly resilient to a moderate disruption in the trainingschedule. Further, the secondary task used in this study was shown to provide an alternativeindex of laparoscopic workload that can complement traditional metrics ofspeed and accuracy. Future research is needed to examine disruption effects over awider range of laparoscopic tasks and longer intervals.

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MEDICIN OCH HÄLSOVETENSKAP  -- Annan medicin och hälsovetenskap -- Övrig annan medicin och hälsovetenskap (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Other Medical and Health Sciences -- Other Medical and Health Sciences not elsewhere specified (hsv//eng)

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