Stress, safety and surgical performance
Project summary
Background
Safe surgical practice requires a combination of technical and non-technical skills. Acute stress can impair both sets of skills, thereby compromising both surgical performance and patient safety in the operating theatre.
This project uses a systematic and scientific analysis to investigate stress in surgeons with the global aim of developing a practical, evidence-based intervention to reduce stress and its deleterious consequences.
Aims
A number of related studies have been carried out, aiming to:
- Identify the key stressors that impact upon surgical performance
- Identify surgeons’ requirements from a stress management training intervention
- Develop and validate the Imperial Stress Assessment Tool (ISAT) to measure stress in surgery
- Develop and validate an intervention taken from sports science, based on the concept of “mental practice” (i.e., the mental rehearsal of a task in the absence of relevant physical action) that enhances surgical skill and reduces stress levels
-
Demonstrate quantitative improvements in surgical performance after using the intervention through a RCT set in a high fidelity simulated operating theatre
Methods
A range of methods and approaches have been used within this project including:
- Standardised systematic review methodology to identify the impact of stress on surgical performance
- Qualitative methodology (eg interviews and ethnographic observations) to elicit surgeons’ stressors and coping strategies in the operating theatre alongside their training needs.
- Quantitative methodology to develop and validate stress assessment tools and to assess the quality of the surgeons’ mental imagery processes
- Randomised controlled trial (RCT) methodology to test the efficacy of a stress management and performance enhancement intervention (mental practice) in a simulated operating theatre
Project team
- Sonal Arora (PI and key contact)
- Nick Sevdalis
- Roger Kneebone
- Ara Darzi
- Raj Aggarwal
Project funders
External collaborators
-
Professor Aidan Moran, University College Dublin
Project start and end dates
August 2007 - September 2010
Project outputs
Awards and prizes
- Arora S. Surgical Education Research Fellowship, Awarded by Association of Surgical Education. 2010
- Arora S. World Health Organization Fellowship. 2009
- Arora S. Excellence in Research Award for surgical education, Annual Congress of Surgeons. 2009
- Arora S. Best Trainee Award, Society for Simulation in Healthcare. 2008 Arora S. Best Multi-media Presentation award, Imperial Surgical Symposium. 2008
Peer-reviewed papers
- Arora S, Aggarwal R, Sirimanna P, Moran A, Grantcharov T, Kneebone R, Sevdalis N, Darzi A. Mental practice enhances surgical technical skills: a randomised controlled study. Annals of Surgery 2011;253:265-70.
- Arora S, Aggarwal R, Moran A, Sirimanna P, Crochet P, Darzi A, Kneebone R, Sevdalis N. Mental practice: Effective stress management training for novice surgeons. Journal of the American College of Surgeons 2011;212:225-33.
- Arora S, Sevdalis N, Aggarwal R, Sirimanna P, Darzi A, Kneebone R. Stress impairs psychomotor performance in novice laparoscopic surgeons. Surgical Endoscopy 2010;24:2588-93.
- Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone RL. The impact of stress on surgical performance: A systematic review of the literature. Surgery 2010;147:318-330.
- Arora S, Tierney T, Sevdalis N, Aggarwal, Nestel D, Woloshynowych M, Darzi A, Kneebone RL. The Imperial Stress Assessment Tool (ISAT): A feasible, reliable and valid approach to measuring stress in the operating room. World Journal of Surgery 2010;34:1756-63.
- Arora S, Sevdalis N. Surgical flow disruptions: measurement and impact of stressful events in the operating room. World Journal of Surgery 2010;34:2247-8.
- Arora S, Hull L, Sevdalis N, Tierney T, Nestel D, Woloshynowych M, Darzi A, Kneebone RL. Factors compromising safety in the surgical environment: Stressful events in the operating room. American Journal of Surgery 2010;199:60-5.
- Arora S, Sevdalis N, Nestel D, Tierney T, Woloshynowych M, Kneebone R. Managing intra-operative stress: What do surgeons want from a crisis training programme? American Journal of Surgery 2009;197:537-43.
- Arora S, Aggarwal R, Sevdalis N, Sirimanna P, Kneebone RL, Moran A, Darzi A. Development and validation of mental practice as a training strategy for laparoscopic surgery. Surgical Endoscopy 2010;24:179-87.
- Arora S, Miskovic D, Hull L, Moorthy K, Aggarwal R, Johannsson H, Kneebone R, Darzi A, Sevdalis N. Self vs Expert Assessment of Technical and Non-technical performance in high fidelity simulation. Am J Surg 2010 (in press)
- Arora S, Sevdalis N. Critical comments on a critical analysis. ANZ Journal of Surgery 2011; in press
- Arora S, Sevdalis N. A systemic analysis of disruptions in the operating room: reply. World Journal of Surgery 2011; in press
- Arora S, Lamb B, Undre S, Kneebone R, Darzi A, Sevdalis N. Framework for the incorporation of simulation into urological training. BJU International 2011;in press
- Hull L, Arora S, Kassab E, Kneebone RL, Sevdalis N. Assessment of stress and teamwork in the operating room: an exploratory study. American Journal of Surgery 2011;201:24-30.
- Arora S, Ashrafian H, Davis R, Athanasiou T, Darzi, Sevdalis N. Emotional intelligence in medicine: A systematic review through the context of the ACGME competences. Medical Education 2010;44:749-64.
- Arora S, Sevdalis N. Systems approach to daily clinical care. International Journal of Surgery 2010;8:164-6.
- Kassab E, King D, Hull L, Arora S, Sevdalis N, Kneebone RL, Nestel D. Actor training for surgical team simulations. Medical Teacher 2010;32:256-8.
- Kneebone RL, Arora S, King D, Bello F, Sevdalis N, Kassab E, Aggarwal R, Darzi A, Nestel D. Distributed Simulation – accessible immersive training. Medical Teacher 2010;32-65-70.
