Martina I. Klein

Perceptual Distortions Produce Multidimensional Stress Profiles in Novice Users of an Endoscopic Surgery Simulator

Objectives: We determine the impact of perceptual-motor distortions on multidimensional stress dynamics in novice users of an endoscopic/laparoscopic surgery simulator during performance of a peg-transfer task. Background: Surgeons find the endoscopic/laparoscopic surgery procedure to be more mentally stressful than open surgery. This investigation was designed to identify specific stress dimensions associated with these procedures and to determine the contributions to that stress made by loss of depth information resulting from image-guided views of the surgical field and by disruption of eye-hand mapping. Because stress reactions might depend upon familiarity with these procedures, the study focused upon novice participants. Method: An endoscopic box-simulator featured in surgical training was used in conjunction with the Dundee Stress State Questionnaire, a well-validated multidimensional stress state instrument. A control group (no perceptual distortions) viewed the simulated “surgical field” directly. Two other groups viewed the surgical field through TV images in which spatial rotation of the images was absent or in which the images were rotated 90° from the actual line of sight. Results: Performance efficiency in the simulator varied inversely with the degree of perceptual-motor distortion. Reactions reflecting increased task coping were observed in all groups. These were accompanied in the image groups by negative reactions involving decreases in hedonic tone and control and confidence and an increase in tense arousal. Conclusions: Perceptual-motor distortions are sources of complex task-induced stress profiles in novices using an endoscopic surgery simulator. Application: Procedures to reduce stress in endoscopic/laparoscopic surgery trainees may benefit from knowledge regarding specific stress dimensions involved.

Using Cognitive Task Analysis to Identify Critical Decisions in the Laparoscopic Environment

Objective: The aim of this study was to identify the critical decisions surgeons need to make regarding laparoscopic surgery, the information these decisions are based on, the strategies employed by surgeons to reach their objectives, and the difficulties experienced by novices. Background: Laparoscopic training focuses on the development of technical skills. However, successful surgical outcomes are also dependent on appropriate decisions made during surgery, which are influenced by critical cues and the use of appropriate strategies. Novices might not be as adept at cue detection and strategy use. Method: Participants were eight attending surgeons. The authors employed task-analytic techniques to identify critical decisions inherent in laparoscopy and the cues, strategies, and novice traps associated with these decisions. Results: The authors used decision requirements tables to organize the data into the key decisions made during the preoperative, operative, and postoperative phases as well as the cues, strategies, and novice traps associated with these decisions. Key decisions identified for the preoperative phase included but were not limited to the decision of performing a laparoscopic versus open surgery, necessity to review the literature, practicing the procedure, and trocar placement. Some key decisions identified for the operative phase included converting to open surgery, performing angiograms, cutting tissue or organs, and reevaluation of the approach. Only one key decision was identified for the postoperative phrase: whether the surgeon’s technique needs to be evaluated and revised. Conclusion: The laparoscopic environment requires complex decision making, and novices are prone to errors in their decisions. Application: The information elicited in this study is applicable to laparoscopic training.

Mental stress experienced by first-year residents and expert surgeons with robotic and laparoscopic surgery interfaces

Prior research has indicated that novices experienced a beneficial stress profile in the robotic surgery (da Vinci) training environment when compared to the laparoscopic surgery training environment. The objective of this study was to assess whether this finding generalizes to expert surgeons. Towards that end, first-year residents’ and attending surgeons’ performances and subjective stress experiences were assessed in a surgical training task that was performed with the da Vinci and laparoscopic surgery interfaces. This study indicated that both groups exhibited superior performance and lower stress with the da Vinci surgical system than the laparoscopic system. The results provide further support for the sensitivity of the Dundee Stress State Questionnaire in identifying different stress responses experienced by trainees and experts in the minimally invasive surgery environment.

Performance, Stress, Workload, and Coping Profiles in 1st Year Medical Students' Interaction with the Endoscopic/Laparoscopic and Robot-Assisted Surgical Techniques

First-year medical students performed a simulated surgical task involving item transfers using a laparoscopic trainer box and the Intuitive Surgicals da Vinci® Surgical System. Performance efficiency in terms of the ratio of successfully transferred items to the sum of transferred items plus drops was greater when using the da Vinci than the laparoscopic system and task-induced stress measured by the Dundee Stress State Questionnaire was greater when working with the laparoscopic than with the da Vinci system. Perceived mental workload indexed by the Multiple Resources Questionnaire was high with both systems. With both systems, profiles of the information-processing resources involved in task performance emphasized manual, short-term memory, spatial, and visual/temporal processing dimensions. As measured by the Coping Inventory of Task Stress, task-focused coping was the dominant coping style used by the students with both surgical systems. The results have potential implications for selection and training with minimally invasive surgery procedures.

