Tijdsdruk, Stress en het brein in de OK!

Daar is hij weer: de prefrontale cortex en omgaan met druk/stress: ”Junior residents exhibit deterioration in performance under a temporal demand, and relative prefrontal disengagement. In contrast, senior residents better maintain prefrontal activation, task engagement, and technical performance under pressure. 

Directe brein data 
“The present study is the first to provide a direct assessment of brain function of surgeons performing under pressure, and the differences exposed between residents are highly relevant for surgical training””.

Cognitieve controle 
Dus die cognitieve controle – d.w.z. de prefrontale cortex online houden – is waar een deel van de druk en prestatie puzzel ligt. Citaat:” The PFC plays a vital role in executive functioning and when ‘‘top-down’’ control of behavior is required”. De vraag is dan: wat is de implicatie voor training?

Citaat:”. Future work should seek to develop training strategies that recruit prefrontal resources, enhance task engagement, and improve performance under pressure”.

Andere kennis parels uit dit onderzoek:

Druk en PFC activatie. 
Stress-induced activation of the hypothalamic-pituitary-adrenal axis and catecholamine release is associated with reduced synaptic activity in the PFC. The inhibitory influence of the sympathetic stress response on prefrontal responses is sensitive to the magnitude of the physiological response. 

De hypothese
De hypothese van dit onderzoek is het waard om nogmaals voor het vowetlicht te brengen ook al hebben we de resultaten al besproken:
” We hypothesize that the ability to maintain attention, concentration, and executive control (inferred from prefrontal activation) in the face of escalating stress is likely to be a significant advantage in maintaining operative performance, indicative of a more experienced and/or safer surgeon, and which if proven, may have translational impact in determining progressive responsibility and practice readiness.

Modi, H. N., Singh, H., Orihuela-Espina, F., Athanasiou, T., Fiorentino, F., Yang, G. Z., Darzi, A., & Leff, D. R. (2018). Temporal Stress in the Operating Room: Brain Engagement Promotes “Coping” and Disengagement Prompts “Choking”. Annals of surgery, 267(4), 683–691.