When we use the words “tense up” or “freeze” to describe physical reactions to stress, we may be on the right track in describing how physicians respond to stress while performing complex procedures.
For doctors dealing with life-threatening emergencies during endoscopy, the management of stress is crucial, but poorly understood. Using virtual reality, my team studied how stress affects how trainees perform during gastrointestinal procedures, as well as the relationship between specific body movements and procedure performance. We’re pleased to be presenting our results during the 2018 Digestive Disease Week.
In the first study, we placed motion sensors on the hands, forearms and foreheads of trainees performing endoscopy on a virtual reality simulator and examined how performance related to reported levels of stress (“Use of Wearable Sensors to Assess Stress Response in Endoscopy Training,” abstract 765). As trainees experienced more stress, they decreased the velocity and acceleration of their arm and hand movements, suggesting less motion and decreased range of movement. Understanding the changes caused by stress is an important first step to help trainees better cope with emergency situations, both early and late in their careers.
This new field of inquiry is part of a growing emphasis on physician self-awareness. Currently, little data exist on how individual factors, such as stress response, impact quality of care and patient outcomes. We hope future research may identify how to better manage and reduce stress during endoscopy—potentially improving doctor education and patient outcomes.
More investigations are needed to determine if there is a definitive connection between stress and negative or positive outcomes. Experienced physicians may respond differently to stress compared to inexperienced trainees.
In a separate analysis of data from the trainees’ time on the simulators, we examined how body motion impacts procedure performance, and we determined that head motion could be used to assess trainees’ motor skills ("Use of Wearable Sensors to Assess Biomechanical Learning Patterns in Endoscopy Training," abstract 764).
We found that head motion correlated with performance outcomes and provided a valid measure of procedural competence. Head motion decreased as doctors advanced in their training and completed more procedures. Excess head motion in trainees suggested they may be looking away from the video monitor to check hand or endoscope position too frequently. This loss of visual focus on the monitor may contribute to prolonged task-completion times and may be related to diminished competence with the equipment.
Additional studies may help us identify an objective set of motion variables to define trainee competence in endoscopy allowing us to create personalized training curricula using this technology. Our current training model relies upon expert mentorship and lacks standardized biomechanical assessment and feedback. Motion sensors could help us develop a driver’s test for endoscopy during which trainees complete a set of tasks with defined motion performance thresholds. In the future, such an educational program could help identify individuals best suited for training in advanced procedures or provide specific feedback to individuals in need of remedial education.
In the first study, we placed motion sensors on the hands, forearms and foreheads of trainees performing endoscopy on a virtual reality simulator and examined how performance related to reported levels of stress (“Use of Wearable Sensors to Assess Stress Response in Endoscopy Training,” abstract 765). As trainees experienced more stress, they decreased the velocity and acceleration of their arm and hand movements, suggesting less motion and decreased range of movement. Understanding the changes caused by stress is an important first step to help trainees better cope with emergency situations, both early and late in their careers.
This new field of inquiry is part of a growing emphasis on physician self-awareness. Currently, little data exist on how individual factors, such as stress response, impact quality of care and patient outcomes. We hope future research may identify how to better manage and reduce stress during endoscopy—potentially improving doctor education and patient outcomes.
More investigations are needed to determine if there is a definitive connection between stress and negative or positive outcomes. Experienced physicians may respond differently to stress compared to inexperienced trainees.
In a separate analysis of data from the trainees’ time on the simulators, we examined how body motion impacts procedure performance, and we determined that head motion could be used to assess trainees’ motor skills ("Use of Wearable Sensors to Assess Biomechanical Learning Patterns in Endoscopy Training," abstract 764).
We found that head motion correlated with performance outcomes and provided a valid measure of procedural competence. Head motion decreased as doctors advanced in their training and completed more procedures. Excess head motion in trainees suggested they may be looking away from the video monitor to check hand or endoscope position too frequently. This loss of visual focus on the monitor may contribute to prolonged task-completion times and may be related to diminished competence with the equipment.
Additional studies may help us identify an objective set of motion variables to define trainee competence in endoscopy allowing us to create personalized training curricula using this technology. Our current training model relies upon expert mentorship and lacks standardized biomechanical assessment and feedback. Motion sensors could help us develop a driver’s test for endoscopy during which trainees complete a set of tasks with defined motion performance thresholds. In the future, such an educational program could help identify individuals best suited for training in advanced procedures or provide specific feedback to individuals in need of remedial education.
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