Determining the Effect of External Stressors on Laparoscopic Skills and Performance Between Obstetrics and Gynecology Residents

Gaby N. Moawad, Paul Tyan, Dipti Kumar, Jill Krapf, Cherie Marfori, Elias D. Abi Khalil, James Robinson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Study Objective To evaluate the effect of stress on laparoscopic skills between obstetrics and gynecology residents. Design Observational prospective cohort study. Design Classification Prospective cohort. Setting Urban teaching university hospital. Participants (Patients) Thirty-one obstetrics and gynecology residents, postgraduate years 1 to 4. Intervention We assessed 4 basic laparoscopic skills at 2 sessions. The first session was the baseline; 6 months later the same skills were assessed under audiovisual stressors. We compared the effect of stress on accuracy and efficiency between the 2 sessions. Measurements and Main Results A linear model was used to analyze time. Under stress, residents were more efficient in 3 of the 4 modules. Ring transfer (hand-eye coordination and bimanual dexterity), p = 0.0304. Ring of fire (bimanual dexterity and measure of depth perception), p = 0.0024 and dissection glove (respect of delicate tissue planes), p = 0.0002. Poisson regression was used to analyze the total number of penalties. Residents were more likely to acquire penalties under stress. Ring transfer, p = 0.0184 and cobra (hand-to-hand coordination), p = 0.0487 yielded a statistically significant increase in penalties in the presence of stressors. Dissection glove p = 0.0605 yielded a nonsignificant increase in penalties. Conclusion Our work confirmed that while under stress residents were more efficient, this translated into their ability to complete tasks faster in all the tested skills. Efficiency, however, came at the expense of accuracy.

Original languageEnglish (US)
Pages (from-to)862-866
Number of pages5
JournalJournal of Surgical Education
Issue number5
StatePublished - Sep 2017
Externally publishedYes


  • education
  • laparoscopy
  • residency
  • residents
  • simulation
  • stress

ASJC Scopus subject areas

  • Surgery
  • Education


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