The best way to train surgeons is to remove the stress of
residency programmes and make surgery a hobby. Under relaxed conditions outside
a formal educational setting, 15 first-year medical students, who aspired one
day to become surgeons, mastered microsurgical suturing and cutting skills in
as little as five hour-long sessions a study conducted by researchers at the University
of Houston (UH) and Methodist Hospital has shown. The study was published in
the journal, Scientific Reports.

“It appears that by removing external stress factors
associated with the notoriously competitive and harsh lifestyle of surgery
residencies, stress levels during inanimate surgical training plummet,” said
Ioannis Pavlidis, Eckhard Pfeiffer Professor and director of the Computational
Physiology Lab at UH. “In five short sessions these students, approaching
surgery for fun or as a hobby, had remarkable progress achieving dexterity
levels similar to seasoned surgeons, at least in these drills.” His partners on
the project, Anthony Echo and Dmitry Zavlin, surgeons at Houston Methodist
Institute for Reconstructive Surgery, gave brief instructions to the students
at the beginning of the programme.

Once the students began cutting and suturing at their mobile
microsurgical simulators, Pavlidis and team tracked their stress levels by
measuring sweat responses near the nose via thermal imaging. The students’
performance in the surgical drills was scored by two experts, based on video

In previous work Pavlidis and Methodist Hospital
researchers found that surgical residents exhibited high stress levels during
their formal training in surgical simulators. These high stress levels
precipitated “fight or flight” responses, resulting in fast, mindless actions
leading to errors and creation of a vicious cycle during the surgical drills.

In the present follow-up work, Pavlidis, Echo and Zavlin
chose trainees outside the surgical establishment, without pressures and
stakes, to examine what happens when environmental stress is neutralised and
only stress associated with the challenging nature of the surgical drills is

“We removed stressful environmental factors, leaving only
the inherent challenge of the surgical tasks, and discovered the
physiologically-measured distress in the form of sympathetic arousal was
moderate and unchanged throughout the five training sessions,” said Pavlidis. In
contrast, Pavlidis reported in the previous study high stress levels in
surgical residents and slow learning processes, where five training sessions
brought no skill improvement. The main factor that sets the two studies apart
is the educational context and stress associated with it.

In this study, where young surgery enthusiasts took up
surgical training without the impact of environmental anxiety, skills were
quickly acquired. Then once a skill like suturing is acquired, it won’t be
forgotten, much like riding a bike.

“If you acquire a dexterous skill when you are not super
stressed, you will acquire it better and faster, because `fight or flight’
responses are not there to mess things up” said Echo. “And once you have it,
the skill won’t leave you. Like a bike, once you learn to bike, you bike,”
Pavlidis added.

Future surgery residents with the skill acquired at a more
opportune time would be able to focus on more advanced experiences inside the
operating room. “Similar paradigms may apply to other artisan professions,
upending training doctrines held sacred for generations” said Pavlidis.


Reference: Pavlidis
I, et al. Absence of Stressful Conditions Accelerates Dexterous Skill
Acquisition in Surgery. Scientific Reports. Published 11 February 2019.