Skip to main content
SpringerLink
Log in

The effect of divided attention on novices and experts in laparoscopic task performance

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Attention is important for the skilful execution of surgery. The surgeon’s attention during surgery is divided between surgery and outside distractions. The effect of this divided attention has not been well studied previously. We aimed to compare the effect of dividing attention of novices and experts on a laparoscopic task performance.

Methods

Following ethical approval, 25 novices and 9 expert surgeons performed a standardised peg transfer task in a laboratory setup under three randomly assigned conditions: silent as control condition and two standardised auditory distracting tasks requiring response (easy and difficult) as study conditions. Human reliability assessment was used for surgical task analysis. Primary outcome measures were correct auditory responses, task time, number of surgical errors and instrument movements. Secondary outcome measures included error rate, error probability and hand specific differences. Non-parametric statistics were used for data analysis.

Results

21109 movements and 9036 total errors were analysed. Novices had increased mean task completion time (seconds) (171 ± 44SD vs. 149 ± 34, p < 0.05), number of total movements (227 ± 27 vs. 213 ± 26, p < 0.05) and number of errors (127 ± 51 vs. 96 ± 28, p < 0.05) during difficult study conditions compared to control. The correct responses to auditory stimuli were less frequent in experts (68 %) compared to novices (80 %). There was a positive correlation between error rate and error probability in novices (r 2 = 0.533, p < 0.05) but not in experts (r 2 = 0.346, p > 0.05).

Conclusion

Divided attention conditions in theatre environment require careful consideration during surgical training as the junior surgeons are less able to focus their attention during these conditions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hall JC, Ellis C, Hamdorf J (2003) Surgeons and cognitive processes. Br J Surg 90:10–16

    Article  CAS  PubMed  Google Scholar 

  2. Berguer R, Smith WD, Chung YH (2001) Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc 15:1204–1207

    Article  CAS  PubMed  Google Scholar 

  3. Arora S, Sevdalis N, Aggarwal R, Sirimanna P, Darzi A, Kneebone R (2010) Stress impairs psychomotor performance in novice laparoscopic surgeons. Surg Endosc 24:2588–2593

    Article  PubMed  Google Scholar 

  4. Carswell CM, Clarke D, Seales WB (2005) Assessing mental workload during laparoscopic surgery. Surg Innov 12:80–90

    Article  PubMed  Google Scholar 

  5. Proctor RW, Dutta A (1995) Skill acquisition and human performance. SAGE publications, California

    Google Scholar 

  6. Hsu KE, Man FY, Gizicki RA, Feldman LS, Fried GM (2008) Experienced surgeons can do more than one thing at a time: effect of distraction on performance of a simple laparoscopic and cognitive task by experienced and novice surgeons. Surg Endosc 22:196–201

    Article  CAS  PubMed  Google Scholar 

  7. Webster JL, Cao CGL. Divided Attention in Using Robotic Surgical Systems. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2004, vol 48. pp 1751–1754

  8. Meneghetti AT, Pachev G, Zheng B, Panton ON, Qayumi K (2012) Objective assessment of laparoscopic skills: dual-task approach. Surg Innov 19:452–459

    Article  PubMed  Google Scholar 

  9. Slagle JM, Weinger MB (2009) Effects of intraoperative reading on vigilance and workload during anesthesia care in an academic medical center. Anesthesiology 110:275–283

    PubMed  Google Scholar 

  10. MANUAL (2012) FLS manual. http://www.flsprogram.org/wp-content/uploads/2013/01/Manual-Skills-Guidelines-2012.pdf. Accessed 5 Sep 2012

  11. Cuschieri A (2000) Human reliability assessment in surgery–a new approach for improving surgical performance and clinical outcome. Ann R Coll Surg Engl 82:83–87

    CAS  PubMed Central  PubMed  Google Scholar 

  12. Moorthy K, Munz Y, Dosis A, Bann S, Darzi A (2003) The effect of stress-inducing conditions on the performance of a laparoscopic task. Surg Endosc 17:1481–1484

    Article  CAS  PubMed  Google Scholar 

  13. Moorthy K, Munz Y, Undre S, Darzi A (2004) Objective evaluation of the effect of noise on the performance of a complex laparoscopic task. Surgery 136:25–30 (discussion 31)

    Article  CAS  PubMed  Google Scholar 

  14. Paschler H, Johnston JC, Ruthruff E (2001) Attention and performance. Annu Rev Psychol 52:629–651

    Article  Google Scholar 

  15. Skinner A, Auner G, Meadors M, Sebrechts M (2013) Ambidexterity in laparoscopic surgical skills training. Stud Health Technol Inform. 184:412–416

    PubMed  Google Scholar 

Download references

Disclosures

Mudassar Ali Ghazanfar, Malcolm Cook, Benjie Tang, Iain Tait and Afshin Alijani have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Cuschieri Skills Centre, University of Dundee, Level 5 Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK

    Mudassar Ali Ghazanfar, Benjie Tang, Iain Tait & Afshin Alijani

  2. Department of Psychology, University of Abertay, Dundee, Scotland, UK

    Malcolm Cook

Authors
  1. Mudassar Ali Ghazanfar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Malcolm Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benjie Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Iain Tait
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Afshin Alijani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mudassar Ali Ghazanfar.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghazanfar, M.A., Cook, M., Tang, B. et al. The effect of divided attention on novices and experts in laparoscopic task performance. Surg Endosc 29, 614–619 (2015). https://doi.org/10.1007/s00464-014-3708-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3708-2

Keywords

Search

Navigation