Surgery
Volume 147, Issue 2 , Pages 246-254 , February 2010

Impact of sleep deprivation on medium-term psychomotor and cognitive performance of surgeons: Prospective cross-over study with a virtual surgery simulator and psychometric tests

  • Kai S. Lehmann, MD

      Affiliations

    • Department of General, Vascular and Thoracic Surgery, Charité–Campus Benjamin Franklin, Berlin, Germany
    • Corresponding Author InformationReprint requests: Kai S. Lehmann, MD, Department of General, Vascular and Thoracic Surgery, Chirurgische Klinik und Hochschulambulanz I, Charité–Campus Benjamin Franklin, Hindenburgdamm 30 D-12200 Berlin, Germany.
  • ,
  • Peter Martus, PhD

      Affiliations

    • Department of Biostatistics and Clinical Epidemiology, Charité—Campus Benjamin Franklin, Berlin, Germany
  • ,
  • Samia Little-Elk

      Affiliations

    • Department of General, Vascular and Thoracic Surgery, Charité–Campus Benjamin Franklin, Berlin, Germany
  • ,
  • Heiko Maass, PhD

      Affiliations

    • Institute for Applied Computer Science, Forschungszentrum Karlsruhe, Karlsruhe, Germany
  • ,
  • Christoph Holmer, MD

      Affiliations

    • Department of General, Vascular and Thoracic Surgery, Charité–Campus Benjamin Franklin, Berlin, Germany
  • ,
  • Urte Zurbuchen, MD

      Affiliations

    • Department of General, Vascular and Thoracic Surgery, Charité–Campus Benjamin Franklin, Berlin, Germany
  • ,
  • Georg Bretthauer, PhD

      Affiliations

    • Institute for Applied Computer Science, Forschungszentrum Karlsruhe, Karlsruhe, Germany
  • ,
  • Heinz J. Buhr, MD, PhD, FACS, FRCS

      Affiliations

    • Department of General, Vascular and Thoracic Surgery, Charité–Campus Benjamin Franklin, Berlin, Germany
  • ,
  • Joerg P. Ritz, MD, PhD

      Affiliations

    • Institute for Applied Computer Science, Forschungszentrum Karlsruhe, Karlsruhe, Germany

,Accepted 20 August 2009.

