Imperial College London
Portrait Picture

Mr Hemel N. Modi

Faculty of Medicine, Department of Surgery & Cancer

Honorary Clinical Research Fellow
 
 
 
//

Contact

 

hemel.modi12

 
 
//

Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Modi:2017:10.1097/SLA.0000000000002289,
author = {Modi, HN and SIngh, H and Orihuela-Espina, F and Athanasiou, T and Fiorentino, F and Yang, GZ and Darzi, A and Leff, DR},
doi = {10.1097/SLA.0000000000002289},
journal = {Annals of Surgery},
pages = {683--691},
title = {Temporal stress in the operating room: brain engagement promotes "coping" and disengagement prompts "choking"},
url = {http://dx.doi.org/10.1097/SLA.0000000000002289},
volume = {267},
year = {2017}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objective:To  investigate  the  impact  of  time  pressure  (TP)  on  prefrontalactivation and technical performance in surgical residents during a laparo-scopic suturing task.Background:Neural  mechanisms  enabling  surgeons  to  maintain  perform-ance  and  cope  with  operative  stressors  are  unclear.  The  prefrontal  cortex(PFC) is implicated due to its role in attention, concentration, and perform-ance monitoring.Methods:A  total  of  33  residents  [Postgraduate  Year  (PGY)1 – 2¼15,PGY3– 4¼8,  and  PGY5¼10]  performed  a  laparoscopic  suturing  taskunder ‘‘self-paced’’ (SP) and ‘‘TP’’ conditions (TP¼maximum 2 minutes perknot).  Subjective  workload  was  quantified  using  the  Surgical  Task  LoadIndex.  PFC  activation  was  inferred  using  optical  neuroimaging.  Technicalskill  was  assessed  using  progression  scores  (au),  error  scores  (mm),  leakvolumes (mL), and knot tensile strengths (N).Results:TP led to greater perceived workload amongst all residents (meanSurgical Task Load Index score SD: PGY1 – 2: SP¼160.3 24.8 vs TP¼202.1 45.4,P<0.001; PGY3 – 4: SP¼123.0 52.0 vs TP¼172.5 43.1,P<0.01;  PGY5:  SP¼105.8 55.3  vs  TP¼159.1 63.1,P<0.05).Amongst  PGY1– 2  and  PGY3– 4,  deterioration  in  task  progression,  errorscores and knot tensile strength (P<0.05), and diminished PFC activationwas observed under TP. In PGY5, TP resulted in inferior task progression anderror scores (P<0.05), but preservation of knot tensile strength. Furthermore,PGY5  exhibited  less  attenuation  of  PFC  activation  under  TP,  and  greateractivation  than  either  PGY1 – 2  or  PGY3 – 4  under  both  experimental  con-ditions (P<0.05).Conclusions:Senior residents cope better with temporal demands and exhibitgreater  technical  performance  stability  under  pressure,  possibly  due  to
AU  - Modi,HN
AU  - SIngh,H
AU  - Orihuela-Espina,F
AU  - Athanasiou,T
AU  - Fiorentino,F
AU  - Yang,GZ
AU  - Darzi,A
AU  - Leff,DR
DO  - 10.1097/SLA.0000000000002289
EP  - 691
PY  - 2017///
SN  - 1528-1140
SP  - 683
TI  - Temporal stress in the operating room: brain engagement promotes "coping" and disengagement prompts "choking"
T2  - Annals of Surgery
UR  - http://dx.doi.org/10.1097/SLA.0000000000002289
UR  - https://journals.lww.com/annalsofsurgery/Fulltext/2018/04000/Temporal_Stress_in_the_Operating_Room__Brain.14.aspx
UR  - http://hdl.handle.net/10044/1/48320
VL  - 267
ER  -
Download