Researchers find stress-free training enhances surgical skills

University of Houston and Methodist Hospital researchers are reporting in Nature Scientific Reports that the best way to train surgeons is to remove the stress of residency programs and make surgery a hobby. Under relaxed conditions outside a formal educational setting, 15 first-year medical students, who aspired one day to become surgeons, mastered microsurgical suturing and cutting skills in as little as five hour-long sessions.

“It appears that by removing external stress factorsassociated with the notoriously competitive and harsh lifestyle of surgeryresidencies, stress levels during inanimate surgical training plummet,” saidIoannis Pavlidis, Eckhard Pfeiffer professor and director of the ComputationalPhysiology Lab at UH. “In five short sessions these students, approachingsurgery for fun or as a hobby, had remarkable progress achieving dexteritylevels similar to seasoned surgeons, at least in these drills.” His partners onthe project, Anthony Echo and Dmitry Zavlin, surgeons at Houston MethodistInstitute for Reconstructive Surgery, gave brief instructions to the studentsat the beginning of the program.

Once the students began cutting and suturing at their mobilemicrosurgical simulators, Pavlidis and the team tracked their stress levels bymeasuring sweat responses near the nose via thermal imaging. The students’performances in the surgical drills were scored by two experts, based on videorecordings.

In previous work Pavlidis and Methodist Hospital researchersfound that surgical residents exhibited high stress levels during their formaltraining in surgical simulators. These high stress levels precipitated “fightor flight” responses, resulting in fast, mindless actions leading to errors andthe creation of a vicious cycle during the surgical drills.

In the present follow-up work, Pavlidis, Echo and Zavlinchose trainees outside the surgical establishment, without pressures andstakes, to examine what happens when environmental stress is neutralized andonly the stress associated with the challenging nature of the surgical drillsis present.

“We removed stressful environmental factors, leaving onlythe inherent challenge of the surgical tasks, and discovered thephysiologically-measured distress in the form of sympathetic arousal was moderateand unchanged throughout the five training sessions,” said Pavlidis. Incontrast, Pavlidis reported in the previous study high stress levels insurgical residents and slow learning processes, where five training sessionsbrought no skill improvement. The main factor that sets the two studies apartis the educational context and stress associated with it.

In this study, where young surgery enthusiasts took upsurgical training without the impact of environmental anxiety, skills werequickly acquired. Then once a skill like suturing is acquired, it won’t beforgotten, much like riding a bike.

“If you acquire a dexterous skill when you are not superstressed, you will acquire it better and faster, because `fight or flight’responses are not there to mess things up,” said Echo. “And once you have it,the skill won’t leave you. Like a bike, once you learn to bike, you bike,”Pavlidis added.

Future surgery residents with the skill acquired at a moreopportune time would be able to focus on more advanced experiences inside theoperating room. “Similar paradigms may apply to other artisan professions,upending training doctrines held sacred for generations,” said Pavlidis.