- Associated Press - Friday, July 14, 2017

COLUMBIA, Mo. (AP) - First-time resident physicians enter the operating room with moist palms and increased levels of stress. But don’t sweat it - a new study strives to objectively monitor stress to help determine when resident physicians are ready to operate.

The study began two years ago but will continue for at least three more to try to identify a trend that will determine exactly when surgical residents reach a level comparable to experienced surgeons, the Missourian (https://bit.ly/2t7jEMZ ) reported. Even experienced surgeons sweat during challenging procedures, but their overall levels are much more stable.

The study was motivated by the need for a more objective measure for evaluating a resident’s readiness for surgery. Jacob Quick, the lead researcher on the study and an acute care surgeon at MU Health Care, said the traditional model of subjectively testing residents works well and experienced doctors are certainly capable of evaluating residents. But as more regulatory bodies have become involved in education, something less “gut level” has been needed.

Previous attempts to find objective measures of potential surgeons have included monitoring heart rates or looking at increased blood flow in different areas of the brain with an MRI machine, but neither of these methods have been used during actual surgery.

“There’s not a great test for it,” Quick said. Some people are very good at taking standardized tests, so those kinds of tests won’t reveal whether someone might falter “when they’re on the fly and an unexpected problem occurs.”

Quick’s study uses sensors to monitor the electrodermal activity of a resident’s skin while the person is performing surgery.

“During a stressful event, you have increased sweating that changes the amount of sodium in your skin, and sodium is an electrolyte that conducts electricity, so you look at the conductivity of skin,” Quick said. “As the conduction potential rises, that is consistent with more stress.”

The test subjects wear the sensors around their wrists like watches and then cover them with the sleeve of their sterile gown and two layers of sterile gloves for the patient’s protection. As the resident operates, the sensors monitor changes on the skin and collect data.

Each resident performs the same surgery for the tests, which is a laparoscopic cholecystectomy, a standard gallbladder surgery.

Several studies have objectively tested surgical residents in simulation. Quick’s is the only objective test that has been used during live surgery. So far, 15 residents as well as several faculty members have participated in the study.

To track their total progress, study of each of the participating residents begins at the start of training and will continue until residency training is completed. Faculty members, meanwhile, were tested to determine “what’s a normal level of stress for a competent, skilled, experienced surgeon and what sort of level of stress you have there versus a neophyte and where that tends to normalize out,” Quick said.

Before each test, the resident about to perform surgery must sit still and quietly for five minutes so sensors can collect a baseline stress level for comparison.

Several staff members in the hospital wore the sensors throughout a normal day and kept a log of their activities to make sure the sensors worked before using them for the study. Megan Crane, a student support specialist at the MU School of Medicine who helps conduct the tests, said she liked testing the sensors by wearing them herself and seeing the variation in her stress levels throughout the day.

It’s a great learning tool for the residents. “It’s exciting how it could change the future,” she said. “Anything that can help improve someone’s skills is pretty cool.”

Jen Doty, the clinical coordinator of surgery for the MU School of Medicine, worked with Crane to monitor the residents as they used the sensors. Both stayed in the operating room for each test and recorded what was happening throughout the surgery to compare their accounts with the data to see which critical points in the surgery were most stressful.

“We’re the feet-on-the-floor people,” Doty said.

The main drawback to the testing is the cost of the sensors, which are about $2,000 each, she said. The cost makes it difficult for the study to be done on a larger scale and at other universities.

“It’s an academic setting, you want to be doing these things,” she said. “Everything is more and more competitive, so you try to make sure that you provide support to people that want to do research. Quick is a researcher, but he’s also a phenomenal surgeon.”

After this study, Quick said he plans to begin looking at motion capture technology to analyze the efficiency of hand movements during surgery, which has been done in simulation but, again, not in the operating room.

“If you can identify a level - once you reach this, you’re good to go - then that gives a way for the residents to operate by themselves,” Quick said.


Information from: Columbia Missourian, https://www.columbiamissourian.com

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