References 

  1. Hyman NH. Attending work hour restrictions: is it time?. Arch Surg. 2009;144:7–8
  2. Howell RE. Resident duty hours: the rest of the story. J Am Coll Radiol. 2004;1:104–107
  3. Akerstedt T, Kecklund G. The future of work hours–the European view. Ind Health. 2005;43:80–84
  4. Pape HC, Pfeifer R. Restricted duty hours for surgeons and impact on residents quality of life, education, and patient care: a literature review. Patient Saf Surg. 2009;3:3
  5. Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351:1838–1848
  6. Sarani B, Alarcon LH. Reducing interns' work hours led to fewer attentional failures and serious medical errors in intensive care units. Crit Care. 2005;9:E3
  7. Philibert I. Sleep loss and performance in residents and nonphysicians: a meta-analytic examination. Sleep. 2005;28:1392–1402
  8. DeMaria EJ, McBride CL, Broderick TJ, Kaplan BJ. Night call does not impair learning of laparoscopic skills. Surg Innov. 2005;12:145–149
  9. Uchal M, Tjugum J, Martinsen E, Qiu X, Bergamaschi R. The impact of sleep deprivation on product quality and procedure effectiveness in a laparoscopic physical simulator: a randomized controlled trial. Am J Surg. 2005;189:753–757
  10. Minion D, Plymale M, Donnelly M, Endean E. The effect of prior night call status on the American Board of Surgery in-training examination scores: eight years of data from a single institution. J Surg Educ. 2007;64:416–419
  11. Gerdes J, Kahol K, Smith M, Leyba MJ, Ferrara JJ. Jack Barney award: the effect of fatigue on cognitive and psychomotor skills of trauma residents and attending surgeons. Am J Surg. 2008;196:813–819
  12. Kahol K, Leyba MJ, Deka M, et al. Effect of fatigue on psychomotor and cognitive skills. Am J Surg. 2008;195:195–204
  13. Leff DR, Aggarwal R, Rana M, et al. Laparoscopic skills suffer on the first shift of sequential night shifts: program directors beware and residents prepare. Ann Surg. 2008;247:530–539
  14. Jensen A, Milner R, Fisher C, Gaughan J, Rolandelli R, Grewal H. Short-term sleep deficits do not adversely affect acquisition of laparoscopic skills in a laboratory setting. Surg Endosc. 2004;18:948–953
  15. Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J. Laparoscopic performance after one night on call in a surgical department: prospective study. BMJ. 2001;323:1222–1223
  16. Taffinder NJ, McManus IC, Gul Y, Russell RC, Darzi A. Effect of sleep deprivation on surgeons' dexterity on laparoscopy simulator. Lancet. 1998;352:1191
  17. Veasey S, Rosen R, Barzansky B, Rosen I, Owens J. Sleep loss and fatigue in residency training: a reappraisal. JAMA. 2002;288:1116–1124
  18. Samkoff JS, Jacques CH. A review of studies concerning effects of sleep deprivation and fatigue on residents' performance. Acad Med. 1991;66:687–693
  19. Lehmann KS, Ritz JP, Maass H, et al. A prospective randomized study to test the transfer of basic psychomotor skills from virtual reality to physical reality in a comparable training setting. Ann Surg. 2005;241:442–449
  20. Kuehnapfel UG, Kuhn C, Huebner M, Krumm HG, Maass H, Neisius B. The Karlsruhe Endoscopic Surgery Trainer as an example for Virtual Reality in Medical Education. Minimally Invasive Therapy and Allied Technologies. 1997;6:122–125
  21. Kuehnapfel UG, Cakmak H, Maass H. Endoscopic surgery training using virtual reality and deformable tissue simulation. Computers & Graphics. 2000;24:671–682
  22. Weiss H, Ortmaier T, Maass H, Hirzinger G, Kuehnapfel U. A virtual-reality-based haptic surgical training system. Comput Aided Surg. 2003;8:269–272
  23. Cakmak HK, Maas H, Kuehnapfel U. VSOne; a virtual reality simulator for laparoscopic surgery. Minimally Invasive Therapy. 2005;14:134–144
  24. Brickenkamp R, Zillmer E. The d2 Test of Attention - Manual. Göttingen: Hogrefe & Huber; 2002;
  25. Thompson MD, Scott JG, Dickson SW, Schoenfeld JD, Ruwe WD, Adams RL. Clinical utility of the Trail Making Test practice time. Clin Neuropsychol. 1999;13:450–455
  26. Moses JA. Test review-Comprehensive Trail Making Test (CTMT). Arch Clin Neuropsychol. 2004;19:703–708
  27. Bliwise DL, Swan GE. Habitual napping and performance on the Trail Making Test. J Sleep Res. 2005;14:209–210
  28. Oswald WD, Roth E. Der Zahlen-Verbindungs-Test. Göttingen: Hogrefe & Huber; 2002;
  29. Armitage P, Berry G, Matthews JNS. Statistical methods in medical research. 4th ed.. London: Blackwell Science Ltd; 2002;
  30. Eastridge BJ, Hamilton EC, O'Keefe GE, et al. Effect of sleep deprivation on the performance of simulated laparoscopic surgical skill. Am J Surg. 2003;186:169–174
  31. Uchal M, Tjugum J, Martinsen E, Qiu X, Bergamaschi R. The impact of sleep deprivation on product quality and procedure effectiveness in a laparoscopic physical simulator: a randomized controlled trial. Am J Surg. 2005;189:753–757
  32. DeMaria EJ, McBride CL, Broderick TJ, Kaplan BJ. Night call does not impair learning of laparoscopic skills. Surg Innov. 2005;12:145–149
  33. Jakubowicz DM, Price EM, Glassman HJ, et al. Effects of a twenty-four hour call period on resident performance during simulated endoscopic sinus surgery in an accreditation council for graduate medical education-compliant training program. Laryngoscope. 2005;115:143–146
  34. Schijven M, Jakimowicz J. Virtual reality surgical laparoscopic simulators. Surg Endosc. 2003;17:1943–1950
  35. Carter FJ, Schijven MP, Aggarwal R, et al. Consensus guidelines for validation of virtual reality surgical simulators. Surg Endosc. 2005;19:1523–1532
  36. Ahlberg G, Heikkinen T, Iselius L, Leijonmarck CE, Rutqvist J, Arvidsson D. Does training in a virtual reality simulator improve surgical performance?. Surg Endosc. 2002;16:126–129
  37. McNatt SS, Smith CD. A computer-based laparoscopic skills assessment device differentiates experienced from novice laparoscopic surgeons. Surg Endosc. 2001;15:1085–1089
  38. Bates ME, Lemay EP. The d2 Test of attention: construct validity and extensions in scoring techniques. J Int Neuropsychol Soc. 2004;10:392–400
  39. Leonard C, Fanning N, Attwood J, Buckley M. The effect of fatigue, sleep deprivation and onerous working hours on the physical and mental wellbeing of pre-registration house officers. Ir J Med Sci. 1998;167:22–25
  40. Bartle EJ, Sun JH, Thompson L, Light AI, McCool C, Heaton S. The effects of acute sleep deprivation during residency training. Surgery. 1988;104:311–316
  41. Villegas L, Schneider BE, Callery MP, Jones DB. Laparoscopic skills training. Surg Endosc. 2003;17:1879–1888
  42. Gallagher AG, Satava RM. Virtual reality as a metric for the assessment of laparoscopic psychomotor skills. Learning curves and reliability measures. Surg Endosc. 2002;16:1746–1752
  43. Smith CD, Farrell TM, McNatt SS, Metreveli RE. Assessing laparoscopic manipulative skills. Am J Surg. 2001;181:547–550
  44. Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J. Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills. Am J Surg. 2003;185:146–149
  45. Strom P, Kjellin A, Hedman L, Johnson E, Wredmark T, Fellander-Tsai L. Validation and learning in the Procedicus KSA virtual reality surgical simulator. Surg Endosc. 2003;17:227–231
  46. Ali MR, Mowery Y, Kaplan B, DeMaria EJ. Training the novice in laparoscopy. More challenge is better. Surg Endosc. 2002;16:1732–1736
  47. Browne BJ, Van Susteren T, Onsager DR, Simpson D, Salaymeh B, Condon RE. Influence of sleep deprivation on learning among surgical house staff and medical students. Surgery. 1994;115:604–610
  48. Reznick RK, Folse JR. Effect of sleep deprivation on the performance of surgical residents. Am J Surg. 1987;154:520–525

 Funded by a grant from the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF), Ref.-No. HapticIO FKZ 01IRA03C.

PII: S0039-6060(09)00500-5

doi: 10.1016/j.surg.2009.08.007

Surgery
Volume 147, Issue 2 , Pages 246-254 , February 2010