Sideways Camera Rotations of 90° and 135° Result in Poorer Performance of Laparoscopic Tasks for Novices

Objective: The aim of this study was to determine the impact of sideways visuomotor rotations between 0° and 180° on novice performance in a laparoscopic simulator. Background: The laparoscopic surgical environment often involves visuomotor rotations because the laparoscope may be placed to the surgeon’s side. Basic research by Cunningham indicated that visuomotor rotations between 90° and 135° result in peak performance decrements. Research by Ames and colleagues failed to replicate Cunningham’s results in the laparoscopic environment, possibly due to (a) confounds from carryover effects or (b) use of an alternative laparoscopic training task rather than the straight-line pointing task used by Cunningham. Two experiments were conducted to determine if Cunningham’s results generalize to the laparoscopic environment when controlling for carryover effects for a three-dimensional “straight-line” pointing task (Experiment 1) and a laparoscopic training task (Experiment 2). Method: In Experiments 1 and 2, participants were assigned to one of five visuomotor rotations: 0°, 45°, 90°, 135°, or 180°. Utilizing a laparoscopic simulator, participants performed either a three-dimensional pointing task (Experiment 1) or a peg transfer task (Experiment 2). Results: In both experiments, visuomotor rotations of 90° or 135° resulted in the poorest performance. Conclusion: When controlling for carryover effects, Cunningham’s results generalize to novices’ performance of a pointing and a peg transfer task in the laparoscopic environment. Applications: The results indicate that 90° and 135° sideways laparoscope placements may result in worse performance for novices in the laparoscopic environment, indicating potentially longer learning curves for these conditions in the laparoscopic as well as other teleoperation environments.

The Impact of Visual Scanning in the Laparoscopic Environment After Engaging in Strain Coping

Objective: We aimed to determine whether visual scanning has a detrimental impact on the monitoring of critical signals and the performance of a concurrent laparoscopic training task after participants engaged in Hockey’s strain coping. Strain coping refers to straining cognitive (attentional) resources joined with latent decrements (i.e., stress). Background: DeLucia and Betts (2008) reported that monitoring critical signals degraded performance of a laparoscopic peg-reversal task compared with no monitoring. However, performance did not differ between displays in which critical signals were shown on split screens (less visual scanning) and separated displays (more visual scanning). We hypothesized that effects of scanning may occur after prolonged strain coping. Method: Using a between-subjects design, we had undergraduates perform a laparoscopic training task that induced strain coping. Then they performed a laparoscopic peg-reversal task while monitoring critical signals with a split-screen or separated display. We administered the NASA–Task Load Index (TLX) and Dundee Stress State Questionnaire (DSSQ) to assess strain coping. Results: The TLX and DSSQ profiles indicated that participants engaged in strain coping. Monitoring critical signals resulted in slowed peg-reversal performance compared with no monitoring. Separated displays degraded critical-signal monitoring compared with split-screen displays. Conclusion: After novice observers experience strain coping, visual scanning can impair the detection of critical signals. Application: Results suggest that the design and arrangement of displays in the operating room must incorporate the attentional limitations of the surgeon. Designs that induce visual scanning may impair monitoring of critical information at least in novices. Presenting displays closely in space may be beneficial.

The Importance of Water is in Question Aquatic Nature Images Do Not Have Significantly Higher Restorativeness Ratings than Green Nature Images

Previous research has indicated that aquatic features in nature may have additional restorative potential. The present study assessed the perceived restorativeness for nature images that contained only aquatic features (no greenery) and compared them to images that contained only greenery (no water) and only urban environments (no water or greenery) instead of using images that had various proportions of water and greenery, as conducted in previous research. There were no significant differences in ratings on the short-version of Perceived Restorativeness Scale’s (PRS) for aquatic-only compared to green-only images, but both had superior ratings on the short PRS compared to urban images. Thus, our findings indicated that aquatic-only images may not increase restorative potential compared to green-only images, at least not as assessed by the short PRS. Future research needs to assess the restorative effect induced by aquatic-only and green-only nature scenery on cognitive performance.

Are All Types of Natural Environments Created Equal? A Comparison of Different Elements in Nature for Improving Restoration in Work Environments:

Prior research suggested images that feature aquatic elements were perceived to be more restorative. Specifically, images with a larger proportion of aquatic elements compared to greenery elements were more restorative than images that contained just greenery elements. This idea has been referred to as the “dose effect” of water. However, related work was not able to extend these results, leading to questions about the validity of the effect. The current study was conducted to determine whether we could replicate the “dose effect” using the same images as previous researchers and whether we could generalize the “dose effect” to a unique set of images. Our results indicated that we were unable to replicate the “dose effect” using the same images utilized in prior research, and we were also unable to generalize it to a unique set of images.

Oxygenation of the prefrontal cortex during sequential planning in the Tower of London

To investigate the utility of neural theories for human planning, this study used near-infrared spectroscopy to investigate prefrontal (PFC) oxygenation for a well-established planning task: The Tower of London (TOL). Changes in prefrontal oxygenated hemoglobin from baseline were measured during task performance. Performing the Tower of London led to a significant increase in oxygenation in the left caudal region of the PFC in difficult trials moves relative to easier trials. The different degree of prefrontal oxygenation agrees with previous research and provides further evidence for a capacity utilization framework for measuring neurocognitive demand. Higher activity in the left rostral frontopolar region predicted better performance in the Tower of London, which agrees with a proposed rostral-caudal control hierarchy for the prefrontal cortex. Observed results support the feasibility of near-infrared spectroscopy to assess activity during tasks requiring planning ability and provide support for two neurocognitive models, capacity utilization and rostro-caudal control hierarchy.

A positive relationship between nature appreciation, emotional functioning, and perception of work value

Previous research has noted potential emotional benefits of being in nature. This study examined whether nature appreciation is also positively related to perception of work-value. Frequency of nature appreciation and a number of variables related to emotion, well-being, and perceived work value were analyzed using hierarchical regression techniques with a publicly available data set, consisting of a large sample of middle-aged and older adults. Nature appreciation was significantly associated with certain emotional outcomes including increased positive affect, well-being, as well as reduced perceived stress. Nature was also associated with increased epinephrine, implying a complex relationship between nature and emotion regulation. Nature offers numerous benefits for individuals across the spectrum of psychological functioning. The findings are relevant for psychologists in promoting the well being of workers.