ODU Prof, Colleagues Awarded NIH Grant to Study Physicians' Abilities to Manage Secondary Tasks While Performing Surgery

Thanks to medical dramas on TV, we all have the image of the busy surgical theater at a hospital. A doctor works seamlessly with several nurses, performing a difficult medical procedure while simultaneously keeping an eye on medical monitoring devices. The actors who play doctors in these fictional operating rooms make that task juggling seem effortless.

However, it's not that simple in real life. Research has shown that less-experienced surgeons have a more difficult time developing "spare attentional capacity" - meaning they aren't as likely as experienced surgeons to successfully juggle more than one task in the OR.

Old Dominion University psychology researcher Mark Scerbo, together with researchers at Eastern Virginia Medical School and the Carolinas Medical Center, has developed a test to assess how well surgeons accomplish so-called "secondary tasks" while performing laparoscopic surgery (a type of minimally invasive surgery in which a small incision is made in the abdominal wall through which an instrument called a laparoscope is inserted to permit structures within the abdomen and pelvis to be seen).

The research, which has been awarded a $322,337 grant by the Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health, could one day be applied to the task juggling involved in any complex surgical procedure performed with a laparoscope or endoscope.

"Almost everything in surgery is done as a team," said Scerbo, an expert in human factors research at ODU. "That requires medical professionals to be able to do these secondary tasks while doing something complex like laparoscopic surgery. We're trying to understand where the cognitive skills are lacking, and where they need to be developed."

Laparoscopic surgery imposes significant visual-motor and attentional challenges on the surgeon, potentially putting patients at serious risk. Although clinicians can use simulators to practice their skills outside the operating room, there is no standard method to determine whether a surgeon has achieved or maintained laparoscopic proficiency.

What this study seeks to do is create an objective assessment of performance of these secondary tasks, while surgeons meet the time and proficiency training requirements of laparoscopic surgery.

"Right now, the only assessment of multitasking performance is a more senior surgeon observing and saying, 'You're good to go,'" Scerbo said.

The objective of this research is to validate a new secondary task that targets the spatial skills needed to mentally translate 2-D display images into the 3-D operational space.

Successful demonstration of the hardware and software system, and objective assessment methods, could potentially be coupled with any spatial task where surgeons use a video display to monitor their activities.

Scerbo said in the first year of their study, the researchers will attempt to create a more sensitive measure of spare attentional capacity that is specific to laparoscopic procedures. "But in the second year, we want to be able to apply it to new surgical procedures. This test is not limited to one particular type of surgery," Scerbo said.

The AHRQ grant is an example of the many collaborative efforts that have been undertaken by Old Dominion's Virginia Modeling, Analysis and Simulation Center (VMASC) and Eastern Virginia Medical School (EVMS).

The National Center for Collaboration in Medical Modeling and Simulation, a joint venture of both institutions, was recently awarded $600,000 from the U.S. Department of Defense Office of Economic Assistance to fund two other medical modeling and simulation projects that rely on the shared expertise between VMASC and EVMS.

A new simulation facility at EVMS, the Theresa A. Thomas Professional Skills Teaching and Assessment Center, opened on September 22. There, researchers from both schools will work collaboratively to perfect M&S innovations in an effort to ensure best practices in health care in the United States.