- Arora S, Sevdalis N. Surgical performance under stress: Conceptual and methodological issues. In T Athanasiou, A Darzi, H Debas (eds) Key topics in surgical research and methodology (pp. 137-146; Ch. 12). Springer Verlag. 2010.
- Sevdalis N, Arora S, Undre S, Vincent CA. Surgical environment: an observational approach. In R Flin, L Mitchell (Eds.) Safer Surgery: Analyzing Behaviour in the Operating Theatre (pp. 405-422, Ch. 24). Ashgate. 2009.
Talks and presentations - International
- Arora S, Tierney T, Sevdalis N, Aggarwal R, Woloshynowych M, Nestel D, Darzi A, Kneebone R. The Imperial Stress Assessment Tool (ISAT): An evidence-based approach for measuring stress in surgery. Association of Surgeons of Great Britain and Ireland (ASGBI), May 2009 (oral)
- Arora S, Sevdalis N, Aggarwal R, Sirimanna P, Darzi A, Kneebone R. The effect of stress on psychomotor performance of laparoscopic novices. Association of Surgeons of Great Britain and Ireland (ASGBI), May 2009 (oral)
- Arora S, Sevdalis N, Kneebone R. Stress, safety and surgical performance. Association of Surgeons of Great Britain and Ireland (ASGBI), May 2009 (invited oral)
- Arora S, Aggarwal R, Sevdalis N, Sirimanna P, Moran A, Kneebone R, Darzi A. Mental Practice enhances surgical performance in novice laparoscopic surgeons – A randomized controlled study. Association of Surgical Education, Utah, April 2009 (oral)
- Arora S, Aggarwal R, Sevdalis N, Sirimanna P, Moran A, Kneebone R, Darzi A. Development and validation of mental practice as a training strategy for laparoscopic surgery. SAGES, Arizona, April 2009 (oral)
- Arora S, Sevdalis N, Aggarwal R, Sirimanna P, Darzi A, Kneebone R. Stress impairs psychomotor performance of laparoscopic novices on a surgical simulator. SAGES, 2009 (poster)
- Arora S, Latif S, Vadhwana, Sevdalis N, King D, Aggarwal R, Bello F, Nestel D, Kneebone R. Distributed Simulation: An innovative tool to enhance medical student education in the OR. International Meeting for Simulation in Healthcare (IMSH), Orlando, Jan 2009 (plenary – awarded best research prize)
- Arora S, Sevdalis N, Woloshynowych M, Nestel D, Kneebone R.A Training Needs Analysis to enhance patient safety; Crisis Training for surgeons. Human factors, Ergonomics & Patient Safety (HEPS), Strasbourg, June 2008 (oral)
- Arora S, Sevdalis N, Woloshynowych M, Nestel D, Kneebone R Stress, Safety and Surgical Performance; Developing Advanced Simulation and Safety (based) Intra-Operative Stress Training (ASSIST). International Forum Quality and Safety, Paris, April 2008 (oral)
- Arora S, Sevdalis N, Woloshynowych M, Nestel D, Kneebone R. Enhancing Performance under Pressure: Designing a Stress Training Intervention. Association of Surgical Education (ASE), Toronto, April 2008 (poster)
- Arora S, Sevdalis N, Woloshynowych M, Nestel D, Kneebone R. Crisis management for surgeons: A Training needs analysis to enhance surgical performance and patient safety. Association of Surgeons of Great Britain and Ireland (ASGBI) April 1008 (oral)
- Arora S, Moorthy K, Sevdalis N, Adams S, Smith A, Vincent C. The making of a safe surgeon: development of a safety skills training programme. Association of Surgeons of Great Britain and Ireland (ASGBI) April 1008 (oral)
- Arora S, Tierney T, Sevdalis N, Woloshynowych M, Nestel D, Kneebone R. The impact of stress on surgical performance: a multi method comparison. Association of Surgeons of Great Britain and Ireland (ASGBI) April 1008 (oral)
Talks and presentations - National
- Arora S, Tierney T, Sevdalis N, Woloshynowych M, Nestel D, Kneebone R Development of a method for measuring intra-operative stress. ACPGBI, July 2008(invited oral)
- Arora S, Suliman I, Ng P. Integrating ISCP into surgical training – What makes a competent surgeon? Society of Academic and Research Surgery (SARS), Jan 2008 (poster)
Talks and presentations - Regional
- Arora S, Aggarwal R, Sirimanna P, Sevdalis N, Moran A, Kneebone R, Darzi A. Mental Practice enhances surgical performance. Surgical Symposium, Imperial College Sept 2008 (oral)
- Arora S, Sevdalis N, Vincent C. Making patients safer. Surgical Symposium, Imperial College Sept 2008 (oral)
- Arora S, Sevdalis N, Woloshynowych M, Nestel D, Kneebone R. Enhancing Performance under Pressure: Designing a Stress Training Intervention, GSLSM summer symposium, Imperial College, 2008
Workshops
- Paige J, Arora S, Seymour N, Aggarwal R, Stefanidis D, Fernandez G. Putting the Meat into Team Training, Association of surgical education, Boston, March 2011
- Paige J, Arora S, Seymour N, Stefanidis D, Fernandez G. Team Training Workshop, IMSH, New Orleans, Jan 2011
- Arora S, Dieckmann P, Sevdalis N. Skills for Trainee Academics and Researchers in Simulation (STARS). International Meeting Simulation in Healthcare (IMSH), Phoenix, Jan 2010
- King D, Arora S, Sevdalis N, Nestel D, Bello F, Kneebone R: Distributed Simulation. International Meeting for Simulation in Healthcare (IMSH), Orlando, Jan 2009
