Niet technische vaardigheden (NTS) spelen een belangrijke rol in het werk van chirurgen (1,2,3). Wat is het effect van a) stress en b) cognitieve belasting op deze NTS? Een leerzaam onderzoek, ik haal er een paar punten uit. Zoals altijd, ga niet af op mijn interpretatie maar lees het onderzoek zelf.
“We found that surgeons’ stress negatively affected their situation awareness and decision making (i.e., their ability to gather information and consider options, specifically)
similarly, heightened cognitive load (as a result of distractions and increased mental demands) was associated with poorer decision making (i.e., ability to consider, select, and communicate options).
We also found that surgeon familiarity with their operative team members was associated with lower reported stress.”
Het werk van de Chirurg
Surgery in an inherently stressful and cognitively demanding profession that is characterized by the innate responsibility of patient care, technical challenges (i.e., specifically unforeseen challenges like bleeding), time pressures, and distractions competing for attention. Increased stress beyond one’s ability to manage the demands can reduce a surgeon’s technical performance”
Het belang van NTS
“Skills such as communication, situation awareness, and decision making are needed for effective surgical performance and to maintain patient safety. Prior research has found that breakdowns in NTS occur more frequently than technical errors in trauma situations, and poor communication is responsible for 43% of errors during all phases of surgical care”
Vriend en Vijand
“Importantly, we are not trying to suggest that all stress is detrimental to performance. Under too little stress, individuals may not be sufficiently activated to perform their best, but as an individual experiences a moderate increase in stress, they become more alert and focused.”
Hoe wordt stress ervaren?
“Unfortunately, the STAI-6 does not allow researchers to determine if stress is perceived as beneficial or distressing by the user, so our future work in this area will include asking surgeons to provide more details about their stress experiences during surgical procedures. “
Wij doen dit in onze trainingen met het ‘emotie kwadrant’.
Subjectieve of fysiologische stress metingen! Ga niet te snel op het een of andere meetprotocol af!
“Another limitation with our study is that we only assessed surgeons’ perceived stress and did not assess physiological stress measures such as heart rate or heart rate variability, which have been shown to be valid measures of stress. However, our team has previously found the STAI-6 to be a more sensitive and germane assessment of stress than physiological measures.
Cognitive appraisal theory postulates that stress results when an individual perceives an external situation to be threatening, and they perceive their own coping resources to manage the demands of the situation to be lacking.Despite increased sympathetic nervous system activation and the resulting physiological responses (e.g., increased heart rate), an individual can still perceive that they have the ability to cope with the demands of a situation, and thus, not experience significant stress from that event. In future work, researchers should combine both subjective and objective measures of surgeon stress in the clinical environment to have a more robust understanding of the relationship between stress and NTS.”
- Anton, N. E., Athanasiadis, D. I., Karipidis, T., Keen, A. Y., Karim, A., Cha, J., Walke, N., & Stefanidis, D. (2021). Surgeon stress negatively affects their non-technical skills in the operating room. American journal of surgery, 222(6), 1154–1157.
- NTS in onze ambu bootcamp https://www.anvh.nl/event/834473
- NTS in de sport https://www.researchgate.net/publication/344612240_Niet_technische_vaardigheden_van_de_cockpit_naar_de_sport