Effect of Short-Term Pretrial Practice on Surgical Proficiency in Simulated Environments: A Randomized Trial of the “Preoperative Warm-Up” Effect
Received 6 April 2008; received in revised form 4 September 2008 published online 04 December 2008.
Background
Surgery is a skill-driven discipline. While other high-stake professions with comparable cognitive and psychomotor skill requirements often use warm-up exercises for achieving better proficiency, the effects of such practice have not been investigated sufficiently in surgical tasks.
Design
Subjects performed standardized exercises as a preoperative warm-up, after which the standardized exercises were repeated in a randomized order. In a variation to investigate the generalizability of preoperative warm-up, the experimental group was allowed to warm-up with the standardized exercises, after which a different task (electrocautery simulation) was performed. To investigate the effect of warm-up on fatigue, participants were involved in eight sessions (four before night call, four after night call), after which the tasks were repeated. Results were analyzed using ANOVA to plot differences between warm-up and followup condition.
Results
All outcomes measures demonstrated statistically significant improvements after all of the post−warm-up exercises (p < 0.01), and were seen in all groups with differing experience levels. In addition, the simple warm-up exercises led to a significant increase in proficiency in followup electrocautery task for the experimental group when compared with the control group (p < 0.0001). There was also significant improvement in performance of the fatigued group to approximately baseline performance (p < 0.05), although they were not able to reach their optimal potential performance.
Conclusion
Preoperative warm-up for 15 to 20 minutes with simple surgical exercises leads to a substantial increase in surgical skills proficiency during followup tasks.
aDepartment of Biomedical Informatics, Arizona State University, Tempe, AZ
bDepartment of Surgery, University of Washington Medical Center, Seattle, WA
cPhoenix Integrated Surgical Residency, Phoenix, AZ
dSimulation Education and Training Center, Banner Health, Phoenix, AZ
Correspondence address: Richard M Satava, PhD, University of Washington Medical Center, BB430, Box 356410, 1959 NE Pacific St, Seattle, WA 98195-6410
ABSTRACT